“I feel so bloated” – “My belly hurts” – “If I eat any more I’ll explode” – I’m so constipated”
Do any of these sound familiar? If so, that’s because digestive complaints are common when struggling with eating disorder recovery and can include constipation, gas, pain, bloating, diarrhea, acid reflux, indigestion and more.
I often hear my clients say their “stomachs have shrunk” which is why they can only eat small amounts of food at a time. Food restriction, as well as bingeing and purging, does indeed cause the muscles lining the entire digestive tract from the esophagus to the anus to become deconditioned and “shrink,” so food empties very slowly.
Food will literally sit in the stomach or bowel for hours, causing gas, bloating and pain.
No matter the composition of the food you consume, your body is going to need time to get accustomed to being fueled on a regular basis.
“Intuitive eating” — or learning to eat according to hunger and fullness — is a long-term goal for recovery. Unfortunately, during refeeding, hunger and fullness cues are way off… most people recovering from an eating disorder have to endure extreme discomfort while eating — the exact opposite of intuitive eating!
A note on bloat
When refeeding, trapped gas combined with food may distend your belly visually. This is totally normal and results from wastage of the muscles that support your abdominal cavity. These muscles are not yet strong enough to “hold” your stomach in. Have patience — this will resolve with regular meals and snacks.
Irritable bowel syndrome (IBS), food allergies and your gut
Irritable bowel syndrome and food sensitivities are commonly seen in people with eating disorders. Your body has forgotten how to process many of the foods you’ve avoided, such as cow’s milk, yogurt, ice cream and cheese, and carbohydrate foods like breads, pasta and cereals.
You may believe that you have a gluten sensitivity and lactose intolerance as you reintroduce these foods and your GI tract reacts badly.
Most of these sensitivities and IBS will resolve with refeeding, so give it time. “Special” diets, or eliminating certain foods in an attempt to alleviate symptoms is not wise to try while in recovery. Work with your dietitian to slowly introduce foods back into your meal plan. If prior to your eating disorder you were diagnosed with a gastrointestinal illness such as celiac, colitis or food allergy, your doctor and eating disorder dietitian will individualize your plan.
Practical tips for dealing with GI recovery symptoms
Constipation Relief Tips:
- Make sure you are eating food at regular intervals. Timing meals and snacks at about 2-3 hours apart tends to make one’s stomach feel less uncomfortable. There is no substitute for food as your medicine.
- Fluids are equally important, as well as fiber, from a variety of sources such as grains, nuts and seeds, fruits and vegetables.
- Consuming fats such as nuts, avocado and oils can also help get your bowel moving more regularly.
- Your doctor might suggest a few medications including fiber supplements, Miralax, and perhaps a probiotic.
Note: It is essential that you discuss any plans to take medication or supplements with your physician.
Gas, Bloating, Cramping and Frequent Bowel Movements:
- There is no way to state this enough — the best treatment for gas, pain and bloating is to continue eating at regular intervals. Digestive enzymes that help break down food and healthy bacteria in the gut are reduced, so extra gas (and smelly gas!) is produced as bacteria “ferments” this partially digested food still sitting in your digestive tract.
- Reduce or halt consumption of sugar-free gum, mints and excessive quantities of fruits and veggies. Another contributing factor to “belly bloat” is sorbitol and fructose, natural sugars that are found in sugar-free gum and mints.
- Your doctor might recommend simethicone (Gas-X) to help relieve gas pain as well as a medication to help food move through your system faster (such as Reglan).
- Belly “soothers” include hot water bottles, warm compresses or heating pads on your abdomen.
- Frequent bowel movements and even diarrhea are common when you start eating more regularly. You can try adding soluble fibers such as oats and oatmeal, applesauce and even rice.
Some alternative suggestions that are worth speaking to your doctor or dietitian about:
- Digestive enzymes such as Lactase and Bean-o may help initially since these natural enzymes are depleted when a person restricts food.
- Peppermint oil (sold in capsules) and mint tea appear to have a very good antispasmodic effect for those with pain and cramping. It seems to help slow the natural peristalsis of the gut by calming muscle contractions in the stomach and intestines. This is not appropriate if you are having acid reflux.
- Speaking of reflux — if you have frequent heartburn, your doctor might recommend a medication to protect your esophagus from damage by acid. This is commonly seen with purging.
- Gentle yoga and mindful meditation have been very effective at reducing stress and anxiety related to recovery, which in turn, can help calm your digestion.
- Don’t hesitate to discuss other medications for anxiety with your doctor, as anxiety can contribute to GI distress.
Gastrointestinal problems are very normal and are to be expected during the first year or two of recovery.
If you still have GI problems that do not resolve with regular, consistent eating and maintenance of a healthy body weight, it is wise to be evaluated by a physician with a complete GI workup. Recovery takes time and much patience. Our minds and bodies work very closely together.