Crohn's, Colitis & Disordered Eating
Eating is one of life's greatest pleasures for many people. Eating is so much more than just for foods nutritional benefits; food can please so many senses with its appearance and presentation, smell, taste and texture. Food can be an important part of social interaction and bring people together like having dinner with family or friends or a special occasion. Thinking back to a delicious meal or occasion around food can ignite happy feelings for so many.
However, for some, particularly for some of us with IBD, eating does not always produce the positive symptoms of pleasure and satisfaction. Instead, it can be associated with gastrointestinal symptoms like pain, bloating, urgency, and diarrhoea, turning eating into a daily battle.
IBD & our relationship with food
People with IBD or IBS can develop patterns of disordered eating (restricting meals, skipping meals, and fasting) to try and help manage symptoms.
I often see in IBS and IBD patients not getting the dietary support they need after diagnosis leading them to look for information elsewhere. With so much conflicting information on the internet about diet and IBD this can become confusing and overwhelming, and many end up on unnecessarily restricted diets for long periods of time.
Dietary changes and restrictions may foster anxiety around food. This may eventually lead to disordered attitudes and practices towards food and the development of an eating disorder (ED) (1).
What is an eating disorder?
The term “eating disorder” encompasses a number of distinct patterns of maladaptive eating that develop for a variety of reasons (1).
Eating disorders are complex mental illnesses. Anyone, no matter what their age, gender, ethnicity or background, can develop one. Some examples of eating disorders include avoidant/restrictive food intake disorder (ARFID), bulimia, binge eating disorder, and anorexia (2).
Eating Disorders and disordered eating patterns can impact us not only psychologically but also physically putting us at risk of nutrient deficiencies and can also have impacts socially such as eating out with friends (1).
Eating Disorders in IBD
Research suggests that almost a quarter of people with Crohn’s Disease and Ulcerative Colitis develop eating disorders (24%) (1). These are diagnosed eating disorders, but I would guess the number of people with undiagnosed eating disorders or disordered eating patterns in IBD is much higher.
A common type of eating disorder in IBD is avoidant/restrictive food intake disorder (ARFID) which affects 10% of people with IBD. Research has shown that ARFID is more common in Crohn’s Disease than Ulcerative Colitis but can occur in both (1).
Avoidant/restrictive food intake disorder (ARFID)
ARFID is different to other more commonly known about eating disorders like anorexia and bulimia, because food avoidance with ARFID can be due to fear of food causing symptoms in IBD rather than a desire to lose weight. Other reasons include a lack of interest in food and sensory avoidance (e.g. texture, colour) (3).
Diagnosis of ARFID is given when a patient experiences significant weight loss, significant nutritional deficiency or marked interference with psychosocial functioning due to food avoidance (1).
However, you do not have to be at that stage to have disordered eating. It can be useful to take a step back and have a look at our relationship with food as sometimes we do not realise it has become disordered.
Take Away
If you worry about eating, have anxiety around making food decisions, or are concerned about your relationship with food, I encourage you to seek help. Speak to your IBD team or get support from a Dietician or Nutritionist to help you navigate food with your IBD, avoid unnecessary restrictions and to reduce to risk of developing an eating disorder.
References
Werlang, Monia E. MD1; Sim, Leslie A. LP, PhD2; Lebow, Jocelyn R. LP, PhD2; Lacy, Brian E. MD, PhD3 Assessing for Eating Disorders: A Primer for Gastroenterologists, The American Journal of Gastroenterology: January 2021 - Volume 116 - Issue 1 - p 68-76 doi: 10.14309/ajg.0000000000001029
Beat. 2020. Do I Have an Eating Disorder?. [online] Available at: <https://www.beateatingdisorders.org.uk/types/do-i-have-an-eating-disorder> [Accessed 18 June 2021].
Kenney L, Walsh BT. Avoidant/restrictive food intake disorder (ARFID). Eating Disorders Review. 2013;24(3).