Maintaining a Healthy Relationship with Food When You Have IBD

Because symptoms of inflammatory bowel disease (IBD) are nearly always brought on by food, it’s not surprising that disordered eating is often a complication of the condition. Even people with IBD who are in remission and have no medical reason to restrict what they eat may do it anyway, to the extent that it’s detrimental — feeling unnecessarily anxious about eating, for example.

If this rings true for you, it’s important to understand that mental and emotional reactions to eating can be managed, so you’ll be able to look forward to sitting down to a meal, rather than dreading it, in time.

The Link Between IBD and Disordered Eating

Everyone who lives with IBD goes through periods of active inflammation that causes any of several gastrointestinal (GI) symptoms. Between times, when in remission, people with IBD are usually able to return to a regular diet. But even if the doctor gives the okay to ease up on dietary restrictions, it’s not always easy to do.

“Often, patients who start working with me are still restricting their diet, even after a decade of remission,” says Alyse Bedell, PhD, director of the psychogastroenterology program at the University of Chicago.

What’s more, one food restriction often leads to another. “What comes with IBD is a lack of control,” Dr. Bedell says. Because people with IBD tend to fear eating something that may trigger a flare, it can be tempting to use food as a way to control the condition, she adds.

This falls into disordered eating, a broad term used to describe anything outside of healthy, typical eating behaviors, and for people with IBD, there’s a spectrum. As you move up the spectrum, food restriction becomes more severe.

It’s possible for IBD-associated disordered eating to progress to a serious eating disorder, such as anorexia, which is characterized by an abnormally low body weight, a fear of gaining weight, and a distorted view of weight. But, it’s more common to develop avoidant eating behaviors with IBD, even in remission, according to a study published in 2022 in Clinical Gastroenterology and Hepatology — one example being avoidant restrictive food intake disorder (ARFID).

“ARFID isn’t tied to concerns about weight or shape but, rather, the fear of the consequences of eating certain foods, leading to significant restriction, distress, and impairment,” Bedell says.

How the Brain and Gut Respond to Anxiety Around Food

Reestablishing a healthy relationship with food requires thinking differently about what you eat as well as resolving your anxiety around it. First, it’s important to understand that people who develop GI issues, including IBD, often experience one — or more — of three states that can affect their relationship with food:

1. Hypervigilance, meaning being extremely sensitive to and focused on sensations in the body. This causes severe anxiety.
2. Catastrophizing, or imagining the worst-case scenario. “These thoughts go through their head quickly,” says Ali Navidi, PsyD, a licensed clinical psychologist in Burke, Virginia. In fact, they may not even be 100 percent conscious of them.
3. Visceral hypersensitivity, in which the brain takes these sensations and amplifies and distorts them. For instance, what starts as a feeling of digestion gets amplified and distorted into pain, says Dr. Navidi.

How to Think Positively About Food and Eating With IBD

Breaking the pattern of those three states is often easier said than done, but there are a few approaches you can take to help banish negative thoughts about food.

Create a Support Team of Specialists

Besides your gastroenterologist, other experts can help you manage the physical and mental aspects of IBD. For example, a dietitian who understands the condition can help you figure out which foods to restrict or avoid during flares. And, given the tight relationship between the gut and the brain, it can be highly beneficial to work with a mental health professional to help you manage depression and anxiety associated with IBD, according to Navidi.

Therapists can use cognitive behavioral therapy, a type of talk therapy that involves changing negative thought patterns and unwanted behaviors. “CBT teaches how to identify dysfunctional patterns of thinking like hypervigilance and catastrophizing, so they can make changes in those patterns,” says Navidi. CBT also helps calm visceral hypersensitivity and anxiety.

Some therapists also use clinical hypnosis. With this type of therapy, you’ll learn how to go into a trancelike state similar to what endurance athletes refer to as “the zone.” “When you’re in that state, you have more access to the mind-body connection, and you can turn down the volume on hypersensitivity,” says Navidi.

Use the Traffic Light Approach

To rethink how you view specific foods, try dividing them into three categories that correspond to the meanings of traffic signal colors. Green-light foods are those you regard as safe to eat, as they don’t cause fear or anxiety. Yellow-light foods are those you tend to consume with caution, because they sometimes trigger symptoms. Red-light foods you may associate with symptoms and flares, and so you steer clear of them altogether. But, working with a GI dietitian, says Bedell, you may be able to transform many of the yellow- and red-light foods into green-light foods. This way, she adds, “What you eat will largely be based on preference, not fear.”

Be Patient

Gradually expose yourself to foods you’ve been avoiding. The first few times you eat one of these foods, it may trigger your body’s stress response, according to Bedell. But, over time, your brain will learn that the food isn’t dangerous, and you’ll be able to enjoy it again.

Keep a Journal

As you add foods back into your diet, write down your experience eating each one. Make note of whether it triggered symptoms or a flare, for example, and in what ways. Be as detailed as possible. “What you measure, you can manage,” Navidi says.

Join a Support Group

Whether in person or virtual, regular meet-ups with others dealing with IBD can play a valuable role in managing the disease. Your care team may be able to point you toward a support group that aligns with your experience, or the Crohn’s & Colitis Foundation website features a page that connects people to support groups throughout the country, putting you just one click away from finding like-minded people with IBD.