Eating Disorders and the AIP: A Conversation with Stefani Ruper

“As a woman living in modern Western culture, you have surely experienced pressure to conform to body image norms at some point. You saw a magazine. You went to a mall. You hung out with your girlfriends. How does it feel to think your body needs to look a certain way in order to be beautiful? Downright awful in my experience. Allowing body image norms to permeate your conscious is the first Old Rule that needs to be done away with. It can make you resent your body, make you feel uncomfortable in your own skin, and put you at war with your very self.”
~ Stefani Ruper

Who is Stefani Ruper?

• Author of the blog, Paleo for Women, she leapt onto the paleo scene writing from the radical perspective that men’s and women’s bodies work differently. She questioned the practice of intermittent fasting and ketogenic diets for women, and wrote the book (literally) on PCOS and hormone imbalances.
• Host of the podcast, Live Love Eat, she led heartfelt conversations about the intersection between food, emotions, and body image.
• Author of the book, Sexy By Nature, she’s a fierce advocate for women embracing optimal health through self-love.
• Stefani herself started restricting her diet at age 10, trying to achieve “the perfect body.” She eventually learned to love her natural size – one that supports robust health, and is now a nationally renowned counselor, helping others do the same.
• While Stefani’s work focuses on empowering women, she loves men as well, and our discussion today applies to both genders.

Why I Called Stefani for an Interview

Healing autoimmunity through diet is an experience that has changed my life, but the fact is, healing diets are restrictive. We remove foods that exacerbate our autoimmune symptoms. We also add in foods that nourish us on a cellular level, so we can heal. It’s a completely new way of eating that’s incredibly challenging at first. Food is an emotional experience for us all, but especially if you struggle with eating disorders. I’ve gotten emails from readers asking how they can navigate the paleo autoimmune protocol (AIP) without triggering disordered eating behaviors of their past. I’ve also seen conversations in the AIP Facebook groups that hint at some people using the AIP as an excuse to eat less. I’ve personally experienced fear of food, once I learned how it can exacerbate my autoimmune disease. My goal with this blog is to help us heal in every way, and I think this is a really important conversation to have. So, I called in an expert.

Stefani, tell us a little bit about your background with eating disorders, both personally and professionally:

I started dieting with a body image mentality when I was 10 or 11 years old. I grew up in a house with dieters. In high school, I woke up and worked out at 5:30am, ate very restrictively all day, and then worked out for an hour and a half again in evening. It was very punishing to my body. Then I would overeat, because I couldn’t keep up that level of restriction.

In 2009, I finally achieved the body image I sought, but it required losing so much weight that I stopped menstruating. I was also vegetarian at the time, and I ate a no-fat diet, literally. So, here I was: infertile with cystic acne. I was the size I wanted to be, but I wasn’t healthy. I went paleo hoping it would fix my health problems, but it didn’t. I finally realized it wasn’t the food, but the restrictive way I was eating that was making me unhealthy. I got angry at society for making me think I needed to do this to be healthy and beautiful. Then, I got indignant on behalf of others. I started blogging about this issue and got this topic into the paleosphere.

Professionally, I’m not qualified to diagnose eating disorders (anorexia and bulimia). In severe cases, those conditions might benefit from pharmaceutical intervention and inpatient treatment. However, I work under the larger umbrella of disordered eating, and have a consulting practice where that is one of my specialties.

There are people in the autoimmune community who have a double diagnosis: autoimmune disease and a history of disordered eating. The paleo autoimmune protocol is an incredible tool for healing, but its restrictive nature can trigger old patterns. What’s your best advice for people in this situation, who want to be healthy in every way?

To eat the AIP in the least controlling manner you possibly can. So, that means buying ALL of the foods on your OK list in high quantities and then having those be the foods in your house. (Check out the Paleo Approach for a list of over 500 hundred foods you can eat.)

Know that you are choosing to follow this protocol to be healthy. This isn’t about restriction. Eat these foods as much as you want, however you want. And don’t think about calories at all. You don’t need to rigidly monitor your intake; in fact, it’s best if you don’t.

Also see the big picture. Do the best you can with the protocol, but don’t freak out about it. Be patient with your autoimmune healing, have faith, and trust the process. If you find your eating disorder being triggered anyway, get some professional help.

