By wayne persky
Founder and President of the Microscopic Colitis Foundation
Over the years, how many of us have heard that frustrating advice from our gastroenterologist when we asked him or her what we should do to control our gastrointestinal symptoms? Or our pain? Or our brain fog? Or our difficulty getting enough sleep? Or our persistent fatigue? Or . . .?
Specialists are not likely to admit that they aren't truly experts on a disease.
Back in 2000, that was the last advice my gastroenterologist gave me — I never went back to see him. Judging by the experiences shared in some of the posts on our Microscopic Colitis (MC) Discussion and Support Board, more than a few of us have had a similar experience. Gastroenterologists prefer to blame the patient, rather than take responsibility themselves, and admit that their understanding of the disease and its treatment leaves a lot to be desired, when their prescribed treatment doesn't work as expected. Apparently, they believe that because they are certified as experts regarding the treatment of acute diseases and chronic conditions of the digestive tract, they can't afford to admit that they don't understand everything there is to know about any digestive system disease.
Beware of requests for repeat colonoscopies.
Gastroenterologists typically behave as though they are surprised when we tell them that their treatment isn't working. Sometimes they want to do another colonoscopy in order to discover what they may have overlooked during the first one. And if we allow them to persuade us to waste our time and money, and go through the discomfort (to say nothing of the risks) of a repeat procedure, they never find anything other than what they found during the previous colonoscopy.
Eating disorders are increasing rapidly.
According to a recently published FAIR Health study of eating disorders, based on data from the years of 2018 through 2022, eating disorders in general (including binge eating, anorexia, and bulimia), increased by about 65% in the U.S. (FAIR Health, 2023, November 15).1 But interestingly, avoidant/restrictive food intake disorder (ARFID) increased by 305%. Unfortunately, the problem with this study is that it only looked at associated mental health issues such as anxiety and depression, without even considering that the eating "disorder" might be due to a physical issue, such as inflammatory bowel disease (IBD).
Note that psychologists are not medical doctors (MDs).
Although psychologists normally treat patients by using conversation and behavioral therapy, they are not licensed by most states to write prescriptions for medications, because they don't have the necessary training in medical care. Psychiatrists, by comparison, are MDs, which means that they can write prescriptions for medications.
Are eating disorders caused by mental health issues, or physical problems?
In other words, are many of these so-called eating disorders actually due to physical problems, such as food sensitivities, or IBD, rather than being due to "mental health issues", as the FAIR Health study article implies. By ignoring any possible associations with physical health problems, studies of so-called "eating disorders", such as that study, only serve to perpetuate the myth that eating disorders are always associated with mental health issues. Consider that the FAIR Health study article shows that 41% of the patients who had an eating disorder also had a diagnosis of an anxiety disorder. 39% of those patients had been diagnosed with depression.
But IBD patients have relatively high rates of depression and anxiety.
By coincidence, an article published this past summer, titled Searching for links between IBD and mental health, through the gut microbiome, found that up to 40% of IBD patients are diagnosed with depression, and up to 30% of them are diagnosed with anxiety, at some point during their lives (Wood, 2023, June 14).2 Hmmmm. Do I smell a rat?
Although many websites discuss the fact that many IBD patients experience eating disorders, few of them mention the numbers that are involved. An article published less than a year ago on the HealthCentral website states that up to 93% of IBD patients "struggle with unhealthy eating patterns" (Taylor, 2023, May 8).3 And the article lists two "red flags" that are indicative of "disordered eating", as suggested by a clinical psychologist at the University of Pennsylvania in Philadelphia. Those two "red flags" are:
Although many websites discuss the fact that many IBD patients experience eating disorders, few of them mention the numbers that are involved. An article published less than a year ago on the HealthCentral website states that up to 93% of IBD patients "struggle with unhealthy eating patterns" (Taylor, 2023, May 8).3 And the article lists two "red flags" that are indicative of "disordered eating", as suggested by a clinical psychologist at the University of Pennsylvania in Philadelphia. Those two "red flags" are:
- Constantly worrying about what you're eating
- Avoiding entire food groups for an extended period of time, even when your symptoms aren't flaring
Does that sound familiar?
It should, because it describes most of us who are using diet changes to put or keep our MC in remission. Note especially, that those two red flag warnings in the above quote totally, and specifically define dietary treatments such as those we are using to keep our MC in remission, as "unhealthy eating patterns", which places them in the category of mental health issues. Although that article specifically refers to Crohn's patients, it certainly doesn't seem to apply only to patients who have Crohn's disease. Why wouldn't it apply to anyone who has any other IBD, and for that matter, anyone who has food sensitivities as a result of some other digestive issue, regardless of the origin.
Obviously, there's a huge disconnect
between IBD patients (and others, who have food sensitivities) and the specialists who treat them. Articles such as these tend to promote the impression that IBD patients who meticulously avoid numerous foods in an effort to control their symptoms, are suffering from mental health issues. But reading these articles reveals that the information on which the articles are based, is provided by psychologists and psychiatrists.
One can't help but wonder if they are promoting misleading information in order to discourage dietary treatment of IBD, or to drum up more business for psychologists and psychiatrists. But whatever the motive, articles such as these make it easy for gastroenterologists to justify recommending that a patient should "see a good psychiatrist", when the prescribed treatment doesn't help.
One can't help but wonder if they are promoting misleading information in order to discourage dietary treatment of IBD, or to drum up more business for psychologists and psychiatrists. But whatever the motive, articles such as these make it easy for gastroenterologists to justify recommending that a patient should "see a good psychiatrist", when the prescribed treatment doesn't help.
