The Link Between Eating Disorders and Gastrointestinal Health
Gastrointestinal symptoms are nearly universal among individuals with eating disorders, and the prevalence of diagnosable digestive disorders is high in these populations. Comorbid digestive symptoms can render nutritional rehabilitation and eating disorder treatment incredibly challenging, and often requires multi-disciplinary care to optimize physical tolerance of an adequate, minimally-restricted diet.
By: Lucy Wild
It is not uncommon for someone who struggles with an eating disorder or disordered eating behaviors to experience gastrointestinal (GI) problems such as irritable bowel syndrome (IBS). In fact, one study found that in a survey of women who had an eating disorder diagnosis, 98% of the population met the criteria for at least one functional gastrointestinal disorder, and 50% met the criteria for IBS.[1] This prevalence has been shown to go the other way as well, with 40% of people who seek treatment for IBS also exhibiting disordered eating behaviors. There is so much crossover between the two because when experiencing gut issues such as IBS, a common practice to relieve symptoms is to cut certain triggering foods out of the diet, but additionally, engaging in disordered eating behaviors and restriction of foods disrupts digestion and can be the cause of IBS.[2] In this way, the tie between eating disorders and gastrointestinal issues is like the chicken or the egg, one was likely to cause the other but that is different for each individual. However, the common thread in all of this is that renourishing the body and consuming an adequate amount of energy is paramount for resolving symptoms.[3]
Even if you do not have an eating disorder diagnosis, disordered eating behaviors of any kind have detrimental effects on the gastrointestinal system. Here are a few examples:
Irregular eating patterns such as the binge/restrict cycle can cause constipation, diarrhea, bloating, abdominal distention, delayed gastric emptying, gastroparesis, and early satiety.[2,4]
Compensatory behaviors such as purging or laxative abuse can cause serious complications such as acid reflux, GERD, or weakening of the abdominal muscles.[4]
Eating diet foods with added fiber and non-nutritive sweeteners or even eating copious amounts of high volume foods such as fruits and vegetables can lead to bloating, gas, constipation, and abdominal discomfort.[3]
New research shows that restrictive eating patterns can damage or alter the gut microbiota, impacting the communication pathways along the gut-brain axis and ultimately leading to altered GI function.[3] These findings are very new and further research is needed.
While it is common practice for someone struggling with IBS to turn to restricting their diet by eliminating certain foods that are commonly thought of as inflammatory, such as gluten or dairy, it is actually more beneficial to renourish the body by engaging in regular and adequate eating patterns throughout the day. Whether you are experiencing an eating disorder or disordered eating, first addressing these issues often resolves the gut issues. This helps by not only ensuring adequate nourishment, but also opens up the diet to a wider variety of foods which can help garner a diverse and healthy microbiota. Additionally, regular eating patterns throughout the day can lead to regular bowel habits.[2]
While adequate nourishment and resolving disordered eating behaviors often reduces GI symptoms, it is not uncommon for GI issues to persist through eating disorder recovery. This is because functional gastrointestinal disorders such as IBS can be triggered by things like lack of sleep, changes in routine, stress, or anxiety.[3] If this is the case, it is important to know that there are nondiet treatments that have been shown to be just as effective on gut health. This is because there is a strong gut-brain connection and therefore anxiety, stress, and depression play a key role in our digestive functioning. Practices such as yoga, meditation, and mindfulness can be very effective at reducing GI symptoms.[2]
Whether GI issues led to disordered eating behavior or vice versa, the two are intrinsically linked and one compounds the other. Therefore, the key takeaway is that a limited diet and an undernourished state negatively impacts the GI system and renourishment is paramount.[3] However, each individual is different, and it is important to check in with a certified eating disorder registered dietitian or gastrointestinal doctor to best resolve your unique symptoms.
At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Lucy Wild.
Lucy Wild is a Dietetic Intern at New York University, where she is also pursuing a Masters of Science in Clinical Nutrition. Lucy received her undergraduate degree from Goucher College where she studied Dance and Environmental studies. Prior to working in nutrition, Lucy has a background in the performing arts working as a dancer and performer. Life as a performer drove her to cultivate a nourishing lifestyle to support her for long hours of dancing and hustling around NYC. She is passionate about food and the joy and community that come with it. Through working as a Registered Dietitian, Lucy hopes to support others in finding joy, pleasure, and gentle nutrition through food and lifestyle.
Resources
1. Boyd C, Abraham S, Kellow J. Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders. Scand J Gastroenterol. 2005 Aug;40(8):929-35. doi: 10.1080/00365520510015836. PMID: 16170899.
2. Lapin P, Harrison C. Disordered Eating and IBS: How Food Fears and Restriction Cause SIBO. Feed Me Phoebe. https://feedmephoebe.com/disordered-eating-gut-issues-sibo-ibs/. Published November 17, 2020. Accessed December 17, 2020.
3. Harrison C, Evans M. The Truth About Digestion and Gut Health with Marci Evans, Certified Intuitive Eating Counselor and Eating-Disorder Dietitian. August 2020.
4. Freuman TD. Managing Gastrointestinal Symptoms in Patients with Eating Disorders Webinar. BALANCE eating disorder treatment center Webinar Series. November 2020.