Let’s talk about food anxieties, please

In a few previous posts, I have mentioned that I experience “food anxieties” and that this has shaped the way I eat (mostly for the worse). Most of it seems to be largely psychological in nature, but there is a bit of sensory processing trouble that comes to the fore as well. It is worse when I am stressed and anxious about other things.

Before I get into what the problem might be (without oversharing) and why I feel the need to try and educate an audience about it, I’ll start with the end result, because it’s very easy to dismiss food anxieties if you don’t have them.

I throw up in my mouth.

That’s right. Throwing up. In my mouth. Even if I manage to avoid this, and force myself to swallow whatever it is that I really, really don’t want to eat, I will be nauseated for the remainder of the day. It will be very difficult for me to eat anything even remotely unfamiliar.

So if anything that I describe from here on out makes you think “That’s ridiculous! You should just eat [whatever it is], or grow up, or get over it,” I’d like you to remember the phrase “I throw up in my mouth.”

Because nobody likes the taste of bile.

In my case, it also tastes like shame, humiliation, and judgement, and this is why I feel the need to write this post. It is actually a difficult issue to write about, because although I have a number of anxiety triggers that elicit empathy from people in my life, the food triggers usually elicit contempt, dismissal and/or confusion. There is almost no empathy or sympathy for them at all. Talking about it usually makes me cry.

This is, I feel, because of the social structures we have placed around eating. We are a society that in large part seems to have a really disordered relationship with food, and at the same time we are a society that is trying to fix that, and seems to be going about it all wrong.

We are a society that associates certain kinds of eating with emotional maturity. Kids are the ones that will refuse to eat healthy food (we are told) and demand chicken nuggets and chips, and spaghetti bolognese. Most of them grow out of it. In large part, I didn’t. It’s understandable that parents put pressure on kids to eat healthy food – it really is. The problem is that when you have an oversensitive kid who responds to disapproval by shutting down and/or crying, that ends up making a bad situation worse. Then, when you get confused parents telling the kid not to cry, because it’s just silly to cry about food (even though the kid is actually crying about the disapproval, not the food; crying about the food is an associative response that comes later, when you start to instinctively link food with disapproval. It did not take me long to reach this point), they feel even more disapproval.

It’s bad enough when it’s your own (well-meaning) parents. Then when you go and stay with friends at their house, you start to panic around dinner time, because what is the food going to be? Are you going to be able to eat it without watning to throw up? Are these really scary (quite lovely, but I was extremely shy) adults that you don’t even really know going to yell at you (or even express mild disapproval or disappointment, which is bad enough) for not eating the meal they are serving the friend of their child?

The answer is usually… well, yeah. Even such innocent, friendly questions as “Didn’t you like it?” bring on a panic attack.

(side note: I can’t even physically handle certain foods without wanting to scream and panic. The sensation of these particular foods on the skin of my hands actually triggers panic. I’ll whimper. It’s involuntary. When going on camps – whether they are work-based retreats or the school camps of my youth – I would hastily sign up for any chore that did not involve handling food or cleaning up food (my favourite is vacuuming. I don’t have to touch anything). This may seem weird. I’m a biologist. I’m perfectly comfortable touching icky things and dissecting them. I give zero fucks about that, which should tell you that the food issue is a serious problem.)

Looking back, I can see that I was a really sensitive kid. I was shy, and anxious, particularly around adults. Around other kids I was more bold – brash, even – but it didn’t take much to get me hiding again. The problem is that, when you cry at the drop of a hat, adults stop taking your tears seriously. Again – like all of this – that’s understandable, but I vividly remember that I never cried unless I was really genuinely upset.

It’s just that I was really genuinely upset a lot, and one of the worst triggers was adult disapproval. I genuinely do have some sensory issues around some foods, which is probably why I didn’t want to eat some things in the first place, but the disapproval factor turned the whole thing into a colossal mess.

Sadly, I don’t have any suggestions to make it better for a kid like me. I imagine if and when I have a kid, I too will be flustered by their refusal to eat the healthsome food I have put a lot of effort into cooking. I will probably get to a point of deathly frustration when I tote up what they will actually eat and come up empty on actual nutritional content.

And yet.

I do have some suggestions on how to make it better for adults like me.

If an adult friend does not want to try the “totally awesome and amazing” food that you are recommending, do not push them. Feel free to say that it is awesome and amazing, but don’t ever, ever shame or guilt someone into eating something or trying to eat something.

If someone is actually honest and says, “Look, I can’t eat that, sorry,” just accept it. Maybe a response like “Aha! All the more for me!” is appropriate (I actually often say “Hey, all the more for you,” when explaining what I can’t get my oesophagus to accept. It defuses tension).

