Food insecurity affects more than just how much people eat. For those living with chronic digestive conditions like IBS and IBD, it also determines whether they can access the specific foods their bodies tolerate. Managing these conditions successfully often depends on avoiding certain triggers, eating at regular intervals, and maintaining adequate nutrition. When food choices are limited by cost or availability, symptom control becomes significantly harder. The relationship works both ways: digestive diseases increase the risk of food insecurity through medical expenses and reduced ability to work, while food insecurity worsens symptoms and makes disease management more difficult. This cycle can persist even when patients have access to appropriate medical care.1

Understanding IBS and IBD

Irritable bowel syndrome (IBS) affects roughly 10-15% of Americans and is one of the most common digestive disorders. It’s classified as a functional condition, meaning the digestive system doesn’t work properly even though medical tests show no visible damage or inflammation. Patients experience chronic abdominal pain, bloating, and changes in bowel habits ranging from diarrhea to constipation. The symptoms can be unpredictable and disruptive, but IBS doesn’t cause permanent harm to the intestines or lead to serious complications like IBD can.

Inflammatory bowel disease (IBD) is fundamentally different. This term covers Crohn’s disease and ulcerative colitis, chronic conditions where the immune system attacks the digestive tract and causes ongoing inflammation. This inflammation damages tissue, leading to ulcers, bleeding, and potential complications that may require surgery. IBD affects about 1% of Americans and causes not just digestive symptoms but systemic problems like fever, weight loss, and severe fatigue. While some symptoms overlap with IBS, IBD is a more serious condition requiring immune-suppressing medications to control inflammation.

Diet plays a distinct but important role in managing both conditions. Many IBS patients find they can reduce symptoms by identifying and avoiding specific food triggers. IBD patients face different dietary challenges: during active inflammation they may struggle to absorb nutrients properly and need to avoid foods that worsen flares, while also maintaining adequate nutrition to support healing. This is where food insecurity becomes particularly problematic. When people can’t reliably access the foods their condition requires, or when cost forces them to eat whatever is available rather than what their body tolerates, managing either condition becomes significantly harder.2

When Food Insecurity Complicates Disease Management

Most dietary advice for IBS and IBD assumes patients can purchase specific foods and avoid known triggers. Food insecurity eliminates that control. When budgets run short, people eat whatever is affordable or available rather than what their condition tolerates. This often means relying on processed, high-sodium foods or accepting whatever a food pantry provides, even when those items include known triggers. The dietary modifications that form the foundation of IBS and IBD management become nearly impossible to follow when cost dictates food choices.

The unpredictability itself creates problems. When someone doesn’t know whether they can afford groceries next week or must constantly adjust what they eat based on available resources, the chronic stress affects digestive function directly. Both IBS and IBD are sensitive to psychological stress through the gut-brain connection. Anxiety about food access can worsen symptoms independent of what someone actually eats, creating a cycle where worry about the next meal triggers the very digestive problems that require careful eating to manage.

Food insecurity also forces trade-offs that undermine medical care. Patients may skip prescription refills to buy food, delay appointments to save on copays or gas money, or reduce medication doses to make them last longer. These aren’t failures of personal responsibility but rational responses when resources fall short of covering both food and healthcare costs. Over time, these compromises erode disease control even when the underlying treatment plan is sound. The result is worsening symptoms, increased complications, and patients who feel they’re failing at management when the actual problem is lack of access to what their care requires.

Adapting Care to Real-World Constraints

Effective gastroenterology care has to account for the realities patients face outside the exam room. When food access is limited, rigid dietary protocols often fail not because patients aren’t trying but because the recommendations don’t match available resources. Gastroenterologists increasingly recognize that treatment plans need to be adaptable, addressing barriers to care alongside the medical aspects of IBS and IBD management.

  • Flexible dietary guidance: Rather than prescribing strict elimination diets that assume unlimited food choices, providers can work with patients to identify affordable, accessible foods that minimize symptoms. This might mean prioritizing a few key trigger foods to avoid when possible rather than demanding adherence to complex protocols. The goal shifts from perfect dietary control to realistic harm reduction that fits within a patient’s actual circumstances.
  • Screening for social barriers: Many gastroenterology practices now include questions about food access, housing stability, and medication costs as part of routine care. Identifying these issues early allows the care team to connect patients with resources like patient assistance programs, food pantries, or social workers who can help navigate financial challenges. These screenings acknowledge that managing digestive disease requires more than just medical treatment.
  • Coordinated support services: When practices employ or partner with social workers, dietitians, and care coordinators, they can address the full spectrum of barriers patients face. A dietitian familiar with budget constraints can suggest affordable alternatives to expensive specialty foods. A social worker can help patients apply for assistance programs or find community resources. This coordination prevents patients from managing complex logistical problems alone.
  • Adjusted monitoring expectations: Standard care often assumes patients can track symptoms consistently, attend frequent appointments, and maintain stable routines. When food insecurity creates unpredictable eating patterns or when transportation and cost limit clinic visits, providers can adapt by using telehealth when appropriate, extending time between appointments when disease is stable, or focusing on the most critical monitoring rather than ideal frequency.
  • Integrated mental health support: Recognizing that stress from food insecurity worsens digestive symptoms, comprehensive GI care increasingly includes mental health screening and referrals. Addressing anxiety and depression as part of treatment isn’t a luxury but a practical necessity for managing conditions where the gut-brain connection plays a significant role in symptom severity.

Comprehensive GI Care at Cary Gastroenterology

Managing IBS or IBD requires understanding the full context of each patient’s life, including the practical barriers that can make symptom control difficult. The gastroenterologists at Cary Gastroenterology recognize that effective care must account for real-world challenges like food access, cost constraints, and the stress that comes with managing chronic digestive conditions. Our team works with patients to develop realistic, adaptable treatment plans that address both the medical and practical aspects of living with IBS or IBD. Contact us today to request an appointment and learn more about comprehensive digestive health care.


1https://www.ers.usda.gov/data-products/charts-of-note/chart-detail?chartId=109859
2https://pmc.ncbi.nlm.nih.gov/articles/PMC12242951/