Does your advice differ, depending on the eating disorder?

Whether you’re an overeater or undereater (and chances are you’re both), my advice is always, always the same: That you figure out where your negative self-talk and body image comes from, learn how you feel about your body, develop a positive relationship with your body, over time you learn to love your body so much that you focus on nourishing it over all other things. Instead of forcing it to look a certain way, you learn to let it look the way it needs to be healthy.

My next question is a bit of a live bomb. There are some people in the AIP groups online who appear to be using the AIP as a mask for their eating disorder – as an excuse to eat less. We’re in the business of helping people, so this is a concern for all of us. But we also don’t want to judge anyone. How can we speak lovingly to this possibility?

I encourage everyone doing the autoimmune protocol to ask themselves the following questions:

1. How do you feel about your body?
2. What is your emotional state when you eat?
3. How much do you consciously control your food intake in terms of portions?
4. Do you count calories?
5. Do you ever feel guilty for eating?
6. Do you analyze your food choices at the beginning and end of every day?
7. Are you trying to avoid death? (Because everyone dies, regardless of diet.)
8. Do you have a diagnosed autoimmune disease, or are you pursuing this diet for other reasons – to achieve perfect health, or the perfect body.

The AIP is an effective treatment for autoimmune disease specifically, but it’s not a healthy diet for the general population. Paleo eaters are into the idea of eliminating foods to make them healthy, so they think the AIP is the healthiest diet of all. It’s just not true. The nature of its restriction makes it hard both psychologically and nutritionally. You shouldn’t do it, unless absolutely necessary.

What are the most unhelpful things you could say to someone you suspect has an eating disorder?

• I think you looked better before. That seems like a good thing to say, but that’s judgment about how they look, and they already feel insecure about that. Now, they’re likely to feel judged, more insecure, and possibly afraid.
• You look great. With disordered eating, people are very concerned with their appearance. You don’t want to affirm or elevate that concern. The most important thing is to reassure them of their worth independent of the way they eat and how they look.
• I think you have a problem. You don’t want to imply they’ve done anything wrong and add to their feelings of low self-worth. It’s very difficult to do this conversation well. You need to be honest, loving, non-judgmental, and know that person very well. Treat it as a discussion, not a lecture. Ask questions, rather than make accusations. If you don’t know what to say, it’s better to say nothing. Simply love them and be a good role model yourself. People rarely change, based on a conversation. They change when they’re ready.

Sometimes the AIP can actually cause an eating disorder – a fear of food. Once you experience how certain foods can exacerbate your disease, it’s common to blame food for all symptoms, and resist expanding your diet, even after your symptoms improve. What advice do you have for this situation?

Take it one day at a time. Every time you eat something new and have a different reaction, you learn something about yourself and your body. That’s empowering knowledge, and you won’t get it if you don’t try. It’s OK to take it slowly and do it in a way that feels safe. If you have a negative reaction, you can take a step back. Or, you might discover you can tolerate more than you ever thought you could. The ultimate goal is to go back to living your life. Don’t let your world be smaller than it needs to be – and that includes the world of food.

Note from Eileen: I wrote a food reintroduction e-book to safely guide you through this process.

If someone wanted to hire you as a consultant as they navigate autoimmune healing and disordered eating, how would you help?  

• I would support you in whatever way you need, individualized to the person.
• I would bolster your love for your body and your respect for your body’s healing process.
• I would help you believe in your body and develop gratitude and appreciation for all it’s doing.
• I would help you think about your diet as a nourishing, exciting thing you’re experimenting with. In doing so, I would help you see it as a choice that’s bringing you greater health and self-knowledge, rather than something that’s restrictive and controlling and scary.
• And finally I would do my best to mitigate any fear you have about outcomes. Everything is OK, this is a learning process, and you’re doing everything you can. This is an important step, it might not be the last one, but you’re moving forward, taking each day as it comes.

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Art Credit: A huge thank you to Rita Loyd for the artwork at the top of this post. She has a whole gallery of beautiful images at the aptly named http://nurturingart.com. She kindly gave me permission to include one for this article.

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