Breaking Free from Food Avoidance: Q&A with Wendy Busse, MSc, RD

Q&A on Understanding and Overcoming the Conditioned Food Avoidance and Sensitivity Trap

Food sensitivities and digestive issues affect millions of people worldwide. Navigating the complex maze of food intolerances, allergies, and sensitivities can be overwhelming and isolating. For many, the journey is filled with fear, confusion, and a seemingly endless cycle of food avoidance and worsening symptoms.

We spoke with Wendy Busse, MSc, RD, a leading expert in food sensitivities who has dedicated her career to helping patients overcome food-related fears and avoidance behaviors. In our interview, Wendy shares her wealth of expertise, resources and strategies to help you rebuild you relationship with food and regain trust in your body.

Let’s get started.

Tell us about your background and what led you to specialize in digestive health, food sensitivities and nutrition?

I have always been interested in the digestive system and immunology, so specializing in food allergy was a natural fit. As a student, I envisioned teaching clients about these topics and providing exact answers.

However, when I started practicing, I soon realized that most clients struggled with symptoms that did not have a definitive treatment. I could provide information and support but not “answers.” I began listening to my clients’ challenges and became interested in how their restricted diets developed. Many clients talked about a vicious cycle of food avoidance and sensitivity.

“The more they restricted, the worse their sensitivities became”

Food became stressful, and their lives revolved around figuring out what to eat. Many clients stopped socializing and were sinking into depression. When they tried reintroducing, they seemed to react to everything.

Helping clients break out of this vicious cycle became my mission!

What are some of the common concerns that patients come to you with?

The most common reason is breaking free from an elimination diet mindset (i.e. ongoing fear-based commentaries about food).

Our clients want to return to a balanced, nourishing diet and relationship with food.

Can you tell us more about this vicious cycle?

I named the cycle the Conditioned Food Avoidance and Sensitivity Trap (C-FAST).

Conditioning is based on associations. If we associate food with symptoms, we naturally avoid that food (conditioned food avoidance). Avoidance tells our brain that food is a threat, so our fear intensifies, and our list of “dangerous” foods grows. Reintroducing “dangerous” foods can lead to a fight-or-flight reaction and physical symptoms (conditioned food sensitivity).

Here is my simplified C-FAST cycle.

The complete model provides more insight, which your readers can access here

Are you saying that fear of food can create food sensitivity?

Yes, it can. That does not mean fear is the cause of all food sensitivity, but for many people, fear can create or intensify their symptoms. Fear conditioning is a normal reaction to life events and happens unconsciously.

“Fear can create or intensify symptoms."

After being bitten by a pit bull, I became hypervigilant around large dogs. If I notice typical pit bull features (my danger cue), I feel sick and leave immediately.  

Danger cues (like food) that are a part of daily life (and you can’t escape from) lead to a constant hypervigilant/reactive state.

How do you help people stuck in the C-FAST cycle?

I developed Rebuild Food Tolerance based on the information that helped clients during my counseling over the last thirty years. This online course helps people understand how they got trapped so they can soften their food and symptom hypervigilance (modules 1 – 7). Clients can then develop and work through a food reintroduction plan (modules 8 and 9).

Modules 1 and 2 are open and provide a valuable introduction to this topic (learn more here).

The course can be completed independently, but I encourage professional support and guidance. I can only take clients from Alberta, Canada, so I have partnered with registered dietitians in other jurisdictions. These dietitians bring their unique expertise, and we learn from each other to provide exceptional client services.

We also know you support clinicians. Could you share more about your work supporting and educating healthcare providers?

I work with clinicians in one of four ways:

• Many clinicians complete Rebuild Food Tolerance and use the concepts in their work.
• As mentioned above, I partner with health professionals who want to help food-sensitive clients expand their diets. The Rebuild Food Tolerance course provides a counseling foundation and saves substantial time because clients can work independently. The team support helps professionals develop their skills and provides a sounding board for challenging cases.
• My CE course, Food Sensitivity Nutrition Care, helps professionals build supportive connections and therapeutic plans for complex clients. Drawing on my thirty years of experience and the latest research, I offer a unique perspective on the Art and Science of this fascinating practice area.
• I am working with an international research group to validate the C-FAST screening tool. This tool will help identify patients potentially stuck in the C-FAST cycle. The research will start this fall (2024) through the Monash University and Università Cattolica del Sacro Cuore of Milan. Learn more here.

