Digestive complaints are common when recovering from an eating disorder. They can include constipation, gas, pain, bloating, diarrhea, acid reflux, indigestion and more.
“Why does my stomach hurt so much? I can’t stand this bloated feeling…it makes me not want to eat!” Denise is a 22-year-old white female, who had been restricting her food for several years. After establishing her treatment with me (a registered dietitian), a physician, and a licensed therapist, she had begun the challenging process of recovering from her eating disorder. I worked with Denise on fueling her body regularly and reducing restrictive behaviors. But Denise was feeling anxious and frustrated by the unpleasant digestive symptoms she was experiencing. “Every time I eat, even when it’s just a little bit of food, I get so bloated. Then I bodycheck, and my Eating Disorder thoughts get so loud it makes it really hard to stick with the eating plan.”
Denise’s story may sound all too familiar if you are working on recovering from an eating disorder. You are not alone. In fact, most people recovering from an eating disorder have to endure extreme discomfort while eating, due to the changes in the digestive system while restriction and other eating disorder behaviors are occurring.
Why digestive discomfort happens
I often hear my clients say their “stomachs have shrunk” which is why they can only eat small amounts of food at a time. Food restriction, binging, and purging, cause the muscles lining the entire digestive tract from the esophagus to the anus to become de-conditioned. They “shrink,” causing food to empty very slowly. Food can literally sit in the stomach or bowel for hours, causing gas, bloating and pain.
Your body needs time to get accustomed to being fueled on a regular basis.
Intuitive eating — or learning to eat according to hunger and fullness — is a long-term goal for recovery. During re-feeding, hunger and fullness cues are way off.
Most people recovering from an eating disorder have to endure extreme discomfort while eating.
This is actually the exact opposite of intuitive eating!
A note on bloat
When you are recovering from an eating disorder, trapped gas combined and food may distend your belly visually. This is totally normal and results from the wastage of the muscles that support your abdominal cavity. These muscles are not yet strong enough to “hold” your stomach in. Have patience — this will resolve with regular meals and snacks.
Irritable bowel syndrome (IBS), food allergies and your gut
People recovering from an eating disorder often experience irritable bowel syndrome and food sensitivities. Your body has forgotten how to process many of the foods you’ve avoided. You may believe that you have a gluten sensitivity and lactose intolerance as you reintroduce these foods and your GI tract reacts badly.
Most of these sensitivities and IBS will resolve with re-feeding.
Give it time. It is not wise to try “special” diets or eliminate foods while in recovery from an eating disorder. Work with your dietitian to slowly introduce foods back into your meal plan. Your doctor or dietician will individualize your plan. If you were diagnosed with a gastrointestinal illness prior to your eating disorder recovery they will take this into account.
Practical tips for dealing with GI recovery symptoms
Constipation Relief Tips:
- Make sure you are eating food at regular intervals. Timing meals and snacks at about 2-3 hours apart tend to make one’s stomach feel less uncomfortable.
There is no substitute for food as your medicine.
- Fluids are equally important, as well as fiber. These can be obtained from a variety of sources such as grains, nuts, and seeds, fruits, and vegetables.
- Consuming fats such as nuts, avocado and oils can also help get your bowel move more regularly.
- Your doctor might suggest a few medications including fiber supplements, Miralax, and perhaps a probiotic.
Note: It is essential that you discuss any plans to take medication or supplements with your physician.
Gas, Bloating, Cramping and Frequent Bowel Movements:
- There is no way to state this enough — the best treatment for gas, pain, and bloating is to continue eating at regular intervals. When digestive enzymes that help break down food and healthy bacteria in the gut are reduced, extra gas is produced as bacteria “ferments” this partially digested food still sitting in your digestive tract.
- Reduce or halt consumption of sugar-free gum, mints, and excessive quantities of fruits and veggies. Sorbitol, fructose, and natural sugars found in sugar-free gum and mints may also contribute to “belly bloat”
- Your doctor might recommend simethicone (Gas-X in the United States) to help relieve gas pain as well as a medication to help food move through your system faster (such as Reglan in the United States).
- Belly “soothers” include hot water bottles, warm compresses, or heating pads on your abdomen.
- Frequent bowel movements and even diarrhea are common when you start eating more regularly. You can try adding soluble fibers such as oats and oatmeal, applesauce, and even rice.
Some alternative suggestions that are worth speaking to your doctor or dietitian about:
- Lactase and Bean-o may help since natural enzymes are depleted when a person restricts food.
- Peppermint oil (sold in capsules) and mint tea appear to have a very good antispasmodic effect for those with pain and cramping. It seems to help slow the natural peristalsis of the gut by calming muscle contractions in the stomach and intestines. This is not appropriate if you are having acid reflux.
- Speaking of reflux — if you have frequent heartburn, your doctor might recommend medication to protect your esophagus from damage by acid. This is commonly seen with purging.
- Gentle yoga and mindful meditation have been very effective at reducing stress and anxiety related to recovery, which in turn, can help calm your digestion.
- Don’t hesitate to discuss other medications for anxiety with your doctor, as anxiety can contribute to GI distress.
During the first year or two of recovery from an eating disorder, gastrointestinal problems are very normal and to be expected.
If you still have GI problems that do not resolve with regular, consistent eating, it is wise to be evaluated by a physician. Recovery from an eating disorder takes time and patience. Our minds and bodies work very closely together.
For more recovery inspiration, head over to our podcast network, The Recovery Warrior Shows.
(Last Updated: September 27, 2022)