Eating disorders and chronic dieting wreak havoc on your metabolism and overall health—not only during the time you struggle with the eating disorder, but in the years after.

From metabolic imbalances to digestive difficulties, immune dysfunction, chronic anxiety and low energy— It’s something I call “post-recovery recovery”, what happens to your body after years of under-eating, over-training, binging, purging, restricting, and everything else in between. 

While many doctors, treatment centers and health books tell you about the ill side effects from active eating disorders, like: 

 

  • nutrient deficiencies
  • hair loss
  • Constipation
  • skin rashes and breakouts
  • brittle nails 
  • weight loss or weight gain
  • seizures
  • fatigue
  • anxiety and depression
  • death 

 

 

 

Many healthcare professionals, treatment centers or books rarely address the chronic health conditions that arise from a long-term eating disorder or restrictive diet, particularly once individuals are in recovery, weight restored (“healthy”) or mentally healed.

 

Post Recovery Recovery “Mystery” Side Effects

 

  • Chronic Constipation, IBS & Bloating
  • Unwanted Weight Loss or Weight Gain (“Metabolic Inflexibility”)
  • Mass Cell Activation Syndrome & Autoimmune Disease
  • Food Intolerances
  • ARFID
  • Missing Your Period
  • Young-Onset Osteoporosis
  • Poor Hunger Cues
  • Anxiety, Low Energy & Fatigue
  • Loss of Identity

 

 

Again, I call these “Post Recovery Recovery” from your eating disorder because it’s often what happens after recovery has ensued—and although your head is in a much better place, your body is still recovering.  

woman struggling with eating disorders, sitting on the floor

 

The Struggle is Real

It’s something I’ve both experienced myself and have seen time in time again in hundreds of patients I’ve worked with in my clinical functional medicine, therapy and nutrition practice:

 

Women who are so over “ED”—they are ready to move on with their lives and break free mentally, but physically, it’s like their body has not “caught up” online. 

 

Exhibit A: 6 Years Post-Recovery

At age 29, I was well over my eating disorder. My near death battle at age 23 was the “wakeup call” I needed to turn my life around and tell ED to “eat my dust.” 

 

However, after treating my body like it was a concentration camp victim for over 15 years, my physical healing journey was on its own timeline.

 

I found myself in a BIG physical health dilemma with a cascade of diagnoses and symptoms, including:

 

 

  • Chronic bloating, constipation and IBS
  • Unwanted weight loss
  • Metabolic “inflexibility”—no matter what I ate, or how much, I stayed lean
  • Hypothyroidism
  • 3 Autoimmune Disease Markers (Hashimoto’s, Lupus, Colitis—Irritable Bowel Disease)
  • Diabetes Type 1
  • Mass Cell Activation Syndrome (MCAS)

 

 

There is ALWAYS a Root Cause to Body Imbalances

Ironically, I had just begun my functional medicine educational journey, and with the help of some functional lab testing and knowledge about nutrition and the body’s biochemistry, it didn’t take me long to get to the “root causes” of these chronic health conditions, including: 

 

 

  • SIBO (small intestinal bacterial overgrowth)
  • Dysbiosis + Bacterial Infections (pathogenic bacteria in my gut)
  • Low Stomach Acid + Digestive Enzyme production
  • High Free Cortisol (stress hormones)
  • Under-Methylation (poor enzyme function and nutrient processing)
  • Mold/Mycotoxin Illness (exposure to living in a home with hidden mold)

 

 

Although those words may sound big and scary, the bottom line is: BOTH my eating disorder and treatment had wreaked havoc on my gut and stress hormones!

The Gut-Health Connection

Consequently, the rest of my health suffered as well (fact: your gut and cortisol levels are the “gateways to health”—immune function, mental health, hormones, metabolism—all of it). 

 

Eating Disorder=Bad Gut Health

In my eating disorder, lifestyle habits that impacted my gut health included: 

 

  • Cutting out entire food groups
  • Eating only 3-10 foods (low variety)
  • Low calorie and low nutrient intake
  • Overtraining 
  • Living in a state of chronic stress
  • Isolation from friends and family
  • Lack of joy in my life and activities

 

 

Conventional Treatment=Bad Gut Health

Many treatment modalities equally did not help my gut. Even though my treatment centers and providers did the best they knew how to do to keep me alive, the long-term consequences and lack of knowledge about how these treatments affected my gut health and hormones were never addressed. These included:

 

 

  • A steady diet of refined and processed foods for months and years at a time (Pop-tarts, pizza and Egg McMuffins were regular staples in my treatment diet)
  • Frequent and high exposure to many foods I was intolerant to with my autoimmune diseases 
  • SSRI’s (Prozac, Lexapro)—long term use
  • Lack of joy and purpose in the recovery process (recovery was often focused on therapy and eating—not life outside the disorder)

 

 

I felt stuck! Although I knew I wanted a way out—both my eating disorder and treatment weren’t helping. Here are 10 health side effects of eating disorders doctors won’t tell you about—and what to about it. 

 

10 Health Side Effects of Eating Disorders That Doctor’s Won’t Tell You About

 

Post Recovery Recovery “Mystery” Side Effects

 

  • Chronic Constipation, IBS & Bloating
  • Unwanted Weight Loss or Weight Gain (“Metabolic Inflexibility”)
  • Mass Cell Activation Syndrome & Autoimmune Disease
  • Food Intolerances
  • ARFID
  • Missing Your Period
  • Young-Onset Osteoporosis
  • Poor Hunger Cues
  • Anxiety, Low Energy & Fatigue
  • Loss of Identity

 

 

1. Chronic Constipation, IBS & Bloating

 

Gut health is rarely discussed in eating disorder treatment. 

 

However, if you’ve ever been in the “milieu” following a meal in a treatment center, you know that extremely foul gas, bloating and IBS are common “phenomenons” experienced universally by patients, and often thought to be “part of the process.”

 

For years, I was told that “gut issues” were normal and to “just deal” with my bloating, constipation and inconsistent bowel movements with Miralax and Colace stool softeners. Lactaid pills were administered like candy whenever cheese, milk or ice cream was being served, and TUMS were regularly passed out when gas struck. Nevertheless, the bloating and constipation persisted, and did not go away—even when I attained recovery. 

 

Why do you feel constipated or bloated in recovery?!



Gut Bacteria 101


Three words: Imbalanced gut bacteria. 

 

Your gut bacteria are the “conductors” of your body’s orchestra of health. 

 

You have MORE gut bacteria (40 trillion) than cells in your body, and your gut bacteria are responsible for:

 

    • Governing your metabolism (how well you absorb and digest your food)
    • Regulating estrogen and your period 
    • Balancing your neurotransmitters (brain cells) and mood
    • Busting anxiety
    • Building up your immune system (helping your body fight pathogens, infections)
    • Boosting your energy
    • Determining your body composition (body fat, bone mass, muscle mass)
    • Helping you see “results” in the gym 
    • Regulating your sleep
    • Keeping your skin clear

 

  • And so much more!

 

 

There’s practically a new study every day demonstrating the vast impact that your gut health has on your total health!

 

Research on individuals with eating disorders in particularly has repetitively shown imbalances in gut bacteria and inflammation in the gut (“leaky gut”). (1, 2, 3, 4)

 

Common Gut Imbalances in Eating Disorders

 

Common imbalances I’ve observed in individuals with eating disorders (active or history) include:

 

  1. Pathogenic bacteria infections and fungal/yeast overgrowth
  2. Insufficient amounts of healthy gut bacteria bacteria
  3. Low gut bacteria diversity 

 

The result:

 

    • Bloating
    • Constipation
    • IBS
    • Gas
    • GERD
    • Liver/gallbladder dysfunction
    • Other “gut-related issues”:
      • Candida
      • SIBO
      • Dysbiosis
      • Parasites
      • Lyme disease or “Co-infections”
      • Leaky Gut
      • Immune Disruption (mass cell activation, autoimmune disease, chronic fatigue)

 

(Just to name a few things)

 

The Gut Microbiome-Eating Disorder Connection

How does your gut “go bad” in the first place? 

 

Several triggers from your eating disorder drive gut up and continued struggles with food the longer the disorder goes on. 

 

Here’s how it works: 

 

Trigger #1: Stress alters your gut microbiome.
Stress always precedes “gut issues” and, in the face of LOTS of stress, your gut microbiome changes, leading to “dysbiosis” and decreased microbial diversity. 

