We all struggle with our relationships with food, but this can be exacerbated by the changes we go through when we undergo a major surgery that irreversibly alters our physiology.
As I have explained previously, surgical gastric procedures such as gastrectomy (VSG), Bypass (RNY), SIPS/SADI, Colectomy, Ileostomy, Cholecystectomy (gallbladder removal) - just to name a few; All have the resultant outcome of irreversibly altering our physiology either by the alteration of placement, function or complete removal of elements of the digestive tract.
The extent to which these impact our ongoing ability to adequately digest or assimilate nutrition depends on the extent of the procedure undergone; this can range from impaired digestive capacity, poor nutrient absorption and resultant deficiency, chronic ongoing constipation/diarrhea, pain, discomfort, mental health decline, and what I really want to talk about, the development of a love/hate relationship with food – more so a “necessary evil” type relationship and why these things develop.
I think the best way for me to open up this conversation is to open-up about my journey into the world of disordered eating as a result of pain, gastric surgery and the multitude of changes on the outside that we must learn to accept and consider as ‘normal’ once we change everything on the inside.
Where do I begin?
I think I should go 'right back', because it is important to consider that there were indications early on that there was trouble in “gut-town” ( and identifying these is also helpful for your Nutritionist in holistically assessing your case).
My Story – In brief
As a child I was born with hip joint hypermobility, migraines with severe vomiting from the age of around 4, suffered severe “growing pains” (diagnosed as juvenile arthritis) in my hips and legs up until the age of around 14, earaches , psoriasis and from as far back as I can remember a sense of anxiety and “heavy heartedness” –(which in adulthood is generalised as depression). My only sense of relief in these times were from pain medications (generally opioids), often times at more than recommended doses, as for some reason pain relief just didn’t seem to work for me like it did for everyone else; apart from the constipating factors.
In my teenage years, the migraines were seldom, but I frequently had headaches, stomach upset, and my fingers locked up … my joints still ached.
You may wonder why I am telling this story, well simply for the fact that all of these aspects of poor health and pain began to impact my relationship with food.
The depression was still there, and I did what every other teenager did to try and have a sense of belonging, I drank alcohol, I smoked and experimented, but even that was short lived, as once again, things did not seem to work for me like they did for others. (however, smoking did help ease pain and anxiety to a degree). It was evident that there was something going on in my system that was stopping me from producing or breaking down certain chemicals, there was something going on with my connective tissue with the joint pain, locking and flexibility, there was something going on with the way that I digested/ or didn’t digest food; but the chemical part… that’s where the food behaviours really began.
When our bodies are not producing those lovely chemical messengers’ serotonin and dopamine – essential for our own sense of joy and reward, we seek to put joy into ourselves in one way or another. This was food for me, and for the most part it was high reward foods/substances (stimulant-types like sugar, caffeine, nicotine), these hit the reward centre of my brain and began the process of habitual behaviour. I began to seek out these types of foods to replace what I could not make.
Towards the end of my teenage years, I began to get horrible back pains that caused spasms throughout my abdomen, these came and went. Then the pain began again in my legs, radiating down to my ankles from my lower back, pains that I still get to this day. It inhibited me from participating in things, I was unhappy and gave joy to myself by rolling my own cigarettes and drinking coffee by the bucket full, by eating sugar and fat laden crap.
Pain medications and anti-inflammatories were my go-to, a somewhat placebo effect that always ended up causing more tummy trouble.
Early 20’s, an unhappy marriage and eating through unhappiness into divorce. Combatting my own food behaviours, whilst combatting a lack of motivation and constant reward seeking behaviours of the other party.
Life was not providing joy; food would have to.
Towards the end of that period, that’s when the pain became too much. It always began in the middle under my sternum, and radiated towards my back, always worse when I ate healthy-type foods (I’m talking veggies, salads, lower fat); I literally could eat pizza and chips and not experience pain, but the moment I tried to get my health in check BAM the pain began.
