Check out my interview with Seattle based Health at Every Size ® naturopath, Lily Stokely who shares her approach to topics such as food allergies, elimination diets and inflammatory foods.
Lily Stokely is physician at Emerald City Naturopathic Clinic specializing in primary care, counseling, biofeedback, physical medicine, family medicine, and eating disorder prevention and treatment. Lily lives and practices from the perspective that every individual has their own unique definition of what it is to be healthy. She is passionate about aiding people in their health journey and loves to work from an integrative, whole body, mind, spirit perspective. Additionally, Lily is a yoga teacher of 8 years with experience instructing private and public classes as well as yoga teacher trainings. To learn more or to schedule an appointment, visit her website www.lilystokely.com/
NJ: Many naturopaths emphasize eliminating sugar or significantly reducing inflammatory foods. While this can be well intended, clients often are left being triggered into viewing foods as "good" or "bad" and feeling guilty or stressed if they eat an inflammatory food. How do you approach this?
LS: It’s important to remember that stress is a major contributor to inflammation as well as an emotional trigger to crave sugar and other “inflammatory” foods. When food rules are placed on an individual and these rules are not followed there is inherent stress that follows. I avoid the use of categorization of inflammatory foods. What is inflammatory to one individual may be supportive for another. It’s important to also remember that when any one food group becomes restricted that the individual is then more susceptible to binges and/or body shame which contributes to other disordered eating, exercise behaviors and increased stress. It is possible that some foods for certain individuals may cause a variety of reactions in the following days. For some there is a psychosomatic response that stems from the shame of eating these “forbidden” foods. Stress and anxiety can cause a vast array of symptoms from numbness in extremities, digestive upset, and brain fog.
The medical providers role here is to help the individual sort through the emotional and physical connections to these foods. Sometimes even if the individual does react to a food they were told to avoid, there often is an emotional reason for choosing to eat the food even knowing that it may cause unpleasant physical responses. It is here that the medical provider can provide support in aiding the individual to be empowered in their ability to make food choices. They then can decide if the emotional need may out weigh the physical symptoms or visa versa in that specific scenario.
NJ: Clients can approach food allergy testing with a diet mindset, almost hoping to be intolerant to something so as to have a medical motivation to cut down on dairy or gluten in hopes of weight loss. What are your thoughts on this?
LS: Avoiding dairy or gluten or any food group is a major misconception in that it is tied to weight loss. If an individual is sensitive to one of these food groups and they begin to avoid it sometimes the body may lose weight, however the body also has the potential to have unchanged weight or even gain weight.
NJ: As a weight-inclusive practitioner, what do you use to assess a client's health if you don’t use weight?
LS: Health at Every Size ® is the practice that each individual has an innate weight in which their body can thrive. This model steps away from the concepts of generalized health based on weight and BMI and embraces the science that demonstrates a body may be at varying weights and can remain in a healthy state. Weight is not an indicator of health independently from other health markers. Health at Every Size ® invites individuals to experience their body and how they live in it so that the true definition of health can be experienced; a body free of limitations. A naturopathic doctor that practices in the Health at Every Size ® model will not use your weight as a measure of your health, but will rather assess your health by how you feel in your body, how much energy you have through out the day, if you are in pain or if your body is able to move freely, and other laboratory markers. For conditions considered to be more metabolically (Diabetes, high cholesterol, hypertension etc) related an intuitive eating approach is taken in regards to awareness of relationship with food and eating behaviors in addition to use of herbs, supplements and other modalities.
NJ: How can someone work on intuitive eating and healing their relationship with food while testing for food allergies or considering an elimination diet? Along those lines, how do you hold space for healing the relationship with food without food allergy exploration triggering the diet mindset?
LS: If rules of a diet are given ahead of time, the individual is less likely to listen to the body’s innate signals in how they relate with a food on a physiological level. If the individual is using intuitive eating, they use the body’s messages as a guide as to what foods are more or less supportive. It takes time to learn to listen to the body’s messages, however health is a life long practice, not a quick fix. Exploring food allergies and sensitivities can be approached from this perspective. If an individual has an allergy or sensitivity to a food, there are always messages that the body communicates. The practice, and where an educated provider on intuitive eating can be most helpful, is to explore the sometimes discrete language of each individuals body. For some this is easy, ie “I get a stuffy nose every time I eat dairy.” For others it may take more patience, ie. “My joints hurt 5 days after eating gluten.” If someone is told they have a food sensitivity without this inner listening practice then they will be put into a restrictive relationship with that food group which sometimes spirals into a restrictive relationship with many food groups. For an individual at risk of an eating disorder, this is where real harm from health care providers can stem.
Cultivating a healing relationship with food can happen simultaneously while exploring possible food sensitivities so long as it respects the individuals own experience of foods and the body sensations that arise. A medical visit that embraces this perspective might offer possibilities of what food reactions might look like and tools to examine where this might occur in an individuals diet. This must be accompanied by the essential aspects of counseling around self-awareness of the physical and emotional relationship with foods.
NJ: Sometimes food allergy testing indicates a client is reactive to foods they never felt to be an issue, often resulting in them becoming overwhelmed about needing to eliminate one more thing from their diet. How do you approach this topic?
LS: It’s important to remember that ALL food sensitivities will have a palpable response in that individuals body. If there is absolutely no response then there is not a food sensitivity. There many options for food allergy laboratory testing evolving; all of which have been shown in research to not be 100% accurate (IgG, IgE, IgA, skin allergy testing etc.). The gold standard in naturopathic medicine for allergy testing is an elimination diet, which although I don’t recommend doing the traditional elimination(more harm than benefit in regards to relationship with food), this infers that the body’s messages and response to foods are the most precise ways to diagnose a food sensitivity.
There is also a spectrum of food allergy, food intolerance, and food sensitivities that is often important to define to fully understand the varying ways foods can affect an individual.
Food Allergy: A severe immune reaction that can result in death or serious harm if ingested. ie. Anaphylaxis. Celiacs disease can also go into this category due to the type of immune reactivity that occurs however symptom presentation and reaction is not always as immediately severe as a typical anaphylactic reaction.
Food Intolerance: The body lacks specific enzymes to digest a food or food group. Ie Lactose Intolerance
Food Sensitivity: Often immune related, however can present on a spectrum of reactions from very severe to sometimes very subtle. The more subtle reactions are sometimes based on quantity and frequency of food consumed and not that the food was consumed or not.
Keeping these definitions in mind is helpful when interpreting food allergy lab testing panels. In the above example, an individual asked to fully avoid a food in which they notice no difference when avoiding the food may have a mild sensitivity that only demonstrates symptoms when the food is eaten in greater quantities. Another example as to where an intuitive eating approach is a better fit as the individual will have less stress around this food and may learn their unique tolerance to the food and how to navigate how much and how often to eat this food.
NJ: How do you approach food allergy testing in your practice?
LS: I will sometimes use food allergy testing and I always will then use that information infused into an intuitive eating approach.
If a patient is having a challenging time sorting through possible reactions to foods and reactions are moderate to severe I find food allergy testing useful. I use it as one tool of many to aid the individual in building a connection between their environment (food being one piece of this) and their body sensations. I spend several visits reviewing the results, counseling them around relationship with this food group and if that feels like a reasonable food that could be contributing to discomfort. These conversations always include aspects of emotional relationship and explore that individual’s experience of how that food relates in their body. Even if the test is positive, it doesn’t always mean the recommendation to limit this food is made.