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How to keep a food and symptom journal with chronic pain and fatigue

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Plain lined notebook ready to use for your custom food and symptom journal

You likely have an intuitive sense that what you eat can affect your pain, fatigue, or other symptoms. But how do you figure out what is going on? A food and symptom journal might be the answer you are looking for.

I am a big advocate for mindful eating. This attention to the experience of eating can lead you to intuitively understand what foods make you feel good and which foods don’t work well for you. However, there are times when writing things down can be hugely beneficial.

Read on for more information on what a food and symptom journal is, how to keep one, and why it is beneficial.

Table of Contents

What is a food and symptom journal?

The basic definition is… basic. A food and symptom journal is a record of what you have eaten and how you feel. The form can vary based on your needs and preferences. Whether you choose pen and paper or digital tools is completely based on what works for you.

It can be an empowering tool to help you self-identify patterns and triggers for your symptoms. A healthcare provider may request that you keep one and report back on your habits and results. It can even enhance your communication with your healthcare team because you have data to report and that they can review to get a better understanding of what is going on.

Why should I track my food intake and symptoms?

The biggest reason for tracking your food intake and symptoms is to take that information out of your head. I generally recommend a pen-and-paper approach to tracking; it is more flexible and the act of writing is often calming. Plus, your pen and paper won’t be able to calculate your caloric intake, which can be very triggering to some people (I’ll get into some of the downsides of tracking below).

When you see your habits, behaviors, and symptoms on a piece of paper, you can see connections that weren’t evident when that same information was in your head. It’s also much easier to see changes over time. If you track your pain levels or exercise, you can see how these things change over time, even if those changes are so gradual that you don’t notice them happening in real-time.

It is also a lot easier to share this information with your healthcare team if it is already in a sharable form. I can’t take thoughts directly out of your brain, nor can your healthcare providers. Plus, medical appointments can be stressful and the time you have with the professional is limited, making it very easy to forget details that you meant to share or questions you meant to ask. Writing down your observations and questions allows you to better prepare for your appointments.

In short, tracking your food intake and symptoms allows you to:

  • Get the thoughts out of your head and slow rumination (overthinking)
  • See patterns between your habits, environment, and symptoms
  • See gradual changes over time
  • Share information with your healthcare team
  • Make note of important observations and questions
stack of books with a fitness tracker in focus on the background
Photo by FitNish Media on Unsplash

What is the best food and symptom tracker?

There are numerous formats that this can take from apps to spreadsheets to designed notebooks to a plain lined notebook. You could even use a combination of tools. During my worst flares at the end of 2018, I used an app* to track my pain levels and medication use. This was particularly helpful at medical appointments because I was able to generate a summary report to share with my medical team, instead of relying on my memory.

* I used mySymptoms Food Diary to track my pain and when I took medications (I would sometimes forget what time I took medications and therefore when I was able to take them again, so I needed to track that). The app does give a report of what it thinks causes your symptoms, but be sure to take that with a huge grain of salt: when I was using it, it said that the pain medication was causing my pain!

As people with chronic pain, we frequently downplay our symptoms. It’s not usually a conscious decision. We don’t want to linger on the thought of our pain. We don’t want to be a burden. We sometimes straight up forget just how bad it was at the worst points. Keeping a detailed record can help you share accurately what is going on

What should I write in my food and symptom journal?

As I said at the beginning of this article, a food and symptom journal can be pretty basic: what did you eat and how did you feel? However, many factors may be relevant for you, including:

  • What, when, and how much you ate and drank
  • Hunger and fullness before & after the meal
  • When did you wake up, when did you go to sleep, and what was your sleep quality
  • Stress level (periodically throughout the day or a single number for the whole day)
  • Symptoms including severity and timing of:
    • Digestive complaints: bloating, gas, diarrhea, constipation, reflux, etc.
    • Pain, including location and quality of the pain (i.e. the pain scale)
    • Fatigue or energy crashes
    • Headaches
    • Mood including anxiety attacks or depressive episodes
    • Anything else that is relevant to your healthcare and well-being
  • Weather
  • Exercise or movement
  • Habit tracking
    • i.e. what are you working on, what is working, what are the challenges

There is a lot that you could include, and you may find it helpful to include a large amount of information. However, there is a downside to tracking.

