Bloating and constipation are considered a “normal” part of life by many—affecting at least 1 in 3 people (NIH, 2020; Lacy et al, 2011). And, if you’ve ever had an eating disorder, constipation and bloating are considered “normal” parts of how you feel on a daily basis.
In fact, studies show that approximately 99.9 percent of individuals who have struggled with anorexia and 70-percent of bulimics—particularly lasting longer than 5 years—experience constipation, delayed gastric emptying (digestion), “fecal incontinence” (difficulty “going” #2) and/or other “functional gut disorders”. (Seleri et al, 2014 ; Kamal et al, 1991).
Even more, a couple more studies, investigating the prevalence of irritable bowel syndrome (IBS) in outpatients with histories of anorexia or bulimia nervosa, have found that approximately 60 to 70% have IBS. This is compared to only 10-15% in the general population (in the US). Additionally, roughly 90% of current or former eating disorder patients will develop IBS within 10 years of the onset of their disorder (Perkins et al, 2005; Saito et al., 2002).
I am one of them, and, chances are, if you are in recovery from an eating disorder, you may be one of them too.
My Bloating, Constipation, IBS & Eating Disorder Story
For the 20 years that I struggled with severe anorexia, orthorexia, ARFID and exercise bulimia (overtraining, purging through exercise) constipation, IBS and bloating were my “norms.”
- Sometimes I went #2. Sometimes I didn’t.
- Bloating and gas was expected after most meals.
- I never questioned if my stool was loose or watery.
- Stomach cramps happened alot (no matter how many healthy salads, carrots or apples I ate)
Even prior to the onset of my eating disorder at age 10, my gut was never quite right.
Fiber One Cereal: My Breakfast of Champions
As young as 5-years-old, I often cried to my mom that I “couldn’t go.” I popped Tums like sweet tarts after meals. And my pediatrician diagnosed me with “slow gut motility”, an “enlarged colon” and IBS—prescribing me a “fiber rich” diet of Bran Flakes, pulp-filled Tropicana Orange Juice and Fiber One Bars, instead of Fruity Pebbles, Capri Suns and Goldfish crackers.
Nevertheless, my gut issues still persisted. Fast forward to both my eating disorder and treatment, things only grew worse.
The Eating Disorder Diet: Pseudo “Healthy Eating”
In my efforts to shape my body and feel good in my own skin—bloating, constipation and IBS included, I tried every diet under the sun:
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- Calorie Counting
- Grapefruit Diet
- Macro Counting
- Clean Eating
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- The Zone
- South Beach
- Intermittent Fasting
- The Medical Medium Liver Cleansing
- The Whole 30
Check. Check. Check. Check. Check. Check.
Been there, got the t-shirt.
There were my pretzels and Diet Coke for lunch days. Healthy Choice frozen 300 calorie meal days. See-how-long-I-can-go-without-food days. Avoid carbs at all cost days. Guzzle back Crystal Light (to prevent hunger) days. Protein-only or veggie-only days. Six small meals per day, or no-meals-per-day days.
Seriously. Every diet…And my “gut issues” still persisted.
Treatment: Pop-tarts, Pizza & Prozac
Then, of course, eating disorder treatment was thrown into the mix. I spent 15 years of my life in and out of hospitals, eating disorder treatment centers, and dietitian offices in pursuit of recovery and “feeling better.”
My typical eating disorder recovery treatments consisted of lots of talk therapy, medication prescriptions and food exposure therapy galore, with little attention or concern to my tummy issues.
- There was the day I had to eat 4 Pop-tarts in one setting.
- Twinkie and Ding Dong snack challenge day.
- Double bagel day.
- Burger King and Chic-Fil-A fast food challenges.
- Double pasta day.
- Lick-the-margarine-off-the-tray days.
- Two large slices of pepperoni pizza and a large milkshake every Saturday night for six months straight. (I am lactose intolerant).
Unfortunately, as my mind fought to heal and make peace with both food and my body, my gut issues only seemed to worsen. To suppress my gas, bloating, constipation, diarrhea, and anxiety about it all the doctors and nurses passed out Lactaid pills, Miralax, Colace, Tums and anxiety meds like candy. They told me “Gut issues are just a part of the recovery process,” with no other discussion or remedies to heal, not just manage, my symptoms. Even more, most doctors, furthermore, do not know that 25% of all drugs (not only antibiotics) negatively impact the gut microbiome (Seitz et al, 2019).
Although my treatment experience may sound unique, it’s not.
Gut issues are common for thousands of other people with eating disorders who go through the motions of recovery and maybe even gain more mental freedom, lessen food fears or try “eating healthy” in the time following treatment.
