Do you get full fast? A GI Doctor explains why

Full Transcript Below:

Jessica Flint

Welcome everybody. I am so excited to have our guest expert here. Now we have doctor Dr. Jordan Shapiro who’s broadcasting from Houston, Texas. Now we met at an Innovations for Eating Disorder order treatment conference in Houston and immediately connected over our shared experience of recovery. So not only is Jordan a practicing gastroenterologist, He is also a recovery warrior who has his own experience of recovering from an eating disorder, which we can get into more today. He is a dedicated father to his 6 year old son, a garden enthusiast, and just the most compassionate medical provider that I’ve met who really puts the patient first. Lot of time people say that, but he truly does care so much, each and every one of his patients. So today, we all get to pick the brain of an amazing doctor, And I know so many of you guys have struggled with these common GI complaints, whether it’s bloating or constipation, diarrhea, abdominal pain.

These are so common in the eating disorder recovery process. So Jordan is a wealth of information, and we’re just very to have him here with us. So everybody give him a warm welcome in the chat. Let him know the love, and we’ll be going through all your questions. And if you have more, we will save them towards the in. So, Dr. Jordan Shapiro, thank you so much for being here today.

Dr. Jordan Shapiro

Thank you for having me. I’m so excited. And it’s, it’s an an area of passion of mine and, love to love to help. So thank you.

Jessica Flint

You are very passionate about it. I can tell. Right? So because I’m, like, this is our go to expert here. So just, like, for a broad general overview. Like, what is the GI system? So when we’re talking about GI complaints or, you know, gut health, what is the the GI system?

Dr. Jordan Shapiro

It’s a great question. So I I think about it like the the tube. So there’s a tube that runs from our mouth to our anus at the other end. And, we we eat. Food goes into it, and every single segment of it is incredibly highly specialized, to to perform specific functions. And then along the way in the tube, there are various accessory organs that attach to it and, You know, pump different digestive enzymes or bile types of things into, the bowel. So, if if If it’s okay. I mean, it can take 2 minutes and kinda just walk from the top to bottom to give people a little orientation.

Dr. Jordan Shapiro

So, I mean, when we eat, The first step is actually, you know, putting the food in our mouth and chewing it where it mixes with saliva. Saliva lubricates things. It has actually certain Digestive enzymes, especially for carbohydrates, to start the process of breaking things down and for fats. And then When we push little pieces of what we’re chewing into the back of our throat actually, as soon as we start to swallow, everything until we need to poop is automated. So, Yeah. Thank thank heavens you don’t have to, like, think your food along the GI tract, and it and it does that for us. But as soon as we swallow it, the esophagus starts to on its own, the food tube from the mouth to the stomach, starts to contract and push the food down in a very, very well organized pattern of of squeezes or contractions. There’s a little ring of muscle at the end of the esophagus that opens As soon as we swallow so that the food can pass into the stomach, and then it closes so things don’t reflux back up.

And then in the stomach, They’re kind of 2 main processes that happen. It’s the everyone kind of knows of the churning of the stomach. It grinds the food up, But it also makes acid and some other digestive, proteins that help break down specifically proteins. And, once the food is kinda ground and digested and broken into a liquid the liquid like substance, the outflow of the stomach opens, and it’s incredibly well regulated to to only let things that are, like, 2 to 3 millimeters or or less through, which is incredible, I think. We think about it as this big, you know, bag that just kinda grinds stuff up, but it’s incredibly well, Regulated by hormones, by nerves. The food that goes into the small intestine, then that’s where we absorb all our nutrients. And so the small intestine is between 15 to 20 feet long in adults. There are 3 sections of it.

A lot of the absorption happens in the in the upper parts. And there are these little finger like projections along the way called microvilli that absorb all the nutrients. In the beginning part of that, just past the stomach, there’s a very important opening, where bile from the liver drains from the bile ducts into the intestine, and the pancreas, puts digestive enzymes into this to the bowel. The digestive enzymes break down fats, Proteins, carbohydrates. Bile is like a detergent. So, and that can have some relevance for some of the disorders we’ll talk about later. But bile, If you think about, like, a, washing everyone’s favorite thing, laundry and washing dishes. But if you think about washing a pan with grease on it, if you just use water, you’ll be there all day scrubbing it.