 

Some common “gut stressors” (both during and preceding the eating disorder) may include: 

      • C-section baby or formula fed 
      • Eating processed foods as a kid
      • Antibiotics
      • Long term medication use
      • Unidentified food intolerances
      • Living in “fight or flight mode” (not resting, breathing, on the go all the time, chewing your food well, etc.)
      • Missing key nutrients in your diet
      • Overwork
      • Restrictive eating or diets (which lead to less diverse bacteria)
      • Binging or purging habits
      • Laxative abuse
      • Overexercise
      • Lack of sleep
      • Circadian rhythm disruption (shift work, screens at night, sleeping during the day, lack of natural light)
      • Environmental toxins (mold, EMF’s, hygiene/cleaning supplies)
      • Alcohol, drugs and/or smoking
      • Loneliness/isolation
      • People-pleasing
      • Constant pressure to achieve or perform
      • Lack of purpose/meaning—elevating stress, anxiety and depression
      • Perceived stress (financial, relationships, acceptance, etc.)

 

Although stress is inevitable in life and your body is hardwired to adapt to stress, if your stressors persist for too long or become too overwhelming for your body to “bounce back”, this leads to an altered gut microbiome.

 

Trigger #2: The changing gut microbiome then affects your appetite, metabolism, hormones (especially cortisol—stress hormones), hunger, and satiety cues (hello disordered eating). Altered gut bacteria tell you what foods to eat (or not eat)—causing cravings, obsessive food thoughts, or not wanting to eat at all.

 

Trigger #3: The metabolic changes in BOTH your gut and hormones contribute to further dysbiosis, which then further contributes to disordered thinking, depression, anxiety, OCD and other psychological issues.

 

Trigger #4: Your environment, personality and life circumstances pull the final trigger!

Why do some people get an eating disorder or “stay stuck” in their eating disorder and others do not—particularly if they face the same gut stressors? This is where psychology and your unique environment, personality and circumstances come into play—all part of the perfect storm

 

Some examples of “perfect storms” that can multiply the “brain-gut” connection in eating disorders include:

 

 

  • Upper middle-class pressures to “look perfect”
  • Getting teased about your weight or appearance
  • Growing up dancing or competing—and constantly comparing yourself to other’s bodies 
  • Sexual assault
  • Poor parental involvement/care
  • Trauma 
  • Being the first child—pressures to succeed
  • Being the middle child or younger child—constantly living in the “shadows” of your older sibling
  • High expectations or demands (work, school, performance)
  • Unhealthy relationships

 

 

The equation: 

 

  • Stress + a disrupted gut microbiome  + the perfect storm” = disordered eating.  

 

 

It’s a vicious cycle. 

 

The Brain-Gut Connection


The brain-gut connection is exactly what it sounds like: Your brain (stress levels) affect your gut, just like your gut affects your brain. Although most psychologists don’t talk about it, your brain health is a direct reflection of your gut health—in fact, the two are physically connected. They are a two-way street! 

 

For instance:

 

 

  • 90% of your serotonin (your “feel good brain chemicals”) is produced in your gut
  • You have MORE neurons (brain cells) in your gut than any other part of your peripheral nervous system
  • Your vagus nerve—the nerve that governs your digestion and stress levels—is directly connected from your brain to your gut

 

 

If you’ve every experienced “butterflies” in your stomach before making a public speech, you’ve felt the “brain connection.”

 

In short: your brain health is “imbalanced” (like an eating disorder, obsessive thoughts about food and exercise, eating, anxiety, depression, stress), it is a common indicator that something in your gut is actually off. 

 

Interestingly, research has found that when you increase healthy gut bacteria, your brain balances out. Evidence in mice demonstrates that probiotics and pre-biotics (fiber that feeds probiotiocs) significantly alters bacterial abundances in the intestinal microbiota, and decreases both anxiety and depression. 

 

The Disordered Eating-Gut Connection

Disordered eating behaviors themselves—not just mental stress—can also cause GI symptoms in many different ways. 

 

Ongoing physiological stress impacts our gut bacteria just like poking a wasp nest—the more you poke, and poke, and poke, the more disrupted your gut microbiome gets:

 

      • 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 raw vegetables, fruits, whole grains and beans (aka what basically every clean eating Instagramer showcases), can cause extreme gas and bloating.
      • Lack of protein, carbs or fats can cause food to digest slower than usual (because nutrient synergy is missing)
      •  Self-induced vomiting can irritate and weaken the esophageal sphincter, leading to gastric reflux. Use of laxatives can lead to weakening of the gut muscles.

 

  • Overtraining “stomps out” and diminishes healthy gut bacteria, leading to more inflammation in the gut, more stress (cortisol) in the gut, decreased stomach acids and enzymes, more bloating and constipation

 

    • Eating diet foods (packaged bars, shakes, frozen foods, artificial sweeteners) can cause elevations of hydrogen gas—primarily because additives, sugar alcohols and other odd ingredients are “foreign” to your gut bacteria
    • Living in a state of “fight or flight” paralyzes your vagus nerve (the “rest and digest” nerve) and suppresses natural stomach 

 

Researchers at UNC-Chapel Hill School of Medicine looking at the gut microbiome in eating disorders–specifically anorexia— have found that disordered eating  significantly diminishes the amount of healthy gut bacteria, further contributing to the anxiety, depression, and further weight and hormone imbalances in people with eating disorders. 

 

In their study, they evaluated the gut microbiomes of patients who underwent a 12 week conventional eating disorder recovery program. At the end of 12 weeks they found that although bacteria diversity had increased, it was still significantly less diverse than that of 12 healthy individuals, whose gut microbiotas were analyzed for this study—begging the further analysis of what a more targeted approach to “gut healing” could do for individuals in recovery from eating disorders.

 

The good news?  I’ve had many clients whose IBS, bloating and constipation, symptoms have completely or almost completely resolved when they stop dieting, and start feeding their body adequately and consistently.  

 

The Bottom Line: An unhealthy (stressed) gut equals an unhealthy you (eating disorders included, along with gas and bloating side effects). A healthy (less stressed) gut equals a healthy you. 

 

2. Unwanted Weight Loss or Gain

 

“Why is my metabolism not working?!” 

 

It’s a cry I’ve heard hundreds of my patients exclaim over the years. There are 3 types of patient profiles I see within the “metabolism mayhem” conundrum:

 

Type 1: Gaining Weight (without Trying)

For some, their metabolism seemingly “stalls”— within months or years following their eating disorder, they start gaining weight by simply looking at a piece of pizza. 

 

Type 2: Losing Weight (without Trying)

For others, their metabolism goes “haywire”—it seems like no matter how much they eat, the food doesn’t “stick”. They have to eat one to two times more food than “most people” to keep weight on, or they easily start losing weight or “backsliding” if they miss a meal or go on vacation. Mentally, they aren’t actively pursuing the eating disorder, but for whatever reason, it seems like their metabolism has another agenda. 

 

Type 3: Metabolic Inflexibility (Stuck in Old Habits in Order to Feel “Normal” Physically)

Lastly, many recoveees experience “metabolic inflexibility”—“the inability to respond or adapt according to changes in metabolic or energy demands”. 

 

After years of disordered eating and restriction, they’ve seemingly trained their body to adapt to one way of eating or “surviving”—and if they “get off track” from that programmed metabolic way, their body pushes back. 

 

For example: If running every single day—rain or shine—was a part of your eating disorder, your body’s “metabolic norm” has been wired to run. You may experience that running seems to help keep your bowels “regular”, your digestion “working” and your neurotransmitters “firing.” However, if you try to skip a day of running, you’re constipated for days, you’re even more bloated after meals and you get brain fog—metabolically inflexible. 

 

Another example: If a low carb/no-carb diet was part of your “metabolic norm” in your eating disorder and you “lived” on high protein shakes, greens and almonds, you may find that when you try to add in some starch (sweet potatoes, rice, winter squash), your blood sugar seemingly goes “nuts”. You get brain fog, shortness of breath or IBS—what gives?! Your metabolism has seemingly been trained to “run on” protein for glucose energy—not knowing what to do with the carbs. 

 

The Common Root Causes of Metabolic Mayhem

No matter which category you fall into, In all 3 cases I often find that there two primary underlying root causes are at play in “metabolic mayhem”, including:

 

    • Chronic cortisol imbalances

 

  • Gut imbalance (SIBO, dysbiosis, gut bacteria infections, fungal overgrowth, leaky gut, insufficient healthy gut bacteria)

 

 

Again, I cannot stress enough how vital your gut bacteria, as well as your stress hormones, are to your full healing process—and, unfortunately, they are commonly out of balance and “managed”—not healed— during eating disorder treatment.