I’m sure the C-FAST Screen will be helpful. In the meantime, how can someone recognize if they are trapped?

Readers can review the first two modules of Rebuild Food Tolerance. If Janet’s Story resonates with your experience, conditioned food avoidance and sensitivity might be a factor in your food reactions and symptoms. Additionally, Are You Stuck in the C-FAST (7^th article in Module 2) has a checklist of typical red flags.

Do you have tips for readers who think they may be trapped?

First, you are not alone! Food-fear messages are rampant in the media, and it is easy to get stuck in avoidance and worsening sensitivities.

If you are trapped, these tips will help you break out:

• Self-compassion: Being kind to yourself is the foundation of self-awareness and change.
• Minimize internet research (especially during symptom flares): It is very difficult to apply critical thinking during a symptom flare (or shortly after). When you feel desperate for answers, misleading/sensational messages sound believable, and you are more likely to make impulsive changes. If you want to research, wait until your mindset has settled, and intentionally choose your next steps.
• Trusted food list: When stuck in the C-FAST cycle, your life can be consumed by deciding what to eat. Ironically, these thoughts keep you stuck. Interrupt this cycle by writing a trusted food list. Follow the list for a set time (e.g. 1 – 2 weeks), then evaluate/adjust your list. If your mind starts its typical commentary (e.g., Maybe I should try carrots again?), say, “STOP; I am following my trusted food list without second guessing it.”
• Understand how you got trapped: Recognizing the source of your fear-based relationship with food will help you take a different perspective. Rebuild Food Tolerance (Module 2) provides further help.  
• Systematic, gradual food reintroduction: Food reintroductions are usually haphazard when people are caught in the C-FAST Cycle – which can reinforce and may even worsen food sensitivity. An intentional plan with gradual and systematic exposure to new food is a better approach.  

What is the difference between food allergies, food intolerances and food sensitivities? What causes each of these reactions?

That’s a great question because these terms are used inconsistently.

• Food Allergy: The immune system recognizes a food component (usually a protein) as “dangerous” and launches an inflammatory attack when the food is eaten.
• Food Intolerance: Food intolerance is an umbrella term for adverse reactions not mediated by the immune system (i.e., not food allergy). FODMAP intolerance would be an example.
• Food Sensitivity: Food sensitivity is often used when symptoms are attributed to food, but the cause is unknown. Scientists have only recently started unravelling the mysteries of how food impacts health. In future decades, we will have a better understanding.

What common misconceptions or myths about food sensitivities and intolerances would you like to set straight?

Food sensitivities are permanent: Our bodies (including how we react to food) continuously change. Therefore, you may tolerate foods you have been avoiding. Review your history with a knowledgeable physician because some adverse food reactions are permanent (e.g., celiac disease, primary lactose intolerance, certain IgE-mediated food allergies), and others must be reintroduced under medical supervision.

“You may tolerate foods you have been avoiding.”

Nourishing our physical body is more important than nourishing our spirit: Our media has become hyper-focused on how food components impact the physical body, and we have lost sight of food as a primary source of pleasure, comfort, and connection. A client told me about combining a bunch of "superfoods" into a salad. When I asked her how it tasted, she laughed and said, "Not that good." The meal may have been good for her body, but not her spirit.  

If someone’s mind impacts their food reactions, their symptoms are “in their head.” In most cases, food sensitivity is an overlap of Mind AND Body. Changing your mental reactions to food and symptoms can help you feel better and give you tools to approach food and symptoms objectively. These skills will make identifying and treating biological causes easier.  

Is there anything else you'd like to share about your work or resources with readers?

Check out my Conditioned Food Sensitivity Podcast! My guests and I discuss practical strategies for overcoming food-sensitivity fear.

Where can readers learn more about you and your research on the web?

My website is FAST Freedom Program. As mentioned, modules 1 and 2 of Rebuild Food Tolerance are open to the public.

Readers are welcome to contact me if they have questions.

What an insightful interview!

Thank you, Wendy, for all the hard work you do to support our community. We are so grateful to have you with us to share your expertise and resources with our readers.