Helping Clients Soften Food Sensitivity Fear
Your Client
•	Think of a current or past client who experiences food sensitivity fear. 
•	Do they clearly communicate this anxiety, or is it something you’ve inferred from their history or how they talk about food? 
•	What does their typical diet look like? 
•	What habits or experiences seem to contribute to their fear? 
•	Have you discussed the impact of psychosocial factors with them? If so, which approaches have been effective, and which have not?
1. How Does the Vicious Cycle Develop?
Pavlovian Conditioning (slide #3)

Fear Conditioning (slide #4)

Food-Illness Associations (slide #5)
	Example	Accurate Associations
 Beneficial Restriction	Inaccurate Associations
 Over-restriction	
Elimination diets	Low FODMAP diet	Systematic elimination and reintroduction can identify biological triggers.	Process increases the risk of food and symptom hypervigilance	
Health research or media	Internet searches, health professionals, etc.	Useful information about food sensitivity mechanisms.	Exposure to misleading information often creates food fear.	
Attributing symptoms to food	“I have a stomach-ache. It must have been the green beans.”	Objective observation can identify biological triggers.	Misattribution is common.	
Overgeneralizing	Green beans bother me, so all green vegetables are problematic.	Systematically testing theories may lead to accurate associations.	People often make assumptions without systematic testing.	

Definitions (slide #6)
•	Conditioned Food Avoidance: food restriction prompted by food-illness associations, encompassing both accurate associations (leading to beneficial restrictions) and those that are inaccurate and lead to over-restriction. 
•	Conditioned Food Sensitivity: as a physical reaction driven by Food–Illness Associations. In other words, fear and negative expectations can create or intensify unpleasant physical sensations. The negative expectations may be conscious (“I think I will react to this food”), but they can also be subconscious (an underlying concern or sense of danger about the food).
C-FAST Model (slide #7)

Learn More: Clients  Free Program  Introduction Module  Exploring the C-FAST Model
Additional Terms (slide #8)
•	Food and Symptom Hypervigilance = C-FAST Model
A heightened and persistent monitoring of food and bodily sensations. Paying excessive attention to potential negative effects of eating and a tendency to interpret normal sensations as signs of food sensitivity. 
•	Avoidant/Restrictive Food Intake Disorder (ARFID) 
Red Flags (slide #9)
Self-administered checklist for clients.
Learn More: Clients  Free Program  Introduction Module  Exploring the C-FAST ModelAre You Stuck in the C-FAST Cycle?

2. Introducing the C-FAST Cycle to Clients
•	Approach Gently (slide #10)
1)	Build trust through empathy & curiosity
•	Compassionately acknowledging challenges and efforts
“Your symptoms sound really difficult, and you have been working hard to manage them through dietary restriction, but it sounds like the limitations have also made your life more difficult.”
•	Clarify goals
2) Non-judgmentally explore how the client’s diet became restricted 
 “When did your food restrictions begin?” – open, curious
  Why did you start restricting your diet? – judgmental, implies avoidance is wrong
3) Explore the impact of restriction
“Have your dietary restrictions affected your day-to-day life?” 
4) Encourage reflection on the potential for food freedom
 “If you could enjoy a greater variety of food, what would change for you?”   

•	Explain Simply (slide #11)
1) Acknowledge their beliefs about a biological cause
“I wish I could give you a clear explanation for why these foods are bothering you. Your experiences don’t fit any of the currently understood food sensitivity mechanisms. However, there’s a lot that we don’t know, and future research may give better answers.”
2) Connect the C-FAST theory to their experience
“In the meantime, we can approach this question from different angles. Food sensitivities are often complex. Many factors can play a role, not just one single cause. One of those factors might be conditioned food sensitivity. This can sometimes develop after following an elimination diet without professional support, like the low FODMAP diet in your case (substitute the specific client’s experience). When we read or hear about certain foods that may cause symptoms and then start avoiding them, our brains can begin to associate those foods with feeling unwell — even on a subconscious level. Over time, this can create a cycle of food avoidance, fear and worsening symptoms. 
It can start to feel like your body is becoming increasingly sensitive, but it is often this vicious cycle, rather than a physical problem with your body.
The good news is that I can help you break this cycle.” 
3) Normalize their experience 
“With so much negative information about food in our media these days, it’s a wonder that we don’t all have food-related fear. I have worked with many clients who have fallen into this trap, and it takes some time, but most have been able to foster a more peaceful relationship and enjoy a greater variety of food and eating experiences.”
4) Ask if the concept resonates with their experience 
“I have real sensitivities; it is not a psychological problem,” is a common client response.
 “Can we talk more about this so I can understand your perspective? What do you mean by real sensitivities?”