 

Multiple research studies show the direct links between your metabolism, stress hormones (cortisol) and gut bacteria:

 

 

  • Low bacteria diversity causes a “hyper-metabolism.” Studies in mice with gut bacteria similar to those with long-term histories of anorexia found that the mice not only had less body fat, but also had to eat 30% more daily calories of chow to maintain normal growth (compared with conventionally raised rodents). They were also more constipated and had slower digestion.
  • Certain gut bacteria make you more prone to “weight gain” (no matter how “healthy” you eat). When researchers switched the gut bacteria of lean mice and heavier set mice, they found the lean mice became heavier and the heavier mice became leaner.
  • Women with histories of long-term eating disorders—particularly that started in childhood— may alter their “cortisol” set point for their lifetime. To date, studies (1, 2) have show that childhood trauma or significant chronic stress on the body (restrictive eating, anorexia, overexercise) may result in a “cortisol set point”—meaning your body adapts to the conditioned level of stress, and your “normal” cortisol may continue to run “high” even once recovery ensues. Common “side effects” from higher levels of cortisol in these individuals may include: altered metabolic rate, increased insulin sensitivity, more prone to anxiety or “type A” behaviors, decreased muscle mass and bone mass, and hypothyroid symptoms (sluggishness, digestive difficulties, fatigue).

 

 

 

  • Long term restrictive eating, low carb diets & diminished gut bacteria can lead to thyroid imbalances—associated with a “slow metabolism.” Women with eating disorders experience two times the rate of thyroid disorders as healthy controls. Your thyroid is your “metabolic mothership”—telling your body how to use all your nutrients efficiently, maintaining lean muscle mass and giving you tons of energy. When the body is starved, the thyroid conserves energy by slowing down metabolism. With long-term restrictive eating, thyroid functioning slows to an absolute minimum. Cortisol then tells your thyroid to stop making the building blocks of active thyroid hormone, and energy diverts away from non-essential hormone functions, such as digestion, metabolism (using your nutrients efficiently) and hormone health.
  • Binge eating is associated with “greater metabolic dysfunction”even if you eat the same amount of calories as you would normally throughout the day. Glucose (blood sugar) regulation is significantly altered during binge episodes—quickly spiking blood sugar levels and cortisol, only to crash within hours of the binge. If this cycle continues regularly, it further drives your body’s cortisol levels out of whack, consequently leading to metabolic and body composition disruption.  

 

 

The Bottom Line: Chronic stress and a disrupted gut microbiome leads to “metabolic” imbalances in post-recovery recovery.

 

 

3. Mass Cell Activation Syndrome + Autoimmune Disease

 

Approximately 80% of your immune system is produced in your gut. 

 

Given that disordered eating can significantly alter your gut microbiome, it’s no wonder that immune system disruption is another common “phenomenon” in Post-Recovery Recovery. (Sensing a theme here?).  

 

Additionally, remember: stress is the #1 culprit of all body imbalance in the first place!

 

 In an eating disorder, you are living in constant “fight or flight mode” (stress mode). 

 

Consequently, BOTH mental and physical stress stimulate your body’s physiological stress response— releasing catecholamines and corticoids (stress hormones), which then “inflame” or suppress your immune cells, and produce a shift in the cytokine balance.

 

Translation: Stress causes inflammation in your immune system!

 

Eating Disorders Cause Imbalances in Th1/Th2 Cells

A healthy immune system has two primary types of immune cells known as: Th1 Cells and Th2 Cells. 

 

Your “Th cells” (short for “T helper cells”) are responsible for directing your immune system to function. T helper cells act like an orchestra conductor for your immune system. As the conductor, your Th1 and Th2 cells send signals to the “musicians” (the rest of your immune system) to play music (keep your body healthy). 

 

Specifically, T helper cells send signals, they release cytokines that guide all your other immune cells to do their job (like attacking of foreign invaders and killing pathogens). Cytokines are simply hormonal messengers responsible for the biological effects in the immune system— like a runny nose and sneezing during allergy season, hives in kids who are allergic to peanuts, and acne in teen).

 

Here’s an overview of what each type of immune cell does for your body: 

 

Specific Roles

 

Th1 Cells: 

 

  • More “immune stimulatory”—characterized by a higher release of cytokines.
  • Th1 cells tend to help your body kill pathogens and foreign better (like parasites or pathogenic gut bugs)
  • HOWEVER, if they are out of balance, they can also perpetuate MORE autoimmune responses and food intolerances/sensitivities (especially if your gut health, cortisol or immune system is off).

 

Th2 Cells:

 

  •  Characterized as  “immune deficient”.
  •  In general, people with Th2 dominance (more Th2 cells), tend to have a weaker immune system (they may get colds, flu’s and allergies easier), because they are more likely to experience an “immediate response” to allergens (peanut allergies, bee stings, pollen, viruses, etc.).
  • That said, people with more Th2 cells in their immune system tend to have lower systemic inflammation overall and autoimmune diseases are better at fighting infections that take hold outside of cells (extracellular infections).

 

 

A balance of BOTH cell types are necessary for helping your body defend against disease, toxins and foreign invaders.

 

However, if stress disrupts your Th1 and Th2 cell balance—one system becomes more dominant than the other, leading to immune “dysfunction” and a host of side effects including:

 

Th1 Dominance (Too Many Th1 Cells; Not Enough Th2 Cells)

    • Food sensitivities
    • Hashimoto’s
    • Low T3 Syndrome
    • Fatigue
    • IBS
    • IBD
    • Celiac
    • Crohn’s Disease
    • Lupus 
    • Gut infections
    • Low pregnenolone levels
    • PCOS
    • Blood sugar imbalances & Type 1 Diabetes
    • Skin conditions (Psoriasis and rosacea)
    • More likely to be thin 

Th2 Dominance (Too Many Th2 Cells; Not Enough Th1 Cells)

  • IgE-related allergies, which are immediate and measured by skin scratch tests 
  • Seasonal allergies
  • Airway constriction
  • Asthma
  • Nasal drip
  • Mucus
  • Eczema (Dermatitis)
  • Hay fever (Allergic rhinitis)
  • Decreased stomach acidity or GERD
  • Histamine intolerance 
  • Hives (Urticaria)
  • Chronic Fatigue Syndrome 
  • Uveitis, Grave’s disease, Sjogren’s, Oral Lichen Planus, SLE (also Th1 dominant)

Eating Disorders=Th1 Dominance

Most commonly, for those with histories of eating disorders and chronic stress (cortisol), I see an over-activated Th1 system, with a selective down-regulation Th2cytokines, leading to increased susceptibility of immune dysfunction, particularly these two manifestations:

 

    • Mass Cell Activation Syndrome
    • Autoimmune Disease

Mass Cell Activation Syndrome

“Mass Cell Activation Syndrome” (MCAS) is a fancy term for “immune system disruption.” MCAS is a condition in which you experience repeated episodes of the symptoms of “anaphylaxis” – allergic symptoms—often times that seemingly come out of nowhere. 

 

Both long term stress and underlying gut pathologies cause this cascade of immune system mayhem—dysregulating your Th1 and Th2 immune systems. 

 

MCAS is most commonly associated with the following symptoms:  

 

  • skin: itching, flushing, hives, sweating.

 

  • gut: diarrhea, IBS, vomiting

 

  • eyes: itching, watering.
  • nose: itching, running, sneezing.
  • mouth and throat: itching, swelling in your tongue or lips, swelling in your throat that blocks air from getting to your lungs.

 

  • lymph system: swollen lymph nodes

 

  • lungs: shortness of breath/trouble breathing, wheezing.

 

  • energy: fatigue, brain fog

 

 

Stressors activate your immune cells to release histamine and mast cell mediators during these episodes, and your body can feel completely out of whack. Histamine is produced in your hypothalamus—the part of your brain that regulates your stress response system. If your immune system is weak, the “littlest” things or changes in your diet, supplements or lifestyle habits can spike histamine and set “mass cell symptoms” off.

 

For example: Eating healthy “higher histamine” foods, like sauerkraut, spinach, avocado or salmon may set off a “histamine response” in your body, leaving you on the toilet or gasping for air if your immune system has had “enough”.

 

Another example: A slight increase in your exercise routine may also elevate histamine have you flat on your back—super fatigued or with swollen lymph nodes.  

 

Bonus: For a more detailed overview of MCAS, check out my functional medicine colleague Dr. Jill’s article

 

Autoimmune Disease

Autoimmune disease is a rising modern day epidemic—surpassing both the mortalities from cancer and heart disease combined in the numbers of people it affects. 

 

Autoimmune disease is exactly what it sounds like—“auto” (self) immune disease—your body is attacking its own immune system. In conditions where the immune system goes awry (i.e. stress and gut inflammation), the body’s immune system forms antibodies that attack other areas of the body, as if they are foreign objects.

