digestive issues in eating disorder recovery (Q&A pt. 5)
Today we will talk about digestive issues in eating disorder recovery. Oftentimes, people who have previously consumed only a very limited range of foods experience digestive issues as as they start to reintroduce the restricted foods back into their diet. Don’t worry – in the vast majority of cases the symptoms will get better over time, but if in doubt you should always have it checked out by a doctor to be on the safe side.
Before you read the box, a little trigger warning in advance. Here, a person reports on the diet they have followed over the past few months. So, if that might be triggering for you, then just skip that part – what you need to know is that the person now sees their quality of life significantly reduced as they can no longer eat out and always get stomach pains when they eat things that weren´t allowed in their diet.
Hey, I have a question or need your advice. I had been on a strict diet since March - no [...], no [...], no [...]. If I went out to eat with my friends once every 2-3 months, then I would take a "healthier" option. The diet seems to have worked and my body seems to have adjusted to it - But the problem is that in December I'm going to New York with my family, it will be my first time there and I want to eat and try whatever foods I want there. But the thing is, whenever I consume the smallest amounts of things that I've cut out of my diet, my body "hates" me. I feel sick and my stomach hurts. I don't even want to eat out anymore because I'm so scared of it. But I want to be able to eat in New York without ruining my own trip or my family's.
table of contents
Symptoms of digestive issues in eating disorder recovery
It is very likely that you will experience extreme bloating, flatulence, cramps, nausea or even diarrhea and constipation during recovery. All those things we usually don’t like to talk about. But it is very important: Experiencing uncomfortable digestive issues is pretty normal in your special situation and you don’t have to be ashamed of it. Your body has been through so much, it just needs a while to get used to normal eating habits again. Your stomach currently takes up to five times longer to digest a meal than a comparable “healthy” persons stomach without the background of an eating disorder.
Your body needs time to get used to eating regularly, enough, and a wide variety of foods again.
What causes digestive issues in eating disorder recovery?
You may have heard that our intestines are lined with the so-called intestinal flora. The intestinal flora is the entirety of all intestinal bacteria that colonize parts of the human large intestine (including the rectum in small quantities). About 10 trillion intestinal bacteria live in our intestines – with a total weight of about one kilo!
The intestinal flora has various tasks, ranging from food digestion, vitamin production, the neutralization of toxins, activation of medicinal substances to immune defence. We can even go so far as to say that our gut microbes affect our psyche, as they produce potent amounts of serotonin, dopamine and norepinephrine (feel-good hormones that affect your mood).
Today we know that our diet, our stress experience and our mental state influence the microbiome. If we eliminate certain foods from our diet and the variety of foods decreases, then the diversity of our intestinal bacteria also decreases, and the microbiome is thrown off balance. A variety of intestinal bacteria is optimal, which is achieved through a varied, high-fiber and colourful diet.
If our microbiome has been thrown out of balance, fermentation and putrefaction processes can occur that not only cause bloated stomach, abdominal cramps and unpleasant flatulence, but also cause the food and the vital substances it contains to simply pass through the gastrointestinal tract, without being adequately utilized and absorbed. This in turn can lead to a vitamin deficiency, which can trigger other symptoms – e.g.
- Your skin is getting worse
- Your hair becomes thin and falls out
- Nails become brittle
- you feel tired and exhausted all the time
- …
The phenomenon lactose intolerance in eating disorder recovery
During my own recovery – anything containing lactose had given me an uncomfortable time in the bathroom. It took me a while to even discover the correlation between my dairy intake and digestive discomfort in recovery. And it took almost even longer for my body to get used to lactose again. Today I no longer have any problems with dairy products, so my lactose itself has actually not been the real problem.
“We have to feed our bacteria in the gut so they can survive, so whatever you eat makes certain bacteria more or less able to reproduce. So, people who consume lactose relatively regularly have more of the enzyme lactase than people who have gone lactose-free for a while. This means that if you weren’t lactose intolerant before your eating disorder, your body only has to get used to digesting dairy products again. So, indigestion during recovery is quite normal and usually temporary.
Dealing with digestive issues in eating disorder recovery
- Gradually increase the variety of foods you eat
For example, if you have trouble digesting lactose, gradually increase the amount of dairy products. A lot at once doesn’t necessarily mean your digestive tract is going to recover faster, because then your intestines are simply overloaded. For example, you can drink 1/3 cup of milk 3x a day and gradually increase it - when you experience diarrhea, an increased amount of fibre my help: e.g. oatmeal, rice and apple sauce, on the other hand, reduce – preferably avoid – sugar substitutes, as these often lead to flatulence. (Especially sugar-free chewing gum)
- Hot-water bottles, lots of tea, loose clothing, a stomach massage, light exercise (yoga, walking,…)
- try to accept your body the way it is right now. It´s doing it´s best to keep you alive. it doesn’t work against you or hate you. It´s on the same team, remember that.
Sit out that uncomfortable period of digestive issues in recovery. It is only temporary. To keep engaging in the eating disorder/disordered behaviours would mean that you are permanently unable to enjoy life to the fullest. Not being able to go out with your friends, not being able to go on vacations, etc. limits yourself and the experiences you can have. That’s really not worth a “smaller” body.
Sources I used
Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr. 1996 Aug;64(2):232-6. doi: 10.1093/ajcn/64.2.232. PMID: 8694025.
Radka Roubalova, Petra Procházkova, …, Anorexia nervosa: Gut microbiota-immune-brain interactions. https://doi.org/10.1016/j.clnu.2019.03.023
The Impact of Starvation on the Microbiome and Gut-Brain Interaction in Anorexia Nervosa
