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I’m a Runner and Ulcerative Colitis Patient—Here’s How I Got to a Positive Place with My Body Image

Unraveling a complicated relationship with chronic illness took more than a decade.

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Content warning: This article discusses disordered eating and associated behaviors. 

I sat there and regretted ordering a double shot. Too much espresso has always been a strong reminder that my sensitive gut can’t handle the extra oomph. While some may argue that coffee is a natural “laxative,” I tend to think it’s gas on the fire when you already have a laxative-like digestive disorder to deal with. It’s basically a double whammy—drink the espresso, aggravate the gut and feel it come out with a force from the other end.

But as I sat up from the throne and groaned softly holding my stomach, I noticed an aesthetically pleasing difference in the mirror. My stomach felt and looked flatter, and I felt lighter. Never mind that I was starving and still navigating life as a newly minted ulcerative colitis patient. I apparently had found one very effective way to stay skinny and look the part I’ve always wanted to look: like a runner.

Twisted, right? But what feels more twisted that it took me nearly a decade to snap out of it.

I was diagnosed with ulcerative colitis when I was 14 years old, around the same time I started my journey as a four-year varsity runner. I always had a slender, taller build, matching the stereotype of a runner. Back in the stone age of 2001, there wasn’t talk among athletes about healthy body image, proper nutrition, or balance between athletic demands and emotional stability. There were no inspirational Instagram posts. If you looked the part, you fit in. If omitting meals made you faster, you belonged. If the mounting pressure to go faster got more than skin deep, ignore it—you have to keep up.

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Ulcerative colitis is a form of inflammatory bowel disease. Symptoms include bloody diarrhea, abdominal cramping, extreme weight loss, to name a few. So as a young teenager navigating a pubescent frame and strange chronic illness, my body and mind were confused. It was the early stages of peer pressure to look a certain way—skinny and strong—and realizing that this new condition actually made it easier for me.

Before my diagnosis, I couldn’t keep anything in. I wasn’t absorbing calories, I was losing blood, and I was exhausted. But I suppose one of the blessings of being young is you can still find ways to run on empty. I managed that first year of high school, running to keep up with my Division 5 varsity team and getting my bearings as a new patient. Once my gastroenterologist discovered what was going on, I was fortunate to have a fast-working treatment, which kept my colitis in remission for the next five years.

Despite my normal high school experience, it was in those teenage years that my mind started writing its own story around what I could do as a patient and runner. I started noting which foods I could eat that would purposely force a bowel movement, and I developed strategies around consuming just enough calories to get workouts in and still be able to fake it through the rest of the day. It was more than just disordered eating as a young athlete. It was doing it in a disordered body. I was already cutting food; combined with forcing myself to the bathroom, it became a problem. And it was my secret.

Fooling the System

My family and I moved to San Diego in 2003, the summer after my sophomore year, and suddenly I was suddenly thrust into a Division 1 running program at my new high school. The stakes were higher and competition was faster. The pressure felt heavier, so my secret tactics kept working. I looked the part. On a good day, my stomach felt washboard flat. On a great day, it even fell inward, my ribs protruding out when I laid on my back. My legs were strong from the hard workouts, but they stayed lean. I fit the mold. I looked like all the other runners on those starting lines.

Some days, I looked even better.

My problems with colitis felt like a distant memory as I graduated and left for college. But underneath the surface, that little taste of control sunk into my psyche, rippling into the next decade of my life.

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I got sick again in 2006. My doctor decided to put me on steroids while we looked for a long-term fix. Those steroids are known as prednisone, and if you’re on them for an extended period of time, your body retains water and your waistline expands. Your face widens too; many call it “moon face.” I hated how I looked during that time; I deleted most photos that were taken. That extreme fluctuation in weight catapulted my self-esteem issues to a higher level, and my desire to control things through running and policing my diet grew.

It was at that point that I wanted to understand this disease more. I found a program called Team Challenge that combined raising awareness with running and decided to sign up for my first half marathon. There was suddenly a way to connect my passion for running with my developing passion for being a voice for others. So when I positioned myself as the perfect patient, a young, vibrant, healthy face of this disease, it felt easier to disguise my diet and abuse and play them off as the runner life.

Smith (far right) with The Team Challenge at the New Orleans Rock ‘N Roll Half Marathon.

One of the “blessings” of inflammatory bowel disease is that the symptoms make it difficult for many patients to gain weight. Absorbing nutrients is already a hurdle; toss in a good flare, and it really did come easier for me to keep my frame small. A fellow patient and I still joke today about people calling it the “skinny disease.” It’s a joke now—but I would silently smile at that reference back then.

When I graduated college in 2009, I thought I had total control over my disease. I did have control, in a way; especially when I stepped out of the shower. I never liked my stomach, and the distaste had only grown as I entered my early 20s. As I inhaled and contorted myself to suck in, I turned to the side and wished that age hadn’t caught up with me. I pinched the extra padding around my belly button and missed the days where there was nothing to grab.