The Gut Conundrum (Treatment & “Healthy Eating” Don’t Always Help Heal Your Gut)
A study published in 2010 (Boyd et al, 2005), examining the prevalence of gut issues amongst eating disorder patients admitted to inpatient treatment, researchers found that 97% of patients had at least one functional gut disorder. Twelve months later, after treatment, 77% of patients still had gut disorders.
Their conclusion: Neither change in weight nor change in eating disorder behaviors (self-induced vomiting, laxative use, and objective binge eating), or psychological variables (anxiety, depression, and somatization) had a significant impact on changing their functional gut disorders from treatment admission to 12-month follow-up.
That said, you don’t have to have a “severe” eating disorder or history of eating disorder treatment to still have gut issues. Dieting, fad dieting, binge eating and food restriction can equally wreak havoc on your gut. This is because what we eat is one of the strongest environmental forces that alters the gut microbiota—for the better or worse (Brown et al, 2012).
For example, while the popularized low-carb ketogenic diet) acclaimed for body fat loss, mental clarity, bloating busting and energy boosting benefits) can be beneficial for some, other less-talked about side effects include: constipation, decreased butyrate (short chain fatty acids), and decreased bifidobacteria (a beneficial bacteria) species (Brinkworth et al, 2009). And overall reduced gut bacteria diversity, IBS and gut inflammation is observed in both those who follow a long term restrictive diet or who overeat or binge eat (Seitz et al, 2019).
Even more, “healthy eating”—in the name of improving your gut health itself (such as an elimination diet, like the Whole30 or SCD lifestyle)—can also further exacerbate a funky relationship with food. In other words: In your efforts to “be healthy”, you can end up with another type of eating disorder or food fears.
Orthorexia—an obsession with healthy eating, is a common trap in which many individuals with a history of eating disorders and gut issues can find themselves entangled. Orthorexia may innocently start as a simple desire to improve one’s eating habits or health, such as with a recommended IBS diet (Low FODMAP) or popularized intermittent fasting, and then slowly evolve into toxic and anxiety-generating behaviors.
Another eating disorder that could be of concern when adopting a “gut healing” or clean eating elimination diet is avoidant/restrictive food intake disorder (ARFID)—characterized by an avoidant and/or restrictive eating behavior that results in accidental under-eating, food fears or nutrient deficiencies. ARFID is different from anorexia, because it’s not necessarily about weight or body image. Instead, ARFID creates fears and anxiety over how certain foods make you feel (bloated, constipated, mast cell activation syndrome), as well as fears about trying new foods that may not be considered part of a particular protocol (AIP, GAPS diet, Low FODMAP, etc.). Unfortunately, long term food restriction—even if not about weight loss—can continue to feed into underlying gut issues, dysbiosis (gut bacteria imbalances) and prevent gut healing, primarily because a healthy gut microbiome thrives upon a nutrient-dense diverse diet and less stress to increase a diversity of gut bacterial species.
(Fun fact: Did you know that higher levels of stress (physical and mental) are associated with increased constipation, IBS , dysbiosis and decreased serotonin levels produced in the gut —your “feel good” brain chemicals? Moreover, considering that 90-percent of your serotonin is produced in your gut, if you have “gut issues,” it’s no wonder that, when you’re low in serotonin, you feel more depressed, anxious, and OCD. Stress and gut issues go hand-in-hand).
Top 10 Gut Issues from Eating Disorders & Chronic Dieting
Some of the most common gut issues experienced by individuals with histories of eating disorders or disordered eating include:
- Constipation. Difficulty in emptying the bowels, hardened stools and infrequent bowel movements (not going every day). Often related to low digestive enzyme production, low stomach acid, stress, liver/gallbladder insufficiency, dysbiosis, and/or sometimes (but not always) related to Candida or SIBO—small intestinal bacterial overgrowth.
- Stomach Cramps, Bloating &/or Gas. The feeling of being “swollen” or feeling like a “balloon.” Often related to low digestive enzyme production, low stomach acid, stress, liver/gallbladder insufficiency, dysbiosis, and/or sometimes (but not always) related to Candida or SIBO—small intestinal bacterial overgrowth.
- IBS. A diagnosis of exclusion, often slapped on as a label for patients with histories of eating disorders when no real root cause can be determined. May be characterized by frequent loose stools, chronic constipation or alternating loose stools and constipation. Often related to low digestive enzyme production, low stomach acid, stress, liver/gallbladder insufficiency, dysbiosis, and/or sometimes (but not always) related to Candida, SIBO—small intestinal bacterial overgrowth or a gut infection.
- Candida. The overgrowth of candida yeast throughout the body—gut, vaginal, nasal and/or oral microbiomes.