You would think that I would know better than to do these things, but sometimes even I have over-encouraged people to eat certain things. I quickly realised I was doing it, and backed off, but I do regret those moments of empathy fail.

And here’s the thing. Even with people who handle it with tact and grace, it’s still awkward, because on the inside, I know that it’s weird (and you can tell. I go bright red. We gingers, we do not have good poker faces).

There’s more.

Do not demand further explanation. Do not even politely ask for further information. Even “I’m just curious.” If you don’t have these issues, you can’t even possibly begin to imagine how awful it is to be the feature of interest at a perfectly normal adult ritual like a dinner or a lunch and be forced to explain your eating habits. It is awful. We have so much emotional baggage around food it’s ridiculous, and you can’t just reason through it in public and decide to be okay. Please, move on and deflect attention elsewhere as quickly as you possibly can. Change the subject, ignore the plate.

You are not the food anxiety whisperer. Even if your food is amazing. Even if you are the greatest chef in all the land and your hours-long meal preparation process results in the sort of gourmand’s delight that makes angels weep and clutch at their overfull bellies. This is not an insult to you. It is just how someone else’s anxieties and sensory system are put together. It is not about you.

Do not say something like, “I could understand if it was [acknowledged confronting food item], but it’s [widely accepted as easy to eat], you can’t even eat that?” Just leave it alone.

And absolutely 100%, for the win, take-it-home-today-and-pay-nothing:

Do not tell the food-anxious person that they are going to die of nutrient deficiencies (or heart disease, or diabetes, or anything).

This is a little like telling a fat person that they are fat. Let me explain.

People who are fat have grown up in a world that is excessively, ludicrously aware of fat. There is not a fat person alive who does not know they are fat. They would have to be literally brain-dead, as in unable to absorb sensory information from the outside world. If a person that you think is fat does not think they are fat, it is much more likely a problem of fuzzy thresholds and ridiculous definitions, and telling them what your definitions are is just going to make them feel (1) angry, (2) offended, (3) hurt, and/or – in the absolute best-case scenario – (4) mystified by your odd behaviour. They have grown up in a world that is constantly going on and on and on and on and fucking on about how “terrible” it is to be fat, and how death-fat is coming for them, and how much energy and money must be spent in order to get rid of fat, keep fat gone, or prevent fat from ever catching up with you in the first place. It is literally impossible to ignore these messages.

And this is, to a certain extent, linked with food anxieties. We have all been told from a very young age about eating fruits and vegetables, the supposed evils of fat (sigh) and sugar, and the food pyramid (double sigh). Healthy eating programmes are run in primary schools. The idea that you might not know that subsisting on certain kinds of heavily processed, nutrient-shallow foods is unhealthy is similarly absurd.

We, the food anxious, are well aware that we are probably eating a diet that is not medically approved. We are probably very worried about it. We really would like to fix the problem. But you are not going to be able to fix it for us. I’ve lost track of how many times I have told people that I would love to be able to eat salads. Salads seem healthy. They seem like you can make them cheaply, and there are lots of ways to make them interesting and tasty. They seem like a great option for hot summer days. They are very easy to construct around allergies and intolerances like fructose malabsorption and insulin issues. Salads seem great.

I can’t do it. Just can’t. I will throw up in my mouth.

So someone looking at my lunch and telling me, “Gosh that’s really unhealthy!” achieves the following:

  • I feel really selfconscious.
  • I feel judged and humiliated for my food choices
  • I probably want to cry (complete with red face and hot eyes)
  • I get really angry, because seriously, what goes in my mouth is my own damn business

Here’s what it does not achieve:

  • any measurable or noticeable change in my eating habits, with one exception.
  • I will now not eat in front of that person. There’s a reason I eat lunch at my desk.

Food anxieties take a lot of energy to maintain. They’re always there, in the back of your head, because sooner or later, you’re going to need to eat again. One of the greatest side benefits of eating keto and tracking my macronutrients for me is that it enables me to plan ahead, and to be confident in my food choices. I am now pretty comfortable with how I eat and what I eat. I’ve covered the bases in terms of macronutrients and the really essential phytonutrients. What my diet does not give me directly, I supplement. I am perfectly comfortable with a few necessary supplements.

I cannot possibly describe how much happier about food I am now. I am now more willing to try new things (although again, I am very unlikely to do that in front of people, because it’s embarrassing when you throw up in your mouth). This isn’t because my sensory processing issues have gone away, or because I no longer have anxiety; it’s because my overall stress level is miles lower, and that gives me more mental energy to challenge myself.

In the back of my mind, I am no longer convinced that I am going to die because of what and how I eat. I am no longer panicking about how I’m going to eat healthy food while accommodating my various issues.

