IBD And Eating Disorders – Is There A Link?

Do you ever secretly just hate people who seem to have a ‘normal relationship’ with food? Whether they say they can eat whatever they like without gaining or losing weight or they just seem to blissfully enjoy the food on their plates with no signs of remorse or anxiety, there’s just something so triggering about them. But why?

“I knew my relationship with food was unhealthy”, one of our staff members recalls. “I didn’t have a full-blown eating disorder but I knew feeling ashamed and guilty and then ‘punishing’ myself with sport or a ‘juice cleanse’ for the ‘huge’ piece of cake I’d had was not how healthy people interacted with food. So they triggered me – they weren’t constantly restricting and beating themselves up as I did.”

There is an ever growing number of people who don’t suffer from an eating disorder but whose eating habits are far from mentally healthy. Eating disorders recovery coach Mia Findlay from the YouTube channel “What Mia Did Next” talks about disordered eating – all of those habits, feelings, and thoughts that don’t fall under the definition of an eating disorder but are nevertheless psychologically unhealthy.

Food-induced anxiety, ‘fear foods’, guilt and blame, exercise as ‘punishment’ for the ‘wrong’ food choices, assigning moral value to food (i.e. “If I eat this, I’m weak/undisciplined/unworthy/a bad person” thinking) and many other thought patterns and beliefs around food can be on the verge of the disordered. Yet, not all those who are disordered suffer from an eating disorder. The question is why?

We begin February on the blog, a month dedicated to eating disorders awareness in Canada and the US, by trying to understand both eating disorders and disordered eating as existing on a spectrum and looking into the ways they intertwine and co-exist with IBD.

The love-hate relationship with food

As far as eating disorders are disorders of the mind first and the body second, they share some surprising similarities with IBD, precisely in the thought patterns patients report. Anxiety around food and eating is a huge theme for both.

“I have developed major eating issues (I typically refer to it as disordered eating) because of my ulcerative colitis.”

Says Marisa Lauren Troy in her courageous blog post that allows us a look on the inside of what an IBD feels like. She goes on to point out that societal recognition that certain behaviors fall under the definition of a disorder and thus, pose a legitimate health concern, can make a sufferer feel seen and validated in their struggle.

Marisa does a great job of describing the relationship with food many people who live with an IBD come to develop. The foods that induce anxiety because they could provoke symptoms, the times when eating is simply not possible and the binge that can follow as a result of this however brief or unwilling starvation.

Her story mirrors the experience a lot of eating disorder survivors report – a cycle of starvation, followed by a binge when the body can’t take it any longer, followed by feelings of guilt and inadequacy. One could argue that food restrictions being forced upon you by your own body’s response to certain food groups or your inability to eat for a while is a completely different experience compared to the self-imposed starvation someone with an eating disorder may go through.

However, disordered eating is not so much about circumstances as it is about the way a person experiences their relationship with food and the way they feel around it. It raises the question of, can an IBD cause an eating disorder? In the case of Marisa Lauren Troy, it can certainly cause disordered eating.

“There have also been times when I eat something I know is bad for my GI tract, so I figure I might as well make it a “bad eating” day. If I am going to suffer anyway, why not eat whatever I like and enjoy it since most days, I have to be much more restricted.”

Marisa explains as if borrowing words from the countless eating disorder survivors who recall the same experience.

The cycle of binging and restriction or binging and purging for some is built on the superficial labeling of food and sometimes entire food groups as ‘good’ or ‘bad’ and it follows the thinking that if you eat just a single cookie, you might as well eat the whole package because you already slipped.

And in the case of an IBD, the labeling of foods and the feeling of being restricted seem inevitable. There are, objectively, foods that can irritate the digestive system and foods that are considered relatively safe. But though no moral value is assigned to them, the restriction and the ‘slip-up’ can still trigger a binging cycle.

The link between autoimmunity and eating disorders

Stories like Marisa’s seem to imply that an IBD has the potential to trigger disordered eating in patients who have not otherwise had struggled with food because it awakes issues of body image, self-esteem, and food restriction. As far as solid evidence of a link between IBDs and EDs goes, however, there is little research out there.

A 2014 Finnish study is one of the most recent and talked about in-depth studies so far but it’s far from exhaustive. The results raise many questions and open new avenues for research in the field of eating disorders and autoimmunity.

The researchers who conducted the study found out that people who suffer from an eating disorder are twice as likely to be diagnosed with an autoimmune disease like type 1 diabetes or Crohn’s. Dr. Raevuori, one of the authors of the study, says that the findings of the study raise important questions about the line between psychological and biological, referring to eating disorders, and to what extent they can be separated.

However, the results of the study have been interpreted in two distinctly different ways. Where Dr. Raevuori and her colleagues seem to suggest that there is a common biological factor for the development of both an autoimmune disease and an eating disorder, some have interpreted the findings to mean that an eating disorder increases the risk of developing an autoimmune disease.

The results of the study don’t seem to give a clear answer beyond establishing the connection between autoimmunity and eating disorders. At this point, we can only speculate based on the anecdotal experience of patients, whose reports are invaluable but don’t constitute empirical evidence for either of the interpretations. Does an eating disorder increase the risk of an IBD or another autoimmune disease or does an IBD lead to disordered eating? Clearly, more research is needed.

Nevertheless, the Finnish study without erasing the psychological components of an eating disorder, suggests an interesting path for further research. If there is, indeed, a biological correlation between EDs and autoimmunity, this could alter our understanding of eating disorders and be an even stronger incentive to remove the stigma around them. It could also answer the question of why some people never develop an eating disorder, however disordered their eating habits might be.

It’s also important to note that, although an eating disorder can damage the digestive tract, there is no evidence to suggest an ED can in and of itself cause ulcerative colitis or Crohn’s. Both diseases are autoimmune and medical professionals and researchers don’t yet have an answer as to why they develop and under what circumstances.

If you have noticed some signs of disordered eating in yourself, whether you also live with an IBD or your digestive system is healthy as far as you know, we urge you to seek a professional opinion. A counselor or a psychologist can be a good first step toward recovery.

You can also search for clinical trials on FindMeCure – in fact, our story begins with searching for a treatment for bulimia. Not every trial you’ll come across is testing drugs either – at least half of the 39 clinical trials that come up for bulimia are observational or focused on basic science.

More understanding is needed in order to treat eating disorders, especially when they ‘team up’ with an IBD. You can be one of the brave people who lend their time to research so we can have that understanding eventually.