- Small Intestinal Bacterial Overgrowth. SIBO is a condition where imbalanced, unhealthy gut bacteria invade your GI tract, leading to symptoms of gas, bloating, nutrient deficiencies, brittle nails/hair, fatigue, skin breakouts, anxiety, autoimmunity, food intolerances and blood sugar imbalances. SIFO (small intestinal fungal overgrowth) may also be present.
- Irritable Bowel Disease (IBD). Both Crohn’s disease and Colitis are autoimmune diseases characterized by inflammation of the upper GI (small bowel), lower GI (colon) or both
- Reflux (GERD) & Heart burn. Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). Heartburn is a form of indigestion felt as a burning sensation in the chest, caused by acid regurgitation into the esophagus. Both are often due to low stomach acid, carbohydrate malabsorption, suppressed digestive enzymes and/or H. Pylori—a gram-negative bacteria that can be a normal resident of the GI tract for some, but in others, can cause ulcers in the lining of your stomach or the upper part of your small intestine that lead to GERD/reflux, heartburn and/or stomach pain.
- Gastroparesis & Slowed Motility. Slowed stomach emptying and/or slowed elimination when of the muscles of the stomach or colon (or the nerves controlling the muscles) causes the muscles to stop working.
- Parasites & Bacterial Infections. Can be contracted from food poisoning, water or the environment. Non-typical residents of the GI tract that can lead to IBS, dysbiosis and immune dysregulation. A history of disordered eating (and stress) can set you up to be more susceptible to gut infections, primarily because your body’s “defenses” (immune system) are down.
- Dysbiosis. Clinically, one of the most prevalent gut “findings” behind gut issues in the post-recovery from eating disorders. In laymen’s terms, dysbiosis means “gut imbalances”—typically a low growth of beneficial species and low bacterial diversity. In short: Restriction, dieting, binging and purging kills gut bugs due to stress and inconsistencies in nutrients, food types, and food quality.
The good news? You are not stuck with gut issues just because you had an eating disorder for life! You can heal your gut, and consequently further heal your brain (thanks to the brain-gut connection)! (Appleton, 2018).
My Gut Healing & Eating Disorder Recovery
Recovery from my 20 year long battle with eating disorders—and my eating disorder brain—truly began when I began to heal my gut, and concurrently, when I began to redefine what a whole, healthy life looked like (not just another fad diet, workout or supplement).
Finding gut healing and peace with food, my body and fitness included:
- Learning what foods a healthy gut likes to eat. (Hint, it’s a balanced diverse diet).
- Testing (not guessing). Figuring out the underlying gut imbalances, hormone imbalances and nutrient deficiencies going on in my body after years of ED.
- Varying up my exercise routine. Saying “peace out” to chronic overtraining and incorporating a blend of weights, HIIT, walking and hiking, yoga, dance, and also being OK with nothing at all. Making movement a lifestyle, not an ultimatum.
- NOT caring about calories, but caring about nutrients
- Supplementing smart. Not taking every pill under the sun. Loving my gut bugs back to life with a blend of herbs, probiotics, prebiotics and, of course, medicinal gut loving foods.
- Practicing 80/20 balance. Giving up “perfection” and purposely integrating more permission, grace and balance. Being OK with not always eating 100% organic. Occasionally (making myself) eat some dark chocolate or try a new recipe—despite food fears.
- Connecting back to people, hobbies, activities and passions that made my heart sing. Soooo much of my life had been wrapped up in my eating disorder. In recovery, I purposely made an effort to join community, start writing again, and play more.
- Detoxing my life, my mind and my liver. Cutting out the habits no longer serving me (overtraining, under-eating, social media scrolling). Eliminating toxins in my environment (skin, beauty, cleaning products, water, foods). Supporting my liver with enzymes and bitters, teas, herbs, infrared sauna, colon support and beyond.
There are alot of pieces to the puzzle that contribute to overall wellness, and my journey is a big reason why, today, I work with women, just like you, who may have a history of disordered eating and gut issues.
If you’ve struggled with constipation, bloating, IBS or other gut issues in your recovery, here are 5 Steps to Heal Bloating & Constipation (or Other Gut Issues) in Eating Disorders.
5 Steps to Heal Bloating & Constipation (or Other Gut Issues) in Eating Disorders
Step 1: Do a Gut Check
Before diving into any clinical testing, protocols or supplements, the first step is to simply check in with your gut and assess how you feel.
Ask yourself, “Why do I feel this way?—(bloated, constipated, gassy, etc.)”
You were born intuitive—knowing when you’re hungry, full, tired, happy, sad—and everything else. Eating disorders have a tendency to HIJACK your brain and body—making you forget how to listen.
Example: Feel bloated every day—especially in the afternoon?
- What are you eating for lunch?