This was such a blow to my already depressed sense of self, a “damned if you do damned if you don’t” type of situation ; I could either continue to eat crap and feel/look like crap, or I could eat healthy and be in pain every day. The emotional pain was always easier, I felt like I had become resilient, but I obviously wasn’t I was just withdrawing and becoming unpleasant.
Pain had changed the way I viewed food. It was scary, unpredictable and the reason I felt so low about myself. It caused me both pain AND joy, it was confusing.
Now, don’t get me wrong, I was always at the doctors trying to discover the underlying cause of all of this. I didn't just sit idle and eat myself into oblivion.
They had no answers. But when the pain became too much, I tried again. I was 29 at this stage.
It was always a scary thing for me, my own father having had bowel cancer early in life and having a section of his intestinal tract removed as a result.
So, this is where we begin the process of body invasion and they begin to take pieces…..
Colonoscopy, endoscopy, ultrasounds and x-rays, all relatively unremarkable except for the presence of duodenal gastritis, delayed gastric emptying, partial spinal disc herniation and facet arthritis. Still no answers.. more frustration. I felt doomed.
My doctor was quick to state it was my gallbladder and that was quickly removed after. The post-surgical assessment noted that there was lacking evidence to indicate disease and few tiny sand like gall stones; nothing that would explain the pain. Now I was down an organ that it seemed I didn’t have to lose. Again, no more answers than before and down a piece of myself, and whilst not a 'vital' organ, still one that had a job and is missed when it is gone.
My digestion got worse, there handfuls of days where I couldn’t go to the bathroom at all and others where it was like my office. I began to get bad reflux, anything too dense or too 'rich' would cause pain and again it was the processed crappy foods that seemed to go down the easiest. I was still miserable.
Fast forward past multiple more diagnostics and doctors visits, another colonoscopy and ending up coming to the decision to undergo gastric surgery as it would ‘resolve the reflux by reducing acid content of stomach (by detaching the stomach) and rerouting/bypassing the sections of small intestine that are effected by immobility’, and aid in getting rid of the weight that my diet had inevitably helped me gain. I was 35 years old when I did this.
At least I would be able to eat "normal food" right?
It was a bittersweet victory.
I no longer have daily stomach pain. (It is infrequent but still presents itself). So it hasn't 100% resolved my issues. It has lessened them to a degree, but the causal factors are still present.
Further investigation has lead to the realisation that all the factors of my childhood indicate a lack of connective tissue integrity which has the potential to translate into poor digestive function.
Spinal manipulation has shown me that my spine has a lot to do with the way my intestines work, (in fact it was my first year into my Nutrition degree and my anatomy and physiology lecturer, that aided my a-hah moment; that spinal nerves link with intestinal nerve groupings and largely impact on the innervation of the intestines) Could all of this been as a result of connective tissue and poor spinal health?
What I also know is that the links between gut health and mental health are bi-directional; meaning that if you don't get what you need your mental health suffers, but conversely if you don't produce what you need your digestive health suffers (did you know that serotonin aids in gut peristalsis? that's the movement of the gut that I lack in places. Depression was a key indicator early on...)
Surgery seemed like the right answer in the beginning, it has helped me to get to a level of health I hadn’t experienced before, but my body has paid the price and it shows. Unlike many public profiled health professionals, I do not possess the “perfect body”, it Is scarred, loose, and better with the lights off, but I understand it more now than I ever did.
Sounds like a good outcome. Well…
While it is true that I am no longer eating all the horrible processed foods out of necessity to avoid this pain, the reality is... I don’t enjoy food a lot of the time now… why?
Well this is because I underwent a couple of surgical procedures that have irreversibly changed the way that I intake, digest, and use food. In some cases, even the way I taste food has changed.
This is where the love/hate relationship was really cemented. Food can become a necessary evil because of all of the changes.
What has changed?
Now when I am in pain, I cannot take pain medications as the small pouch of a stomach that I have been left with does not contain enough/ if any enzymes to break them down, therefore they are dumped whole into a lower portion of my small intestine and begin to burn (this is where the ulcer risk lies). I have to 'cope with pain' or risk ulcers and gastric pain.
