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Food isn’t the villain—pain is. When eating reliably triggers symptoms, the body learns to avoid. We sat down with Dr. Jennifer Gaudiani—internal medicine physician, eating disorder expert, and author of Sick Enough—to map how chronic illness, neurodiversity, and medical bias shape the modern food struggle. Forget stereotypes: most eating disorders aren’t visible, and many people who restrict are doing so to dodge real discomfort, not to chase a number on a scale.

We walk through the biology of undernutrition at any size: slowed digestion, early fullness, gastroparesis, SIBO, and that constant chill from an energy-conserving body. Then we connect the dots with endometriosis, MCAS, POTS, EDS, and IBS, showing how flares after meals condition avoidance and fuel shame. Dr. G shares a compassion-first playbook: patient-led goals, gentle nutrition steps, pro-motility options, mast cell stabilization, and realistic pacing that reduces symptom spikes. The aim isn’t perfect variety; it’s adequate energy without punishment.

Neurodivergent listeners will feel seen. ADHD and autistic traits can blunt hunger cues, amplify sensory aversions, and make meal planning feel impossible. We talk about how restriction can temporarily quiet a loud brain—and why treating the neurobiology (including ADHD meds when appropriate) can unlock genuine recovery. ARFID gets a clear, non-judgmental breakdown: not thinking to eat, texture disgust, or fear after choking, vomiting, or pain are common threads, not personal failures.

We close with what real recovery can look like for complex illness: being believed, easing suffering with targeted tools, and defining progress on your terms. Loved ones get specific guidance too—validate without fixing, and let the care team coach so relationships stay kind and steady. Want more from Dr. G? Visit gaudianiclinic.com and keep an eye out for the new edition of Sick Enough. If this conversation helped you feel understood, subscribe, share with a friend, and leave a review to help others find their way back to gentle nourishment.

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