People with inflammatory bowel disease (IBD) are no strangers to fasting prior to procedures. Or, in some cases, to manage symptoms. How people cope with this time ranges from not wanting food anywhere near to them to binging cooking shows. But why?
Treatment of IBD has changed significantly since my diagnosis in 1989. Back then, one of the first things used was “bowel rest.” Meaning: no food. (Chiu) I was treated with prednisone and sulfasalazine and given an IV through which I received nutrition. But no food and no water. For weeks.
There was nothing to do in the hospital in the 90s besides watch TV, and it was full of food commercials. I was out of my room wandering the hall during mealtimes so often that they sometimes paged me when my medical team was looking for me.
This experience just happens to be mine and it’s certainly not the most extreme example of food restriction in the broader spectrum of IBD patient experiences. There are many reasons people aren’t able to take in food because of digestive disease, either for a short time (like during colonoscopy prep), or for long periods (such as for those who live with gastroparesis).
Over the years since my diagnosis, I’ve met many people with IBD who actually enjoy watching shows about food when they can’t eat, such as during a colonoscopy prep. That seems bonkers to me, because I do not want to see, smell, or think about food when I’m fasting. So I was curious about how common each perspective is, and why people would watch baking competitions between drinking ginger ale and going to the bathroom over and over.
What Do Patients Think?
That’s why I decided to ask people who follow About IBD on Twitter and Instagram if they watch programs about food on TV when they’re fasting.
“When you’re on a liquid diet or fasting, do you like to watch media (shows or videos) about food”?
- No opinion
Here’s what people answered in my poll:
- Yes: 26%
- Sometimes: 11%
- No: 53%
- No opinion: 11%
- Yes: 24%
- Sometimes: 17%
- No: 53%
- No opinion: 6%
More Context on Food and Fasting
Twitter responses from people with IBD gave some further elucidation:
“I was NPO in the hospital and kept going back to Food Network. I guess it did not bother me.”
[Editor’s note: NPO stands for nil per os, meaning “nothing by mouth,” and is a commonly used medical abbreviation.]
“Yes, but then I get super hangry when I can’t eat the food on the TV.”
“Surprisingly, seeing food doesn’t bother me — I say that as a hopeless foodie! I’m too busy fixating on what the scope will say. In the endoscopy area at GSTT [Guy’s and St Thomas’ NHS Foundation Trust], there’s a sign asking visitors not to eat out of consideration for those fasting — which is considerate in itself.”
“Absolutely not. It makes me irrationally angry to see food content when fasting or on [a] liquid diet.”
Polls have limitations: the first of which being that it’s only folks who follow About IBD on social media and who actually see the post who can answer. Additionally, the potential answers are limited by space, which doesn’t leave much room for nuance.
Even with those caveats, it wasn’t quite a blowout. Half of the people who responded don’t like looking at food. But a quarter of responders seek out food content, and 11% to 17% more like looking at food content at least sometimes.
I think it’s also important to point out that there is a difference between seeing food or food commercials and not finding it bothersome and actually choosing to binge an entire season of Top Chef while picking all the red and orange gummies out of the bag and only eating the yellow and green ones.
Why Do We Do This?
I couldn’t find any research that looks into why people may want to engage with food content when they’re actively fasting. That doesn’t mean it’s not out there: it just means I couldn’t find it. Or maybe this survey is a start.
There is study on how seeing food commercials affects how much people eat. For kids, one study showed that food commercials increase how much they eat, but they didn’t find the same effect on adults. (Boyland) Another study on only adults showed that when people are exposed to food commercials and then do a task that occupies their brain, they eat more. (Zimmerman)
The science is not quite settled but it does seem that watching food commercials may have an effect on what kids eat and might also affect adults in some circumstances. That still doesn’t get to the idea behind why someone would or wouldn’t watch a show about food while they’re hungry.
In the developed world, we’re bombarded with food imagery. It’s almost impossible to get away from it if you don’t want to see it. Our relationship with food is individualized, so I’m not going to make generalizations about diet while fasting or not or at any other point in the IBD journey. (I have interviewed plenty of experts on this, and what they say is more important.)
More reading and listening on diet from About IBD:
- Reporting from Advances in IBD 2019: Current Opinions on Diet and IBD
- About IBD Podcast Episode 127 – The Plant-Based Crohn’s and Colitis Cookbook
- About IBD Podcast Episode 102 – Finding Success with Nutrition Therapy – Dannielle Jascot, MS, CNS, CDN
- About IBD Podcast Episode 101 – Barbara Olendzki, RD, MPH, LDN – Every Mom Matters: The MELODY Trial
I will say this: as with most things in the IBD community, preferences can’t be assumed. For caregivers and care partners, it’s worth asking your loved one with IBD about what they would prefer during the times in their life when they aren’t able to eat.
For hospitals, medical centers, and even private practices, it’s worth considering how often patients are asked to fast. Is it truly needed, and is it being done for the shortest possible time are important factors to consider.
But even above that: are patients who are fasting being treated with kindness and consideration? I know I don’t appreciate having to walk past a coffee shop on my way to a test for which I’ve had to fast. When the test is over, is there a way to offer patients a drink or some simple snack food immediately? Or are they sent on their way to fend for themselves with only a non-salted cracker in their belly?
Maybe more people would be willing to undergo tests and procedures if they were offered some dignity in the recognition that fasting is difficult and eating is natural, healthy, and pleasurable.
Chiu E, Oleynick C, Raman M, Bielawska B. Optimizing inpatient nutrition care of adult patients with inflammatory bowel disease in the 21st century. Nutrients. 2021;13:1581. doi: 10.3390/nu13051581
Boyland EJ, Nolan S, Kelly B, Tudur-Smith C, Jones A, Halford JC, Robinson E. Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. Am J Clin Nutr. 2016;103:519-33. doi: 10.3945/ajcn.115.120022.
Zimmerman FJ, Shimoga SV. The effects of food advertising and cognitive load on food choices. BMC Public Health. 2014;14:342. doi: 10.1186/1471-2458-14-342.