The “Food the Main Course” Conference It is a dietitian-designed, organized, and led conference which specifically focuses on the treatment of digestive disorders and gastrointestinal (GI) conditions.
I recently attended my first “Food the Main Course” Conference, and it was a phenomenal experience and I’m so excited to share with you a few of the things that I learned (or re-learned!).
I love people. It’s one of the reasons I became a dietitian. So, attending live conferences fills my cup in so many ways. And this conference has me buzzing!
I reconnected with old and beloved colleagues, met new and inspiring dietitians, finally got to hug my virtual colleagues for the first time, and was immersed in new research and ideas.
For those of you who don’t know, the intersection of GI disorders and eating disorders (EDs) has been a long-time passion of mine. So much so that I’ve spoken about it at conferences and on podcasts, written about it, and developed a workshop as well as an entire course on the subject with my amazing colleague Lauren Dear. And that is because the vast majority of people who have an ED also have a co-occurring digestive disorder. Some data shows prevalence rates over 90%!
It’s my belief that if you work with EDs or you have one – caring about and for the GI tract is essential. If eating is physically painful, efforts towards recovery become that much more complicated and harder to access. AND an undernourished gut is a gut that hurts and malfunctions. Food is one essential cornerstone to helping digestive woes, which is complicated when it often feels like the source of the pain.
In no particular order, here are some of the highlights from the “Food the Main Course” Conference that I just can’t stop thinking about.
I LOVE listening to dietitians who blend passion, deep knowledge, and expertise. I was blown away by how well the presenters know the current research landscape, can speak to it with precision (assessing strengths and limitations), and how skillfully they pair that with the wisdom and experience of their patients and their clinical work. These GI dietitians are changing lives. Does that sound familiar? It’s how I feel about my ED dietitian colleagues!
Just like with EDs, dietitians are considered to be essential members of a multidisciplinary team. And patients receive the best care when each member of the team is valued, supported, communicating with one another, and encouraged to do their best work. Each member of the team is seen as possessing vital contributions. (I understand that this doesn’t always translate in practice. But at least it’s a practice standard.)
The GI field seems to have a handle on and respect for individuals with EDs in a way I have never seen in any other branch of medicine or mental health! From much of the published literature to many of the speakers at this conference, they are aware of the high rates of EDs within the GI population. And now more than ever, they are making specific recommendations about how to care for patients who have both. This includes clearly describing the risk of elimination diet protocols for patients with past or current EDs and the importance of accurately assessing for this complex overlap. Too many patients with GI problems are inaccurately diagnosed and treated for an ED. And too many patients with an ED are not given proper GI care and simply sent away for ED treatment. We can and must do better.
Right now there are no appropriate screening tools to assess EDs in the GI population. One example is the NIAS tool which screens for ARFID. In research this tool reveals very high prevalence rates of ARFID in the GI population. But it’s believed the numbers are inaccurately inflated because it is not sensitive enough to discern symptoms and behaviors driven by GI conditions vs. driven by an ED. Currently, it’s up to clinicians to ask really good questions to try to understand the drivers and maintainers of eating behavior that may be leading to a reduced quality of life, poor mental health, and worsened digestive health.
Another unsurprising parallel between the digestive world and the ED world are the major gaps in our understanding as well as treatment options. This means clinicians need to be endlessly creative, listen and trust the lived experience of their patients, and work collaboratively with their clients and fellow team members to identify solutions that work.
I have SO much more I’d love to share with you on this topic, including my passion for mind-body techniques such as GI massage for constipation and gut-directed hypnotherapy. I’m planning to return to these topics in the near future so stay tuned!
But if you are looking for more on this topic, below are some resources as well as a few helpful research citations you might want to dive into further.
Resources for Both Clinicians and Individuals
To learn more about gastrointestinal issues and eating disorders course I mentioned that I offer with my colleague, Lauren Dear, you can check it out here, Digestive Disorders & Eating Disorders: A Complicated Mix.
Self-Study Workshop: The Gut-Brain Connection
Free Guide: “Beyond Food Restriction: 23 Essential Tools for Clinicians Treating Digestive and Eating Disorders”
“Mind Your Gut: The Science-based, Whole-body Guide to Living Well with IBS” by Kate Scarlata and Megan Riehl
The Gut Health Podcast with Kate Scarlata and Megan Riehl
Helpful Research Citations
Fink M, Simons M, Tomasino K, Pandit A, Taft T. When Is Patient Behavior Indicative of Avoidant Restrictive Food Intake Disorder (ARFID) Vs Reasonable Response to Digestive Disease? Clin Gastroenterol Hepatol. 2022 Jun;20(6):1241-1250. doi: 10.1016/j.cgh.2021.07.045. Epub 2021 Aug 5. PMID: 34364999; PMCID: PMC8816975.
Keefer L, Ballou SK, Drossman DA, Ringstrom G, Elsenbruch S, Ljótsson B. A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction. Gastroenterology. 2022 Jan;162(1):300-315. doi: 10.1053/j.gastro.2021.09.015. Epub 2021 Sep 14. PMID: 34529986.
Murray HB, Doerfler B, Harer KN, Keefer L. Psychological Considerations in the Dietary Management of Patients With DGBI. Am J Gastroenterol. 2022 Jun 1;117(6):985-994. doi: 10.14309/ajg.0000000000001766. Epub 2022 Apr 8. PMID: 35404301; PMCID: PMC9169764.
Peters JE, Basnayake C, Hebbard GS, Salzberg MR, Kamm MA. Prevalence of disordered eating in adults with gastrointestinal disorders: A systematic review. Neurogastroenterol Motil. 2022 Aug;34(8):e14278. doi: 10.1111/nmo.14278. Epub 2021 Oct 7. PMID: 34618988.
Riehl ME, Scarlata K. Understanding Disordered Eating Risks in Patients with Gastrointestinal Conditions. J Acad Nutr Diet. 2022 Mar;122(3):491-499. doi: 10.1016/j.jand.2021.03.001. Epub 2021 Apr 20. PMID: 33893063.
Scarlata K, Catsos P, Smith J. From a Dietitian’s Perspective, Diets for Irritable Bowel Syndrome Are Not One Size Fits All. Clin Gastroenterol Hepatol. 2020 Mar;18(3):543-545. doi: 10.1016/j.cgh.2019.08.018. Epub 2019 Aug 19. PMID: 31437487.
Staller K, Abber SR, Burton Murray H. The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. Lancet Gastroenterol Hepatol. 2023 Jun;8(6):565-578. doi: 10.1016/S2468-1253(22)00351-X. Epub 2023 Feb 28. PMID: 36868254.
