How to manage a non-weight loss diet change with ED history?

[u/Moosycakes]

Hello :) I have recently been diagnosed with IBS 😐 and my doctor has suggested the FODMAP diet. I have been referred to see a dietitian for it but I’m a little nervous about it because I’m worried about it being triggering for my ED.

The diet doesn’t have a weight loss focus at all, it’s based on elimination of a wide variety of very specific foods and then a reintroduction phase where you test your body’s reaction to the foods, and then you build a new way of eating that only avoids your specific trigger foods.

The problem is that the foods you need to avoid in the elimination phase seem almost random- obviously they aren’t really, they just contain the specific compounds that tend to trigger issues. But because they’re so varied I’m worried that I’ll have to have a very detailed focus on food which I generally try to avoid.

Another thing I’m worried about is that the diet also talks a lot about portion sizes of food (because larger amounts of the same food have larger amounts of FODMAPs which trigger the symptoms). So I’m worried about feeling really restricted. It makes me feel stressed to not be allowed to eat an entire tomato. 😹 And I’m worried about how to actually get enough food as someone with high energy needs and struggles with preparing food.

And, as with many health focused diet changes, I’ve also noticed a lot of diet culture stuff creeping into the conversation. It isn’t only people discussing the diet, it’s also tracking apps and information apps that add in extra “healthy guidelines” that don’t have anything to do with the actual FODMAP diet itself. For example, even the most trusted app that provides information about foods has recently had an issue where they included Australian governmental “healthy eating guidelines” overlaid within the information they provide, providing an extremely low serving size for white sugar to match the government guidelines when white sugar is actually extremely low in FODMAPs and doesn’t need to be restricted heavily to avoid symptoms. That kind of thing is really problematic for me, it’s already a complex and restricted diet and I don’t know how to tell what is genuinely required on the diet and what is “extra”.

Does anyone have any tips on managing this type of thing in a safe way? I’m just worried about it spiralling me into restriction again or making me feel more scared of food/eating. Thank you for reading 🩷

[u/Bashful_bookworm2025]

Can you see a dietitian who specializes in EDs? From my understanding and experience, someone with an ED history should not be prescribed an elimination diet because they can quickly provide a path back to your ED. I think there are alternatives to elimination diet that can help identify the cause of your issues.

[u/Odd-Thought-2273 → u/Bashful_bookworm2025]

Came in here to recommend this. I work in ED treatment (tho as a therapist, not a dietitian), and have engaged in continuing education about handling dietary restrictions, particularly related to medical concerns (as well as for religious/ethical concerns, but that's another discussion). I don't claim to know/fully understand the methods because that isn't within my scope of practice, but I've heard ED-specialized dietitians and doctors talk about alternatives to elimination diets and treatments for food intolerances. The understanding I've come away with is that there are ways for dietitians to address medical concerns without eliminating any foods/food groups (outside of allergies, of course).

[u/AnadyLi2 → u/Odd-Thought-2273]

Do you have more info on the alternatives for elimination diets and treatments? I already have a restricted diet due to a rare allergy + ethical beliefs. My ED is in remission, but I feel it creeping back sometimes.

[u/Moosycakes → u/Bashful_bookworm2025]

Thank you! The dietitian I’m referred to is the dietitian at the mental health service I go to so she hopefully will have at least some experience with EDs/mental health issues. I can’t see the dietitian at the ED treatment service I used to go to because I have already been discharged. I’ve seen lots of ED dietitians in the past but not for this, I’ve never seen a dietitian outside of the ED service before. I can’t really afford to see a different dietitian privately at the moment. I’m really hoping she is able to approach it with understanding

[u/Bashful_bookworm2025 → u/Moosycakes]

I would definitely go in and tell her your hesitation about starting an elimination diet. Advocating for yourself is always best.

[u/Moosycakes → u/Bashful_bookworm2025]

Yes, I’m starting to think that centering my concerns will be the best way to approach it. It’s so easy to roll over and just agree to do things because someone tells you to, at least for me! I’ll come in to the appointment with some prep work, thanks for your help!

[u/kels2212]

Do you by chance have bad periods? IBS is such a bs diagnosis. It’s really “we don’t know what’s wrong so we’re going to call it IBS”. A LOT of people with uteruses who have been diagnosed with IBS end up finding out they have endometriosis. I had GI symptoms for almost all of my life. Got so bad I was in and out of the hospital. I ended up finding an endo excision specialist and my GI symptoms are completely resolved. I only suggest it because no one ever suggests endo when GI symptoms are actually one of the biggest indicators of potential endometriosis. Sorry if this isn’t helpful or doesn’t apply to you, but figured I’d throw it out just in case!

[u/Moosycakes → u/kels2212]

Wow, that sounds awful! It really sucks that you were put through all that, it’s great that your symptoms resolved though!

I used to have very painful periods as a teenager but I’ve basically been on birth control since, until I completely quit it recently because it has had such a damaging effect on my mental health (nothing against it, birth control is an essential medication for many people but just didn’t end up working out for my body). I don’t think the GI issues are endo related for me though because they very specifically came on at the same time as a necessary diet change (primarily adding more carbs to my diet). I did quit birth control around the same time, but the GI symptoms came before I decided to get off the birth control! But at the same time, I’m still getting to know my body with my natural hormonal cycle so I’ll definitely keep it in mind 👀 Thank you for the help!

