What’s a Gut of a Guy or a Girl to do? Gastrointestinal Symptoms and Eating Disorders… (July 2015)
Any colleague specializing in eating disorders often hears their clients mention how they feel bloated. As a Nutrition Therapist, I like to dig deeper into this problem and ask a series of questions that help to illuminate what is going on like:
- Do you feel constipated?
- Do you experience heartburn?
- Dysphagia (swallowing difficulties)?
- Chewing problems?
- Anorectal Pain?
Although these are just some of the questions I ask my eating disorder clients, such gastrointestinal symptoms are rather common, especially when refeeding (the reintroducing of calories) is taking place.
Did you know that researchers from the University of Australia found that 98% of 101 female patients admitted to an eating disorder unit had the criteria for various gastrointestinal disorders? In addition, did you know that 50% of them had Irritable Bowel Syndrome (IBS)?
Sadly, many of our clients have various gastrointestinal symptoms, but are either embarrassed to discuss them. At the same time, they are not having the proper questions asked in order to help them reveal such problems during this difficult transition.
Did you know it is also common for female clients to have pelvic floor function? Various OBGYN’s that I work with will diagnose the patient and send them to physical therapy. The challenge is that some of the treatment team members often are not aware that the patient currently has an eating disorder or had a previous history of an eating disorder. Pelvic floor dysfunction may also be a common cause of abdominal distention.
When the digestive symptom is severely damaged from purging, a peptic ulcer can develop. This is an area of the stomach or duodenal lining that becomes eroded by stomach acid. The result is significant pain whenever the client eats or drinks just about anything. If this is happening, your client needs immediate attention, especially if they are vomiting blood.
Research has shown that satiety and bloating are higher in patients who have eating disorders. Patients with Irritable Bowel Syndrome (IBS) who have an eating disorder are more likely to develop psychological issues like anxiety, obsessive compulsive disorder (OCD) and other manifestations of disordered eating. The longer the client remains entrenched in the depths of their eating disorder, the more likely they will develop motility issues – problems of digestion – because food will take longer to be digested. I have found that clients develop various food rules and phobias as a byproduct of this difficulty. Although many had rules to begin with, the difficulty often leads to an intensification of such rules.
A proven fact is that irregular eating patterns (i.e. restricting meals/food during the day, with binging at night, then adding carbonated beverages, chewing gum, and having caffeinated beverages with artificial sweeteners) exacerbates the bloat and negative symptoms that a client will experience. In addition, when laxatives/diuretics are incorporated in the disordered eating or eating disorder, a client will feel added gas and bloat as well.
Clients always ask me about our gut flora bacteria and what are the implications? Basically, when the eating disorder client has unpredictable eating times, gut flora bacteria that aid in digestion are impacted by the diet, the eating disorder symptoms, and gastrointestinal symptoms. Microflora are essential to healthy living because they break down many different food sources, produce a variety of important molecules that help mature the immune system, and support molecules that a human brain needs to function properly.
Chronic food restriction and disorderd eating patterns end up changing the production and life cycles of the gut flora, greatly effecting digestion. When clients ask me about probiotics , I recommend that they speak with their gastroenterologist if they are seeing such a doctor or find one to see. Some gastroenterologists are supportive of probiotics and others are not.
The good news is a client does not have to take such supplements because they can obtain probiotics in various food sources which we speak about during the “legalization of food” process. The eating disorder research is now indicating that probiotics can improve the mood and behavior of the patient. Of course, food is the first course of treatment, but anything that supports that main challenge can be a welcome addition.
When I am working with an eating disorder client, we examine and adjust their fluid and fiber intake, frequency of binging and purging as well as looking at the other questions I noted above. When the majority of their food intake is fiber based, it is not surprising if they feel bloated and their stomachs feel unwell.
Chicory Root is a hidden source of fiber in yogurts, cereals, and crackers. Clients are often surprised to discover this about the foods they eat on a regular basis. We explore together what their safe foods are and what kind of meal plan would work for them to realize our “mutual goals” of restoring and maintaining their physical health and mental well-being.
It is important to make sure an eating disorder client is speaking about these gastrointestinal issues to their mental health practitioner. If they are not in therapy, I suggest that they start therapy and offer professional recommendations. This is the same as when I recommend a doctor like a gastroenterologist. It is important to know that I am a nutrition therapist and a certified eating therapist and professional boundaries need to be understood and respected. In order to provide the best multi-dimensional care possible to a client, a team of diverse professionals is often required.
- Bravo, Forsythe, Chew, Escaravage, Savignac, Dinan, Bienenstock & Cryan. 2011. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS http://dx.doi.org/10.1073/pnas.1102999108
- Hudson Jl, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61 (3);348-358.