This article was written by Associate Registered Nutritionist (ANutr) Sophie Gastman, and reviewed by Registered Dietitian Maeve Hanan.

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Recovering from disordered eating is anything but a straightforward journey. It involves not only overcoming psychological barriers, but can also involve battling the uncomfortable physical side effects too. 

One common physical side effect of disordered eating recovery is digestive issues, such as bloating, constipation, diarrhea and acid reflux.

Research has shown that 98% of people with eating disorders experience at least one functional gut disorder (1).

A particularly common crossover is the prevalence of IBS and disordered eating, which you can read more about here. 

It’s important to recognise that each person’s recovery journey is unique, and not everyone will experience gastrointestinal (GI) issues. However, it’s also essential to understand that encountering GI issues during recovery is quite normal. This article will provide insights and practical tips for managing digestive issues during recovery.

Understanding Digestive Issues in Disordered Eating Recovery 

Making the decision to recover can be difficult enough. However, it can be even more frustrating when you feel like your body is acting against you, causing digestive symptoms that may tempt you to resume disordered eating behaviours. So, why do they occur?

Nutritional Deficiencies and Imbalances 

The most significant cause of digestive issues with disordered eating is due to nutritional deficiencies, particularly when there is a low energy intake over a period of time. 

When our body isn’t getting enough energy from food our brain starts searching for an alternative fuel source. This can lead to slowing the metabolism down and breaking down muscle, including those of the GI tract.

Over time, this affects the structure and functionality of the GI tract, resulting in difficulties in the ability to digest food. Additionally, the muscles in the stomach and intestine may also lose tone and strength, leading to conditions like constipation and gastroparesis. 

Gastroparesis is a term that refers to the delayed emptying of food from the stomach into the small intestine.

It often presents with symptoms such as gas, bloating, abdominal pain, and a feeling of fullness despite consuming small amounts of food – all of which are commonly reported symptoms during disordered eating recovery. 

Additionally, we all know how much our diet impacts our gut microbiome, which in turn impacts our digestion. Insufficient food intake will affect specific microbial species that rely on particular nutrients to survive, leading to imbalance and reduced diversity.

Research has demonstrated that individuals with anorexia have a lower diversity of gut microbiota compared to healthy individuals, particularly in strains involved in gut health and immune defense (2).

Gut diversity is important for a whole host of reasons, but overall it makes our microbiome more capable and resilient (3). 

Irregular Eating 

Most people who choose to recover from disordered eating will have a history of irregular eating patterns, which include things like having food rules, calorie limits and skipping meals. 

Skipping meals or fasting for long periods of time can contribute to digestive issues. For instance, several studies have found an association between acid reflux, constipation and skipping breakfast (4).  

Moreover, restriction and irregular eating patterns can make you more vulnerable to binge eating as prolonged physical hunger can lead to feeling preoccupied with food and a psychological sense of deprivation.

Episodes of binge eating, characterised by consuming large amounts of food in a short period of time, can overwhelm the digestive system and also lead to bloating, indigestion, diarrhoea and constipation (5). This is especially true if you are sensitive to FODMAPs, which are highly fermentable sugars that commonly cause IBS symptoms. Consuming large amounts of food means you’re likely to be taking in high levels of FODMAPs which can also contribute to feeling uncomfortably full, abdominal pain and bloating. 

This is why it’s so important to stick to a good structure of regular eating throughout your recovery to help reduce the risk of bingeing as well as lessening the impact of any digestive issues. 

Anxiety Around Eating 

At any stage of your recovery, it’s natural to experience anxiety related to eating. You might feel stressed about reintroducing certain fear foods, eating the ‘right’ thing, or eating more food than you are used to. 

Whilst these feelings of anxiety are completely normal, the impact of it on our digestive system shouldn’t be underestimated. Anxiety and stress can wreak havoc on our guts, and you may even find it exacerbates the type of symptoms that make you feel like you don’t want to eat, hindering your recovery journey and potentially leading to a cycle of stress and anxiety. 

