Eating Disorders and GI Issues


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Regardless of the diagnosis, those struggling with eating disorders typically experience multiple gastrointestinal (GI) symptoms. I have treated thousands of ED patients with varying GI complaints. They experience everything from pain, bloating, nausea, gas and constipation to diarrhea. This can be a very frustrating experience when you are trying to navigate the recovery process. My patient tell me that they feel as though they can’t trust their bodies and they don’t know what to eat because so many things seem to make them feel uncomfortable. To make matters worse, people  dismiss their pain and tell them, “It is just your eating disorder talking”.  Despite their best efforts to eat normally, their stomach continues to hurt and they feel frustrated and confused. They asked themselves, “Wasn’t all the hard work work of recovery supposed to make me feel better, not worse?”.
If this scenario sounds familiar to you, don’t be discouraged, you are not alone and there is help available. You must first come to terms with one of the harsh realities of recovery: it can take a while for your body to return to normal GI functioning. This can be a physically and emotionally uncomfortable process that makes you vulnerable to returning back to your prior eating habits. Be strong.  With the right help and guidance you can get through this and enjoy all of the wonderful advantages of recovery without painful GI symptoms.
Here are some strategies to help you maintain your ED recovery despite GI issues:
1.  Follow meal plan— When you have stomach discomfort, it is natural to want to avoid the pain by decreasing your food intake.  This is dangerous when you are in ED recovery! Trust the wisdom of your dietitian and try not to problem solve on your own.  Oftentimes, the changes in how are bodies process and absorb food are caused by your disordered eating patterns. Restricting your intake can make things worse. Confer with your RD and medical doctor and see their assistance prior to making changes. They ca help make adjustments to your meal plan as necessary that support minimizing GI discomfort and maintaining your ED recovery progress.
2. Restore weight— The body does a lot to compensate when you are malnourished. One of the things it does is to slow down how quickly food moves through the GI system. This is done in an effort to improve the absorption of essential nutrients. Once you have achieved an appropriate nutrition level and the body feels that it is getting enough of the vital nutrients that it needs, it will begin to move food through more efficiently. If you keep your caloric intake and/or body weight low it will slow down the healing process.
3. Avoid expensive invasive tests, when possible— I have countless patients that come to see me AFTER they have undergone extensive and invasive tests and procedures that have only made them feel worse and didn’t reveal any helpful information. Having experience working with patients with eating disorders and GI issues is helpful in avoiding these unnecessary interventions. Time, patience and partnership are the best tools when navigating this process.  Once I can explain to them what is happening with their bodies and what they can do to support the healing process, they are less inclined to undergo extensive testing. We will occasionally  add the conservative use of medications to decrease their symptoms and make the process more bearable.
4. Understand that not all abdominal pain is due to constipation— A common misconception among those in ED recovery is that if their stomach hurts, they are constipated. This is not always the case. There are numerous causes for GI discomfort other than constipation and they all can feel the same. However, the treatments are very different. Medications such as probiotics, digestive enzymes, motility stimulators, proton pump inhibitors and anti-nausea medications may be best suited to treat your specific issue.  If we treat all GI discomfort as constipation we may be doing more harm than good.
5. Seek the guidance of your Eating Disorder treatment team —  Because of the overlap between ED and GI symptoms, it is important that you seek guidance from professionals who understand eating disorders and the strong connection between the brain and the gut. Having physical pain and emotional distress can make it difficult to determine if everything you are feeling has an organic source or if there is a psychological component to what you are experiencing. Regardless of the origin, your pain is real and you need experienced help navigating it so that you don’t fall back into the old ED behaviors that you have fought so hard to overcome.
6. Set realistic expectations — Your eating disorder didn’t happen overnight and all of the GI symptoms associated with it will take time to resolve.  The GI system is unfortunately one of the last systems of your body to get back to normal during ED recovery.  Be patient with your body, work with experienced eating disorder professionals and heed the counsel of your knowledgable dietitian. Together, you can formulate small incremental goals that support your ED recovery as well as minimize your GI symptoms.
GI symptoms during ED recovery are real and with help, you can overcome them!