Diet, Culture, and Your Body
Western society has certain expectations around what, when, and how much we “should” be eating. These dietary expectations may or may not be supported by scientific evidence and tend to focus on rules and restrictions instead of tuning into our own body cues.
Our society also has expectations about what our bodies “should” look like. But these expectations are often impossible to meet, can lead to feelings of inadequacy, and don’t take race, body type, or gender spectrum into consideration.
IBD Diet Culture
IBD patients may be inclined to try a new diet in the hope of improving symptoms or quality of life. Some diets have been researched and others have not, but many have not been studied adequately to warrant implementation. Just like with medications, restrictive diets can have side effects too. Potential side effects of restrictive diets can include:
- Nutrient deficiencies
- Increased risk for osteoporosis
- Malnutrition, which negatively impacts disease outcomes
- Decreased food-related quality of life
- Disordered eating patterns
- Progression to eating disorders, which negatively impacts disease outcomes
It’s natural to want to make changes quickly to your diet so that your symptoms can improve as soon as possible. Instead, try to make one small change at a time so that these changes are easier to stick with for the long haul. It’s what our diet looks like overall rather than what it looks like in one meal or one month that can play a bigger role in benefitting our microbiome.1
Cultural and Religious Aspects of Food
Our cultural background, where we grow up, our ethnicity, religion, and diet culture may all play a role in our relationship with food. Research suggests that up to three quarters of patients with IBD have a decreased satisfaction in eating since their diagnosis.2 Aim to keep the cultural influences in your diet wherever possible as this will likely contribute to increased satisfaction in eating. Instead of trying to find “safe” recipes, focus on swapping out trigger ingredients for better tolerated alternatives so that you can maximize your tolerance and satisfaction in eating.
For instance, if you grew up consuming a lot of spicy foods, remove heat-producing chilies and add flavor in other ways, such as with fresh cilantro, lime juice, and green onions. Alternatively, you can just reduce the heat-producing chili in the recipe to a level where you no longer experience symptoms. Having the recipe as is may also be a decision you make, understanding it will trigger symptoms.
Disordered and Restrictive Dietary Behaviors
Disordered eating can describe a range of irregular eating patterns. Even if a person does not meet criteria for an eating disorder, patterns of disordered eating may significantly impact one's mental health and quality of life. According to a research review by Day et al., there is a high occurrence of self-reported food avoidance and restrictive dietary behavior among IBD patients. Research sugggests that up to 93% of people with IBD have disordered or restrictive eating behaviors.3 Disordered or restrictive eating behaviors can include:
- Spending too much time or consideration on food, your diet, or your body
- Delaying or skipping meals
- Restricting foods and/or food groups that have not been medically recommended
- Rigid rituals related to food and exercise
- Following restrictive diets that have not been medically recommended by your doctor or dietitian
- Feelings of loss or control around food, including binge eating
- Feelings of guilt or shame after eating certain foods
- Feelings of fear or anxiety around eating certain foods.
Why are disordered eating behaviors so common in people with IBD?
It's possible that IBD patients feel they are not provided adequate support with answering their diet and nutrition questions. They might search the internet for answers, where they can encounter nutrition misinformation. The internet and social media have a lot of conflicting information about what people with IBD should eat, which can lead to overwhelming feelings and confusion.
Instead of searching the internet, try to find a single or a few trusted sources, such as the Foundation website, for all your nutrition information. For more individualized support, find a dietitian who focuses on helping people with IBD.
Eating Disorders in IBD
Eating disorders are behavioral conditions defined by specific diagnostic criteria around persistent disturbance of eating behaviors that can affect a person's functioning. Some common types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, orthorexia nervosa, eating disorders not otherwise specified, and avoidant/restrictive food intake disorder (ARFID).
ARFID is an eating disorder where the amount and/or type of foods eaten are restricted not because over distress over body image, but due to factors such as concern over the negative consequences or symptoms experienced with eating, lack of interest in eating or food, or avoidance as a result of sensory characteristics of food. As people with IBD may experience pain related to eating, there may be a sense of fear or anxiety around meals and a desire to restrict food intake in order to prevent discomfort. Limiting food intake may provide a perceived sense of control for a person but may not be the most helpful approach to manage symptoms.
Eating disorders are common in people with IBD. Research suggests almost one in every four adults with IBD has an eating disorder.4,5 In one study, up to 29% of adult Crohn's disease patients with active disease hit the cutoff criteria for moderate binge eating disorder.6 Eating disorders can occur in people of all body sizes, shapes, and genders. In fact, in one study people with IBD in larger body sizes were more likely to present with eating disorders than those in other body sizes.5
One challenge with research in this area is that we currently don't have eating disorder screening tools that are validated specifically for patients with IBD. The increase in eating disorders could be falsely high, triggered by adaptive eating behaviors due to symptoms or fear of symptoms. More research needs to be conducted to learn more about the connection between eating disorders and IBD.
Eating disorders have been associated with worse disease outcomes,7 so if you have an eating disorder, it's important to prioritize treatment for it. Seeking psychological care for an eating disorder is an important step and your gastroenterologist may be able to refer to you to a GI behavioral health provider or an eating disorder specialist. If you believe your relationship with food and/or your body could improve, find a gut-specialized psychologist and IBD-focused registered dietitian to work with. It's also helpful to keep your IBD healthcare team aware of your eating disorder treatment.
Some tips for managing co-occuring eating disorders and IBD include learning to ask for what works best for you in IBD medical visits to best manage eating disorder symptoms. For instance, if getting weighed at your appointments is triggering disordered thoughts about your body, then inform your health team. For your next visit, you could request a blind weight (if being weighed is necessary for doing medications).
Your Relationship With Your Body and IBD
Our bodies naturally change over time—through childhood, puberty, pregnancy, post pregnancy, and menopause or growing older. IBD may also impact your body. Some examples of times where IBD may impact your body include:
- Active inflammation may lead to weight loss and malnutrition8,9
- Steroids may increase your appetite and lead to weight gain
- Reaching remission may lead to weight gain
Weight changes, surgery, the unpredictable nature of symptoms, and active disease may all make you feel differently about your body. Weight changes may also impact other people’s reactions, which can impact how you feel about your body. Find support from a gut-specialized psychologist and IBD-focused registered dietitian to learn to manage your relationship with food and/or your body.