This attempt to distort the facts even extends to IBS.
A recently published research article showed that because of neurological information exchanged by way of the enteric nervous system (the gut brain axis), the researchers were able to show more genetic associations between IBS and psychiatric disorders, than between IBS and digestive disease (as if that's actually relevant) (Tesfaye, et al., 2023).4 But note that a review of that research project in Gastroenterology & Endoscopic News points out that of 132 independent IBS-associated loci recognized during the project, 116 were novel (in other words, they had never been identified previously), and 70 were shared between IBS and psychiatric disorders (Geyer, 2024, January 5).5 That means that only 16 of the loci had been identified by previous research. Therefore, 7 1/2 times as many new independent IBS-associated loci were discovered during this research project, than had ever been known before. Does that maybe suggest that the researchers may have been searching much harder to find genetic associations with mental health issues, than associations with digestive system disease?
And look what happens to the title
when the research project is reviewed in that Gastroenterology & Endoscopy News article — the chosen title is IBS Shares Genetic Makeup With Psychiatric Disorders. This appears to make it embarrassingly obvious that gastroenterologists are doing their best to try to portray food sensitivity issues as psychiatric disorders, rather than digestive system disorders.
Do GI docs actually wonder why so many IBD patients have malnutrition?
A very recent Medical Xpress article discussed research that showed that approximately 15% of Crohn's disease patients, and 12% of ulcerative colitis patients were found to meet the diagnostic criteria for malnutrition (Solomon, 2024, January 15).6 They found that 28% of those who had active disease, and 8% of those who were in remission were found to have malnutrition.
Gee, I wonder why.
You don't suppose it might have anything to do with being afraid to eat, because so many foods trigger a reaction for IBD patients, do you? It's a shame that we can't see the faces of these researchers as they write the original articles describing research such as this, so that we would be able to tell whether they're writing the articles with a straight face.
More than 20 years ago, I was told to see a good psychiatrist.
So gastroenterologists have obviously been committing this little peccadillo for a long time. And these articles are mostly published relatively recently, so the articles certainly can't be blamed for this aberrant behavior by so many gastroenterologists. They've been displaying their bias for many years. It's very likely though, that the inspiration for articles such as these likely stems from inherent biases that are shared not only by gastroenterologists, but by many medical specialists. And articles such as these certainly perpetuate the problem, by opening the door to allow gastroenterologists to make such claims freely, and if they happen to be questioned, they can cite the articles as proof of their position.
That said, it's certainly possible that the conclusions drawn by the articles that we're discussing here may be based on data that are technically correct (so that the research is valid). But the fact that the conclusions of the articles put so much emphasis on an association between altered eating habits and mental health, while deemphasizing any association between the basic reasons behind altered eating patterns and physical disease, raises serious questions about possible preconceived agendas, and cherry picked data. At the very least, it smacks of biased reporting.
That said, it's certainly possible that the conclusions drawn by the articles that we're discussing here may be based on data that are technically correct (so that the research is valid). But the fact that the conclusions of the articles put so much emphasis on an association between altered eating habits and mental health, while deemphasizing any association between the basic reasons behind altered eating patterns and physical disease, raises serious questions about possible preconceived agendas, and cherry picked data. At the very least, it smacks of biased reporting.
References
1. FAIR Health. (2023, November 15). From 2018 to 2022, Eating Disorder Claim Lines Increased 65 Percent Nationally as a Percentage of All Medical Claim Lines. FAIR Health, retrieved from https://www.fairhealth.org/press-release/from-2018-to-2022-eating-disorder-claim-lines-increased-65-percent-nationally-as-a-percentage-of-all-medical-claim-lines
2. Wood, M. (2023, June 14). Searching for links between IBD and mental health, through the gut microbiome. The University of Chicago Medicine, Retrieved from https://www.uchicagomedicine.org/forefront/gastrointestinal-articles/searching-for-links-between-ibd-and-mental-health-through-the-gut-microbiome
3. Taylor, M. (2023, May 8). Does Having Crohn’s Disease Up Your Risk for Disordered Eating? HealthCentral, Retrieved from https://www.healthcentral.com/condition/crohns-disease/crohns-disease-eating-disorders-risk
4. Tesfaye, M., Jaholkowski, P., Hindley, G, F. L., Shadrin, A. A., Rahman, Z., Bahrami, S. . . . Andressen, O. A. (2023). Shared genetic architecture between irritable bowel syndrome and psychiatric disorders reveals molecular pathways of the gut-brain axis. Genome Medicine, 15(60) Retrieved from https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-023-01212-4
5. Geyer, S. (2024, January 5). IBS Shares Genetic Makeup With Psychiatric Disorders. Gastroenterology & Endoscopy News, Retrieved from https://www.gastroendonews.com/Functional-GI-Disorders/Article/12-23/IBS-Shares-Genetic-Makeup-With-Psychiatric-Disorders/72241?sub=&tken=28D0302C8A43FD2FA8C07583E1176C63D13D7F836F03BE9FDCFC2888550&enl=true&dgid=&utm_source=enl&utm_campaign=20240109&utm_content=3&pos=3&utm_medium=title
6. Solomon, L. (2024, January 15). Malnutrition often seen in patients treated for inflammatory bowel disease. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-01-malnutrition-patients-inflammatory-bowel-disease.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter
