Eating Disorders, Restrictive Dieting and the Affects on Gut Health.
The road to recovery from an eating disorder is pathed with many obstacles, both physical and psychological. Many individuals find they face gastrointestinal issues that severely hamper their efforts, but there is hope.Eating Disorders, Restrictive Dieting and the Affects on Gut Health.
There are four primary diagnoses of eating disorders recorded in the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders). These are anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorders otherwise not specified.
There are specific diagnostic criteria listed for each of the four key diagnoses; however, if you only fulfil a few of these criteria, it doesn’t mean you always have a healthy relationship with food and weight. There are more subtle forms, often referred to as disordered eating. It should be noted that individuals who demonstrate disordered eating may still be at risk of gut health issues.
Research has revealed the number of people in Australia living with an eating disorder at any given time is estimated to be around 1 million people or 4% of the population (Deloitte Access Economics, 2019). This number increases to over 16% of the Australian population when disordered eating is accounted for (Hay, Girosi, & Mond, 2015). That is mind-blowing.
It’s important to remember these figures only provide a statistical overview. Eating disorders and disordered eating are highly individual and varied. Not everything will be captured in the data nice and neatly.
Most of the research done in gut health and eating disorders has focused explicitly on anorexia nervosa. However, the same issues can also be present in other eating disorders such as bulimia nervosa.
Today, we will focus on eating disorders and how they impact gut health, especially in the recovery phase.
Because the truth is that every individual who has struggled with an eating disorder also experiences digestive issues that interfere with their recovery.
Impact of Eating Disorders on the Mind-Body Connection
It’s incredibly easy to oversimplify diseases into physiological or psychological entities. But you can’t impact one entity without expecting it to affect the other.
Psychologically, dysfunctional eating behaviours may provide some emotional salve in the short term. However, the shortage of energy being eaten forces the body to prioritise the biological functions of the heart, brain and lungs in favour of hormones, bones, blood and digestion. This is to keep the person alive.
To add on top of this is the gut-brain axis that is connected through the vagus nerve. This nerve is the key structural component that connects all major organs within the body – from gut to brain.
As the body reduces metabolism efficiency to preservation mode, the digestive tract is affected. This affects our hormones, immune-system and hunger and fullness cues (Waldholtz & Andersen, 1990) and can last well into recovery. This dysbiosis of the gut caused by malnutrition can also be linked to higher anxiety and depression rates which can exacerbate the mental health state (Seitz, et al., 2019).
Can Eating Disorders Cause Gut Health Issues?
In a one-word answer…YES.
Most people who suffer from an eating disorder also experience gastrointestinal issues such as irritable bowel syndrome, heartburn, bloating, constipation, trouble with chewing or swallowing food, nausea, stomach pain and fullness. These symptoms follow them well into their recovery and often hamper their attempts at getting better.
Let’s look at what types of issues are present – breaking it down into the behaviours inherent with the most common eating disorders, such as bulimia and anorexia nervosa.
What is the link between Food Restriction and Gut Health?
Food restriction or eating insufficient calories for your needs is present in many different types of eating disorders.
Calorie restriction often leads to delayed gastric emptying. This is when food stays in your stomach longer than it should. When a person even slightly increases their calorie food intake, it can lead to bloating, abdominal pain, and constipation causing distress – especially for individuals who are recovering from an eating disorder. (Zipfel, et al., 2006)
There is increasing evidence to demonstrate that food restriction is also linked the gut microbiome being modified – and not in a good way (Mack, Cuntz, & Gramer, 2016) (Seitz, et al., 2019).
As you know, the gut microbiome is responsible for helping our bodies metabolise nutrients and play a significant part in physical and mental health. People with altered microbiome can’t digest fibre, in the same way, someone with a healthy gut microbiome. This can lead to numerous gut issues (Seitz, et al., 2019). This dysbiosis can also perpetuate malnutrition, making it more difficult to recover from an eating disorder (Lam, Maguire, Palacios, & Caterson, 2017)
Additionally, microbiome dysbiosis has also been associated with higher inflammation and stress levels, resulting in elevated cortisol levels – the stress hormone. Having higher cortisol levels has been linked to increased gut permeability problems leading to an overall increase of inflammation throughout the body (Seitz, et al., 2019).
Therefore, it’s vitally important to work on restoring gut health when recovering from an eating disorder. This takes time. Sometimes longer than anticipated, but it’s worth the effort, as it will reduce the gastrointestinal problems inherent with recovering from an eating disorder.
The Microbes Affected
Microbial responses to drugs varied across all studies; however, overall, it has been found that the bacterial species with the highest abundance in healthy individuals was the one that was significantly susceptible to these drugs (Maier, et al., 2018).
What are the effects of Binge Eating on Gut Health?
Binge eating is the act of eating large amounts of food in a short period. It’s a symptom of certain types of eating disorders, most notably but not restricted to bulimia nervosa. Ultimately, binge eaters tend to have inconsistent eating patterns around all meals, which cause a multitude of gastrointestinal symptoms, including constipation, diarrhoea, gas and abdominal bloating.