But if you use some detergent, it breaks it into little tiny fat globules, and it lets it scrub off. So bile does the same thing for us. It helps to break, or or emulsify fat into little droplets so that we can actually absorb it. The gallbladder is attached to the bile ducts that come out of the liver, helps store a little bit of extra in case we have a bit, you know, higher fat meals, so we have a little reserve. And all that, again, is just incredibly synchronized and orchestrated to help us digest our food. Passes through the small intestine. Along the way, nutrients are taken out. There’s, a lot of, fluid that’s secreted and then reabsorbed.

And then it gets to the colon, which, is about 4 feet long in most adults. It’s much larger caliber along the colon as things move towards the end, the rectum and the anus. Water gets absorbed. So, you know, in a normal setting, we have fairly, solid formed stool. And then once It gets to the end. There’s a very incredible, set of reflexes where we this rectum stretches with stool. We feel the urge to go. And there are little sphincters down there that kind of relax so that we can pass the stool.

And we have control over the one at the very bottom, where if you squeeze, like, around the anal area, right now, sitting here, you have some control, but the whole Urged to go, and the relaxation of everything else down there to get ready to pass the stool is automated. And then, Fortunately, we have control over the final say so that we don’t walk around pooping on ourselves. So that’s that’s kind of a a quick run through, like, passage through the GI tract. And, and I think helpful just because we’ll talk about how some of those normal things become abnormal with, disordered eating.

Jessica Flint

And there’s so many organs involved, though. So if one like, we’re not meeting certain nutritional needs or, like, even macronutrients. Right? Like, that could disturb the whole balance. It seems like it’s very, well orchestrated how everything works together in sync.

Dr. Jordan Shapiro

Absolutely. Yeah. It’s it’s amazing. I mean and there’s, there’s a there’s a very interesting quote from a colorectal surgeon once who said, we always think about our hands as these exquisitely sensitive, you know, parts of our body where we can distinguish different textures. But, they said, you know, if you think about, like, the anorectal canal, I mean, it can usually distinguish, is this that I’m getting. Is it solid? Is it liquid? Is it gas? So that we know what’s passing. And, well, it’s kinda goofy to think about it. Also, it is pretty incredible that what we usually think of is just this tube has so many specialized functions.

Jessica Flint

Yeah. So how do when we look at, like, the different subtypes of eating disorders and let’s just, for today, focus on, you know, anorexia restriction, bulimia with purging behaviors and and binge eating. Do you see differences that arise for people who have different types of eating disorders and the impacts of that on the GI system.

Dr. Jordan Shapiro

Sure. Yeah. I think, you know, by far, the most common types of disorders that we see are what What we often call either motility disorders where the nerves and muscles become, the function becomes abnormal, so things either move too quickly through, move too slowly through parts of the GI tract, or, that there’s increased sensation where things are hurting, without a clear structural cause. The so we’ll and we’ll talk a lot about this because those include things often like, Gastroparesis, where the stomach empties slowly, irritable bowel syndrome like symptoms, which is pain and either diarrhea or constipation or or both. But and then there are also structural things that can happen, and Those are things that probably are a little bit more specific to, like, purging, for instance. We see patients who get, little tears in the end of the esophagus called Mallory Weiss tears where they may see some blood come up with, with, with vomiting. A more serious injury to the esophagus called Boerhauser syndrome, which is just it’s literally a rupture of the esophagus, which is a surgical emergency. Sometimes we’ll see, you know, acid reflux like changes where there are ulcerations in the end of the esophagus.

