Gastrointestinal Issues and Eating Disorder Treatment

For malnourished patients recovering from eating disorders (ED), the process of restoring weight safely and steadily is a central focus of treatment. As individuals begin to renourish after periods of severe food restriction, they often experience a range of gastrointestinal (GI) issues, which can make the process of recovery all the more challenging.  GI discomfort is so prevalent in eating disorder recovery that one study found that 98% of their subjects – all of whom met criteria for an eating disorder – reported at least one notable GI complaint like pain, gas, bloating, constipation etc. It’s worth noting that GI problems in people with eating disorders are common before treatment starts as well.

Common GI Issues During Eating Disorder Recovery

Below are a few of the common GI issues we see during the early stages of recovery. All of these challenges typically resolve on their own as the body acclimates to refeeding.

1. Extreme fullness: Severe food restriction leads to slowing of the digestive system as a whole. As body weight and food intake decrease, the food moves through the stomach to the intestines at a much slower pace. This process is called gastroparesis or delayed gastric emptying. Essentially, digestion slows to a snail’s pace and food stays in the stomach for longer, causing the sensation of extreme fullness – sometimes even hours after a meal. For individuals suffering from delayed gastric emptying, you may still feel full – maybe even stuffed – hours after a meal and then it’s time to eat again.
2. Stomach and abdominal pain: Extreme dieting, binge-eating and purging lead to de-conditioning of the entire digestive tract, starting at the esophagus and going all the way down to the anus.  So the whole system slows, working less productively and efficiently. This de-conditioning leads to early satiety (getting full really fast), bloating and pain due to slowed digestion (the delays referenced earlier), and also symptoms like constipation, nausea, gas and bouts of diarrhea. ED behaviors also lead to imbalance of important gut bacteria. This lack of diversity in the gut contributes to bloating and gas. Only continued nourishment can help the body re-establish bacterial diversity in the gut.
3. Water retention: Part of the body's recovery from malnutrition and restricted eating is regaining hydration. Because the fluids in the body are rebalancing quickly as the patient begins to eat more, it's normal for the patient to gain water weight rapidly (the medical term for this is edema). Water retention can look like sudden weight gain, and it can be very upsetting for patients who are already fixed on their weight and body. To keep treatment on track, it's important that patients know to expect water weight and understand that it's not the same as gaining body mass.
4. Food sensitivities: As the patient's digestive system builds back up to a normal level of functioning, they may be less able to digest certain foods or food groups. Patients might think that they are allergic to these foods because eating them causes pain or discomfort, but it's more likely that these symptoms are temporary reactions caused by the patient's malnutrition and related digestive problems.
5. Rebounding hunger: It might sound obvious, but feeling hungry is a physiological change that comes along with recovery from malnutrition. Some patients may feel extreme hunger as their bodies regain normal functioning, which can be alarming. Be sure that patients know these changes in their experiences of hunger are normal and that they won't last forever.

Adding Anxiety to the Mix

It’s worth noting that, if you have an eating disorder, it’s highly likely that you experience what may be extreme anxiety at times. This anxiety heightens as you challenge yourself to eat more. The stress of eating invariably will activate your sympathetic nervous system, triggering an acute stress response to prepare your body to “fight” or “flee.” These responses are important evolutionary adaptations that increase our chances of survival in threatening situations. Mealtime certainly feels threatening when you have an ED, but the triggering of fight/flight mode works against our efforts to eat. Our bodies were not designed to eat and digest when triggered in fight/flight mode! We need our parasympathetic nervous system to take over to help us rest and digest. It’s essential to practice skills to soothe one’s system when activated, to restore balance and calm in order to properly digest one’s meals.

How to Manage GI Symptoms During Treatment

So what can you do to manage these very unpleasant GI symptoms that most certainly will plague the early part of your recovery process?

1. It may sound counter-intuitive, but keep eating! Even if you feel full, it’s important to re-establish regular eating patterns and adequate portions of food. No more than four hours between meals/snacks. Consistency is everything.
2. Try to focus on foods that are calorically dense but lower in volume. It’s not the time to fill your belly with salads, fruits and veggies. They take up too much space. If you have fruits and veggies, they should not be the center of the meal. Incorporating dried fruit is a good way to give your body fiber to assist with regular bowel movements without increasing the volume of your meals, leading to fullness. Liquids tend to empty the stomach easier than solid, so incorporating caloric supplements or smoothies into your eating plan may be helpful.
3. Try not to over-do the water since it may fill you up without the necessary calories your body needs.  
4. Practice self-soothing before, during and after meals. Deep breaths, calming thoughts, and distractions -- these behaviors help calm the system so the body can focus on digesting.
5. Wear comfortable, loose-fitting clothing. It’s not the time for tight waist bands that put pressure on your belly and increase uncomfortable sensations as your belly naturally expands with food, fluids, etc.
6. After meals, sit back with a warm pack on your belly. Read or watch TV. Let your body rest and digest. If you notice that moving gently helps your digestion, talk to your provider about whether an easy walk or household chores are appropriate.  
7. While the gold standard treatment for gastroparesis post-restricted eating is nutritional rehabilitation (eating!), there are several medications that can be helpful in more severe cases. It’s important to consult with your medical doctor about options.
8. Keep eating! If you do so, we can expect the GI issues to resolve steadily and consistently over the course of a few weeks.

 If you or a loved one is struggling with an eating disorder and suicidal thoughts and/or behaviors, please reach out to our team at info@columbuspark.com to discuss treatment options.