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Disordered Eating in Crohn’s Disease and Ulcerative Colitis

So food. We all need it to survive, yes? But what happens when you have a disease that attacks your digestive system creating bleeding open wounds (ulcers) and damaging inflammation in any or all of the following: your mouth, esophagus, stomach, small intestine, colon, and rectum (or just your colon and rectum if you have UC)?

Can Having IBD Lead to Disordered Eating?

I feel so lucky that I get to talk to thousands of people who have Crohn’s disease and ulcerative colitis because of my website and the community that we have on the internet. You let me into your lives with IBD and share with me things that you have sometimes been afraid to share with anyone. With the safety of hiding behind our computer screens we laugh and we cry together and we all feel better and then… I am left with the wheel in my head spinning like it is this morning as I sit here and drink my coffee and write this post.

 There seems to be a lot of unspoken eating disorders lurking in our community and not many people talk about it. Let’s digest this shall we? 

Inflammatory bowel disease can cause terrible pain and sometimes that pain occurs during or after you eat. So then maybe you decide not to eat as much… or at all. Inflammation located in the small intestine can affect the ability of nutrient absorption. This malabsorption can result in dramatic weight loss that can mess around with your body image.  There are patients who have to stop eating all together and be fed intravenously or by a feeding tube for a period of time.

Symptoms of IBD are usually embarrassing and you may try to control them by eating at specific times or by skipping meals.

Certain foods may not be tolerated and so you wind up in a cycle of eating only your “safe” foods and that list keeps shrinking. 

Steroids can cause weight gain creating a poor body image and possibly unhealthy habits to lose the weight.

Bowel obstructions, surgeries that may leave you with new food 

restrictions, etc. etc. All of these things can lead to disordered eating. (Not so) fun fact: Iron deficiency anemia can cause an eating disorder known as pica: strange cravings for non-food items such as dirt, clay, or ice. 

You see where I am going with this? Inflammatory Bowel Disease and it’s treatments have a lot to do with our digestive systems, our weight, and often what we put into our bodies. I’m not talking about eating disorders here that fit nicely into the boxes of anorexia or bulimia; though IBD may have some impact on developing one of them but I am unaware of any studies. There IS disordered eating going on in the IBD community. How could there not be?

Over Restrictive Eating is Not Uncommon in IBD

Think about it…

If you find that you can only eat certain foods without feeling miserable then you are going to stick to those foods right? But there are some of us who become so focused on “safe foods” that it disrupts our thoughts and interferes with daily life. It can become so bad that you are only eating those foods every single day and you are cancelling plans and constantly fearing food or places where they will serve food because you won’t be able to eat YOUR food.

Or perhaps you start restricting your food because of the pain that IBD causes when you eat. You find that not eating as much helps reduce your symptoms but soon you are caught in a cycle of restriction that gets worse and worse. Maybe you find that you experience diarrhea so many minutes or hours after you eat so you start to plan your eating schedule around your life. Perhaps you decide not to eat dinner because you are going out later…

Then there is the whole but you don’t look sick thing. A number of you have told me that you keep your weight low because people do not believe you are sick unless you look sick.

Is it About Control?

Often eating disorders are not about the food or about weight; they are about having the ability to control something when other areas of your life are out of control. Having IBD can be pretty traumatic at times and you often feel out of control. 

It’s not that surprising that disordered eating habits occur in people living with IBD. This post only touches the surface on this topic and how complicated it can be. If this is something that you struggle with ask your doctor if they can refer you to a Registered Dietitian and GI psychologist who can help with this problem. 


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