eating disorder dietitian discusses what is an eating disorder
  • December 2, 2023

Eating Disorder Recovery Bloating: A Comprehensive Guide

Taking the first step towards recovery from an eating disorder can sometimes be accompanied by unexpected and distressing gut challenges. […]

Taking the first step towards recovery from an eating disorder can sometimes be accompanied by unexpected and distressing gut challenges.

Digestive issues, including bloating, constipation, diarrhoea and swelling are common side effects when recovering from an eating disorder, and it can be confusion to know what to do to alleviate the discomfort. 

Experience bloating can often feel isolating, however these issues are very common during the recovery process with research finding  that 98% of people with eating disorders experience at least one functional gastrointestinal disorder (1)

Sometimes referred to as “Anorexia Bloating” in this article, we’ll take a deep dive into these digestive concerns, why they occur and simple strategies to consider.  

What is bloating

Bloating is a common gut issue characterized by an expanded stomach, discomfort, and sometimes severe abdominal pain due to excess gas accumulation. (2)

It also often results in a sensation of fullness, tightness in the abdomen, and in some cases, acid reflux.

Commonly, bloating can be the result of: 

  • Eating quickly
  • Food intolerances creating digestive distress 
  • Constipation
  • Hormonal shifts, particularly those linked to the menstrual cycle
  • Irritable Bowel Syndrome (IBS)

Bloating is common, with research showing that approximately 18% of people experience it at some point.(3) 

Typically, the accumulated gas will eventually pass naturally over time. 

However, it’s crucial to acknowledge that persistent bloating may signal underlying medical concerns requiring appropriate intervention and treatment. 

 

How Is Eating Disorder Bloating Different? 

Dealing with body changes throughout the recovery process can be difficult, especially if bloating is common part of the process.

Eating disorder (ED) bloating, particularly in cases of Anorexia Nervosa (AN), differs from bloating not caused by an ED due to the unique gastrointestinal (GI) issues arising from disordered eating behaviors. 

Eating disorders can cause delayed gastric emptying also known as gastroparesis. This is where food remains in the stomach for extended periods, subsequently disrupting the digestive system. 

This delay results can increase the fermentation of food in the tract, producing more gas and leading to bloating. 

This is often exacerbated by restricted dietary intake, nutritional deficiencies, electrolyte imbalances, and laxative misuse, all which can occur during an eating disorder.

These complex factors collectively make eating disorder bloating a distinct and more complicated issue compared to bloating experienced by people who do not have an eating disorder.

Digestive Issues Associated With Eating Disorders

People experiencing disordered eating and eating disorders are often faced with a myriad of gut concerns. 

  • Gastroparesis: This condition, characterised by delayed stomach emptying, often results from prolonged starvation and calorie restriction. It can leave someone feeling overly full — akin to the sensation after a large meal — even if they’ve only consumed a small amount.
  • Bloating & Abdominal Distention: Gastroparesis, coupled with weakened abdominal muscles, can lead to bloating and abdominal distention. 
  • Constipation: This can be a consequence of gastroparesis, dehydration, and insufficient food volume in the gut, leading to irregular bowel movements. As well as a side effect of malnutrition. 
  • Diarrhoea: This occurs when food moves too swiftly through the gut, not allowing adequate time for the absorption of nutrients, resulting in loose, watery stools.
  • Flatulence: Excessive gas can be uncomfortable and distressing for many.
  • Abdominal Pain: General discomfort in the stomach area.
  • Nausea: A feeling of wanting to vomit.
  • Early Satiety & Persistent Fullness: Feeling full quickly and a constant sensation of fullness are common.

What causes eating disorder recovery bloating

Pre-existing Gut Disorders

Some people experiencing eating disorders may have previously been diagnosed with gastrointestinal conditions such as Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD). 

Compensatory Behaviors

Compensatory behaviors such as vomiting and laxative misuse can be common in eating disorders. Unfortunately, these can significantly disrupt normal gut functioning.

Laxative dependency can occur from overuse, causing the gut to stop reacting to the usual dose of laxatives, requiring a higher amount to produce the same results. 

In severe cases of laxative use, organ damage can occur including a stretched colon and in some cases increase the risk of colon cancer (4). 

Starvation and Malnourishment

When the body is in starvation mode, it doesn’t want to expend energy on digestion. 

The body slows down metabolism and breaks down muscles for energy. This can lead to weakened muscles and impaired digestion due to restriction.

Irregular Eating

A common symptom of disordered eating includes irregular eating patterns, food rules, calorie limit and skipping meals. 

Fasting or missing meals, especially breakfast, can lead to digestive problems, with some studies finding a connection betweenacid reflux, constipation, and skipped morning meals

Binge eating episodes, which involve ingesting substantial amounts of food quickly, can overload the digestive system, resulting in bloating, indigestion, diarrhea, and constipation.  (5)

The Gut-Mind Connection:

The gut-mind connection, which refers to our mood having an impact on our gut symptoms has been well established.

Anxiety and other mood concerns related to eating can have a significant impact on digestion. 

The stress and anxiety experienced during recovery can exacerbate digestive symptoms, another challenge during the recovery process.

Medication Side Effects

Some medications used to treat anxiety and depression can contribute to constipation and associated bloating and gas. It is always important to speak with your medical team before changing any medication. 

Delayed Gastric Emptying

Also known as gastroparesis, this condition is associated with the slow emptying of the stomach, leading to bloating and constipation. 

This has been long associated with many eating disorders including Anorexia Nervosa and Bulimia Nervosa (6). 

Research has also associated Anorexia Nervosa (AN) with a slowed transit of food through the entire digestive system, from intake to elimination. This delay not only leads to bloating but also constipation, further exacerbating bloating issues (7).

High Fibre Intake: 

Although usually part of a balanced diet, high fibre diets can slow the digestion of food through the gut, contributing to bloating.

Coupled with a digestive tract that is not functioning as efficiently as possible, this can exacerbate bloating considerably.

The body requires time to adjust to the increased fibre intake and fibre modification may be required during the recovery period. 

Eating A Lot Of Diet Or Artificially Sweetened Foods: 

Over-reliance on ‘diet foods’ or foods containing artificial sweeteners can lead to gut symptoms.

Practices like excessive gum chewing introduce swallowed air causing bloating. Gum also contains sweeteners such as sorbitol and xylitol which can cause a laxative effect. 

Other artificially sweetened foods like protein bars and sugar-free lollies, as well as high-fiber ‘filler’ foods like konjac noodles can trigger digestive discomforts due to their laxative effects and irritation to the gut.

Eating Disorders And IBS 

Eating disorders and Irritable Bowel Syndrome (IBS) are often seen together. 

IBS is characterised by digestive distress including bloating, abdominal pain and distension, diarrhoea and constipation . 

The underlying cause for IBS is unclear, but it is thought that stress, mental health concerns, diet patterns, hypersensitive gut nerves and family history may play a role. 

Research confirms this connection, with one study revealing that a significant 64% of participants with eating disorders met the diagnostic criteria for IBS. (8) 

Intriguingly, among these participants, a substantial majority (87.6%) developed an eating disorder prior to experiencing IBS symptoms. (8)

In another study, 52% of female patients admitted to an eating disorder unit were found to meet the IBS criteria, with a staggering 98% meeting the criteria for at least one gastrointestinal disorder (9).

The relationship is also thought to be bi-directional. Meaning that ED’s can be linked to IBS, and IBS linked to EDs. 

One study that looked at  IBS patients and healthy adults found that individuals with IBS exhibited a heightened risk of developing eating disorders, this risk was higher among female and younger patients (10). 

Strategies To Help With Eating Disorder Recovery Bloating

It is important to recognise that bloating is completely normal during the recovery process. Although this may be disheartening to hear, recovery takes time and digestion doesn’t change overnight.

Here are some simple strategies that may assist you on your journey to recovery. 

  • Wear Loose-Fitting Clothes: Opt for comfortable and loose clothes to ease stomach discomfort.
  • Modify Your Fibre: You may wish to work with an online eating disorder nutritionist such as our team here at Imbodi Health, to modify your fibre balance during your recovery process. We offer free 15 minute discovery calls here. 
  • Eat Regularly: Build a regular and consistent eating schedule – your gut loves predictability 
  • Medication Review: If you think medication may be contributing to your bloating, it may be worthwhile to speak to your treating doctor, psychiatrist or psychologist. You may also wish to speak about medications that can temporarily relieve symptoms like gastroparesis or constipation.
  • Manage Stress and Anxiety: We know there is a strong gut-brain connection. Consider working on strategies to help manage stress, anxiety and other emotions during your recovery journey.
  • Stay Hydrated: Water helps to move everything through. Make sure to drink enough (but not too much) each day.
  • Use Natural Belly Soothers: Consider remedies like hot water bottles to provide comfort to your gu
  • Practice Gentle Movement: If approved by your treating team, gentle movement can work wonders for the gut as it helps to stimulate the digestive system. Consider light activities such as yoga or walking.
  • Continue Your Recovery Plan: Stay committed to your recovery journey, tell your treating team such as your eating disorder recovery coach, dietitian, psychologist, psychiatrist or GP about what’s happening for you. They can often provide helpful strategies individualised to you. 
  • Surround Yourself With Support: Who you surround yourself with is important. Build yourself a network of support – friends, family and health professionals that can help you during your journey.

Remember, recovery takes time, and your gut health may not normalise immediately. Some people might face lingering effects due to prolonged restriction and starvation. 

In Summary 

Navigating through the journey of eating disorder recovery often brings the challenge of dealing with uncomfortable bloating. 

We want to highlight that eating disorder recovery bloating is common and complex, but you don’t have to do it alone. With the help of friends, family and a supportive healthcare team (and if you need one – book a free discovery call with an Imbodi Health Eating Disorder Dietitian) you can trial different strategies that are personalised to you.

Building your own supportive community and continuing on with your recovery plan are important in this journey.

But remember improving your gut function can take time.

Patience and consistent effort are important as you work towards reclaiming your gut health and overall well-being during eating disorder recovery.

This article was written by Credentialled Eating Disorder Dietitian Kiah Paetz book in a free 15 minute discovery call with her here 

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