And part of this is because I’ve accepted that there are things I’m never going to be able to eat, and I’ve written them off. I’m no longer constantly guilty about the things I should try. I figure if I get intrigued one day, I can give it a shot in a safe space.

However, there are still some anxieties around eating in front of people. I’m still waiting for someone to ask why I haven’t eaten my salad (that often comes with various meals), and ask when I’m going to grow up. I’m still suspicious that someone will look at my meat-and-cheese-heavy plate and feel the need to comment on it. I’m still incredibly nervous about going to dinner at people’s places if I don’t know them very well. I’m still scared of giving offense because I can’t process certain sensations. And I’m scared that it will get so bad that I will cry, which is beyond humiliating.

So I write this post to help people with food anxieties understand that they are not alone, and to help people without food anxieties understand that it’s not simply a matter of “growing up”; that our relationship with food is actually much more complicated than that, and that society’s well-meaning attempts to boost our nutritional health have actually made it worse.

I write it in the hope that less people, in future, will ask me:

“Oh. What was wrong with it?”

This Keto Life: Why Keto? or MMM! TASTES LIKE INSULIN

When someone wants to overhaul their diet, be it for reasons of nutritional improvement, managing intolerances or weight loss/gain (body recomp), there is no shortage of advice to be found on the internet. Unfortunately, as a friend of mine put it, there’s also a giant bucket o’crazy.

Why, you may be wondering (and I strongly suspect several people in my life of wondering, which is not a bad thing), did I go for this very low carbohydrate deal instead of just trying to refine a “balanced diet”? It seems like a weird choice to many people, and it’s very hard to say, “I did some research” without sounding like a die-hard graduate of Google University.

The fact that my research includes the primary literature and critiques thereof is, I think, a big deal, but then we enter into a grey area of whether or not it should trump the decades old all-things-in-moderation, calorie-counting advice.

I did try that. I have done Lite’n’Easy. The main reason I did it is because I have a lot of food anxieties, and emotional panic around meal planning: the idea of paying someone else to plan the meals and hand them over was incredibly appealing, and it would force me to confront some of my triggers in a safe way (i.e., at home, where no-one will see my response, which incidentally does occasionally involve vomiting).

It’s not that Lite’n’Easy didn’t “work” for those goals. It did. There are now a few more things I can eat – it took hard work, and it was exhausting, but I had the extra emotional energy because now I wasn’t panicking about the decision making.

However, it’s pretty pricey, and long-term it gets a bit dull, and it wasn’t resolving my other issue.

The other issue is the big, fat, spanking arrow pointing me towards low carb.

The other issue is my insulin response.

For a long time, I didn’t know it was my insulin response. I thought it was fructose (I am, among other things, not able to effectively absorb fructose in my gut). I thought that sucrose (since it’s a disaccharide made up of half-fructose) was setting off that issue, and that’s why it made me feel sick.

The problem was timing. Fructose malabsorption is a gut issue. It takes a little while for food to get to your gut. Meanwhile, sugar also takes about twenty minutes to hit your bloodstream.

Here’s the problem: the sick feeling I get from eating really sweet stuff happens within seconds. Seconds. The sweeter the taste, the stronger the feeling (and the final nail in the coffin is my recent realisation that even stevia – in sufficient quantities – elicits this response, despite containing no sugar. I’ll explain). It’s a nasty feeling: a sort of falling sensation, followed by abruptly feeling so hungry that you feel sick, and then – maybe about twenty minutes to half an hour later – an extended anxiety/panic/fight-flight sensation. This is because of the cephalic phase insulin response which in me appears to be extremely overenthusiastic. Insulin is released before the sugar (or, sadly, replacement non-sugar sweetener) hits your bloodstream, in order to clear available fuels out and make way for the incoming fuels (be they sugar, fatty acids, protein, etc); this is why as you eat, your appetite can increase (“I totally did not think I was hungry but *munch munch* I am ravenous!”).

And, of course, the only way your brain knows that you’ve eaten something sweet before it absorbs any of it is the taste. More is released as you eat, and as your blood sugar goes up – that’s a bit more straightforward – and, of course, if your blood sugar goes down too far (once all the insulin has come out to play and sucked it all up), out comes glucagon (or a variety of other hormones) to release it back into the bloodstream. A rapid sugar crash can also stimulate the release of stress hormones such as cortisol and noradrenaline, which incidentally explains the fact that I get panicky and stressed as well after a sugar crash.

The fact, therefore, that I feel sick almost instantaneously suggests that my body is responding to the taste – it can’t be responding to anything else because I haven’t actually absorbed it yet.

Therefore, it must be insulin.

If high insulin makes me feel sick (and I already knew from talking to a couple of specialists that high fasting insulin is correlated with hidradenitis flares and other inflammatory issues that I have), then obviously the best way to deal with this particular metabolic quirk is to keep insulin low.