It was in those years immediately following college that I developed my own formula. Drink more espresso; it clears you out. If you are only running in the morning, it’s OK to skip lunch or even dinner. You definitely can’t listen to any of those Team Challenge coaches. They don’t know how you do things. Portions don’t change if you run more miles. Stress fractures are not your fault. It’s the prednisone’s fault. It’s not your fault.

With the exception of my own forced mishaps, I was symptom-free for the 11 years following college. I’d see my gastroenterologist for regular colonoscopies, visit once a year for vitals, and get blood work done. I was the maintenance queen, and the best part was that there were no signs of depletion on any of my tests. At least not right away.

I was fooling the system, both medically and physically. The silence about body image and chronic illness was deafening. People talk about medications, colonoscopies, and scans; no one talks about the mental side. And it’s only in the last few years that nutrition has come into the conversation. I was dumbfounded when I was handed a brochure about vitamin D- and calcium-rich foods at a recent bone density scan. It was the first time a doctor had ever brought up nutrition as part of my treatment. I’m still waiting on the brochure about the importance of therapy. Mental health is left to the patients, connecting and sharing their stories to gather support. While I have regular therapy now, I would have loved support back then.

The Breaking Point

It wasn’t until I decided to train for my first marathon at the end of 2014 where I started to realize the damage I had caused. As the mileage grew, my stomach started to hate running more. Recovery times grew longer and hunger grew greater, but I was determined to keep my diet the same through all of the extensive training. And since this was my first time putting my body through that type of physical distress, I pulled it off. Or at least that’s what I told myself.

It yearned for more calories, but my ego screamed louder to keep dropping the weight and maintaining my appearance. While I never counted actual calories, I paid attention to portion sizes and made sure to eat the same amount as if it were a half marathon, even though I was running twice the mileage.

I crossed the finish line as a 28-year-old standing in my 15-year-old frame. While I was thrilled to hit my goal of qualifying for the Boston Marathon, I was hungry. And for the first time, I knew that I could never survive another training block like that.

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About a year later, I was getting into the meat of my Boston Marathon training. Things were going OK—I had one 26.2 under my belt, so knew more what to expect. But my diet remained steady at under-eating. I’d snack a lot more to silence the growls, and the empty calories hardly concerned me since I was running 50 miles a week. But as the mileage ramped up to those final two long runs before race day, my energy plummeted. My body started shutting down and slowing down. My confidence took a huge dip.

Around the same time, I had gotten routine blood work as requested by my gastroenterologist. I blamed my low energy on my low iron, and I blamed my low iron on having colitis. That was just the nature of it, right? You can’t absorb as much. It surely wasn’t because I was cutting corners on my dinner plate. I was deep in denial with 10 years of strong evidence to validate it: What I was doing produced results. It got me on varsity. It got me noticed. It got my half marathons under 1:40. It got me to Boston Marathon. It was working.

On my final 20-miler before the big race, I knew from the first five miles it was going to suck. It was hot, a bird had crapped on my water bottle, and I was so tired. When I finished—barely, save for a ton of walking breaks—I sat on the curb near my car and cried. I texted a close friend and fellow athlete and simply said, “I can’t do Boston.”

It was in that moment, feeling those words drip with self-doubt and self-deprecating hate, that I knew I needed to stop depriving myself of my true potential. Boston was my ultimate goal, and I was looking at throwing it all away simply because I didn’t want to eat my lunch. I was starving for self-acceptance—and a giant burrito.

That day, I went home and ate everything. I couldn’t tell you if it was that text, the magnitude of Boston, years of exhaustion, or maybe a combination of all of it—but I had hit my bottom. That moment was my wake-up call. If I was going to make it to that  Boylston Street finish line, I needed to eat. I needed to fuel. I needed to put on weight. I need to accept me for me, not for what I perceived I needed to be. I needed to give up the control I was fighting so hard to hold onto. I needed to trust that the rest would follow.

I did end up crossing that finish line, all time goals out the window. That run was a celebration of so many things, but the biggest was celebrating myself and leaving all judgments about my body on the course. I finished with a full heart…and a full stomach hours later.

When I look back on that time of my life, I sometimes want to lose the weight. I want to cut the corners and skip meals and use my same tricks to drop bloat and drop pounds. I want to not remember how I looked when I was on prednisone. When I eat three meals a day, I can feel that urge to want to run twice to burn it off . But then I look at myself in the mirror and see the curves of a woman whose husband tells her she’s beautiful every day. I see an athlete who has overcome so much adversity to be able to run despite the physical and emotional symptoms. I don’t police my diet anymore. I don’t judge myself when I want a burrito. And while I never felt I needed a nutritionist, I did need therapy, which really did save my life as a runner.

I took a long break from running after Boston to pursue other workouts and to explore myself in different areas of strength. Running will always be where my heart lives, but for the first time, I gave myself permission to not let it define who I was. And for the first time, I got vulnerable about my disease, sharing my struggles in an honest way with other patients. I felt OK with not being “perfect.” And when I feel like skipping a run or any workout simply because I don’t feel like going, I let that side win…but more importantly, I’m OK with it.

I’m a healthy 20 pounds heavier than when I crossed the finish line of my first marathon. I like to think the extra weight is the weight of loving myself. And for the first time, I’m willing to carry it.

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