 

Common autoimmune diseases include: 

 

    • Lupus
    • Hashimoto’s
    • Celiac
    • Colitis
    • Crohn’s 
    • Multiple Sclerosis
    • Rheumatoid Arthritis
    • And many, many more

 

There are hundreds of diseases! However, regardless of the name of the condition, all autoimmune diseases share a common root cause—you guessed it: a disrupted gut microbiome and chronic stress. 

 

Individuals with eating disorders are 50 to 75% more likely to have an autoimmune disease. Researchers speculate that both neuro-inflammation and gut inflammation in eating disorders further drive both conditions (eating disorders and autoimmunity). 

 

In fact, one study in women with anorexia or bulimia found they actually had autoimmune antibodies that made it harder for them to regulate food intake and body weight—concluding that eating disorders and autoimmune conditions may be bi-directional (in other words: the autoimmune disease triggers disordered eating, and vice versa, disordered eating perpetuates stress and triggers autoimmunity). 

 

Bonus: The Autoimmune Wellness blog is an excellent resource for all-you-need-to-know about autoimmune disease and holistic healing (remission is possible)!

 

The Bottom Line: 

Immune conditions in Post-Recovery Recovery after an eating disorder are common byproducts of chronic stress and an altered gut microbiome (1, 2, 3, 4). 

 

4. Food Intolerances 

 

Eating disordered do funky things to your relationship with food—including making you intolerant to some foods themselves. 

 

All too often, when recovered individuals claim to react poorly to certain foods but labs don’t show an allergy, their concerns are dismissed and they’re told, “It’s all in your head,” or “It’s part of the healing process—just deal with it.”

 

However, ever-evolving research proves that food intolerances are not just psychological or make-believe. In fact, food intolerances are more common than food allergies—with approximately 1 in 5 people experiencing sensitivities and adverse reactions to compounds in certain foods. 

 

Allergies vs. Intolerances

The difference between a food allergy and sensitivity is the body’s response. 

 

When you have a food allergy, your immune system causes the immediate reaction—an “IgE response”. If you have a food sensitivity or intolerance, on the other hand, the reaction is triggered first by the digestive systems. 

 

You may be sensitive or intolerant to a food for several different reasons, including:

 

    • not having the right enzymes or enough stomach acid you need to digest a certain food
    • underlying gut pathogens or infections
    • over-exposure to proteins in the same offending foods—and your gut bacteria’s inability to digest and absorb those foods
    • adverse reactions to food additives or preservatives like sulfites, MSG, or artificial colors
    • sensitivity to the compounds naturally found in certain foods like FODMAPS (onions, broccoli, or Brussels sprouts) and high-histamines 

 

Symptoms of food intolerance vary, and may include:

 

    • Gas, bloating & diarrhea 
    • IBS
    • Brain fog
    • Headaches & migraines
    • Hyperglycemia/hypoglycemia
    • Low immune system
    • Respiratory issues
    • Skin breakouts
    • Heartburn
    • Irritability or nervousness
    • Metabolic and hormones imbalances

 

If left unmanaged or unaddressed, and keep eating the offending food(s), you increase your risk of developing an autoimmune disorder, mass cell activation syndrome, lingering digestive issues and more. 

 

Why Food Intolerances Happen in Eating Disorders

 

Food Restriction Decreases Gut Bacteria

 

A healthy gut microbiome is a diverse gut microbiome. While research is still in its infancy of what the “ideal” human gut microbiome should look like, research on modern-day hunter gatherers, like the Hazda tribe, relatively free of all modern day diseases reveals that these people have a wide diversity and abundance of gut bacteria. They even contain strains of bacteria we consider “pathogens” in our Western society, but because their microbiome is so diverse and they eat a diverse diet (about 10x more carbs and fiber than we do), they are still disease free. 

 

Unfortunately, long-term restrictive diets wreak havoc on your gut microbiome, consequently reducing the amount and diversity of your gut bacteria, and increasing your susceptibility to both gut pathogens as well as sensitivities to a variety of foods that you were once able to tolerate. 

 

For one, short chain fatty acids (derived from healthy gut bacteria that feast on a variety of whole food carbohydrates, healthy fats and proteins in the diet) are essential to strengthening your immune system. However, without enough gut-friendly foods to feed them, your immune system (and food toleration) goes down. 

 

Individuals with eating disorders also tend to eat “super clean” foods in their diet out of the need for “safety” and “control”—gravitating towards low fat, low carb and/or low protein diets, as well as eating the same 5 to 10 foods every day. 

 

Consequently, this also increases your susceptibility to food intolerances—sort of like the “hygiene hypothesis.”

 

According to the hygiene hypothesis, the cleaner we are in our daily lives (excessive handwashing, anti-bacterial gels, etc.), the more we decrease our immunity and our immune system’s ability to fight pathogens and disease.  Likewise, the cleaner or more restrictive we eat, the more we decrease our gut bacteria and its ability to tolerate and digest different types of foods (even “healthy” foods). 

 

Eating the Same Things Everyday Increases Intolerances

Simply put, we can become intolerant to the foods we eat every single day—eventually experiencing several ill side effects if we don’t vary things up. 

 

Eating the same things every day reduces your own oral tolerance for a wider variety of foods, because lack of diversity in your diet reduces the abundance and variety of gut bacteria. You don’t have a rich, diverse gut microbiome to help you digest food proteins and eventually those microbes can become “sick” over eating the same things day in and day out. 

 

In turn, your immune system and digestive system becomes over reactive.

 

 A key component of loss of oral tolerance and multiple food sensitivities is over reactive dendritic cells. Dendritic cells are immune cells that roam the small intestine. They have long arms that sample different proteins and determine whether the immune system should react to them. Your dendritic cells think practically everything they encounter needs to be attacked. 

 

What causes dendritic cells to become overly reactive? Proteins that aren’t thoroughly digested due to deficiencies in gut bacteria, stomach acid and pancreatic enzymes is one cause. Low SIgA cells, antibodies that are a first line of defense in the gut, are another. 

 

We can address hyper reactive dendritic cells by improving breakdown of proteins (digestion) and decreasing stress and inflammation in the body. 

 

Stress Increases “LPS”, TNF-α   & “Leaky Gut”—Making Foods More Difficult to Digest

LPS—short for lipopolysaccharides- and TNF-α—short for Tumor necrosis factor—are both cell signaling compounds involved in systemic inflammation. Both LPS and TNF-α are commonly high in eating disorders and other chronic stress conditions. As a result, the more inflammation in the body, the more susceptible you are to “leaky gut”. As a result, your body cannot absorb essential nutrients, which can lead to hormone imbalances and a weakened immune system (hello food sensitivities). 

 

Binging & Purging Disturbs Gut Bacteria Balance

For those with histories of binging and purging, these dieting behaviors equally disturb the gut microbiota—leading to increased susceptibility to food intolerances and a variety of other health consequences (because a “disturbed gut microbiota” simply cannot digest and absorb foods as efficiently). 

 

In binge eating for instance, chronic exposure to food antigens, accellular carbohydrates, synthetic chemicals and compounds (a.k.a. “food antigens”) in processed, refined foods in particular diminish our own healthy gut bacteria—simply because our gut bacteria were not wired to digest and absorb large quantities of these foods in abundance. 

 

Interestingly, a previously imbalanced gut microbiota itself can also lead to struggles with binge eating in the first place. 

 

People who have higher levels of a certain metabolite—indole— in the gut microbiome are more prone to engage in “hedonic” eating, or eating for pleasure rather than hunger. Indole is a byproduct from the metabolism of tryptophan—an amino acid found in foods, associated with promoting serotonin production (our “feel good” brain chemicals). Although indole is not a bad thing—high amounts of it are what may lead to increased likelihood for binge-like behaviors. Circulating total tryptophan levels are increased in germ‐free mice that lack gut microbiotameaning decreased bacterial abundance is linked to higher tryptophan and indole. 

 

As for binge-purge behaviors and your gut bacteria, researchers have found that individuals with higher amounts of ClpB protein—produced by E. Coli bacteria—are more prone to have suppressed appetite cues and increased urges to eat and purge because this protein acts like an “antibody” to your body’s food-regulating cues. 

 

Purging alone also disrupts and wipes out your intestinal flora—both in your gut and your oral microbiome, where you have the same composition of gut bacteria as is located in your small intestine. By making yourself sick, you not only disrupt the balance of gut bacteria, but you also alter your vagus nerve’s natural functions.

 

Your vagus nerve is the nerve that controls your digestion, balances your gut bacteria and runs your  parasympathetic nervous system ( your peaceful “rest and digest” mode). Your vagus nerve also governs your  “gag reflex”—your body’s natural ability to “gag” and prevent you from choking, or getting sick (such as throwing up if you have food poisoning). 

 

However, in bulimia, the more you stimulate your own gag reflex unnaturally, the more you alter your vagus nerve’s own ability to function on its own—further disrupting your natural digestion, stress response and inner eco-system.  In fact, if bulimia goes on for too long, you can experience an “overactive gag reflex” —characterized by high sensitivity levels in your vagus nerve which leads to evocation of gag reflex at the slightest instance—and…once more, further disrupted gut microbiota. 

 

The Bottom Line

Eating disorders of all types disrupt bacterial balance, abundance and digestion inhibiting your immune system and gut’s ability to tolerate a variety of foods (because a more diverse, healthy microbiome=a happier, healthier you and increased food toleration). 

 

5. ARFID

Given that un-intended food intolerances or sensitivities frequently happen as a a result from eating disorders, ARFID—avoidant restrictive food intake disorder—is another common conundrum in “Post Recovery Recovery” that is rarely addressed. 

 

ARFID is the avoidance of certain foods—not because you’re scared of getting “fat”, but instead because you don’t like how certain foods make you feel

 

In my Post-Recovery Recovery, my poor gut health, impaired HPA axis and lowered immune function significantly toleration for many foods:

 

 

  • Sweet potatoes and rice gave me hypoglycemic crashes
  • Oxalates in spinach gave me IBS
  • Histamine in salmon, avocado and sauerkraut gave me shortness of breath
  • Nuts and almond milk gave me constipation
  • Yogurt and kefir gave me diarrhea 
  • 100% dark chocolate gave me heart palpitations

 

 

I felt stuck—like my body was working “against me”. Although I had made peace with food mentally, physically, my gut, immune system and central nervous system were totally out of whack. 

 

Common symptoms and signs of ARFID include:

 

  • Fear about how food makes you feel
  • Anxiety over food—especially the “unknown” or times you’re out of control (travel, eating out, etc.)
  • Unwanted weight loss
  • Lack of appetite 
  • Trouble digesting specific types of foods

 

 

ARFID is most commonly diagnosed in kids who are coined “picky eaters.” However, both the eating disorder and conventional treatment can wreak havoc on your gut, consequently resulting in increased food sensitivities and fears because your body ultimately feels out of sorts. Essentially, a dysbiotic gut microbiome can tell you “not to eat” because it does not feel good when you do. 

 

The good news: As I focused on healing and restoring my gut, stress system and immune function, my body’s ability to tolerate foods significantly increased, but it was not easy (We’ll get to my tips soon). 

 

6. Missing Your Period 

 

Amenorrhea or a “missing” period is common in individuals with eating disorders—defined as 3 cycles or more of a missed period, and affecting at least 1 in 2 women of menstruating ages who are overtrained or undernourished. Hormone imbalances, including imbalanced cortisol (as described above) and suppressed estrogen levels can strip your body’s energy supply towards hormone health and balance.

A period is your body’s monthly “report card” of health—so it makes sense why, when you struggle with an eating disorder, it’s not happening. However, now that you’re in recovery or even physically “weight restored? why is your period still missing?!

 

Reasons Why Your Period is Still Missing

  1. Your hypothalamus (the part of your brain that signals female hormone production) has not fully recovered—it is still stressed out
  1. You’re overtraining or accidentally undereating
  2. Your immune system is out of whack
  3. History birth control pill use
  4. Your liver can’t clear cortisol or metabolize estrogen

 

Let’s briefly chat about each:

 

Hypothalamus Stress

“Hypothalamic amenorrhea” gets its name because your hypothalamus in your brain plays a BIG role in period loss. 

 

Your hypothalamus a part of your brain that is in charge of many important processes in the body, including regulating temperature, metabolism, energy balance, the stress response, circadian rhythms, hormone production and regulating your cycle. Your hypothalamus is the “master regulator” of your endocrine (hormone) system. The hypothalamus releases the hormones that signal the pituitary gland, which then send signals further downstream to your other glands—like your ovaries, adrenals and thyroid to produce and balance hormones.

 

Essentially, if your hypothalamus is “offline” then chances are your hormones and cycle are also offline. 

 

How does your hypothalamus get “offline”?!

 

Not to sound like a broken record, but stress (chronic inflammation) is the #1 driver of hypothalamus dysfunction and period loss—specifically stress of your HPA Axis. 

 

Common stressors preventing you from getting your period in recovery include: 

    • Unaddressed trauma
    • Lack of other self-care behaviors (you may be eating enough or “weight restored” but if you are not sleeping enough, working out too much for your body to handle, not drinking water, or still carrying lots of anxiety)
    • Limbic system dysregulation 
    • Gut inflammation (such as gut infections, leaky gut or dysbiosis)
    • Suppressed neurotransmitter production—dopamine, serotonin, norepinephrine (spectifically due to gut imbalances)
    • History of chronic under-eating, overtraining, binging and purging creates a new “set point” of stress for the hypothalamus-during the eating disorder your hypothalamus forms new “neural pathways” in order to protect you (preventing normal hormone production and balance until addressed)

 

One thing to remember is that the hypothalamus is part of a negative feedback loop in regulating many of the glands, so if your downstream hormones are high (particularly cortisol), then they will tell the hypothalamus not to signal the pituitary to stimulate the glands. 

 

HPA Axis 101

Your HPA Axis is your body’s “stress response” or “fight or flight” system that consists of the 3 primary organs that regulate your hormones—cortisol and sex hormones included. These organs include:

    • Hypothalamus 
    • Pituitary
    • Adrenal Glands

Your HPA Axis is vital for helping your body “overcome” stress and balance your hormones—especially cortisol (your stress hormones).  Unfortunately if cortisol is too high or too low from chronic stress, then your sex hormones—including estrogen, progesterone and testosterone also get out of balance.

 

How Your HPA Axis Affects Your Hormones

Here’s an overview of how each part of your HPA Axis effects your hormones and period. 

 

Hypothalamus Role

Your hypothalamus is the part of your brain that controls the release of hormones (like estrogen and progesterone) from the pituitary gland.

 

Pituitary Gland

Your pituitary gland’s main function is to secrete hormones into your bloodstream.

 

Adrenal Glands

The adrenal glands are small glands located on top of each kidney. They also produce hormones that you can’t live without, including sex hormones and cortisol. Cortisol helps you respond to stress. With adrenal gland dysfunction, your glands make too much or not enough hormones.

 

The Bottom Line: Once more, stress on your HPA Axis is the #1 reason why your period “goes missing.”

 

Overtrained, Undernourished

The last thing your body wants to do when you can’t feed yourself enough or support your energy output with proper recovery is have a baby or form another life inside you! Simply put: Lack of a period is often a sign the energy expense is too high, energy intake is too low (enough carbs, fats and proteins).

 

Immune Dysregulation

The menstrual cycle is greatly regulated to your immune system. There are receptors on many immune cells specifically for estrogen and progesterone. Disruption of your immune system via chronic stress therefore alters estrogen and progesterone uptake (and remember: more than 80% of your immune system is in your gut). 

 

In healthy menstruation, your immune system—and inflammation—is also continually shifting throughout the month:

 

Follicular Phase + Ovulation

During the follicular phase of the menstrual cycle (i.e. the first part of the cycle, days 1-12), as estrogen levels drop, antibodies rise and women experience increased immune inflammation.

 

Early & Mid Luteal Phase (Mid Cycle) 

During most of the luteal phase of the cycle (i.e. the second part of the cycle), the immune system is suppressed—there is less inflammation overall, and the opportunity to fertilize an egg and get pregnant. 

 

Last Part Luteal Phase + Menstruation (Your Period)

Estrogen levels drop once more and the inflammatory responses return and as levels of a hormone-acting lipid called prostaglandin increase. 

 

Throughout all phases, your immune system shifts to both promote and prevent pregnancy at different times. When inflammation rises, your body does not want you to get pregnant. When inflammation lowers, your body is better able to fertilize an egg. 

 

If you haven’t gotten your period back, there’s a big chance your body’s inflammation is up-regulated the majority of the time.  In fact, often times, your FSH and LH hormones (pre-cursor hormones for estrogen and progesterone production) are still in tact—they are just low, (really low), because your cortisol levels (stress hormones) and inflammation from your HPA Axis are really high. You are still ovulating (dropping an egg), but you are simply not menstruating—or bleeding—during that time of the month. Your body is unable to carry out the full cleansing process and shedding of your uterine lining. 

 

Birth Control Pill 

The “pill” may initially be intended to regulate your cycle or “get your period back”, but it is a synthetic—meaning your body is not naturally producing its own hormones still. When women go off of it, they often find their period seems just as dysregulated because the mechanisms that produce their own hormones (the HPA Axis, liver, gut) were never addressed. long-term birth control use can also lead to a build-up of those excess synthetic hormones in your body—specifically your liver. This overload of estrogen consequently causes cortisol markets to rise along with inflammation. 

 

Other common roadblocks include the increased risk of dysbiosis, leaky gut and bacterial overgrowth from synthetic hormones. We all know how badly antibiotics can affect our digestive tracts. But did you know birth control pills are just as bad as antibiotics for your gut? Two long-term studies–one from in1976, the other in 1984–tracked more than 200,000 women found that women who took hormonal birth control pills were more likely to develop gut disorders like IBD. 

 

You have hormone receptors everywhere in your digestive tract and the added hormones in your body from the pill can affect those receptors, often leading to dysbiosis, bacterial infections and candida. Additionally, use of high-dose synthetic estrogen for birth control increases  your risk of forming tiny clots in your gut’s network of blood vessels, along with a host of side effects—from gas, constipation and bloating, to dysregulated menstrual cycle and infertility.  

 

Poor Liver Health

The liver regulates the balance of sex hormones, thyroid hormones, cortisone/cortisol and other adrenal hormones. It transforms or removes any excess from the body. If the liver cannot do this properly, there is the risk of hormonal imbalances—especially if cortisone (the precursor to cortisol) is high, leading to suppressed estrogen levels.

 

The bottom line: Recovery from chronic stress does not happen over night, and if you don’t have your period, your body may still be in “repair mode” (Check out the Period Project Book  to hack your period in recovery). 

 

7. Young Onset Osteoporosis 

 

Osteoporosis, one of the most common bone density issues—especially as we age, is when bone becomes more porous and thus more brittle as we age. 

 

Osteopenia is a precursor to osteoporosis, and both are diagnosed using bone mineral density scanning using a DEXA machine. Osteomalacia is a softening of the bones due to vitamin D deficiency, and is another cause of bone fractures.

 

Osteoporosis and its precursors are common known side effects of eating disorders—specifically chronic anorexia, long term restrictive diets and overtraining. However, if osteoporosis is diagnosed in young women, in my experience, doctors have seemingly rarely known how to treat it. 

 

Overall, bone mass is determined by the balance between bone formation (build up) and resorption (break down). If bone formation is more active than bone resorption, a net anabolic (“build up”) effect is observed. If resorption outpaces formation, the net effect is catabolic (“break down” or osteoporosis). Eating disorders steer bone health towards a “catabolic” (break down) state. 

 

“You Have Osteoporosis”

At age 23, I first heard the words, “You have osteoporosis,” followed by, “This is rare in young women…I’m not 100% sure how to treat it,” and my treatment prescriptions:

 

Conventional Treatment of Young Onset Osteoporosis

    • Drink more milk and eat more yogurt and cheese
    • No high impact activities (like CrossFit, jumping or HIIT)
    • Potentially try Fosamax —a medication used to “slow bone loss” in older adults 
    • Go on birth control

 

In fact, I even had one doctor tell me, “Lauryn, if you don’t go on birth control, you will be in a nursing home by the time you’re 40 or 50.” (How’s that for some encouragement?!)

 

To say the least, I felt pretty stuck when I initially found out I had the condition…until I began to dig deeper into the biochemistry and mechanisms involved in the osteoporosis process—beyond just “nutrient deficiencies.” 

 

Once I understood those, “reversing osteoporosis” became more possible, and is something I have experienced to date in my ongoing Post Recovery Recovery journey. 

 

Why Osteoporosis Happens

In a healthy bodies, our bone mass provides support, mobility, and protection for vital organs, as well as acting as a mineral bank account for calcium and phosphate. In order to keep us “strong”, our bones continuously undergo bone “remodeling”—a lifelong process where mature bone tissue is removed from the skeleton (a process called bone resorption) and new bone tissue is formed (a process called ossification or new bone formation). 

 

In the case of osteoporosis, however, more bone tissue is lost than is formed. 

 

Why?!

 

For one, it doesn’t take a rocket scientist to conclude that nutrient depletion and deficiencies lead to body breakdown—including the bones. Given that eating disorders strip your body of nutrients, your organs, muscles, hormones and bones don’t get the full nourishment they need to thrive. 

 

But, beyond nutrient depletion, osteoporosis goes a step further though— involving inflammation of your immune system, oxidative stress of your HPA Axis as well as your gut bacteria. 

 

Osteoporosis: An Autoimmune Disease?

Recent research actually suggests that osteoporosis is an autoimmune disease—characterized by the body’s own “self attack” and breakdown of your bones. In fact, rapid bone loss and increased fracture risk are actually implicated in a range of autoimmune diseases themselves, such as rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis (PSA), inflammatory bowel disease (IBD), and systemic lupus erythematosus (SLE) 

 

Considering what we’ve learned about how eating disorders impact your immune system (upregulation of inflammation and oxidative stress), this makes total sense.

 

Osteoclasts (bone cells that breakdown bone tissue) exhibit similar characteristics as dendritic cells—messengers in your immune systems that signal “inflammation.” If osteoclasts are “upregulated”—more inflammation signals go to your bones, in turn also up regulating your immune system inflammation. Your T-cells (Th1 and Th2 system) promote bone loss in inflammatory contexts. 

 

Additionally, osteoblasts (bone cells that form bone tissue) are significantly influenced by immune cells. If your immune system is more “inflamed”, this suppresses osteoblast activity—preventing the formation of new bone. 

 

Interestingly, however, recent findings also reveal that T-cells may also have the capacity to promote bone formation—when we balance the immune system (similar to how autoimmune disease symptoms go into remission when we balance the immune system).

 

Osteoporosis & Gut Health 

Healthy gut microbes can increase bone mass and improve osteoporosis by inhibiting osteoclast proliferation and differentiation, inducing apoptosis, reducing bone resorption, or promoting osteoblast proliferation and maturation. The opposite is true too: Unhealthy gut microbes can decrease bone mass

 

Intestinal microflora regulate growth factor insulin-like growth factor (IGF)-1 levels, and thus regulate bone formation and absorption. Lower levels of IGF alter bone metabolism and bone mass. 

 

A long-term study in mice colonized with healthy gut bacteria found significant increases in femur length, spinal bone mass and the inside layers of bones compared to mice without bacterial administration, demonstrating that healthy gut bugs affect bone formation, growth plate function, and bone resorption. Similarly, researchers also found that antibiotic treatment—consequently eradicating healthy gut bacteria—reduced bone mass in test subjects.

 

Osteoporosis & Your HPA Axis

Both mental and physical stress influence hypothalamic–pituitary–adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids (cortisol) and cytokines (inflammatory proteins). 

 

High cortisol from stress indirectly acts on bone by blocking calcium absorption which decreases bone cell growth, and even a short stint of higher cortisol can cause a decrease in bone mass.

 

In short: When your HPA Axis is imbalanced (too much cortisol, poor hormone production and regulation—particularly estrogen, progesterone and growth hormone), it welcomes osteoporosis with open arms. 

 

Most research and general healthcare knowledge talks about how physical stress causes osteoporosis (i.e. under-eating, overtraining or too much physical load on the body), often prescribing physical treatments to address the physical causes (like eating more calcium rich foods, lifting weights or taking estrogen), while overlooking the significant role that HPA Axis plays in both the development and ongoing nature of osteoporosis. 

 

A “holistic, anti-stress” approach to treating osteoporosis therefore would involve more attention paid to the remission of HPA Axis oxidative stress as a whole—not just calcium supplementation, birth control pills or calcium-fortified (fake) foods like cereals and yogurts—including:

 

    • Emphasis on a balanced, real-food diet as a whole—fat, fiber, protein with meals (and eating enough calories for your body—baseline 1800-2200/day). If you’re concerned about how to do this, I strongly recommend working with a nutritionist to help you ensure you’re eating an appropriate amount of food and helping you regain a normal menstrual cycle if you’ve lost yours.
    • Traditional, bone-building foods—power packed in all essential nutrients:
        • organ meats
        • bone broths
        • fermented foods
        • cod liver oil
        • pastured meats and dairy
        • variety of seasonal vegetables
        • variety of essential fatty acids (coconut oil, ghee, duck fat, olive oil, flaxseed, nuts and seeds)
        • prunes (a “superfood” for osteoporosis)
        • “calcium rich” foods* like:
            • Bone-in canned wild salmon/sardines
            • Grass-fed hard cheese
            • Grass-fed full fat plain yogurt & kefir
            • Blackstrap molasses
            • Figs 
            • Dark leafy greens (collards, chard, kale, beet greens, turnip greens)
            • Broccoli
    • Supplementation, including:
      • Vitamin D3 (if low on bloodwork)
      • Vitamin K2
      • Vitamin A (Extra Virgin Cod Liver Oil)
      • Magnesium Glycinate
      • Collagen
      • Vitamin C
      • HPA Axis Adaptogenic Herbs (like Relora, Rhodiola, Cordyceps, Ashwaganda, etc.)