But a lot of the things that we see the most common symptoms don’t actually have a Structural abnormality that you’d see either during, like, an endoscopy from above or a colonoscopy or or a CAT scan. So yeah. So, I mean, I think I think that those disorders where the the nerves get impacted and either sensation or movement is abnormal, are much more common than structural things. And then, you know, the other the other group of, disorders or changes that we’ll sometimes see are kinda related more to the microbiome. And we don’t have a terribly well a good way of testing that accurately to say, you know, it started at point a and it got to point b, but there’s a lot of research going on about the, bacteria in our gut and how those change from normal to abnormal states and the impact of fasting, the impact of restrictive eating, the impact of, you know, overexercising, for instance, can change those. We just don’t yet have science to identify, like, the exact pattern to be able to change it. So but think about your most common thing are kinda changes in the nerves, which is either sensation or movement, too fast, too slow, changes in the microbiome, which often manifests as bloating, gas, distension, which are very common, issues in patients, individuals with eating disorders. And then the the least commoner, I think, what a lot of patients fear the most is I mean, I can remember, Like, when I was in active eating disorder and purging, I mean, I can remember just having that fear, like, is this the time that’s gonna, like, irreparably destroy my esophagus.

And and I think that those like, the combination of shame and fear actually keep a lot of people from seeking care because even though the most common things can cause a lot of, distress and symptoms. Most of them are not actually, like, irreversible, irreparable, like, permanent damage to the GI tract, which is important for people to know because I think we we tend to kind of catastrophize and think, gosh. You know, those things can happen, but, yeah, I think that combination of just shame and fear and all those things, a lot of people just, We just keep going, and we’re like, well, I’ve made it this far, and so, hopefully, this next time isn’t the isn’t the the one. So, Yeah.

Jessica Flint

So the way I see when you’re saying this, like, structurally, if I if I understand that structurally, you mean, like, the tube is, like, all good. Like like but it’s almost like the it’s to the motility and the sensations, but I kinda get the sense, like, too, of, like, a car if we were to, like, keep riding without changing the oil. Every time we’re like, Is this the time the check engine light’s on? Like, is this the time I’m gonna kill myself? Yeah. So, like Yeah. It it’s, you know, the check engine light’s on. Your motility’s Your motility’s having an issue. You’re it’s either too fast or too slow or the sensations are being would the sensations be lost or, like, over is it both like a hypersensation? In or

Dr. Jordan Shapiro

hyphen It’s often increased. So pain, feeling distension, you know, at amounts of actual, like, gas in the The bowel that are they’re not that abnormal. It’s just we feel them at lower thresholds. And, and the motility stuff I mean, examples just to kind of map Put on to, like, well, what would I feel? So, I mean, swallowing and feeling like food gets stuck as it’s passing down. While there are a number of things that can cause that that include, you know, masses and strictures where it’s scarred, closed. The majority of the time when that shows up, in, you know, in patients with Eating disorders or disordered eating. Everything is is normal appearing, and it’s just the movement of the esophagus just becomes sluggish due to often restrictive intake or, if there’s repetitive, repetitive purging, then sometimes that can just kind of Impact the nerves. And and we see that, you know, in other things too.

If somebody gets a stomach bug, and they’re vomiting and having diarrhea even if they don’t have anything sort of baseline. Sometimes that just sort of stuns the system for a period of days or weeks or even occasionally longer, but usually, they will recover. And so we’ll Talk more about I know in some of the later questions about the the prognosis for things getting better with recovery is actually, usually very good. And so, Yeah. I I think about it. I mean, it’s it’s different, but it kinda a lot of the end symptoms are very similar what we see in patients who might get a stomach bug and just not get better afterwards for longer.

Jessica Flint

That’s good to for people to hear because I know that was a question that came up like, what are the long term consequences of this? So, like, in the moment, it feels like this is forever, but the body is able to heal itself. It is able to repair increased motility or decreased motility in the sensation.

