This article was written by Registered Associate Nutritionist Sophie Gastman and Registered Dietitian Maeve Hanan.
There are a number of links between disordered eating and IBS. Sometimes it can be a ‘chicken and egg’ situation as struggling with disordered eating can increase the risk of IBS, and having IBS can increase the risk of disordered eating.
Read on to learn more about the connection between disordered eating and IBS.
What is Disordered Eating?
Unlike eating disorders, which are defined by a set of narrow criteria, disordered eating does not have an official definition. It typically refers to an unhealthy relationship with food as well as a range of abnormal eating behaviours such as having rigid rules around food and eating, skipping meals, participating in fad diets, and obsessively tracking calories. Unfortunately, disordered eating has become quite common as a result of the normalisation of dieting and weight loss.
So the main difference between disordered eating and an eating disorder is that disordered eating is a broader term, and you don’t need to meet diagnostic criteria, like those laid out in the DSM-5 and ICD-10, in order to fall into the category of disordered eating.
Eating difficulties are also a spectrum, so it’s quite common for people to move in and out of the categories of ‘disordered eating’ and ‘eating disorder’.
There’s more research related to eating disorders rather than disordered eating, partially because these are easier to define. So this article will refer to both eating disorders and disordered eating as we explore the link between these eating difficulties and IBS.
What is IBS?
IBS (irritable bowel syndrome) is one of the most common gut disorders.
It causes symptoms such as bloating, abdominal pain, and a change in the frequency or appearance of your stool (poo).
As there is no test to diagnose IBS, diagnoses are made based on a set of symptoms as well as excluding other possible gut issues like coeliac disease, bowel cancer and IBD (inflammatory bowel disease).
For example, the Rome IV diagnosis criteria defines IBS as recurrent abdominal pain on average at least 1 day per week in the last 3 months that is associated with 1 or more of the following (1):
- Related to defecation
- Association with a change in frequency of stool
- Association with a change in form (appearance) of stool
It also classifies IBS into subtypes:
- IBS-C: IBS with constipation
- IBS-D: IBS with diarrhoea
- IBS-M: mixed IBS (i.e. constipation and diarrhoea are common symptoms)
- IBS-U: meets IBS criteria, but none of the above subtypes
IBS and Disordered Eating
There are a number of similarities between eating disorders and IBS. For example, these are both more common in women and linked with mental health issues and personality traits such as self-blame and low self-esteem (2-3).
Gut issues are common in those struggling with disordered eating and eating disorders.
Restrictive eating and malnutrition lead to under-fuelling of the digestive system and digestive muscles can also weaken.
Feeling overly full and uncomfortable is also common in eating disorder recovery while working on normalising food intake.
Disordered eating habits such as bingeing, purging and restricting food intake, as well as the resulting poor mental health can all negatively impact the gut and worsen gut symptoms.
A study on the prevalence of IBS among people with eating disorders discovered that 64% of participants met the criteria for IBS.
Out of all those participants, a large majority (87.6%) developed an eating disorder before they started struggling with IBS (4).
According to another study, 52% of female patients admitted to an eating disorder unit met the criteria for IBS, and 98% met the criteria for at least one gut disorder (5).
This link exists in both directions. A study comparing IBS patients to healthy adults discovered that those with IBS had a higher ED risk, particularly in females and younger patients (6).
This may be related to symptoms of IBS triggering fear of eating certain foods due to the physical discomfort felt afterward, leading to avoidance of entire food groups and developing a long list of fear foods.
Bloating can also often be confused with the experience of ‘feeling fat’ among those with disordered eating and body image issues, causing increased anxiety around eating.
Managing Gut Issues with Disordered Eating
As gut issues are so common in disordered eating, making progress with recovery leads to a significant improvement in gut symptoms.
Although gut symptoms can sometimes feel worse before it starts to feel better while the body is healing and adapting.
One of the most important steps in managing gut issues if you have disordered eating is to first focus on consistency and balance. Nourishing your gut with regular, adequate, balanced, and varied meals throughout the day will help reduce any IBS symptoms that are related to disordered eating habits. A dietitian can support you with this step, as well as helping to identify any possible individual food triggers that may be present.
Taking the time to eat and properly chew and digest your food can also make a big difference.
It’s important to understand that many ‘filler foods’ and low-calorie foods are gut irritants that could be contributing to symptoms.
- Chewing too much gum can cause you to swallow a lot of air, resulting in bloating.
- Drinking too much coffee as an appetite suppressant can have a laxative effect.
- A high intake of sweeteners can irritate the gut and trigger symptoms like bloating and diarrhoea.
- Excessive fibre intake from eating too much fruit and vegetables can also cause extreme gas and bloating.
Disordered eating and gut issues can frequently lead to an endless cycle of stress; for example, being in a constant state of stress about food or weight gain can trigger digestive issues, which in turn, can cause an individual to worry about these subsequent digestive symptoms.
Research has shown that there is a significant connection between IBS and the gut-brain axis (aka the ‘2-way connection between your brain and the gut) (7).
This emphasises the importance of stress management in reducing gut issues as stress causes the brain to release cortisol and other hormones, which all act on the gut, contributing to IBS symptoms (8).
If you suffer from this stress cycle, it may be beneficial to learn stress-relieving techniques to destress before meals, such as short guided meditations, deep breathing exercises, journaling or eating with others. Mindfulness has also been shown to reduce gut symptoms, which can be practised at meal times by taking the time to eat, chew and digest food with minimal distractions (9).