 

 

  • Strength-building resistance exercise, walking, mobility/yoga, play + cutting out chronic cardio and long-distance running. Running shorter distances and ensuring proper nutrition is key, and mixing endurance exercise with resistance exercise is likely the best way to promote bone health.

 

 

The Bottom Line

Osteoporosis is a byproduct of nutritional deficiencies, but primarily presents and heightens due to an overactive immune system, HPA Axis and a dysbiotic, “leaky” gut. 

 

 

 

8. Poor Hunger Cues

In an ideal world, we’d eat in response to a hunger cue the majority of the time. (Note: not 100% of the time. Sometimes we eat for fun and social reasons. But generally, most of our eating is done because our bodies and brains need more fuel). 

 

Unfortunately, hunger cues are not always accurate in eating disorders—even once you’re in recovery. 

 

Identifying Hunger

 

Many of my clients often attribute “hunger” to one primary cue—the sense of an empty, growling, pit in their stomach. If they don’t feel this type of hunger cue, then “hunger” is not on the table. 

 

Others who have wrestled with binge eating or purging report “hunger” in terms of their cravings—when a craving strikes, that must be hunger right? Or, if they feel a little blood sugar dip after , that’s the cue for a snack or meal (when it may just be their blood sugar roller coaster and cortisol speaking). 

 

Identifying Fullness

 

On the flip side, the feeling of “fullness” is also super confusing for some people. Several report feeling constipation and bloating after meals—due to an underlying gut issue—wondering, “Does that mean I am full?” 

 

Others recognize that feelings of “fatness”, “heaviness” or anxiety makes them feel full—not hungry; while others actually interpret those feelings and thoughts as hunger—ravenous for anything to fill the void they have inside. 

 

To say the least, hunger and fullness is downright confusing!

 

The Science of (Confused) Hunger & Fullness Cues

 

Our physiological hunger cues are governed by two primary hormones: Leptin and Ghrelin. 

 

Leptin is a hormone known as the “satiety hormone” that decreases your appetite

Ghrelin is a hormone that increases appetite, also known as the “hunger hormone.”

 

In anorexia, Ghrelin levels (increased hunger hormone) are generally higher.  In bulimia and binge eating disorder, Leptin levels (increased satiety cues) are usually higher. 

 

However, in all cases (anorexia, bulimia and binge eating disorders), the brain gets super confused about what it is feeling!

 

Even though it seems like those with anorexia should feel hunger from their Ghrelin cues—as  the disease progresses, they often don’t. And even though it seems like those with bulimia or binge eating disorder should feel increased satiety from their Leptin cues, as the disease continues and progresses often don’t. 

 

The brain seemingly trumps the body. 

 

You have your gut microbiome and HPA Axis to thank for that!

 

Your Gut & HPA Axis Alters Hunger Cues

 

Feeling (Falsely) Full: Elevated CCK Hormone

Early satiety, that is, feeling full after taking even a small amount of food, is often reported in recovery—specifically from anorexia. 

 

This is often due to a rise in Cholecystokinin or “CCK”

 

CCK is a satiety inducing peptide produced in the gut. In addition to inhibiting food intake, CCK inhibits gastric mobility (making you also feel more constipated). Cholecystokinin (CCK) administration in animal models exhibits reduced food intake in comparison to controls.

 

Researchers also have observed that many women with anorexia have normal CCK profiles when they enter treatment (due to hormonal responses adapted to low food intake), only to experience an initial increase in CCK (and decreased appetite cues) with the change of eating habits and weight gain in treatment, eventually returning back to normal with continuous recovery efforts. 

 

Hunger-Fullness Confusion: Under-functioning Hypothalamus

Another big driver of “altered” hunger-fullness cues is your hypothalamus—your brain region that regulates appetite and motivation to eat. 

 

In a comparative study of brain scans between 26 healthy controls and 26 women with anorexia or bulimia, researchers found that those with eating disorders had widespread alterations in the structure of brain pathways governing taste-reward and appetite regulation. The alterations were found in the white matter, which coordinates communication between different parts of the brain. 

 

There were also major differences in the role the hypothalamus played in each group. Among those without an eating disorder, brain regions that drive eating took their cues from the hypothalamus. 

 

In the groups with an eating disorder, the pathways to the hypothalamus were significantly weaker and the direction of information went in the opposite direction. As a result, researchers concluded that the brains of those with eating disorder histories may be able to override the hypothalamus and fend off the signals to eat.

 

Common Hunger-Fullness Cues

Given that your gut and hypothalamus signaling for your hunger cues may be off—particularly for the feelings of “stomach” hunger, here are some common “signs and symptoms” of hunger (that are not always felt in your stomach):

 

 

  • Shakiness (especially between or before meals)
  • Shortness of breath
  • Feeling light headed
  • A pit or knot in your stomach
  • Thinking about your next meal or snack—a lot 
  • Fatigue
  • Feeling heavy/weighed down (physically)
  • Seeing spots
  • Feeling lightheaded or spacey
  • Feeling weak
  • Apathy for doing regular 
  • Feel like you may pass out

 

 

Likewise, here are some common “signs and symptoms” of fullness:

 

  • Feeling satisfied and nourished
  • Feeling stuffed
  • Not wanting to take the next bite (although your taste buds may tell you to)
  • Food not sounding appetizing 

 

 

Practicing Hunger-Fullness Cues Awareness

 

It won’t happen overnight, but here’s a simple exercise to begin laying new neural pathways for your brain and body to “sync” back up. 

 

So, here is your homework assignment. Get out a sheet of paper and write the following categories:

 

Starving:

Over-hungry:

Appropriately Meal Hungry: 

Snack Hungry:

 

Now, I want you to write down as many physical and mental descriptors as you can for each category. Here are some give you some examples.

 

 

  • Starving: stomach pain, headache, terrible mood, no energy, weakness, apathy, no longer thinking about food (because you’ve denied yourself) or inability to get food off your mind

 

 

 

  • Over-hungry: growling/empty stomach, shaky, can’t think of anything but eating, lightheaded

 

 

 

  • Appropriately Meal hungry: grumbly stomach, lack of concentration, low energy, mouth watering at the thought of food

 

 

 

  • Snack hungry: distracted thinking, energy dip, little grumbles in stomach

 

 

Ok, the next step is to keep this paper around for 3 days. Pay attention to moments that you think you might be in one of these categories and ask yourself the following questions:

 

 

  • Am I hungry?
  • How hungry am I?

 

  1. How do I know? This “how do I know” part is your cue to write down any physical descriptor you have that fits your particular level of hunger.

 

The Bottom Line 

Hunger may not always be a “pit in your stomach”—but also part of how your body physically feels (or does not feel) as well as how you think.

 

9. Anxiety, Low Energy & Fatigue

 

Three words: HPA-Axis Dysregulation

 

Chronic stress from the eating disorder can continue long after the behaviors have faded. Generally, research has noted higher free cortisol levels in those with  anorexia, and lower free cortisol levels in those with bulimia. Additionally, for those with longer histories of the disorder—particularly anorexia—research has also noted impairments in “normal” cortisol signaling and a new “set point” for cortisol levels, even once recovery has ensued. 

 

Common side effects of HPA-Axis Dysregulation or “adrenal fatigue” in Post-Recovery Recovery include:

 

 

  • Anxiety or low mood
  • Increased food intolerances
  • Low blood pressure
  • High resting heart rate
  • Muscle wasting or weakness
  • Feeling wired and tired at night
  • Low energy & general fatigue (despite sleeping)
  • Insomnia
  • Hormone imbalances
  • Hypoglycemia between meals
  • Dependence on coffee, sugar or articial sweeteners to “function”
  • Apathy or burn out
  • Low T3 (thyroid hormone)
  • Hypothyroidism
  • Feeling dizzy when standing
  • Belly fat accumulation
  • Skin breakouts or acne
  • Inability to tolerate exercise like you once did
  • Allergies & immune sensitivties
  • Shortness of breath
  • IBS, constipation or bloating (frequently)
  • Electrolyte imbalances

 

 

The Bottom Line

HPA-Axis Dysregulation is a side effect of long term stress. You’re not “stuck” with HPA-Axis Dysregulation forever, but you do need to take proactive steps in order to continue to heal. 

 

10. Loss of Identity

 

Who are you without the eating disorder?

 

It is a big question many in recovery struggle to answer—especially if you’re eating disorder has been with you for a long time. 