There does not appear to be any drawback to keeping insulin levels low (unless you have Type 1 Diabetes, which is a very specific metabolic situation). I haven’t been able to find anything, other than people complaining that adaptation is hard, which it is.

At the same time, there appear to be extraordinary benefits to keeping insulin low. Lower insulin promotes better metabolic health: lower overall cholesterol (although the benefit of this is genuinely debatable now that we have more refined techniques for subdividing serum cholesterol into different categories), lower triglycerides (not really debatable – this is undeniably a good thing, barring a completely groundbreaking study that would show otherwise at this point), lower blood pressure (again, up to a certain point, that’s a good thing – too low is possible). There are other benefits, although they are mostly in the “we have supporting evidence” category rather than “it’s solidly proven” category.

And in my case, it promotes “not feeling sick” which I can totally get behind.

The absolute best, number one, beats-all-comers method for keeping your insulin levels low is to reduce sugar and other carbohydrates. Since this naturally means increasing fats in the diet (you can’t live off protein – google “rabbit starvation” if you don’t believe me), it was necessary to do a bit more research and confirm that fat wasn’t the demonic beast it has been made out to be, and the primary literature has absolutely confirmed this.

(What this all means is that, if you want yoghurt, the absolute worst thing you can do for your metabolic health is pick the low fat, full-of-sugar yoghurt. It’s sold as the healthy option and this drives me bonkers, knowing what I now know)

This is how I selected “keto” (aka very low carb) as my dietary option. This is how I weeded through the big ol’ bucket of crazy when it comes to nutritional advice. I took a symptom that I have – one that is known, one that I can personally detect and feel (although yes, it has been confirmed with a few blood tests. The fact that my fasting insulin went from “crazy crazy high” to “kind of a bit too high” after quitting wheat was informative) – and worked from that. High levels of fasting insulin are correlated to many (not all) of my weird problems.

Now, this all makes a certain amount of logical and narrative sense, but there are still people who will ask why I don’t go for a “balanced” diet, with “all things in moderation”, and my response will be that I don’t eat arsenic in moderation either, and sugary things basically are like poison to me (fast-acting in terms of nausea, slow-acting in terms of overall inflammation problems and knock on health effects).

“Just a tiny bit of arsenic? Live a little!”

No. I don’t wanna feel sick.

Unfortunately, it now also seems like I need to be avoiding a certain dose of alternative sweeteners as well.

I came to this terribly tragic discovery last week. I’ve been experimenting delightedly with low-carb baking, and along with that, I use liberal amounts of stevia as a sweetener. I ate a piece of my glorious low carb raspberry cheesecake and immediately felt sicker than if I’d downed an Allens raspberry (my very favourite lolly). The same thing happened when I ate one of my low carb shortbreads.

Now, initially, when I made these things, I added less than the recommended amount of stevia, because I don’t have much of a sweet tooth. What I love about cheesecake is primarily the texture – the soft creamy filling and the biscuity base. A hint of sweetness (to overcome the sourness of the almond meal in the base and the cream cheese in the filling) honestly should be enough for me to enjoy it. For shortbread, I do need a bit more sweetness (relatively speaking).

But the second time I made these things, I followed the recipe more closely (I’d swapped to liquid stevia, which is much more concentrated, so I felt I should be precise), and that’s when I started to feel so sick. Husband also reported that it was much sweeter this time around.

Since then, I haven’t made the cheesecake again, but I have made the shortbreads – several times – and if I only add a quarter of the recommended sweetener, I’m fine.

It looks like there is a threshold of sweetness to my response, and I need to juggle and stay below that threshold, no matter what sweetener I use, in order to avoid a nauseating insulin spike. Stevia is definitely safer for me than most other sweeteners – I’ve found that my worst insulin response (as sweeteners go) is inspired by sucralose (Splenda). Aspartame and sorbitol are okay. Xylitol is perfectly fine as far as blood sugar is concerned but my gut does not like it and there are some pretty hardcore consequences (I can probably have it in small quantities).

Incidentally, an insulin spike of that size will shut down ketosis for longer than I’d like, which means that I will be getting a bit less energy from the fats that I eat, and I will not be as efficient in my workouts, so I have multiple reasons to avoid it. It also will cause water retention, which will irritate my joints and lead to inflammation, and then of course, if I have a highly inflammatory internal environment, I may get some of my other special symptoms. Much better to avoid the whole mess.

In summary, I targeted my fancy eating plan to my personal symptoms. This is one reason why, although I do recommend dropping carbs for most people, I also add that very low carb, ketogenic diets are not for everyone. Not everyone has my crazy intolerance of sweetness and carbohydrate (although it seems to apply to more people than you might think, based on some anecdotal evidence).

For me, this works.