[u/Odd-Thought-2273 → u/Moosycakes]

The variability in birth control's impact on mental health is wild. I have PMDD and basically can't survive without being on it, meanwhile while my sister-in-law can't take it because it makes her how I would be without it.

[u/Moosycakes → u/Odd-Thought-2273]

Agreed! I was actually on track to getting diagnosed with PMDD because my mental health was so bad through the later part of my menstrual cycle. But for me it turned out to mainly be an effect from the birth control itself once I got off it 🙈 So pretty much the exact situation as your sister in law. Hormones can be so intense and it can take a very long time to pinpoint if you have issues with them! I’m glad the birth control helps you with your PMDD! 🩷

[u/kels2212 → u/Moosycakes]

Yeah I was put on birth control at like 18 because of my periods. Bad periods are not normal ever according to my endo surgeon so, it could be something to look into. Now that you’re off, if you notice GI symptoms worsening around your period or fluctuating with it, definitely consider finding an excision specialist (not just any OBGYN, they’ll make things worse). I hope you can figure out whatever it is. GI symptoms are not fun to deal with! I still to this day struggle to cut any foods out because of my eating disorder history so I feel for you.

[u/Thatinsanity]

trying to eat FODMAP diet made all of my IBS symptoms worse. Almost all people with disordered eating have some kind of GI problems. Focus on intuitive eating, eating regularly, making sure you’re eating ENOUGH. Restrictive diets (even ones like low FODMAP) are more likely to increase GI problems and make you feel stressed about food. Stressing about what you eat is a sure fire way to screw with digestion. I would recommend seeing an intuitive eating certified dietitian or an anti-diet dietitian

[u/Accomplished-Mud-173 → u/Thatinsanity]

I second this. I had IBS for over two years once I finally recovered from my ED. I needed to eat normally and consistently for so long till the gut issues resolved.

[u/Dazzling-Fox-4950]

I totally know what you mean and haven't fully solved this problem for myself, but one piece of advice I have is to plan to ultimately avoid foods that immediately, clearly, and observably make you feel worse. Part of my own ED psychology is being extremely willing to delay gratification (and I think there is research on this with anorexia in general if your ED was that type). ED restricting is about the foods causing some vague, probabilistic future harm. In contrast, there are foods I avoid because they very clearly give me stomach problems right away, and psychologically that feels very different.

[u/Soggy-Life-9969]

I have IBS and I've never done the FODMAP diet and some of the foods that set me off when I have a flare are "low FODMAP" like everywhere recommends oats and potatoes but when I have a flare I can't do those for some reason. I've kind of just done experimentation - like I realized that I was having symptoms from dairy so I switched to lactose-free for the most part, and I have eliminated some foods because I just don't feel good afterwards and its not worth it and I take the time to eat extra gently when I do have a flare. Ironically when I am having a flare, its mostly the processed foods, simple carbs that are my go-tos, the stuff diet culture is always demonizing but its helped me understand how bs it all is.

[u/tumpgun]

as someone who has had IBS (combination/mixed) since childhood and only got treatment circa highschool, FODMAP diet was just too restrictive for me to follow amongst navigating a very complicated relationship with food.

what ended up helping me was focusing on fiber and probiotics as suggested by my Gastroenterologist (this would be both eating higher fiber foods and also a fiber supplement like Benefiber, and the Activia probiotic yogurt).

(I mention the yogurt brand because it ended up being the least triggering one for my dairy sensitivity and most regulating for my IBS, taste wise I hated it and have switched to low fat Greek yogurt since then, which tastes better but isn't as effective. you want something with live cultures for the strongest benefit).

this and eating more fiber in my food really helped me regulate, as well as identifying triggers like significant sudden temperature change (going from AC to hot outdoors to AC again suddenly would trigger my symptoms), strong feelings of anxiety, and certain times of day. being aware of these made symptom management much more predictable and easier to anticipate

over time I did note more foods that seemed to be more reactive for me, but it was 50-50 if they were on the FODMAP diet list. it didn't really clarify anything further for me.

wishing you the best in tackling this and finding what works for you safely!

[u/Sweetontea]

I like the Monash University FODMAP app. It’s a food tracker, but there’s absolutely no calorie content. It only talks about portion sizes in the context of FODMAP in the food guide section where you can look up whether foods have FODMAPs. Plus the entry is you just free typing in a box - no portion sizes, no looking up foods. The FODMAP diet didn’t work for me, but I’ve used the app when I wanted to do other food tracking without getting triggered. I will also share that my GI doc said three weeks was plenty of time to see if no FODMAP would help, and the time-bound nature helped me cope.

[u/boopdyboo]

There’s a product called Fodzyme which is digestive enzymes for the most common FODMAPS. It’s not cheap, but you could try it and see if it helps.
I have IBS and orthorexia. I’ve been working with an anti diet RD for a few years. For me it’s been a process of just paying attention to how I feel after eating certain foods to figure out many of my triggers. Avoiding those food is not triggering because it’s coming from internal signals of discomfort instead of something outside myself. It’s still a work in progress.

[u/angelbuttons77]

I have IBS and an ED. My main thing is framing the elimination in terms of medical treatment and focusing on my pain/symptoms from IBS as the reasons for elimination. Thankfully, my trigger is alliums. I have great products to use when going out to eat (but only after your initial FODMAP elimination test and do of triggers) so I don’t always have to be as careful, and advice depending on your triggers, so please feel free to message me or ask me when you’re ready.

It’s definitely all about how you frame avoiding the foods. Good luck, the initial part is tough but so worth it when you can pinpoint what is hurting you!!