Dr. Jordan Shapiro

Yeah. It’s incredibly resilient. I mean, even the the microbiome and the bacteria, like taking an antibiotic or doing a colonoscopy and drinking all the laxative to flush things out. I mean, in the in the week or two afterwards, there’s complete Disarray of normal bacteria, and it looks horrible. And in a normal state, within a 2 week period, that bounces back to normal. And so I think a lot of the longer term issues people have are still still can get better, but I think some of the reason that sometimes the symptoms persist is Repetitive insults to the system, even though it’s pretty resilient with, you know, 1 or 2 insults. I think when it’s repetitive, there is a potential that those changes can be longer lasting. But, still, Even even with that, like, the majority of patients get a lot better with, with recovery.

Jessica Flint

And you think that is, like I’ve always and, you know, I could be this is nonmedical the way I I see it, which is like that we have to earn our body’s trust back because Boys can see if you’re, like, restricting so much. The body’s like, I’m gonna go in, like, low maintenance mode. I’m not gonna do anything. Like, I’m gonna, like, check out. You know? And then that’s why, like, why aren’t you moving? It’s like, well, like, you’re not you know, you haven’t really, like, checked in. So, anyways, I know that’s a very simplified way of looking at it. But when people do start giving themselves more regular feeding, more adequate nutrition. The body does start to, like, jump on board with time when it earns stress back.

Dr. Jordan Shapiro

Absolutely. I think that the 2 most common symptoms, which are often overlapping, we see that with our, patients who get Slowed emptying of the stomach called gastroparesis, and an overlapping syndrome called functional dyspepsia, which is that, like, Often, I eat and I take 2 bites and I’m stuffed. And I know I need to eat more, but I can’t. And so that’s actually loss of an a nerve reflex that we all have at baseline called the accommodation reflex. So I always tell my patients, if you think about, like, An accommodating family member or friend. Like, if you’re driving through town and you need a place to stay and you call them, like, they will make room for you. Our stomach actually in a normal state does that. As soon as food is coming down the the food tube, the esophagus, even before it hits the stomach, The upper part of the stomach actually expands to make room for it, and, that can get lost in, especially in restrictive, types of eating disorders.

And so that does recover with recovery. And there’s actually a a medication sometimes that can just be a little nudge to, to be able to tolerate that. And so we see that with and without actual objective signs that the stomach isn’t fully emptying normal, but it they often go together can be can be seen even if the stomach empties normal that people are just like, I don’t feel nauseous. I’m not vomiting. I just I take 2 bites, and I’m I’m uncomfortable.

Jessica Flint

Wow. That’s so fascinating because I know it’s such a common experience with people who are recovering from restriction. So literally, they could just say, like, I have to learn how to accommodate. I can’t accommodate more food. Right now, We kinda lost that connection to be able to accommodate more.

Dr. Jordan Shapiro

Yeah.

Jessica Flint

So what’s the but is it then to not stop and be like, well, doesn’t work for me. It is about to start to gradually increase that accommodation through to regular eating.

Dr. Jordan Shapiro

Yeah. Yeah. It is it is. And just to know that they’re not causing you know, we often associate symptoms with, especially pain and discomfort with evolutionarily. Like, there’s a threat to me. Like, you know, pain, stay away from pain. And and in this case, I think just understanding they’re not causing damage or harm. It’s it’s a little uncomfortable.

There are some medicines that can help with the pain piece. There’s a medicine called, you know, buspirone that is off label, has been studied for just the loss So that accommodation reflex not specifically studied in patients with eating disorders, but, and and it actually It can help, and I’ve used it in quite a few patients successfully just to get over the hump until they’re able to tolerate enough and recover. So, you know, I that is a I know in a lot of medical, talks, it’s like you have to be very explicit. This is an off label use of a medication, but, it is a medicine that there’s some research for, and it’s it’s kind of a niche thing, but it is it can be really, really helpful just as a to throw out a tip to talk to doctors about if people people are struck. Well, it’s

Jessica Flint

just so helpful too to know, like, this is to be expected. This is normal. This accommodation reflex or, you know, lack of it. It’s normal to have that and to push through it.

Dr. Jordan Shapiro

Yeah.

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