I recently started seeing a dietitian/nutrition counselor.  Like many of us with IBD, I have food sensitivities.  If I eat the wrong thing, my digestive system revolts, writhing and spasming, inflating with gas, irritating the wounds inside, and pushing the food through and out as fast as possible.  The problem is figuring out which foods are the wrong foods for me.  Like everything else IBD related, reactions to foods can be vastly different from one IBDer to the next.  IBD can cause issues in different parts of the digestive system, and Crohn’s disease specifically can occur anywhere in the digestive system from the mouth to the anus and anywhere in between.  There are many factors that affect how your body reacts to the disease and what symptoms and intolerances you have.  The crappy part (see what I did there) is figuring out what to expect from your personal brand of intestinal disease.  For me, that means expanding my diet from the extremely restricted variety of foods I could tolerate when my disease was more active and adding in new foods without spending the rest of my day on the toilet.  It may sound crazy, but that’s one of the most difficult things I’ve ever had to do in my life.  

When I was more sick – I mean super sick – I couldn’t eat anything without nausea, cramps, bloating, abdominal pain, diarrhea, and more.  When eating causes you pain, eventually you just don’t want to eat anymore.  The constant punishment associated with eating can trigger food PTSD where you avoid food as a conditioned response.  The medical term for this is Avoidant/Resistive Food Intake Disorder (ARFID).  ARFID is an eating disorder where people avoid eating foods not because of a concern over body image but to avoid the negative consequences of eating, sometimes limiting their diet to only a few types of food.  While the BRAT diet and other restrictive diets can be good to give your intestines a break while actively flaring, they are not good for you long term.  Restricting your diet so much can lead to nutritional deficiencies and other issues.  Eating disorders like ARFID are common among IBD patients for obvious reasons.  Restricting your diet is easy to do when you’re constantly nauseous and never hungry.  The hard part is adding foods back in.  This can be both a physical and mental hurdle to jump, and it’s not easy if you’ve trained yourself to avoid foods that you don’t consider “safe foods.”

What sucks is that the symptoms from eating foods can be unpredictable.  I’ve eaten something once and felt fine and then eaten the same food a week later and ended up on the toilet before I’d even finished the meal.  Experimenting with new foods can feel like torture.  The average person doesn’t have to worry about pooping their pants at work because they had a few bites of “blackened chicken from that new restaurant down the street.  IBD patients already have to miss work or social activities for doctor’s appointments and flare ups.  We don’t want to have to miss out on even more just in the hopes that our body decides to embrace a new food option, especially when there’s an equal or greater chance that it won’t go well.  

The takeaways from my first nutritional counseling session were kind of obvious, but I needed to hear them anyway: 

1. Start Slow.
   • Don’t add multiple foods at once.  Try one new food and see how it goes before adding in more.
2. Limit how much you eat.
   • Only eat a few bites of the new food and see if that goes okay before eating more.  This seems obvious, but I tend to go into shark feeding frenzy mode when I taste something good for the first time in months or years, and I have been known to gobble up way more than I should and regret it later.  Do what you can to avoid biting off more than you can chew (or digest).  For me, this means only putting a small amount on my plate and locking the rest away in a sealed Tupperware to keep me from going back for more.
3. Consider the texture of the food.
   • Softer and pureed foods are the easiest on your digestive system and are easiest to break down and digest.  Cooking foods and making smoothies are great ways to get variety into your diet without as much risk of a reaction.
4. Keep a food journal.
   • Duh, right?  If you keep track of what you’re eating and when you have symptoms, it’s far easier to link the two together.  This can be difficult though unless you are diligent about logging every meal, snack, or morsel you consume throughout the day.  There are several apps available to make this easier and to prompt you with push notifications to make sure you don’t forget to log those foods.  They’re worth checking out.

I wanted to share some of this info in the hope that it encourages fellow IBDers to give new foods a shot while keeping the experience as safe and comfortable as possible.  Another resource that can be very helpful is meeting with a therapist who specializes in eating disorders.  ARFID can be difficult to overcome on your own, and with IBD the food phobia is totally justified.  I feel like ARFID from IBD isn’t quite the same as more well-known eating disorders, but ultimately, I suspect the treatments are similar.  The goal is to restore a more positive relationship with food.  A nutritionist is worth talking to if you want help from a professional to decide on the best options to start out with.  I recommend finding a nutritionist with experience in GI issues, and not one that usually helps people lose weight.  Losing weight is the opposite of what I need.  The nutritionist I saw also didn’t judge me and understood the challenges I am facing.

Overall, if you’re struggling to add in new foods or you’re afraid of anything outside your “safe foods” list, know that you’re not alone.  It is common to feel this way, and it is something you can overcome, at least to a point.  Some foods will likely still give you problems, but once you know what foods you can eat you can diversify your diet and avoid long-term issues like malnutrition.

Check out the Nutritional Therapy for IBD website where you can read more about diets that can help with IBD symptoms while allowing a good variety of foods.  There are options for all kinds of IBDers!
Click Here

Here’s a link to the Crohn’s and Colitis Foundation page where you can learn more about ARFID and nutrition with IBD:
Click Here