Other things to think about are developing good toilet habits, monitoring your fluid intake, getting enough sleep, and reevaluating your relationship with exercise to include more gentle movement.
Finally, it’s important to seek individual advice from your doctor and dietitian depending on your symptoms as symptom management will look different for everyone, and certain medication and supplements can be helpful in some cases.
What About the Low FODMAP Diet?
The low FODMAP diet is sometimes recommended to treat IBS symptoms. The diet involves limiting certain carbohydrates that are fermented by bacteria in the gut which can trigger digestive symptoms such as bloating, gas and stomach pain.
However, the low FODMAP diet is only a temporary solution used with the intention of gradually reintroducing high FODMAP foods and should only be followed under the guidance of a dietitian who has been trained in this approach.
While the low FODMAP diet has been shown to help many people with IBS, it is important to weigh the benefits and risks of the diet on an individual basis, as its restrictive nature can do more harm than good to gut diversity, food tolerance and food fears. Therefore, it is not appropriate for those with eating disorders or for those who are at risk of developing an eating disorder due to the risk of triggering disordered eating habits.
For example, a study on the low FODMAP diet among IBS patients found that 23% were at risk of eating disorder behaviours, and this ED group demonstrated significantly greater adherence to the low FODMAP diet compared to the non-ED group (10). These findings highlight the complex link that exists between eating disorders and IBS.
A registered dietitian may use the low FODMAP diet in a gradual and modified way as a last resort for individuals with disordered eating, however this always depends on the individual situation.
Those who suffer from IBS and disordered eating need not lose hope. As discussed above nourishing the gut and managing stress can have a massive impact IBS management.
Gut-directed hypnotherapy is another treatment option that has been shown to be just as effective as a low FODMAP diet. A study comparing hypnotherapy to low FODMAP diets for IBS treatment discovered that hypnotherapy was not only just as effective as a low FODMAP diet, and it also resulted in better psychological improvements (11).
Yoga based interventions have also been shown to reduce gastrointestinal symptoms in IBS patients in a comparable way to the low FODMAP diet. In a randomised controlled trial comparing yoga based interventions to low FODMAP diets, no differences in overall gut symptoms were found between the groups, suggesting that yoga may also be a viable treatment option for those with disordered eating (12).
Overall, it is clear that the relationship between IBS and disordered eating goes both ways. This also means that a lot of the management strategies for disordered eating can help with IBS too, such as stress management and regular eating.
However, recovery and symptom management are very individual and strategies, should be trialled one at time when working one to one with your doctor and dietitian.
- Rome IV Criteria – IBS [accessed April 2022 via: https://theromefoundation.org/rome-iv/rome-iv-criteria/]
- Ali, A., Toner, B., Stuckless, N., Gallop, R., Diamant, N., Gould, M. and Vidins, E., 2000. Emotional Abuse, Self-Blame, and Self-Silencing in Women With Irritable Bowel Syndrome. Psychosomatic Medicine, 62(1), pp.76-82.
- Morrison, T., Waller, G. and Lawson, R., 2006. Attributional Style in the Eating Disorders. Journal of Nervous & Mental Disease, 194(4), pp.303-305.
- Perkins, S. J., Keville, S., Schmidt, U., & Chalder, T. (2005). Eating disorders and irritable bowel syndrome: is there a link?. Journal of psychosomatic research, 59(2), 57-64. [accessed April 2022 via: https://pubmed.ncbi.nlm.nih.gov/16185999/]
- 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.
- Kayar, Y., Agin, M., Dertli, R., Kurtulmus, A., Boyraz, R. K., Onur, N. S., & Kirpinar, I. (2020). Eating disorders in patients with irritable bowel syndrome. Gastroenterología y Hepatología, 43(10), 607-613. [accessed April 2022 via: https://pubmed.ncbi.nlm.nih.gov/32718838/]
- Ancona, A., Petito, C., Iavarone, I., Petito, V., Galasso, L., Leonetti, A., Turchini, L., Belella, D., Ferrarrese, D., Addolorato, G., Armuzzi, A., Gasbarrini, A. and Scaldaferri, F., 2021. The gut–brain axis in irritable bowel syndrome and inflammatory bowel disease. Digestive and Liver Disease, 53(3), pp.298-305.
- Padhy, S., Sahoo, S., Mahajan, S. and Sinha, S., 2015. Irritable bowel syndrome: Is it “irritable brain” or “irritable bowel”?. Journal of Neurosciences in Rural Practice, 06(04), pp.568-577.
- Naliboff, B., Smith, S., Serpa, J., Laird, K., Stains, J., Connolly, L., Labus, J. and Tillisch, K., 2020. Mindfulness‐based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterology & Motility, 32(9).
- Mari, A., Hosadurg, D., Martin, L., Zarate-Lopez, N., Passananti, V. and Emmanuel, A., 2019. Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?. European Journal of Gastroenterology & Hepatology, 31(2), pp.178-182.
- Peters, S., Yao, C., Philpott, H., Yelland, G., Muir, J. and Gibson, P., 2016. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 44(5), pp.447-459.
- Schumann, D., Langhorst, J., Dobos, G. and Cramer, H., 2017. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 47(2), pp.203-211.