- What activities are you doing after lunch?
- How was your sleep the night before?
Often times, when we check in, we quickly figure out the “why” behind some of our most pressing concerns. For this one, keeping a 3 day mindful eating mood, food and poo log can be super helpful.
Step 2: Get Back to Basics
There are 7 “baseline essentials” for a balanced, happy biome. If seven—or even one—are out of balance, constipation, bloating, gas, IBS and beyond has more opportunity to play. The 7 baseline essentials include:
- Breath. Your breathing rate signals “peace” or stress to your gut microbiome on a daily basis. Ideally, at rest, you want to inhale and exhale a total of 5-7 breaths per minute—rest and digest. Unfortunately, the average breath rate of most folks is between 14-20 breaths per minute—stress mode, all day long. Thanks to the “brain-gut” connection, your gut feels this.
- Hydration. Carries nutrients to gut bacteria and cells, rids of wastes and toxins. Flushes your lymph. Are you drinking at least half your bodyweight in ounces of clean, filtered water daily?
- Nutrients. Include a fat, fiber and protein with meals, and ideally 5-7 servings of veggies per day—including 2-3 cups of dark leafy greens.
- Absorption. Boost digestive enzymes and stomach acid—chew your food really well, and take supplemental digestive bitters and enzymes as needed.
- Elimination. Daily movement and heat; as well as daily poo—if neither of these are happening, your detox pathways can get clogged.
- Rest. Gut healing happens the most when we are not stressed: Sleeping 7 to 8 hours per night, in touch with our circadian rhythms (biological clock—sleeping, eating and working during the most ideal times of day), and incorporating “recess” breaks or rest breaks in the day—including a solid morning and bedtime routine.
- Connection. Gut microbes thrive upon connection—making time for social relationships and connections with other people; and happy and at peace, doing things we love to do (passions, hobbies, activities). Although it sounds far fetch, a happy heart equals a happier, less stressed gut biome.
Step 3: Change One Thing
Ever tried to make a BIG change in your life, only to end up back where you started? Change is not necessarily easy, which is why focusing on taking one baby step at a time will get you closer to gut wellness. Instead of overhauling all of your habits or taking a million supplements, pick ONE of the 7 baselines to focus on, or just ONE of the “Boost Digestion” hacks (step 5).
Step 4: Let Food Be Thy Medicine
This one deserves a category all it’s own—especially if you have a history of an eating disorder. In the gut healing space, there is often a heavy focus on “killing pathogens”, restricting and elimination. However, contrary to popular belief, a thriving biome actually prefers and needs a diverse, nutrient-dense diet. Here are some gut loving superfoods:
- Celery juice
- Ginger, garlic & turmeric
- Prebiotic fibers (cooked and cooled rice/potatoes; green tipped bananas and plantains, jicama, leeks, asparagus, cassava, lentils, dandelion, chicory, dark chocolate, veggies of all sorts, apples, pears)
- Wild caught fatty fish, pastured egg yolks, organic proteins and organic organ meats
- Bone broth and meat broth
- Fermented vegetables
- Extra virgin olive oil, coconut, ghee
- Fresh herbs: thyme, oregano, sage, basil, cilantro, parsley
- Cruciferous veggies
Step 5: Boost Digestion
Need some in-the-moment hacks to bust constipation and bloating? I’ve got lots up my sleeve! Here are 10:
- Apple Cider Vinegar. Add 1 tbsp. to 2-4 ounces of water and drink before meals.
- Magnesium Calm. 1/4 tsp in water before bed to easy constipation.
- Fermented veggies & kefir. Eat 1-2 forkfuls of sauerkraut or other fermented veggie with 1-2 meals per day, or 2-4 oz of kefir (water kefir, goat’s milk, cow’s milk) as tolerated)
- Tea. Sip ginger or peppermint tea for bloating, and try Smooth Move tea for constipaiton.
- Double dose Iberogast and digestive enzymes.
- Rub Castor Oil or peppermint or lavender essential oils on your stomach, and perform an abdominal massage.
- Use a squatty potty and take your time to “go.”
- Move it, move it. Try downward dog and upward dog sequences, while deep breathing. Go on a walk. Or jump up and down like you are on a rebounder 10-20 times to jostle things up.
- Add ghee, extra virgin olive oil, coconut oil to your veggies, and cook and soften veggies to consume (instead of eating raw)
- Avoid artificial sweeteners and swig back an extra glass or two of warm lemon water instead.
Bonus: Partner with a Practitioner + Do Gut Testing
Still hitting roadblocks in how you feel? Don’t go it alone. Contact us today to schedule an Initial Consult Appointment + Exam so we can help you figure out what’s going on in your gut and give you next steps to heal.