“You are right. Conditioning may not play a big role for you. Our minds impact how our bodies function and how we react to food. In some cases, it is a significant contribution and in others, it is very minimal. And that might be the case for you. I just wanted to make sure that we’ve explored all possibilities”.
5) If it resonates, review the C-FAST Model and discuss strategies to rebuild trust.
See the Free FAST Freedom Program for resources. 

3. Helping Clients Expand Their Food Tolerance Zone (slide #12)
•	Rebuild food and body trust before reintroducing food
•	Emphasize the benefits of diet expansion
•	Food challenge vs. gradual reintroduction 
•	Reintroduction goals
•	Make food decisions with an objective mindset rather than fear and misinformation
•	Food is no longer a source of stress and fear that dominates their life
•	Gradual reintroduction guidelines
•	Client decides what to reintroduce 
•	Ask the client to consult their physician
4. Scope of Practice and Division of Responsibility (slide #13)
Intervention	Description	Professional	
Food Fear Education & Support (Coaching)	When habits drive the C-FAST Cycle, these clients can usually soften food sensitivity fear with education and support. Awareness of habits that led to and continue to sustain the C-FAST cycle; strategies to change habits and respond, rather than react.
֍FAST Freedom Program	Any Health Professional 	
Therapy for Food Fear	If psychopathology drives the restriction (rather than habits), the client needs additional expertise from a mental health professional. Psychopathology may precede the C-FAST cycle (drawing them in) or result from being stuck long-term.	Mental Health Professional	
Assess Diet Adequacy	Restricted diets are not inherently inadequate.	Dietitian	
Food Reintroduction Education & Support 	Clients create their own reintroduction plans with education and support.
֍ FAST Freedom Program	Any Health Professional	
Food Reintroduction Safety	Clients should choose foods in consultation with their physician. 	Physician	

And change PP
Take Home Messages
Food restriction, anxiety around eating, and worsening symptoms can create a self-reinforcing cycle, progressively diminishing quality of life.
Fear conditioning provides a helpful framework to understand this pattern. The Conditioned Food Avoidance and Sensitivity Theory (C-FAST) model captures the factors that can lead to and perpetuate this cycle.
Breaking this cycle requires a respectful, client-centred approach that validates lived experiences while broadening the discussion to encompass both biological and psychosocial factors.
The FAST Freedom Program is a free course to empower individuals with practical tools to break this cycle and regain confidence around food, with an optional six-week, paid group program. Learn more here. 
Key References
Busse W, Arriagada L, Volpato E, et al. Conditioned Food Avoidance and Sensitivity Theory (C-FAST)- A Novel Conceptual Framework to Understand Food Sensitivity Fear. Neurogastroenterol Motil. 2026;38(4):e70314. doi:10.1111/nmo.70314
Mikhael-Moussa H, Bertrand V, Lejeune E, et al. The Association of Avoidant/Restrictive Food Intake Disorder (ARFID) and Neurogastroenterology Disorders (Including Disorders of Gut-Brain Interaction [DGBI]): A Scoping Review. Neurogastroenterol Motil. Published online March 30, 2025. doi:10.1111/nmo.70039
Weeks I, Abber SR, Thomas JJ, et al. The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder. J Clin Gastroenterol. 2023;57(7):651-662. Published 2023 Aug 1. doi:10.1097/MCG.0000000000001853.
Hadamitzky M, Lückemann L, Pacheco-López G, Schedlowski M. Pavlovian Conditioning of Immunological and Neuroendocrine Functions. Physiol Rev. 2020;100(1):357-405. doi:10.1152/physrev.00033.2018.
de Graaf MCG, Lawton CL, Croden F, et al. The effect of expectancy versus actual gluten intake on gastrointestinal and extra-intestinal symptoms in non-coeliac gluten sensitivity: a randomised, double-blind, placebo-controlled, international, multicentre study [published correction appears in Lancet Gastroenterol Hepatol. 2024 Mar;9(3):e8. doi: 10.1016/S2468-1253(24)00014-1]. Lancet Gastroenterol Hepatol. 2024;9(2):110-123. doi:10.1016/S2468-1253(23)00317-5. 
Wu J, Masuy I, Biesiekierski JR, Fitzke HE, Parikh C, Schofield L, Shaikh H, Bhagwanani A, Aziz Q, Taylor SA, Tack J, Van Oudenhove L. Gut-brain axis dysfunction underlies FODMAP-induced symptom generation in irritable bowel syndrome. Aliment Pharmacol Ther. 2022 Mar;55(6):670-682. doi: 10.1111/apt.16812. Epub 2022 Feb 15. PMID: 35166384.