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IBS, Bloating, & Body Image: Digestion During Eating Disorder Recovery

by | Jun 6, 2024

Good digestion feels great, no doubt about it. I’ll be the first to admit that having a consistent, comfortable morning (or afternoon, you do you) poop, little to no bloating, and no weird belly pain is ideal. Improving your digestion and gut health are valid goals to have, for sure. But the number of solutions out there to “heal your gut” or “beat bloating” is overwhelming, making this totally confusing for anyone dealing with dysfunctional food and body thoughts or in eating disorder recovery.

The thing is, disordered eating actually causes digestive issues (and vice versa), so we have a real ‘chicken or the egg’ situation here. In our current culture where just about anyone can launch a supplement line and thin, white wellness influencers are convincing you that bloat is the reason your stomach isn’t perfectly flat, rather that an un-flat tummy being NORMAL, it’s smart to be skeptical.

As always, my eye is on helping you create and maintain a harmonious, healthy, and balanced relationship with food, your body, and your health. So I’d like to explain the link between bloating, funky digestion, and eating disorders, and guide you toward feeling better.

How Emotions and Eating Disorders Affect The Gut and Digestion

Feelings of excitement, love, and joy, as well as intense fear, anxiety, and stress, are all felt in the gut. Think about it, where do you feel it when you have to slam on your breaks all of a sudden in traffic, or when your new crush turns out to adore you too? In your stomach. Anxiety belly is a real thing.

Eating disorders are conditions of trying to attain or maintain control or safety. Eating – or not eating – have become the tool by which to do that. It could be distraction from difficult emotions or trauma, coping with a world who tells you your body is wrong and needs to be smaller, or can develop for countless other reasons.

Eating very little, or very chaotically in the case of the binge-restrict cycle or a binge-purge cycle, are going to cause a host of digestive issues – bloating, diarrhea, constipation, reflux, it’s all on the table.

And the self-protective, but woefully childish motivation of the eating disorder may assume that bloating, constipation, or other digestive issues can be fixed by eating less food, rather than eating more. But that’s the problem.

As Marcy Evans, an eating disorder and digestive health dietitian, points out on Food Psych back in the day, folks with eating disorders are very often highly sensitive individuals, who can be easily overloaded and overwhelmed with information. This is certainly not a deficit, it’s a gift, but it can be overwhelming.

In fact, the more psychological distress someone experiences, the worse their digestive symptoms tend to be. This highlights the crucial point: bloating is not just about food, and the solution cannot be found in food alone.

How To Tell Real Bloating Solutions From Diet Culture

If you have lots of bloating and in recovery from an eating disorder or still dealing with disordered eating like binging, restricting, or food anxiety, taking care of your gut should be part of your plan, for sure.

But cutting foods out of your diet or immediately popping a probiotic and another handful of supplements is NOT WHERE YOU SHOULD START.

While there is certainly some good information out there that can help people with true digestive problems, way too much of the content I see these days is more about achieving a “flat tummy” than helping with actual bloating. This is just broadening and perpetuating anti-fat bias, disordered eating, and diet culture. 

It is simply not true that any amount of discomfort needs a solution. Periodic bloating and gas are normal. It’s normal for those who menstruate to feel bloated for a few days before their period starts, and usually for a day or two once it does. 

It’s normal to feel extra full after a big meal, or with certain kinds of meals. It’s normal to weigh more at the end of the day (also, PSA: stop weighing yourself). It’s also very normal for stress and anxiety to make you bloated and crampy and if you’re anxious about food, when you go to eat, you’re eating in a state of anxiety.

It’s also unfortunately normal to feel uncomfortable and bloated when you’re eating eating disorder recovery and you are trying to eat more. But that does not mean you should stop.

Why I No Longer Teach the Low FODMAP Diet 

Before I fully embraced Intuitive Eating and my desire to help people out of the oppressive dieting prison so they could find authentic well-being, I had one foot pretty deep in the functional nutrition world, often recommending the low FODMAP diet to everyone with digestive issues.

I quit doing this after about a year because I saw very clearly that it was not helping, not really. Some people were finding a small amount of improvement in bloating and gas when they cut foods out, but not always, and many times it just made their symptoms worse. 

They were more worried about food, developing disordered eating and food preoccupation, eating weird combinations of things, and spending lots of time (they did not have) cooking. I was accidentally doing harm.

While a few people found relief, discovering that cruciferous vegetables, beans, or garlic were troublesome for them, the most significant improvement came when I talked to them about their food anxiety, body image, and disordered eating. Several clients who had been trying the low FODMAP diet had a profound realization: it was their anxiety about body image that needed addressing, not their intake of complex carbs. It was clear as day.

So I quit that and went whole hog into the work I do now. And I am so glad I did. I help way more people with their digestion by helping them recover from disordered eating, under-eating, inconsistent eating habits, and food and body anxiety. 

And that brings us here. If you’re dealing with bloating in eating disorder recovery or any other digestive symptoms and you know, deep down, that you’re not eating enough, or that you’re restricting food all day and binging at night, this list is for you.

6 Tips For Improving Bloating During Eating Disorder Recovery

If you’re experiencing bloating, constipation, diarrhea, or other irritating IBS symptoms and are trying to leave disordered eating behind, it’s normal to be frustrated. I’m going to lay out the steps I take with my clients who come to me with abdominal issues. You’ll notice I don’t mention cutting things out until #6.

Adequate nutrition: under-eating causes bloating

Not eating enough slows digestion, leading to constipation, gas, and bloating, as food sits in the gut for too long, fermenting and causing problems. If you’re chronically under-eating and your digestion is slow and you’re bloated often, the only thing that will help is if you start eating more. There are no magic supplements to fix a starved gut. 

This means eating several times a day, breakfast, lunch, dinner, and maybe a snack or two, depending on your individual needs and schedule. 

Other eating disorder behaviors like chaotic eating, binge eating, and purging can worsen bloating, constipation, diarrhea, cramping, nausea, and even gastroparesis (slow stomach emptying). In fact, 98% of people with eating disorders also have functional gut disorders like IBS or reflux. (the eating disorder comes first, in case you were wondering)

If you have a lot of fear foods, or have tried and stayed on the low FODMAP or other elimination diets, and are eating limited foods, you might not be getting adequate nutrition.

I know it can feel terrifying to start eating more if you’re very emotionally tied to not gaining a single pound. It is hard, no doubt about it. But instead of letting the anxiety and fear win, I lovingly nudge you toward getting help and finding recovery. Working on body image, ditching the dieting mindset, and digging deep to improve your relationship with food will change your life.

If this first step feels challenging for you, I suggest getting support from a HAES-aligned dietitian. You can read about my services here and can read a full list of certified Intuitive Eating counselors here. Many focus on digestive wellness too! 

 

Take a break from elimination diets

Many folks with bloating or constipation who think they have food sensitivities or intolerances understandably try to cut out foods to alleviate symptoms. However, doing this without professional guidance is kinda like the wild west. It can lead to a highly restrictive diet, causing anxiety and potentially triggering disordered eating. And it won’t fix your bloating if you’re cutting out the wrong foods, not getting adequately nourished, or it’s causing even more anxiety.

I see clients all the time with and without eating disorders who come to me after they’ve already cut out gluten and dairy to ease bloating. Many have also then cut out grains, beans, and fruit, until they’re left with only a handful of “safe” foods. This is not the right approach. I’ll say it again, a starved gut is not your friend. 

In some cases, attempting to self-manage bloating or constipation through elimination diets can trigger eating disorders, causing people to become obsessed with counting calories or macros and fixating on every detail of their diet. It can be a slippery slope. This amount of fixation causes tons of anxiety and is before you know it, you are terrified to eat.

Get Enough Sleep and Rest

Many body processes are mediated by melatonin and circadian rhythm. Folks whose circadian rhythm is disrupted are more likely to have IBS. There is a ton of research suggesting that light pollution and our modern dependence on electronics in the evening could be disrupting our natural melatonin production, which may contribute to gut issues. In fact, one study gave melatonin to people with IBS and saw promising results. Fascinating stuff!

Getting good sleep has benefits far beyond digestion, to mood, chronic disease prevention, metabolic health, and more. And yes, you need at least 7, more likely 8-9 hours of sleep every night. You can’t store it up for the weekend.

Some suggestions to help you get your eight to nine hours:

  • Turn the lights out indoors at night or use gentle lamps instead of overhead lights
  • Turn off the electronics an hour before bed a few nights a week. Or at the very least, put them on night mode
  • Go for a walk after dinner – it’s useful for our bodies to experience natural light both during the day and at night
  • Eat lunch outdoors! Bonus – you’ll be getting that elusive vitamin D
  • Practice cooling and relaxing activities at night such as restorative yoga. Honduras-based yoga teacher, Reiki master, and all-around great gal, Jessica Mahler (we met during our yoga teacher training in Brooklyn), teaches a wonderful restorative class and is an advocate for the style and for an overall ‘love yourself and take deep breaths’ approach to health. Reading what she has to stay always allows me to take a big exhale. You can find her on Instagram at @live_your_light.

Be Honest About STRESS & Anxiety (ABOUT FOOD AND OTHERWISE)

In our culture where we continue to moralize “clean eating” and thin bodies, there is a lot of shame and anxiety available for you for no good reason. Just take a look at any health magazine and you’ll see “5 things this doctor says you need to stop eating yesterday”, and all the alarmism about the “obesity epidemic”, it’s a LOT. 

Since IBS is a functional gut disorder, the problem is a miscommunication between the gut and the brain.

Orthorexia, an obsession with healthy eating, is on the rise. And, indeed, orthorexia can certainly cause malnourishment, but it can also lead to extremely high (too high) fiber intake and anxiety about eating the “right” and “wrong” things.

