Navigating Food Fear, Disordered Eating & Gut Issues Together (with guests Dr. Madison Simons and Janelle Smith, RDN, CEDS)

If eating has become a source of fear because of digestive symptoms, you're not alone. For many people living with IBS, IBD, and other GI conditions, repeated eating-related symptom flares create powerful food–symptom associations that make avoiding certain foods feel like the safest choice. Over time, however, this understandable protective response can become restrictive, limiting nutrition, social connection, and overall quality of life.

In this episode, we're joined by digestive health and eating disorder dietitian expert, Janelle Smith, RDN, and GI psychologist Dr. Madison Simons to explore the overlap between gastrointestinal disorders, food fear, and disordered eating.

Together, we explore how fear around eating develops, how healthcare providers tell the difference between healthy caution and fear that's limiting daily life, and how people can gradually rebuild confidence with eating through compassionate, evidence-based care. We also explain why working with a team—including a gastroenterologist, GI dietitian, and GI psychologist—can make all the difference in helping people feel more comfortable with food, expand their diets, and get back to living life more fully.

In this episode, we discuss:

• Why progressively restricting foods can worsen fatigue, anxiety, nutrition, and overall quality of life
• Why avoiding foods because of GI symptoms can be an adaptive response, your brain is trying to help you, and this isn't inherently "pathological"
• How the amygdala, your body's alarm system, and visceral hypersensitivity create powerful food-symptom associations
• Signs that food avoidance is no longer serving you and may be driven by fear
• How clinicians use open-ended conversations and screening tools to identify disordered eating and ARFID risk
• When dietary therapies like the low FODMAP diet are appropriate and when they're not
• Least-restrictive nutrition strategies, including gentle food swaps and stepwise reintroduction
• Which evidence-based supplements may help manage symptoms without adding unnecessary diet restriction
• How exposure ladders, "micro-dosing" feared foods, and coping strategies can reduce anticipatory anxiety
• Why reframing symptoms as sensations and separating discomfort from danger is a powerful part of recovery
• How a collaborative care team can help people regain confidence, nourish their bodies, and expand their lives—not just their diets.

f you or someone you love has ever felt overwhelmed by food fear because of digestive symptoms, this conversation offers reassurance, practical strategies, and hope. While some dietary changes may be appropriate to manage GI conditions, recovery is about learning to distinguish necessary restrictions from fear-driven avoidance, rebuilding trust in your body, and finding the right support so food can become a source of nourishment and enjoyment again.

This episode has been sponsored by Ardelyx.

Reference:

Simons M, Issokson K. From Food Fears to Food Freedom: How Do We Best Manage Restrictive Eating in Inflammatory Bowel Disease? Crohns Colitis 360. 2025

Scarlata K, Zickgraf HF, Satherley RM, et al. A Call to Action: Unraveling the Nuance of Adapted Eating Behaviors in Individuals With Gastrointestinal Conditions. Clin Gastroenterol Hepatol. 2025;23(6):893-901.e2. doi:10.1016/j.cgh.2024.11.010

Riehl ME, Scarlata K. Understanding Disordered Eating Risks in Patients with Gastrointestinal Conditions. J Acad Nutr Diet. 2022;122(3):491-499. doi:10.1016/j.jand.2021.03.001

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.