Bloating in eating disorder recovery

7 Feb, 2024
Jennifer Low
Bloating in eating disorder recovery

Co-written by Gina Giebner (Gastro Dietitian) & Jennifer Low (Eating disorder Dietitian)

Eating disorders are complex mental health conditions that have physical consequences.

Bloating in eating disorder recovery is a common complaint, and one that can severely hinder a person’s efforts at recovery.

While the psychological and emotional aspects of these disorders are well-known, their impact on the gastrointestinal (GI) system is often overlooked.  Often people are told that when they recover from their eating disorder the symptoms will improve.  Whilst that is often the case, trying to manage these debilitating symptoms whilst also recovering from an eating disorder, can feel very overwhelming.

In this blog post, Gina, our specialist gastro Registered Dietitian, explores the various GI symptoms that people with eating disorders may experience & provides some ways that these can be alleviated in the short term (in the longer term, recovery from the eating disorder will eventually mean that you don’t have these symptoms anymore).

Stomach Pain and Bloating:

Stomach pain and bloating, along with constipation, are probably the most frequent issues we see in clinic.  People with eating disorders, particularly anorexia nervosa, often restrict their food intake, which can lead to a reduced production of stomach acid and digestive enzymes.

This can result in delayed gastric emptying, bloating, discomfort, and abdominal pain.  This does all improve with time and proper nourishment, but in the meantime have a look at Gina’s tips below.

Top 3 tips
● Try finishing a meal with a mint, ginger or fennel tea
● Manage stress and anxiety in healthy ways – such as yoga or mindfulness practices
● Avoid fizzy drinks

Acid Reflux and Heartburn:

One of the most common GI symptoms associated with eating disorders is acid reflux, also known as gastroesophageal reflux disease (GERD).

Acid reflux occurs when stomach acid flows back up into the oesophagus, causing a burning sensation in the chest and throat. Frequent vomiting can contribute to the development of GERD.

Top 3 tips to reduce symptoms

  • Eat regularly through the day
  • Swap your caffeine drinks to de-caffeinated
  • Chew well and eat slowly, allowing time before lying down after food (around 60 minutes before going to bed)

Diarrhoea and Constipation:

The irregular eating patterns and restrictive diets associated with eating disorders can disrupt normal bowel movements. Diarrhoea may occur as a result of malabsorption due to inadequate nutrient intake. On the other hand, constipation can arise from insufficient fibre, energy & fluid intake. Both symptoms can be distressing and contribute to further disordered eating behaviours.

Top 3 tips
● Try to finish a meal with soft fruits, such as kiwi, and a calcium rich food like Greek Yoghurt
● Make sure you are drinking enough (around 6-10 glasses/mugs a day)
● Eat regularly through the day

Gastroparesis:

Gastroparesis, a condition characterised by delayed stomach emptying, and is commonly seen in individuals with eating disorders. Malnutrition and electrolyte imbalances can affect the normal muscular contractions (peristalsis) required for food to move through the digestive system. Also, because lack of energy causes the all the processes in the body to slow, just the lack of energy itself can mean that stomach emptying is delayed, which can lead to feelings of fullness and bloating in eating disorder recovery, when someone is trying their best to nourish themselves more fully.

Gastroparesis can lead to feelings of fullness, early satiety (fullness), as well as nausea.

Top 3 tips
● Stick to softer, easy to digest foods
● Eating little and often throughout the day
● Eating 6 smaller meals a day can be better tolerated

Dental Problems:

Frequent vomiting associated with some types of eating disorders can have a detrimental effect on dental health. The stomach acid that comes into contact with the teeth during episodes of vomiting can erode tooth enamel, leading to tooth sensitivity, decay, and even tooth loss. Poor nutrition can also weaken the teeth and contribute to oral health problems.

Top 3 tips
● Finish a meal with a calcium rich food like a lump of cheese/Greek yoghurt
● If cold drinks feel painful on sensitive teeth, then try having warmer drinks, such as decaffeinated or herbal teas
● Stick to softer, easy to eat foods for the time being

Malnutrition and Nutrient Deficiencies:

As we know, eating disorders often involve restrictive diets, cutting out of whole food groups, limited variety and inadequate food intake, leading to malnutrition and nutrient deficiencies.

The lack of essential vitamins, minerals, and other nutrients can affect the entire body, including the GI system. Malnourished people may experience weakened GI muscles, impaired digestion, and absorption issues, further exacerbating their symptoms.

Top 3 tips:
● Eat regularly through the day
● Try to eat a variety of different foods throughout your week
● Seek advice from a registered dietitian on any micronutrient supplements

Electrolyte Imbalances:

Electrolyte imbalances, such as low levels of potassium, sodium, and magnesium, are common in individuals with eating disorders. These imbalances can disrupt the normal functioning of the GI system, leading to irregular bowel movements, muscle weakness, and increased risk of dehydration.  These imbalances are detected through blood tests and need to be carefully managed by your GP or treatment team.

In conclusion, gastrointestinal symptoms, in particular bloating and tummy pains during recovery from an eating disorder, can significantly impact a person’s physical health and overall well-being. It is crucial to recognise and address these symptoms as part of a comprehensive treatment plan.

Seeking professional help from specialist Registered Dietitians is essential to manage both the psychological and physical aspects of these conditions. By understanding and addressing any GI symptoms, we can support people on their road to recovery, and improve their quality of life.

Gina, our fabulous gastro dietitian, often carries out one or two sessions with our clients who have disordered eating to make symptoms more manageable, whilst they are making positive changes to recover from their eating disorder.

Find out more about our services here.

Jen Owner of JL Nutrition Clinic

Jennifer Low, Registered Dietitian, PgDip, MSc Nutrition, BSc Psychology