For those with IBD, food can be one of life’s greatest stressors, and often people with IBD are at risk to develop a sort of food PTSD. What can happen is that they start to avoid certain foods for the fear of painful flare-ups and sometimes start to take it too far.
While there is limited research, studies available show a potential relationship between IBD and disordered eating. Not one causes the other, but the presence of one complicates the illness and recovery of the other. Because of that overlap, it can make the diagnosis of an eating disorder very difficult, and a delayed diagnosis can further complicate the disease and lead to a worse prognosis.
As registered dietitians specializing in IBD, we know how important it is to have a healthy relationship with food and understand your frustration and struggle when it comes to finding the right food for you. Below we’ll discuss the link between IBD and disordered eating as well as ways to protect yourself against eating disorders.
Disordered Eating vs Eating Disorder
Disordered eating is a term used to describe unusual changes in eating habits and patterns. In patients with IBD it can look like:
- Skipping meals for fear of symptoms
- Obsessively weight food
- Restricting foods
It starts to classify as an “eating disorder” when:
- It becomes pathogenic
- There’s a deep fear of gaining weight
- Obsessive thoughts start to take over
- There’s a desire to control, and
- There’s an inability to disengage from restrictive behaviors
It’s important to note that eating disorders involve disordered eating, but not all disordered eating is extreme enough to be diagnosed as an eating disorder. Disordered eating, however, can be a slippery slope to developing an eating disorder.
What Is the Relationship Between Eating Disorders and IBD?
Studies available show that there is a link between IBD and disordered eating. The research describes the relationship between the two as reciprocal, meaning that they affect and are affected by each other. The existence of one can complicate illness and recovery from the other.
Symptoms of ED and IBD overlap each other as well, which can make eating disorders difficult to spot. As a result, an ED can survive and disguise itself as IBD.
Impact on Illness
IBD patients can intentionally or unintentionally develop disordered eating behaviors to help manage their symptoms. That, in turn, could activate the growth of an eating disorder.
Eating disorders could, in turn, worsen IBD symptoms, and the damage could be fatal as IBD already compromises the system.
Eating disorders in IBD:
- Hurt the course of IBD
- Reduce the quality of life
- Increase risk of anxiety, depression, and somatization disorders
- Cause laboratory abnormalities
- Cause or exacerbate malnutrition
We start to see an overlap in eating disorders and IBD when:
- A restrictive diet is introduced
- Unintentional weight loss causes stress, which can trigger an eating disorder
- Painful IBD symptoms start to create a fear of eating
- We see food as “good” and “bad” for IBD
- Significant medical trauma causes fear and anxiety and disconnects us from our bodies
As a patient, practitioner, or family member it’s important to be aware of these overlaps and triggers to ensure the person with IBD can take action and get help as soon as possible if needed.
What Happens to The Body When We Restrict?
The association between restrictive eating and nutritional status is essential in patients with IBD because they are at a higher risk for malnutrition. Studies have shown that between 16% and 68% of patients with IBD are malnourished.
Consequences of restrictive diets:
- It could result in deficiencies in people that are already susceptible
- It may lead to poor metabolism and reduction in vital hormones
- Slowed digestion and heart rate
- Digestive pains, poor skin, chilliness, and restlessness
When we restrict our diet, we also restrict nutrients to our entire body. Here are just a few examples of how disordered eating can impair certain organs:
- Constipation, gastroparesis, and in severe cases swallowing/esophagus
- Deficiencies in nutrients for hair, skin, and nails
- More pronounced lowered diversity in the gut microbiome
- Becomes over vigilant, anxious, and disengaged because it has to be on guard to defend against death or risk.
- Slower heartbeat, increased vagal tone (like a hibernating bear), and loss of muscle mass if there is>75% increase in BPM upon exertion.
- Bone marrow stops making RBC
- More bone is resorbed with low estrogen
- Reduced new bone formation (BD loss is rapid)
- AN has a 60% increase in function risk compared to age-matched controls
- Spinal (trabecular rich) bone is particularly impacted because it’s more metabolically active.
- Hypothalamus is suppressed because it is not safe to conceive
What Types of Blood Biomarkers Might Suggest Starvation/Malnutrition?
There are different biomarkers for IBD, which have been undergoing studies for some years now. If you or your doctor suspects you’re experiencing malnutrition, they may order blood work.
- Lowered TSH, T4, T3, estrogen, leptin/LH, testosterone, FSH
- Increased liver enzymes AST/ALT, cortisol
Ways to Protect Against an Eating Disorder in IBD
It is important to take measures to help protect IBD patients from developing eating disorders.
Though eating disorder recovery may be more complicated for those with IBD or other digestive conditions, recovery is possible. Here are some tips for managing IBD and eating disorders:
- Have consistent meals, even if you don’t feel good (this includes things like a smoothie. It doesn’t have to be a traditional meal, but it does need to be consistent)
- Approach meal times with an open-minded, neutral approach
- Work to reduce the dichotomy of foods, stripping them of “bad” and “good” labels.
- Be open and honest with your healthcare team about your mental health and the underlying pattern of symptoms.
- Understand the difference between what a trigger is and inflammation vs. irritation (link to blog)
- Understand that thoughts are not reality, approach food with curiosity rather than all-or-nothing thinking
- Find someone you trust to talk to about the difficulties of managing IBD.
- Rely on non-food and exercise-related coping mechanisms. Rather try things like meditation, journaling, hot baths, or dancing!
Get Help from an IBD Specialist
We understand the difficulty of managing IBD and how much stress it can cause. We strive to help our clients have a better relationship with food while helping to manage their IBD symptoms. If you think you need to add an eating disorders informed dietitian to your healthcare team, our team of registered dietitians can help. Contact us today for more information.