Digestion and Eating Disorders: Where to Start
Eating disorders and digestive struggles go hand and hand but often are not addressed together. Here's some support for your digestion in your recovery journey.
If you’ve been in eating disorder treatment before and struggled with digestive symptoms (most people do), you’ve probably heard “it will get better if you follow your meal plan.” While it has some truth to it, it feels dismissive of someone’s current pain and discomfort and may not be the only fix.
I see many clients who end up with an eating disorder or disordered eating after having digestive symptoms. Maybe they went to a gastroenterologist and were told it’s “just IBS” or anxiety. It makes me so frustrated knowing that they likely spent hundreds on a specialist visit without much help. Some GI docs are great but others are not so helpful.
The story often goes that they end up on social media or Dr. Google and find a restrictive elimination diet plan. I never blame someone for wanting to make a change because they are in pain, embarrassed, or uncomfortable about their daily GI symptoms. Some eliminations may truly help short term or long term too.
Yet, restrictions can often lead to missing out on specific nutrients, disordered eating patterns, obsessive thoughts and worries about food, and difficulty implementing it in day to day life. It makes it hard to eat out, eat socially, or find joy in food.
Many eating disorder clients either have long-term GI symptoms or end up with digestive symptoms during recovery and feel stuck with what to do about it.
It’s possible to work on supporting digestion throughout the process, whether you’re working on eating disorder recovery, in recovery but still struggling with digestion, or somewhere in between.
Why Digestion is Impaired
As a knowledge-hungry person that is always learning, I always want to know what is going on physiologically. There’s a reason digestion is impaired with eating disorders, disordered eating, chronic dieters, or in people in living in modern socieyt.
One of the foundations I look at with all my clients is energy intake.
Are you eating enough?
This is a very dietitian thing to ask and look at first, but it’s important. Digestion requires eating enough energy, carbohydrates, protein, fats, and mcironutrients.
If nutrient intake is low, the body is going to compensate and will not function as well. It’s going to prioritize keeping you alive by keeping your heart beating, lungs breathing, and brain working the best it can. Digestion is going to slow down. This often means constipation, bloating, gas, feeling fullness or food sitting in the stomach, gastroparesis, or reflux. Some people it may mean diarrhea or a combination of everything.
We start here because it’s surprisingly common for people to undereat. I’ve had sessions with clients coming for general nutrition support or GI support who are eating nutrient-rich foods or are trying to eat “healthy.” It’s not the case for everyone, but a lot of people are undereating…by a lot. They’re shocked and surprised when I say that because diet culture has taught us to always think we’re eating too much.
It’s easy to do if you’re including a lot of fiber-rich foods but limiting things like carbs or fat. We’ll talk about this below, but if you’re living in a state of stress, hunger cues and appetite can be diminished too.
Eating enough has to be a starting place because your body needs enough energy, macronutrients (carbs, protein, fats), fiber, and micronutrients to support digestion overall. You may need individualized support from an eating disorder dietitian to help you figure out what nutrition your body needs right now, as well as support inplementing your meal plan.
This may be controversial, but I find that micronutrients are often missed in eating disorder treatment. Yes, we don’t want to overly focus on nutrition and obsess about the nutritional components of every food, but micronutrients are essential for digestion, mental health, and the functioning of our body. We can approach micronutrients from a non-restrictive place by testing for deficiencies as indicated and focusing on a nutrient-rich intake through food and/or supplements.
Next is the nervous system.
I’ll argue that most of us have dysregulated nervous systems these days. We live in a hyperconnected, distracted, overwhelmed society and are overloaded with stressors in daily life, as well as from news, social media, and more.
When our nervous system is stuck in stressed state, we can fall into commonly known patterns of fight or flight (sympathetic nervous system), as well as freeze, fawn, or a collapsed state (dorsal-vagal, parasympathetic). I love using the polyvagal theory in my work (and life), and adding in nervous system work has been so helpful for me.
Our digestive tract is often called our second brain and is connected via the gut-brain axis. It has its own nervous system called the enteric nervous system. Our language is filled with phrases like “gut instinct,” “trust your gut,” and “gut feelings.” There’s research on the bidirectional impact of the gut and brain on mental health, gut function, and the gut microbiome.
When we move out of the sympathetic nervous system (fight and flight) into a more parasympathic ventral-vagal state, we can enter more of a “rest and digest” state. Digestion has a chance to function better in this state, and the body is more able to repair and heal its systems.
Exploring and learning how to understand your nervous system, as well as how to regulate it, can be so helpful to support digestion. Working on adequate nutrition - energy and micronutrients - can also support the nervous system because if blood sugar is low or the brain isn’t getting enough nutrition, anxiety is going to run high.
When our nervous system is more regulated, the body can focus on repair instead of simply survival. Throwing probiotics at the situation may help a little, but targeted nutritional changes or supplements will have a bigger impact if nervous system work is part of the picture.
Where to Start
The next question you may have is - “Okay, I understand why things may be impacted, but what can I do?” If you’ve spent time on Instagram, it’s easy to become overwhelmed with posts on the gut microbiome, probiotics, prebiotics, gut infections, stool tests, and more. While one product may help one person, it may be a waste of money or be harmful to another person.
First off, depending on the stool test you do, it may not be accurate, or you may spend a lot of money to get test results that show your gut microbiome is out of balance. One of the common approaches is to “kill” the pathogenic bacteria. That may help in the short term with symptoms, but it doesn’t address the underlying imbalance.
Instead of getting sucked into a protocol or trying to micromanage a bodily function, let’s look big picture at supporting digestion with some foundational health practices for your whole body (mind included). Sure, gut microbiome work may be helpful through a balancing, restorative approach vs just killing the “bad guys,” but I’d rather focus on big picture practices first before wasting money on stool tests and supplements that may not help in the long run.
The “Fix It” Mentality
Often, conventional and functional medicine approaches to digestive health is focused on “fixing” the problem. Your body is not a problem to be fixed. For whatever reason, something may be out of balance for your unique system, and we can work to restore it. This may take time, purposeful stepping out of “fix it” mode (something I’m working on too), and exploring your body’s unique system instead of chasing “perfect” digestion or another wellness obsession.
Supporting digestion is for your quality of life, so you can nourish yourself comfortably and explore life beyond your eating disorder.
We’ll talk about foundational health practices for digestion, nervous system, recovery, and overall wellbeing in following posts, but here are some initial go-to tools I offer to support digestion or the symptoms. Yes, they may not get to the root of the GI issues but can ease some of the discomfort in the meantime.:
Deep belly breaths before or after meals. When you use your diaphragm, you’re supporting the parasympathetic nervous system. This can be a structured breathwork practice or a few deep breaths in and out of the nose before and/or after meals.
Heating pad on your belly after meals if there’s pain or discomfort. While this doesn’t address the underlying digestive symptoms, it can feel nice and help ease some of the tension or pain in your stomach. Lying on your left side can also support the flow of digestion.
Herbal tea like peppermint or ginger. Tea can be a soothing ritual for your nervous system, and herbal teas like peppermint and ginger have digestive supporting properties.
Wear clothes that fit well, especially around the belly. Tight fitting clothes may cause more physical discomfort, as well as increase mental distress around body image.
Eat consistent meals/snacks during the day, and have some variety. This is going to be individual to you, but predictable meal times can help establish rhythms within your body. Variety could be having different meals/snacks or types of food throughout the day, week, month, or year. Again, this will be unique to you and what is doable to you, and you can work to expand variety with time.
Stay tuned for foundational whole-person health practices, digestive health education and tips, and nervous system regulation tools to support your relationship with food and your body.