Eating disorders are mental illnesses. Even chronic dieting and disordered eating are intensely emotional experiences that can directly impact your digestion. If you’re experiencing bloating in eating disorder recovery, make sure you’re taking care of your mental health as best you can and not adding fuel to the fire by cutting out more foods. 

And if you’re just highly stressed out because of an over-scheduled, high-octane life, this could also cause digestive issues. You must deal with your stress or find ways to lessen it. Find a counselor or incorporate daily mindfulness activities into your life. Some other ideas that can help calm you mind and build more resilience to stress:

  • Spend time in nature.
  • Ask for fewer hours at work.
  • Build stronger boundaries.
  • Eat dinner with friends and family.
  • Exercise.
  • Volunteer for causes that are important to you.
  • Restorative yoga anyone?

The APA has some tips on emotional health.

Eat Some, But Not Too Much, Fiber

Getting a fiber in your diet is indeed preventative against many chronic diseases including gastrointestinal diseases like Crohn’s disease. But it is not true that cramming “30 plants per week” into your diet, or eating only high-fiber foods is good for you. There is such a thing as too much fiber.  

Super high-fiber diets are not comfortable. You also need enough non-fiber foods containing adequate fat, protein, and carbohydrates.  

Avocado and eggs for breakfast and two big salads during the day is not adequate food in general, and could easily be too much fiber and not enough “other stuff”. Sometimes less fiber is necessary for your gut to chill out a little.

Refined carbohydrates are a totally fine part of your diet. I like the old school recommendation to make ½ of your grains whole grains. Not ALL of them. Include fiber-rich starches like farro, barley, buckwheat, beans, and sweet potatoes. And eat fruit on the regular. 

And please, one salad a day tops.

care for your gut, But Don’t Overthink It

Probiotics and prebiotics can support your digestion and overall health, but you need to be eating enough food in general for this to help. Prebiotic fibers are the compounds that the probiotic bacteria feed on and ferment into the beneficial metabolites. 

Need some ideas on what foods with prebiotics and probiotics?

  • Have a morning smoothie with a cup of kefir and a banana (recipe: 1 banana, 1 cup whole milk kefir, 1/2 teaspoon turmeric, 1/2 teaspoon cinnamon, 2 tablespoons peanut butter)
  • Enjoy a weekend breakfast of scrambled eggs with white rice and kimchi (a personal favorite)
  • Add sauerkraut to your sandwich – I really like Hat Creek Provisions and Wildbrine brands. Or make your own!

By eating plenty of fiber-rich whole grains, you’re providing the food the probiotics need. Ideally, you’re eating a wide variety of different fruits and vegetables in general. Prebiotic foods include: 

  • allium vegetables – onion, leeks, garlic, scallions 
  • asparagus
  • apples
  • beans and legumes of all kinds
  • bananas
  • artichokes
  • whole grains including oatmeal!

But please remember that you can’t just pick this suggestion out of this list. If you aren’t getting enough bulk, protein, and starch in your diet, these fibers will just make you feel worse.

Identify Trigger Foods, With Caution

If you’ve done all this for an extended period and you’re still experiencing issues, you can try identifying trigger foods. I’d recommend getting help from a dietitian who is experienced with digestive issues and eating disorders,. This is especially important if you’re prone to food and body image anxiety. 

The low FODMAP protocol can be helpful for someone with true intolerances. The standard protocol involves cutting out all high FODMAP foods for 2-6 weeks and then systematically introducing them back in. As I’ve said, I do this with clients when appropriate, and am always aiming to prioritize eating as many foods as possible.

Final Thoughts

There are so many anecdotal tales and influencers on the internet and social media these days. It’s totally overwhelming. Not to disqualify people with lived experience – those stories matter too. But someone’s tale of how they “healed their gut” by cutting out gluten may not be what you need, especially if you’re in eating disorder recovery, officially or not.

If you have serious digestive issues, it makes sense you’d want a solution to that like yesterday. Remember to demand good evidence before you start a new protocol, especially if you have a disordered eating history. Restrictive diets may do more harm than good by limiting the diversity of nutrients and beneficial bacteria in the gut.

If you are ready to get figure out what’s causing your bloating once and for all and do that with someone supporting you in your eating disorder recovery, I’d love to help. Set up a discovery call with me today and we’ll talk about how to get started. 

About Emily

Emily Van Eck, MS, RDN specializes in intuitive eating, mindfulness-based eating practices, embodiment with food and movement, and healing from years of weight-bias and disordered eating. She helps all kinds of people find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified Intuitive Eating counselor with a master’s degree in nutrition science. Read more about her here.

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Hey there, I´m Emily

A non-diet and weight-inclusive dietitian, intuitive eating coach, and body image healer. Here on the blog, I focuses on exploring intuitive eating, gentle nutrition, the complex arena of body image and feminism, anti-oppression, and all the ways these things intersect. I want us all to be free to own our appetites, and our desires, and eat really, really well. 

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