Navigating Dietary Restrictions in Eating Disorder Recovery: A Compassionate, All-Inclusive Approach
By: Ali Beckman, MS, RD, LD, CEDS-C, Director of Clinical Nutrition & Movement Services at Alsana
At the beginning of the recovery journey, many individuals ask if and how their dietary restrictions can be maintained. Unfortunately, the answer is complex and may require processing with your treatment team to fully answer.
At Alsana, we believe that it is necessary to honor your history, values, culture, and needs in order to obtain a holistic recovery. However, we also recognize that eating disorder beliefs and symptoms of malnutrition may make even the best intended dietary choices complex. Let’s talk about how we help you find balance.
Work with a Registered Dietitian to Understand the "Why” Behind the Food Restriction
Not all dietary restrictions are disordered, and true recovery CAN happen with restrictions put in place. However, in making peace with food it is helpful to remove any unnecessary barriers to nutrient intake. During your recovery process, it’s essential to ask: “Is this restriction rooted in medical necessity, deeply held values, or in fear and control?”
Your Dietitian can support in gently exploring the origin of each food restriction, by helping:
- Clarify whether the restriction is medically necessary like in the presence of a food allergy
- Note: the malnourished gut has a tricky time digesting food, making it difficult to tease out what is a food intolerance versus a symptom that will improve with nutrition rehabilitation
- Reflect on whether it’s values-based, like following a vegetarian diet from ethical or religious beliefs
- Identify whether the restriction may be reinforcing disordered patterns
This conversation is NOT about challenging or taking away your personal values- it’s about ensuring your energy and nutrient needs are being met while honoring your identity and healing your relationship with food.
Assess Nutritional Adequacy of Your Dietary Plan
Whether you’re managing an anaphylactic allergy, practicing Halal, or following a vegan diet, nutritional adequacy isn’t a given. Your dietitian should support you to ensure you are consuming a broad range of fuel groups, are meeting your energy needs, and are not unintentionally avoiding any types of food due to habit, fear, or any other reason. For example:
- Gluten-free does not mean carb-free or grain-free. We utilize gluten-free alternatives to support clients in finding satisfying, energy-dense alternatives to meet their energy needs.
- A vegetarian or vegan will need to intentionally include diverse protein sources, a B12 supplement, and iron-rich foods.
Prioritize Nutrition Rehabilitation – Even if That Means Temporarily Pausing Some Dietary Restrictions
In the initial phases of eating disorder recovery, the brain and body need consistent, adequate energy to begin healing. Sometimes a dietary restriction (even one rooted in culture or ethics) can unintentionally reduce variety, limit flexibility, increase fullness, or cause anxiety.
There may be instances where your team may recommend temporarily pausing a non-medical restriction during nutrition rehabilitation. This allows your body time to heal so you can healthfully embrace these values down the line.
Some ways this can be approached might include:
- Collaborating with a spiritual advisor, community leader, or mentor to identify permissible exceptions within your belief system when medically indicated (for example: getting a rabbi’s blessing to utilize dairy supplement after eating a meal with meat or eating during traditional fasting events such as Lent, Yom Kippur or Ramadan).
- Choosing plant-based proteins for most meals, but including some animal-based proteins during nutrition rehabilitation to lower fiber content of meal plan and decrease gastrointestinal distress
Your treatment team should work with you to ensure that any pause or shift in dietary restrictions are temporary, purposeful, and aligned with your ultimate goals.
Identify Potential Sources of Rigidity within the Dietary Restriction
Work with your full treatment team to dive into your food beliefs and behaviors through a curious, non-judgmental lens. Utilize your team to:
- Monitor how each dietary restriction impacts your energy intake, flexibility with food, and social life
- Explore and challenge maladaptive rules that may be hidden within well-meaning dietary restrictions
- Engage in processing if identity, trauma history, or culture are tied to food rules
- Create real-life eating experiences (grocery shopping, cooking, restaurant outings) within your dietary plan
With this curious exploration, we may be able to identify when a dietary restriction has become overly rigid and is interfering with healing.
Embracing Food Flexibility – Without Judgment
At the end of the day, some dietary restrictions may be fully embraced while others may be challenged as part of the recovery process. Either way, recovery involves flexibility and curiosity within your food choices. In working with a trained, professional team, you should be able to find meals and snacks that include all of the fuel groups to support your body in healing. Within those eating opportunities, find ways that food can be utilized to support your traditions, connect to your support system, and find joy in food.
Final Thoughts: You Don’t Have to Choose Between Recovery and Your Beliefs
At Alsana, we believe that your dietary needs, values, and recovery goals can co-exist. It may take time, education, flexibility, and trust—but with the right team, it is absolutely possible.
If you’re wondering whether your dietary restriction is helping or hurting your healing, talk to your care team. You’re not alone in this exploration—and you don’t need to abandon who you are to get well.
Want support navigating recovery with a dietary restriction?
Learn more about our personalized, compassionate care at www.alsana.com
