A Review Of 33 Studies Uncovered A Common Struggle For People With IBD
If you live with inflammatory bowel disease (IBD), you probably know the food guessing game.
Maybe dairy leaves you bloated, high-fiber foods make a flare worse, or you've stopped ordering certain meals because you don't want to risk feeling awful afterward.
Avoiding foods that trigger symptoms can be helpful, but it can also be easy to keep adding things to your do-not-eat list.
A recent systematic review1 looked at how often people with IBD experience food avoidance and disordered eating, and what might be behind these patterns.
About the review
Researchers analyzed 33 studies involving more than 13,000 adults with IBD.
They looked at research on food avoidance, disordered eating behaviors, and diagnosed eating disorders to understand how common these experiences are.
Avoiding certain foods is often part of managing IBD, but knowing what actually triggers symptoms isn't always straightforward. Without guidance, people may end up cutting out more foods than they need to.
Food avoidance affects up to 97% of people with IBD
Across the studies, 36.6% to 97.3% of participants avoided at least one food, with most studies reporting rates between 60% and 90%. Avoidance was generally more common during active flares than remission.
Disordered eating behaviors were also reported, with most studies finding rates between 10% and 25%.
Around 10% to 20% of participants showed signs of avoidant/restrictive food intake disorder (ARFID), which involves avoiding food out of fear of pain, nausea, or other unpleasant symptoms rather than concerns about weight.
Researchers also found that anxiety about digestive symptoms, psychological distress, and body image concerns were linked to more restrictive eating, often even after accounting for disease activity.
When avoiding trigger foods becomes something more
Skipping certain foods during a flare is one thing. Feeling afraid to eat them even after symptoms improve is another.
The review found that food avoidance and disordered eating behaviors remained common among people whose IBD was in remission. This suggests that the fear of triggering symptoms can stick around even when the symptoms themselves have settled.
Living with a digestive condition can make you especially aware of how your gut feels after every meal.
But when that awareness turns into constant worry about what might happen after eating, it can become harder to tell which restrictions are genuinely helping and which are being driven by fear.
How to protect your relationship with food while managing IBD
You can take your symptoms seriously without unnecessarily limiting what you eat. Two things can help:
- Work with an IBD-informed dietitian: Before cutting out multiple foods or entire food groups, get professional guidance. A dietitian can help identify genuine food triggers, make sure you're getting enough nutrients, and guide food reintroductions when appropriate.
- Talk about food-related anxiety: If you're becoming increasingly afraid to eat, avoiding more foods, or struggling to enjoy meals even during remission, bring it up with your care team. The review's authors highlight early psychological and nutritional support to prevent restrictive habits from becoming more ingrained.
The takeaway
Your gut shouldn't have the final say over every meal, especially when your IBD is under control.
If food rules are starting to run the show, a dietitian and mental health professional can help you find a little more freedom at the table.