Eating disorders and inflammatory bowel disease (IBD) are complex health conditions that can significantly impact an individual’s quality of life. While they may seem unrelated at first glance, research shows that these two issues can intersect in profound ways. Understanding the relationship between eating disorders and IBD can be helpful for effective treatment and support.
Understanding Eating Disorders
Certain eating disorders such as anorexia nervosa and bulimia nervosa are serious mental health conditions often driven by a strong desire to change one’s body weight, shape and size. These individuals often suffer from an intense fear of gaining weight. This high preoccupation with body image often results in a disturbance in eating behaviors, leading to severe physical and psychological consequences.
Avoidant restrictive food intake disorder (ARFID) is another eating disorder that is characterized by food restriction but is not driven by a distorted body image or fear of gaining weight. ARFID presents as 3 different subtypes:
- Aversive/fear: fear of aversive consequences of eating such as choking, vomiting or GI distress (most common among IBD patients)
- Avoidant/picky eating: sensory sensitivity leading to highly selective eating i.e. smells, taste, textures
- Restrictive/appetite: poor appetite and lack of interesting in eating
What are red flags for ARFID?
- Limited food variety
- Low interest in foodLack of pleasure with eating
- Avoidance of social eating
- Hesitancy to complete reintroduction protocols
For some individuals with IBD, managing symptoms often necessitates dietary changes, leading to a heightened fear of certain foods, particularly the foods that exacerbate GI symptoms. This fear, stress and anxiety often leads to restrictive eating patterns, making them susceptible to developing an eating disorder such as ARFID.
Individuals with an eating disorder may experience worsening symptoms of IBD related to malnutrition. Evidenced by, impaired immune response and worsening gastrointestinal health, potentially triggering IBD flares. Other physiological effects from malnutrition such as electrolyte imbalances can further complicate IBD management.
Treatment Approaches for IBD and Eating Disorders
Given the complex relationship between IBD and eating disorders, a multidisciplinary approach is key. This involves gastroenterologists, registered dietitians and mental health professionals. Treatment plans should address both the physical aspects of IBD and the psychological components of eating disorders. Research shows that early intervention is key in recovery from an eating disorder and reduces the risk of relapse.
Nutrition Support
Nutrition plays a crucial role in managing IBD and ARFID. A registered dietitian can help tailor dietary plans that help minimize symptoms while supporting a healthy relationship with food. This may involve strategies to expand food variety through reintroduction planning and ensuring overall nutritional adequacy.
Mental Health Support
Therapy also plays a role in helping individuals manage their IBD, especially in the presence of an eating disorder. Therapists will help individuals challenge disordered beliefs about food and body image and encourage healthier coping strategies. Cognitive-behavioral therapy (CBT) has been shown to be effective in treating eating disorders, particularly in ARFID. Support groups may also provide valuable community and understanding.
Key Takeaways
The relationship between IBD and eating disorders is complex, but recognizing the interplay between these conditions is essential for effective treatment and recovery. Awareness, understanding and early intervention is key in recovery and improving your quality of life. If you think you are struggling with an eating disorder related to your IBD, please consult your doctor and seek the support of a registered dietitian and/or therapist.
References:
Howard, M., Hembry, P., Rhind, C., Siddall, A., Uddin, M. F., & Bryant-Waugh, R. (2023). Cognitive behaviour therapy (CBT) as a psychological intervention in the treatment of ARFID for children and young people. The Cognitive Behaviour Therapist, 16. https://doi.org/10.1017/s1754470x22000629
Sanchez-Cerezo, Javier et al. 2024. Subtypes of avoidant/restrictive food intake disorder in children and adolescents: a latent class analysis. eClinicalMedicine, Volume 68, 102440
Yelencich, Emily et al. 2002. Avoidant Restrictive Food Intake Disorder Prevalent Among Patients With Inflammatory Bowel Disease Clinical Gastroenterology and Hepatology, Volume 20, Issue 6, 1282 - 1289.e1
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