 

While many standard treatment models for those in recovery focus on physical recovery (weight restoration and body function stabilization) and psychotherapy, like CBT and DBT, for gaining awareness of your eating disorder and thought patterns, life in recovery (and after ED) is rarely discussed. 

 

Again: Who are YOU without the eating disorder? And, what does “recovery” actually mean? 

 

For years in my own healing, I often told my treatment team, my parents and my friends I wanted recovery and I was working on recovery, but…I actually had NO IDEA what recovery actually meant. 

 

I said I wanted it (because that’s what “good patients” should say and because others told me I should want it),  however, in my mind, the word “recovery” was synonymous with:

 

 

  • Fat
  • Loss of control
  • Not good enough
  • Pleasantly plump
  • No “slight edge”
  • Ugly
  • Unworthy

 

 

With these thoughts crowding my brain space, how well do you think my recovery process went?…(Crickets. Crickets.). It didn’t go—for years. Recovery was scary and actually more negative. Consequently, for years, I stayed completely, utterly, 100% stuck in my old ways of doing things—my eating disorder mentality—even if I was weight restored and “healthy” on the outside at different points. 

 

It wasn’t until I began to re-define the meaning of “recovery” to mean a renewed lifestyle and mindset makeover that recovery began to happen.

 

During this process, I began to replace my old definitions of “recovery” (“fat”, “loss of control”, “unworthy”) with new definitions—freedom, thriving, wellness. 

 

I also began to explore and define who I was without the eating disorder, and began caring about other things in my life—like my passions, hobbies, skills, purpose, people and my faith—that the eating disorder began to fall to the wayside.

 

The Bottom Line

A BIG reason why you still have “disordered eating” thoughts in Post-Recovery Recovery? You haven’t embraced a renewed life unshackled from the “old way” of doing things.

 

The good news? I have tools to show you how to do just that if you’re ready…

 

4 Essentials to Heal in Post-Recovery Recovery

 

Recovery is no easy under-taking, and with all these side effects (Post Recovery Recovery), you may be wondering if it is even worth it? 

 

The short answer: YES!

 

When given the right tools your body innately wants to heal itself. I repeat: When given the right tools, your body innately wants to heal itself. 

 

Here are 3 Essentials to Heal in Post-Recovery Recovery:

 

Essential #1: Love Your Gut

Essential #2: De-Stress Your HPA-Axis

Essential #3: Connect to Your Heart

 

We’ll briefly cover each of these with some simple small hacks to experience big changes: 

 

Essential #1: Love Your Gut

 

Hydrate

Aim to consume half your healthy body weight in ounces of water daily (ex. 140 lbs=70 ounces or a little over 8 cups). 

 

Boost Digestion

Support your natural digestion “superpowers” —take 1-2 digestive enzymes with meals and consider HCL tablets or a tablespoon of apple cider vinegar in water with meals. 

 

Probiotic Up

Integrate a quality probiotic at least 1 to 2 times per day. I recommend using both a soil based formula and low-histamine probiotic into your daily routine while you rebuild your gut back up. (Be Warned: Not all probiotics are created equal. More than 90% of probiotics on shelves do not contain the probiotics they claim).

 

Eat Gut-Loving Superfoods

Foods particularly loving for your gut include:

    • Fermented foods (as tolerated)
    • Prebiotic fibers (cooked and cooled potatoes/rice, asparagus, jicama, squash, cruciferous veggies)
    • Bone broth/meat broth
    • Organ meats
    • Essential fatty acids (ghee, butter, coconut oil, olive oil, flaxseed)
    • Pastured, organic meats and eggs
    • Clean filtered water

 

Vary Your Foods

A happy healthy microbiome is a diverse microbiome—thanks to a diverse diet. Although you don’t need to eat something different for every single meal, consider coming up with 2 to 3 “rotating” meal ideas to mix it up often. 

 

Test, Don’t Guess. 

Customized testing is the gold standard for knowing what is going on “under the hood” for your unique body and gut microbiome. Work with a functional medicine practitioner to perform baseline gut testing both via assessment and possible lab testing. Testing may include: comprehensive stool analysis, organic acids urine testing, comprehensive blood work, DUTCH cortisol-hormone testing, SIBO breath testing—depending on your unique needs, signs and symptoms. 

 

Address Underlying Gut Pathologies

Testing and work with a practitioner can help you identify any pathologies at play, such as dysbiosis, parasites, leaky gut, insufficient healthy bacteria, yeast and beyond. Once you know specifically what is going on for you, a short-term therapeutic “healing protocol” involving antimicrobial herbs or gut-soothing nutrients may be warranted to help your gut microbiome reshift. 

 

Boost Your Immune System

Supporting your gut health and HPA Axis will naturally boost your immune system, but here are some of my extra immune boosting hacks to help you if you have signs and symptoms of immune dysregulation:

 

 

Essential #2: De-Stress Your HPA-Axis

 

Get Your Beauty Sleep

Aim for 7-9 hours of sleep each night, and jumpstart a good night’s sleep with good sleep hygiene, including: 

  • Limiting screen use at night with blue-blocker glasses
  • Dimming bright overhead lights
  • Drinking sleepy time tea

 

Just Breathe

The power of deep breathing naturally calms the central nervous system and heals the hypothalamus. Practice deep breathing with one of these practices:

 

  • Nose breathing: Ideally you want the majority of your breaths to come in through your nose. Mouth breathing elevates the stress response. If you struggle with stuffy sinuses, consider trying a cleansing citrus nasal spray to clear pathogens in your airway.
  • 4-7-8 breathing: Begin by placing the tip of your tongue against the ridge of tissue behind the upper front teeth. With a quiet inhale through the nose and an audible exhale through the mouth, inhale for a count of four, hold your breath for a count of 7, and then exhale through your mouth, making a whooshing sound for a count of 8. Repeat this cycle at least three more times.
  • Belly breathe: Take a deep breath and focus on expanding your belly, rather than your chest. Watch your abdomen fill up as you breathe in and flatten as you breathe out. 

 

  • Alternate nose breathing: Begin by pressing your thumb on your right nostril and breathe out gently through your left nostril. Next, breathe in through the left nostril gently, and press the left nostril closed with a different finger. Remove your thumb from the right nostril and breathe out through the right nostril. Next, breathe through the right nostril, close the nostril, and then exhale from the left. Continue with this pattern alternating between nostrils.

 

Tap Your Brain

Brain tapping and bio-feedback is an integrative daily therapy that helps your brain rewire neural pathways and get your HPA-Axis “unstuck” from its old ways. 

 

Goldilock’s Fitness

Your body was made to move! That said, balance is key to keeping your HPA Axis working for you (not against you). A balanced fitness routine is encouraged: strength, power (HIIT), flexibility (yoga), lifestyle movement (walking, hiking, daily activity), occasional low intensity aerobic (spin, swimming, biking) and FUN (dance, group classes, rock climbing, skating, surfing, sports, etc.). Aim for the “Goldilock’s” approach to exercise—just right. (Note: If you find yourself “making yourself” go to the gym, chances are you’re not listening to that approach). 

 

Make a To-DON’T List

Stacking your “to do” list is sort of like what happens when you lift weights—such as pressing a barbell over your head. Some weight on the bar is a positive stressor—pressing weight can help you get stronger. But what happens if you keep loading that barbell with more and more (and more) weight? Eventually that positive stressor may become a plain ol’ overload stressor—you hit a “breaking point” and your body can’t handle it, or even lift it. 

 

For that reason, consider making a “To DON’T” list—the things you don’t need to do or that or not serving you towards your general goals of less stress and hormone balance. 

 

To take this a step further, try the “top 3 sticky note list”—every morning or night before you go to bed, make a list of your top 3 priorities for the day—the top 3 things that you would most like to focus your energy, attention and efforts towards. The top 3 things that, when you lay your head down on your pillow that night, you will be happy that you accomplished. 

 

If you check all 3 things off, great, you can add more. But for starters, just focus on 3.

 

Supplement Smart*

There are several helpful HPA Axis supports that can help support your body’s natural healing mechanisms as you recover. It’s important to work with a functional medicine practitioner or other healthcare provider who can guide you in your unique needs. These may include:

 

 

*Consult with your provider before using

 

Essential #3: Connect to Your Heart

 

I’ll ask you once more: Who are you without ED?

 

Until you can answer this question, Post Recovery Recovery will be super challenging. 

 

For this reason, I created Body Love + Food Freedom—a guided, holistic 12-week mindset and body recovery program to help you write a NEW story for your health and healing.

 

In it, I’ll give you the play-by-play guidance to help you heal—not just manage—your recovery, and experience a new type of recovery program like none other. 

 

Join the tribe today!