As the first third of my small intestine has been bypassed, I no longer absorb nutrients as I should. Science has shown us that this is where the majority of our absorption takes place. Most of my vitamins have to be in liquid form and I will have to take these for the rest of my life; and others, no matter what I take, will not make a dent in my levels. For instance, Iron – to which I have to undergo infusions for. Made more evident during pregnancy (I am currently 31 weeks as I write this - and let me tell you post-surgical pregnancy is a whole other ballgame - as is post-surgical IVF -) having my last levels come back in so incredibly low that I had to have back to back infusions over two weeks.
I have to remain vigilant with my supplementation and try not to forget.
What they don’t tell you is:
What they don’t tell you is that before you had surgery, your food behaviours were governed by factors that should have been addressed first, as these factors come with you and add to the ones you develop from the way that your life is changed. That you lose sight of the health you were seeking and simply shift the focus from avoiding one type of pain, to another.
They don’t tell you that mental health should be your main focus going into and coming out of surgery.
What they don't tell you is that you may find yourself hating the food you once loved because your body has changed its needs and you wont know what they are unless you are taught.
What I know now.
That education is key to understanding and healing our bodies. That its more than watching carbs or eating high protein, it is ALL about balance, and more than that it is about the BALANCE of ALL THINGS in life.
I see so many people fixated on losing weight through surgery, rather than gaining health that they avoid certain food groups or refuse to eat as much as they should for fear of “gaining it all back”. Now more than ever choosing the 'easy' option as they have allowed things to become too hard. Not taking a step back and finding out what the physiological changes mean to your needs long term.
Sometimes we need to alter our thinking about food and alter the foods we consume to achieve healing, to reset the status quo (as it were) and begin to adopt a new style of normalcy that brings things back into perspective of what is important. Human connection, health, wellbeing, mental health, nourishment, joy…
I now know, more than ever that food has the capacity to harm and heal, and you need to listen to what your body is telling you... if it is blocked up, it needs one thing, if it's the opposite, it needs something else, do not try to recreate the wheel or flog a dead horse, change can be the best thing, as well as not following the pack. Lets face it, you stopped being one of the crowd when you had your surgery; everything is different and so are your needs. That we must stop blaming food and start looking at our actions and choices, and if we are in the dark... reach out for guidance.
I now know that we need to emphasise that beauty has NOTHING to do with weight, nothing to do with loose skin, nothing to do with what you were physically versus what you look like now…. BUT has everything to do with WHO YOU ARE and the happiness and positivity you project into the world. It has everything to do with the baggage you carry and don’t address. It needs to be unpacked. These are the issues that need to be remodelled so we can have a better, healthier relationship with food, that allows variety, moderation, joy and experience.
This is quite a difficult concept to master, as everything we see equates health and happiness with physical beauty… even some of the more mainstream ‘nutritionists and health advocates’ send this message with their bikini body ready plans and stories of their own wonderful weight loss journeys that helped them be the person they wanted to be. The person that 'they wanted to be'... thin? To me that seems too superficial and surface level, I want to help you realise the person YOU ARE. The weight you carry is not pounds or kilos, it is a soul, a kindness, a sense of humour, a mother, father, sister, brother, a dream and a passion. This is the weight of you and the true beauty.
You have to nourish your being inside and out, top to bottom…A happy soul is a beautiful one.
What I now know is that normal doesn’t have to mean putting up with pain or discomfort, doesnt mean sticking with sadness or displeasure or sticking with a model that is not ideal but manageable, something that only 'kinda works' … normal can mean constant and dynamic change in tune with what you need and that guidance and support are there if you ask for it.
I mean, that's what I am here for !
Mental nutrition is BioME Integrative Nutrition's
Own Health and
Wellness Blog. Covering all things from what goes in to what comes out after Bariatric Surgery and beyond.
Carrie Ross: Clinical Nutritionist | BSc Nutritional and Dietetic Medicine | Nutritional/ food Behaviour Counselor |Bariatric Health Coach | Social Trainer |Author