The gut microbiome is affected by modified eating patterns because our microbes are sensitive to our internal clock (circadian rhythms). These constant disruptions in eating habits can lead to microbiome dysbiosis associated with hormonal imbalances, inflammation and digestion issues (Lam, Maguire, Palacios, & Caterson, 2017).
Also, the act of binging interferes with the body’s ability to digest and causes delayed gastric emptying and over-expansion of the stomach. This leads to pain and in the worst-case scenario – stomach rupture.
What are the Effects of Compensatory Behaviours on Gut Health?
Compensatory behaviours are those activities individuals have used throughout their illness to help them achieve a goal. They include laxative overuse, self-induced vomiting, diuretic use, over-exercising and enemas.
These behaviours are all linked in some way to ongoing gut health issues, including lower oesophageal sphincter damage, motility problems, diarrhoea and constipation (Forney, Buchman-Schmitt, Keel, & Frank, 2016). Let’s look at some of the more common behaviours.
Laxative use can cause constipation, bloating, cramping, motility problems, and decreases in microbiome diversity, leading to similar issues discussed above (Forney, Buchman-Schmitt, Keel, & Frank, 2016). When used over extended periods, this causes the bowel to become reliant on laxative stimulation to pass a bowel movement. It is imperative that if individuals are still using laxatives, they wean off them with a medical professional’s help to decrease the risk of severe gastrointestinal consequences.
Self-induced vomiting that is seen in many forms of eating disorders impacts the upper gastrointestinal tract. The valve between the oesophagus and stomach can become floppy allowing for acid reflux symptoms, which can last well into recovery. There will also be gas, bloating, indigestion and constipation and an increased risk of gastritis – the inflammation of the stomach’s lining, resulting in abdominal pain.
Over-exercising can be associated with leaky gut syndrome, which causes increased inflammation in the gut and overall body in general. (Seitz, et al., 2019).
Gut Health Recovery
Refeeding is one of the vital processes in recovery from eating disorders. However, digestive symptoms can make it very uncomfortable and hinder any progress. Experiencing any gut health issue is distressing, particularly when you try to heal your relationship with your body and food.
Reducing the symptoms can help you in the recovery process.
- The best thing you can do is regulate your eating patterns. This not only helps with recovery but many of the gastrointestinal issues.
- Slow down your eating. Chewing your food thoroughly will help with digestion and may reduce bloating. Also, mindful eating can help reduce the stress around eating, which tends to exacerbate gastrointestinal issues.
- Learn to meditate. This will decrease your cortisol levels which exacerbate gut distress.
- Consider assisting your gut microbiome with an excellent quality broad spectrum PREbiotic and whole-food gut health repairer – one that is gentle on the gastrointestinal tract such as Gut Performance®. Using harsh forms of fibre can often reactivate gastrointestinal issues putting the recovery at risk.
If you or someone you know is recovering from an eating disorder, the reintroduction of foods is best done under the guidance of a registered dietitian to reduce the risks to the gut and improve gut health overall.
The connection between gut health and recovery is evident and must be addressed if the healing is to be successful and sustainable.
But remember, healing is possible. It takes small actions toward health every day to make a significant impact.
Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. (2016). The medical complications associated with purging. The International Journal of Eating Disorders, 49(3), 249-259. Retrieved 2021, from. https://doi.org/10.1002/eat.22504
Hay, P., Girosi, F., & Mond, J. (2015). Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. Journal of Eating Disorders, 3(19). Retrieved 2021, from https://doi.org/10.1186/s40337-015-0056-0
Lam, Y. Y., Maguire, S., Palacios, T., & Caterson, I. D. (2017). Are the Gut Bacteria Telling Us to Eat or Not to Eat? Reviewing the Role of Gut Microbiota in the Etiology, Disease Progression and Treatment of Eating Disorders. Nutrients, 9(6). Retrieved 2021, from https://doi.org/10.3390/nu9060602
Mack, I., Cuntz, U., & Gramer, C. (2016). Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched-chain fatty acid profiles and gastrointestinal complaints. Scientific Reports, 6. Retrieved 2021, from https://doi.org/10.1038/srep26752
Seitz, J., Belheouane, M., Schulz, N., Dempfle, A., Baines, J. F., & Herpertz-Dahlmann, B. (2019). The Impact of Starvation on the Microbiome and Gut-Brain Interaction in Anorexia Nervosa. Frontiers in Endocrinology, 10(41). Retrieved 2021, from https://doi.org/10.3389/fendo.2019.00041
Trott, M., Jackson, S. E., Firth, J., Jacob, L., Grabovac, I., Mistry, A., . . . Smith, L. (2020). A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eating and weight disorders. Retrieved 2021, from https://doi.org/10.1007/s40519-019-00842-1
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Zipfel, S., Sammet, I., Rapps, N., Herzog, W., Herpertz, S., & Martens, U. (2006). Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects. Autonomic Neuroscience: basic & clinical, 129(1-2), 99-106. Retrieved 2021, from https://doi.org/10.1016/j.autneu.2006.07.023