From Food Fears to Food Freedom: How Do We Best Manage Restrictive Eating in Inflammatory Bowel Disease?

Prior research has estimated the rates of avoidant/restrictive food intake disorder (ARFID) to be between 10% and 54% in patients with inflammatory bowel disease (IBD). However, recently published studies have questioned the ability of providers to differentiate the presence of ARFID in patients with gastrointestinal (GI) symptoms and highlighted the relationship between ARFID and food literacy, which may reflect poor cognitive or psychological flexibility to navigate dietary restriction. We suggest the discourse around ARFID has neglected the neurological basis of fear conditioning as to how and why patients develop fear around eating in the setting of severe postprandial symptoms. In this review, we discuss the role of the amygdala in post-ingestive learning and how this needs to shape the approach to dietary liberalization for the highest likelihood of success. We provide specific strategies for practice when working with patients who experience significant fear of eating, including the framework for and development of appropriate exposure hierarchies to guide the reintroduction process. We encourage collaboration with dietitians and psychologists trained in gastroenterology when possible.