This post is the final installment of a series on intuitive eating and IBS. Read part 1 to learn more about what IBS is, and a discussion of the pros and cons of different dietary approaches to treatment, and part 2 to learn approaches to managing symptoms that don’t involve dietary restriction. Today’s post will discuss the relationship between disordered eating and IBS, and strategies for coping with IBS when you are also struggling with disordered eating.
Looking back on my dietitian education, one thing I really wasn’t aware of early on was the relationship between IBS (and other digestive disorders) and disordered eating. This is frustrating to me today, because I see where I could (and probably did) do a lot of harm treating clients with digestive disorders with a restrictive approach to food, without fully screening for disordered eating. I mention this because if you have IBS and struggle with disordered eating, you may have received a lot of dietary advice, even from professionals, that worsened your disordered eating. So please know that although I’m sure it was well intentioned, it may have been given by someone who really didn’t understand how harmful it can be.
IBS is incredibly common among people diagnosed with eating disorders. One study found that in a survey of women diagnosed with an eating disorder, 50% met the criteria for IBS, and 98% met the criteria for at least one functional gut disorder. Of course, that doesn’t mean everyone with IBS has disordered eating, but it’s been my experience that almost every client I’ve worked with who suffers from IBS engages in some disordered eating behaviors, or at the very least experiences stress and anxiety around food that contributes to symptoms.
If you struggle with disordered eating and IBS, there may be an element of “chicken or the egg” to it. IBS can trigger disordered eating behaviors - dietary restriction and elimination diets can have a snowball effect, and fear of experiencing symptoms after eating can make eating a stressful experience.
Disordered eating behaviors can also cause GI symptoms in many different ways. Restriction can cause the muscles in the digestive tract to atrophy, or weaken, which can lead to constipation, bloating due to trapped stomach gasses, and gastroparesis, or delayed stomach emptying. Eating limited food variety can disrupt the microflora of the gut. Excessive fiber consumption, from eating too many vegetables, fruits, whole grains and beans (aka what basically every clean eating blogger tells you to do), can cause extreme gas and bloating. Self-induced vomiting can weaken the esophageal sphincter, leading to gastric reflux. Use of laxatives can lead to weakening of the gut muscles. And while damage to the gut is more severe in eating disorders, engaging in disordered eating behaviors (dieting counts as a disordered eating behavior!) can cause digestive symptoms. I’ve had so many clients whose IBS symptoms have completely or almost completely resolved when they stop dieting, and start feeding their body adequately and consistently.
If you struggle with disordered eating and IBS, here’s some tips that may be helpful:
Be wary of elimination diets.
Elimination diets are appealing, but they can do a lot more harm than good if you’re not in a good place with food. Elimination diets can create a lot of stress around food, even for someone without disordered eating! That stress often worsens symptoms. Before eliminating any food or attempting an elimination diet, make sure you’re working wIth a dietitian who has experience with IBS and disordered eating (happy to help!). Working with a dietitian, they may be able to do a food-symptom journal and identify likely dietary triggers, like lactose intolerance, which can quickly and easily be tested in a methodical way, rather than randomly eliminating more and more foods.
Focus on consistency and balance first.
Working with a dietitian, aim to fuel your body adequately throughout the day with a combination of fat, protein, carbohydrate, and produce. Typically that means eating something, either a meal or a snack, every 3-4 hours, alining with the gut’s rhythms. Overtime, this will help diminish IBS symptoms that are related to disordered eating patterns, then you can see what symptoms still remain and target those with medication, supplements, lifestyle or dietary intervention. I think it’s really important to prioritize establishing consistent eating patterns, because that actually helps your body tolerate foods that may trigger symptoms when paired with disordered eating patterns. For example, this study shows how high FODMAP foods are more likely to cause symptoms in people with eating disorders than those without.
Low calorie foods and methods of appetite suppressing may contribute to symptoms.
Eating airy, low calorie foods like popcorn or rice cakes, chewing excessive gum, or drinking carbonated beverages to suppress appetite can cause you to swallow a lot of air, which can contribute to reflux and bloating. Many sugar free foods are made with sugar alcohols, that can cause diarrhea and bloating. Same goes for fiber enriched foods (I’m looking at you fart bars…I mean fiber bars!) which often use a fiber called inulin that the bacteria in our gut kinda goes crazy for. Coffee is another drink often used as an appetite suppressant, but the caffeine can have a laxative effect. I’ve also heard of people trying to “fill up” on water before eating, but more often this will just lead to reflux and loosening the sphincter from the stomach to the esophagus that’s supposed to keep food inside.
Destress before meals.
Part of eating disorder/disordered eating recovery is learning to eat adequate meals, and reintroducing foods that may have been off-limits. This can be really scary, and that fear/stress can contribute to symptoms. Sucks, right? I mean, here you are just trying to feed your body, and our silly little brain and it’s irrational fears are getting in the way!
It can be helpful to learn strategies to destress before meal time so your gut is a little less stressed before food goes in. Try a 2-5 minute guided meditation or deep breathing exercise, and try to make your eating experience less stressful by eating alone or with other people (depending on your needs) or eating with distraction or with mindfulness (again, depending on your needs).
Work with therapist
A therapist is a crucial part of the team in treating eating disorders, but I often find people with disordered eating behaviors or IBS are hesitant to work with someone for mental health. Because the brain-gut connection is so strong, and because there is such a strong connection between anxiety and IBS, I think working with a therapist is just as important. A therapist can help you learn strategies for stress management, or how to better cope with stressful or anxiety provoking situations. They can also help teach you strategies for sitting through discomfort - a big part of eating disorder recovery, AND learning to cope with the uncomfortable physical feelings that come with IBS!
You may feel worse before you feel better.
I know, way to end on a positive note! The truth is, when it comes to healing from an eating disorder or disordered eating, your GI symptoms may feel worse before they start to feel better. That’s not true for everyone, but that is many people’s experience. If that has been yours, please know that you’re not doing anything wrong, it’s just your body getting used to being fed again. The discomfort doesn’t last forever. Be prepared with some simple self care strategies - a heating pad can do wonders! - and work with your team to help cope with symptoms as you’re learning to feed your body again.
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