When we feel anxious, our sympathetic nervous system triggers the ‘fight or flight’ response. This triggers a cascade of physiological responses which can disrupt normal digestion and lead to symptoms like bloating, stomach pain, and irregular bowel movements. This is because our gut is highly sensitive to our emotional state due to the bi-directional communication between our guts and our brains. 

One specific consequence of high stress levels or elevated cortisol is increased gut permeability (6). What this essentially means is that the tight barrier in our guts that normally controls what gets absorbed into the bloodstream becomes compromised and allows in partially digested food, toxins, and other microbes. Not only does this cause the symptoms mentioned above, but it can also trigger immune responses and potentially lead to food sensitivities. 

Diet Foods 

An over-reliance on ‘diet foods’ considered as ‘safe foods’ in eating disorder recovery can also contribute to gut symptoms as many of them are common gut irritants. 

For example: 

• Chewing too much gum can cause you to swallow a lot of air, which can make you feel bloated and uncomfortable 
• Drinking too much coffee in a bid to suppress appetite can have a laxative effect  
• Consuming a lot of sweeteners, for example, in the form of sugar free beverages, or low calorie ‘diet’ bars can irritate your gut and also trigger symptoms like bloating and diarrhea 
• Incorporating a lot of ‘filler’ foods like konjac noodles or shiritaki rice, which are low in calories and high in fibre, can lead to excessive gas and bloating due to the high fibre content 

Strategies for Managing Digestive Issues 

Constantly feeling like you’re full, misinterpreting bloating for weight gain or feeling ‘fat’ can be really difficult feelings to manage and complicate your recovery. However, there are some practical tips to help ease discomfort and reduce any digestive issues during recovery: 

• Wear loose fitting clothes: Opt for comfortable clothing that allows your stomach to expand freely, reducing feelings of bloating and stomach pain. 
• Stay hydrated: Drinking enough water will help with the breakdown and absorption of nutrients, as well as preventing constipation. However, avoid drinking too much fluidto prevent filling up on this in place of food. 
• Eat regular meals: Embrace a structured eating routine to allow your digestive system to adapt and begin functioning normally. Avoid grazing throughout the day and instead aim for regular meals with planned snacks in between. 
• Manage stress and anxiety: Engage in techniques such as mindfulness or meditation, build a support network and add more self-care activities into your routine. 
• Seek professional help: Consulting a registered dietitian and/or therapies speacialising in eating disorders can provide personalised guidance in meal planning and support you on your recovery journey. 
• Continue your recovery plan even when digestive issues feel difficult, as ultimately restoring your physical health and relationship with food will lead to long term benefits for your gut and digestion.

Remember, healing takes time and it’s important to be patient! 

Conclusion 

Managing digestive issues during disordered eating recovery can be challenging but understanding the causes and implementing practical strategies, such as sticking to a regular eating pattern and managing your stress and anxiety, can help alleviate the discomfort. 

If you are struggling with disordered eating or recovering from disordered eating, you can find information about how we can support you here.

References 

1. Boyd, C., Abraham, S. and Kellow, J. (2005) ‘Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders’, Scandinavian Journal of Gastroenterology, 40(8), pp. 929–935. doi:10.1080/00365520510015836. 
2. Morita, C. et al. (2015) ‘Gut dysbiosis in patients with anorexia nervosa’, PLOS ONE, 10(12). doi:10.1371/journal.pone.0145274. 
3. Lozupone, C.A. et al. (2012) ‘Diversity, stability and resilience of the human gut microbiota’, Nature, 489(7415), pp. 220–230. doi:10.1038/nature11550. 
4. Yamamoto, Y. et al. (2022) ‘Association between eating behavior, frequency of meals, and functional dyspepsia in young Japanese population’, Journal of Neurogastroenterology and Motility, 28(3), pp. 418–423. doi:10.5056/jnm21146. 
5. Santonicola, A. et al. (2019) ‘Eating disorders and gastrointestinal diseases’, Nutrients, 11(12), p. 3038. doi:10.3390/nu11123038. 
6. Kelly, J.R. et al. (2015) ‘Breaking down the barriers: The gut microbiome, intestinal permeability and stress-related psychiatric disorders’, Frontiers in Cellular Neuroscience, 9. doi:10.3389/fncel.2015.00392.