A subtle explanation for your persistent intolerance to food, that seems to worsen—rather than improve—even as you eliminate more foods, may exist.

For the first 20 years of her career as a dietitian, Wendy Busse’s goal was to help clients determine the cause of their digestive distress with an elimination diet—a gold-standard tool for determining what foods were associated with their symptoms.

“People were coming to me on these really limited diets and saying, ‘I’m still reacting. What’s happening?’” Busse told The Epoch Times.

In most cases, and when used correctly, elimination diets can be liberating. They work by taking out potentially problematic foods—one or more—and then slowly reintroducing them to see which are causing gastrointestinal (GI) symptoms such as gas, bloating, diarrhea, and constipation.

However, for some people, elimination diets end up creating unnecessary food restrictions or escalating the fear of food, leading to worsened symptoms.

Busse has termed the scenario “conditioned food avoidance and sensitivity trap (C-FAST)”—a growing problem that’s dominated Busse’s practice for the past decade. This vicious cycle of food restriction and worsening symptoms nullifies the purpose of the elimination diet, which is to help people return to enjoyable and symptom-free eating.

Food Restriction Hypervigilance

Elimination diets can be time-consuming and confusing. Such diets can cause or intensify hypervigilance and stress around food and GI symptoms, Busse said. Hypervigilance is when your nervous system is stuck in “fight or flight,” constantly on the lookout for danger.

Often, the stress and fear are subconscious.

Recognizing when fear is involved makes a difference, Busse said. The more quickly you can identify that you’re in the cycle, the faster you can break out. Warning signs of being stuck in C-FAST are:

• Frequently thinking of or researching the dangers of food


• Feeling tension when eating food


• Paying excessive attention to your symptoms


• Refusing to reintroduce food to your diet

Objectively Assess

It’s important to approach elimination diets with a mind-body perspective and ultimately remove only foods that are truly aggravating.

“The end result may be, ‘I really do feel better when I avoid this food, but you’re making that decision objectively, rather than a fear-based decision based on something you read or heard,” Busse said. “Really, in the end, if you are able to reintroduce a lot of previously restricted foods, then yes, probably some conditioning was involved in what you were restricting or avoiding.”

Conditioning is a process during which certain experiences can evoke a specific outcome. For instance, repeatedly learning about lactose intolerance could alter physiology to create the same set of symptoms. Anyone can be prone to conditioning, Busse stated.

To prevent conditioning, she suggested to:

• Minimize internet research


• Follow a trusted food list


• Think less about food


• Look for nonfood explanations for symptoms

Pre-planning meals can help people think less about food, she said.

One client who worked with Busse wasn’t able to add any foods back to her diet. However, her relationship with food changed drastically. The woman used to get upset whenever she met her friends for coffee because there was nothing she could eat. Now, they meet for a walk instead.

“She was no longer fighting it, and food was no longer a source of stress in her life.”

Defining Food Restriction

Sometimes, fear developed during elimination diets can lead people to avoid eating, which causes the condition to overlap and contradict traditional beliefs about food restriction behavior. That can make it hard for clinicians to identify the root cause.

Restrictive eating is clinically diagnosed as avoidant/restrictive food intake disorder (ARFID), which has roots in a disinterest in food in infancy and early childhood. ARFID symptoms include lack of appetite, fear of choking or vomiting, and aversion to the taste, texture, odor, or appearance of food.

Because ARFID is considered an eating disorder, featuring distorted body image or preoccupation with body image, Busse said it isn’t an accurate way to categorize patients struggling with C-FAST.

However, she noted that there are some overlaps between C-FAST and ARFID, particularly in that those who struggle with the conditions also tend to have anxiety.

A 2024 study of 42 adults with ARFID published in Journal of Eating Disorders noted the evolving understanding of the condition, in that it appears to affect adults of various ages and with various psychiatric conditions.

The study found that among those followed, more than half had anxiety and mood disorders. Those with ARFID also struggled with neurodevelopmental disorders such as attention deficit disorder or autism spectrum disorder, trauma, obsessive-compulsive disorder, and digestion-related diseases such as Crohn’s disease and celiac disease.

The latter reveals that ARFID may not strictly be a mental health dilemma, indicating the complicated mind-body nature of food restriction that may not be fully understood. The involvement of emotions doesn’t negate physical symptoms, Busse said.

Create Calm Around Food

Ultimately, the goal is to add as many foods as possible to your diet after the elimination period. However, it’s not always possible, and Busse no longer judges client success by how many foods they were able to add back. Rather, she aims to help them have positive feelings about food while reducing the time and energy they spend thinking about, researching, and worrying about it. 

Madsen also incorporates mindfulness strategies with her clients, regardless of whether they recognize the role emotions play in their food reactions.

Simple relaxation habits are helpful for anyone who wants to have a healthier relationship with food, Busse said.

Habits can include:

• Eating meals at the same time every day


• Chewing slowly and completely


• Taking gentle belly breaths before meals and when digestive discomfort arises


• Finding ways to practice relaxation

Over the years, Busse has also found that the reasons people feel better on an elimination diet may have less to do with eliminating a certain food than adopting healthier eating patterns, experiencing a placebo effect, natural fluctuations of improvement that would have happened regardless of intervention, or feeling better because of the care given by a health professional.

“Oftentimes, people are pursuing a physical cause. They want an explanation for why food is bothering them. The suggestion that fear may be involved can make clients think, ‘Then it must not be real food sensitivity and I’m exaggerating my symptoms or making my symptoms up,’” she said. “It’s been a real challenge to get it across that these are real symptoms.”