Is it healthy to keep a food journal?

Keeping a food and symptom journal can be a powerful tool. It can help you see patterns and share information with your medical team. However, it can also be stress-inducing and triggering.

The sheer amount of information that you could track is overwhelming; where do you even start? And once you have all this information, how do you begin to figure out what is triggering your symptoms?

And then you have to consider that, sometimes, there is no cause for a flare. They can just happen without any rhyme or reason. The hypervigilance of tracking everything could all be for naught.

Not to mention the fact that hypervigilance can worsen symptoms. Simply paying attention to the minute changes in your pain and symptoms raises stress levels. And stress can directly trigger many symptoms including pain, fatigue, and digestive symptoms.

So, yes, there are times when a food and symptom journal is powerful (see the earlier section on why you might choose to keep a journal) but we need to balance that out by being aware of some of the challenges.

What food-tracking apps do dietitians recommend?

There are so many apps, and more pop up every day. Rather than recommend a specific app, I’ll give you a few things to watch for:

  • Default to ones that do not give you numbers or allow you to opt out of seeing numbers such as calories, macros, or weight. These numbers can be highly triggering, particularly if you have a history of eating disorders. If you do use these apps, limit the amount of time you spend with them.
  • Ensure there is space to leave notes, the more context the better
  • Apps, like Recovery Record, which were designed specifically for people in recovery from eating disorders, can be particularly beneficial
  • If all else fails, just take a picture with your phone or write notes in a blank notebook. Keeping it simple is usually a good thing.

When to stop tracking your food intake

woman with her head in her hands staring at her computer screen. Perhaps she is hungry but overwhelmed at the thought of tracking her intake and symptoms
Photo by Elisa Ventur on Unsplash

The red flags I tell my clients to watch out for when they are tracking their intake are emotional cues:

  1. Resentment
  2. Overwhelm
  3. Obsession

Resentment: If you find yourself feeling resentful at having to track your intake… You might think: Other people don’t have to write down everything they eat. I wish I didn’t have to. Why am I even bothering with this?

Overwhelm: If you are overwhelmed at the thought of writing down what you are eating or you would rather not eat than write down what you ate…

Obsession: If you get anxious at the thought of not being able to write down something that you have eaten or you choose not to eat something purely because you don’t want to be judged by someone reading your journal or you choose not to eat something purely because you don’t know how to add it to your journal…

These are all red flags that you are entering dangerous territory of disordered eating and eating disorders. The eating disorder signs, symptoms, and effects will vary based on the different types and an individual’s experience, but these emotional flags are generally present as red flags.

The emotional experience that I want my clients to have when they are journaling is somewhere between neutral and curious. You may even feel grounded or calm. However, if negative emotions dominate your thoughts around journaling, it is high time for a break.

Food and symptom journal template

I can practically hear you following along and saying, “But how do I actually do this? Give me a template!” So here it is:

Food journal example

If you would like a printed copy of a food and symptom journal to fill out,
you can get it on Amazon here:

This food and symptom journal is also available as a printable PDF for people who join the Anti-Inflammatory Path to Wellness. To learn more about the course, click here.

Bottom Line:

A food and symptom journal is a tool that you can add to your toolbox, but it is just one tool of many. The information here should help you determine whether keeping a food and symptom journal is the right choice for you right now. If you choose to track your habits and symptoms, be sure to watch for emotional red flags that it is time for a break. Stay curious and open to learning through this process and you may be surprised by how powerful this tool is.

If you would like to uncover even more tools for your healthy lifestyle toolbox, check out the Bare Minimum Health Plan: How to keep the wheels turning when you are exhausted and in pain.

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