More than half a million people in the UK are living with inflammatory bowel disease — nearly double what was estimated a decade ago [1]. Most of them are young. Most of them eat out. And most of the time, they manage their condition well enough that you would never know they had it.
But their relationship with food is not like everyone else's. If you are one of them, you know that what you can eat depends on how you are feeling that day, that week, that month. And you know how hard it can be to explain that to someone who has never experienced it.
What inflammatory bowel disease is
Inflammatory bowel disease (IBD) is the umbrella term for two distinct chronic conditions: Crohn's disease and ulcerative colitis. Both involve your immune system attacking your digestive tract, causing inflammation. But they differ in important ways [2].
Ulcerative colitis affects only the large intestine and always starts at the rectum, spreading continuously along the colon. The inflammation is in the inner lining of the gut wall. During a flare, that lining becomes ulcerated and bleeds, producing diarrhoea — often bloody — with urgency and cramping that can be severe.
Crohn's disease can affect any part of the digestive tract from the mouth to the rectum, and most commonly affects the end of the small intestine. Unlike colitis, the inflammation goes through the full thickness of the gut wall, which is why Crohn's can lead to complications like strictures (narrowing from scar tissue) and fistulae (where the inflamed bowel breaks through to adjacent tissue). Symptoms include abdominal pain, diarrhoea, fatigue, and weight loss.
Both conditions go through periods of active disease — flares — and periods of remission, when you may feel largely well. This variability is the defining feature of IBD as a lived experience. What you can eat comfortably today may be impossible next week. The condition you are managing is not a fixed list of intolerances. It is a moving target.
How common is it?
IBD affects about 1 in 123 people in the UK — over half a million individuals — and prevalence has continued to rise [1,3]. The conditions most commonly develop between the ages of 15 and 30, meaning the majority of people with IBD are young adults.
Importantly, IBD is not IBS. The two are often confused — understandably, since both involve the gut and both cause digestive symptoms. But IBD is an immune-mediated inflammatory disease that causes structural damage to the gut. IBS is a functional disorder with no structural damage. The mechanisms, treatments, and dietary implications are fundamentally different [2].
Your relationship with food
The relationship between IBD and food is more complex than for IBS. In IBS, the FODMAP framework gives you a reasonably consistent dietary map. In IBD, the picture is more individual and more variable.
During a flare, your inflamed gut is often unable to handle foods that would normally be fine. High-fibre foods — raw vegetables, whole grains, legumes — can make symptoms worse when the bowel is actively inflamed or narrowed. High-residue foods (those that leave significant undigested material) may worsen diarrhoea or pain. Spicy foods, fatty foods, and alcohol are commonly reported as triggers during flares [2].
During remission, you can often eat a largely unrestricted diet, though you will typically have a well-developed personal knowledge of what causes you difficulty. The challenge is that remission can shift to a flare without warning, and a meal that was entirely manageable last time may not be this time.
This unpredictability is what makes eating out with IBD so difficult. You are not managing a fixed condition with fixed rules. You are making decisions based on how your body is responding right now, and you need enough information about the food to make those decisions well.
What this means when you eat out
When you are choosing where to eat, and what to order, the most useful thing a restaurant can give you is specific ingredient information.
During a flare, knowing whether a dish is high in insoluble fibre, whether it uses a cream-based or broth-based sauce, whether the vegetables are raw or cooked, and what kind of fat it is prepared in can all affect your decision. During remission, you may be more relaxed — but you will still benefit from knowing what is in the food, because your body's response can shift.
Look for restaurants that break down their dishes by ingredient. If the information is not on the website, ask when you arrive. Questions like "is this sauce cream-based or stock-based?" or "are the vegetables raw or cooked?" are not fussy questions. They are the questions that allow you to eat safely and enjoyably given what your body is doing that day.
If a restaurant uses Edible, the ingredient information is built into the menu — so you can check it before you arrive and make your decision when you are feeling calm and clear-headed, rather than under pressure at the table.
You cannot always predict how your body will respond. But you can give yourself the best chance by having the right information before you eat.
Coming in Part 3: gastroparesis — a condition most people have never heard of, what it does to the way your stomach processes food, and how to navigate eating out when portion size and texture matter more than ingredients.
References
Crohn's & Colitis UK. IBD in the UK report. 2022. Available from: https://crohnsandcolitis.org.uk/news-and-stories/news/new-report-reveals-true-scale-of-crohns-and-colitis-in-the-uk
Caron B, Honap S, Peyrin-Biroulet L. Epidemiology of inflammatory bowel disease across the ages in the era of advanced therapies. J Crohns Colitis. 2024;18(Suppl 2):ii3–ii15. DOI: 10.1093/ecco-jcc/jjae082
King D, Reulen RC, Thomas T, Chandan JS, Thayakaran R, Subramanian A, et al. Changing patterns in the epidemiology and outcomes of inflammatory bowel disease in the United Kingdom: 2000–2018. Aliment Pharmacol Ther. 2020;51(10):922–934. DOI: 10.1111/apt.15701
