Digestive Disorders and Eating Disorders: A Complicated Mix

August 6, 2020 Clinician Training

Several years into my work as a nutrition therapist I found myself really grappling with a clinical dilemma. Many of my clients were not only suffering from an eating disorder but they were also suffering from pretty severe digestive issues. And these digestive issues were not only complicating their recovery but they were seriously impacting my clients’ quality of life. In fact, many clients who had made tremendous strides in their eating disorder recovery were suffering with digestive symptoms that other clinicians had promised would go away once they got better from their ED.

So I delved into the research, participated in a year long integrative nutrition therapy training, exchanged supervision with colleagues who specialize in digestive health, attended workshops, and I thought A LOT. In fact, I want to make a big shout out to my friend and colleague Lauren Dear who is an amazing digestive health dietitian and has taught me so much.

All of this study (and continued study!) led to a series of talks on the intersection of EDs and digestive disorders that I have given and presented, plus the development of a training course on this very topic.  For now, I’d like to share some juicy tidbits!

Critical Research Nuggets: Digestive disorders and eating disorders

• Up to 98% of clients with eating disorders have a functional gut disorder (FGD) (Note: FGDs are things like Irritable Bowel Syndrome, gatric reflux, bloating, constipation, and diarrhea (to name a few).
• People who suffer from FGDs and EDs share the same underlying mental health challenges- namely anxiety and depressive disorders
• These mental health challenges can lead to digestive symptoms that can perpetuate long after the ED symptoms have resolved
• EDs can actually cause FGDs and FGDs can make a person vulnerable to the development of an ED. This means it is BOTH the chicken and the egg.
• Childhood GI issues are a key risk factor for the later development of an ED
• Both EDs and FGDs negatively impact body image. A person who suffers from both has a double whammy to contend with!
• Anorexia Nervosa changes the gut microbiome by deceasing bacterial diversity. Lower numbers of bacterial diversity are associated with greater levels of eating disorder psychopathology.

Specific Concerns for the ED Population

Traditionally, medical providers and dietitians have encouraged an elimination diet of some kind to treat these enduring and often puzzling symptoms. However, eliminating foods is really the opposite of the goal of nutrition therapy for EDs. Restriction, even if medically indicated, complicates ED recovery. In my personal experience, I have seen well-intended clients/practitioners advocate for an elimination protocol that has led to full blown relapse. So what are we to do as clinicians who feel desperate to help our clients fully recover and treat any concomitant digestive health concerns? I have a few take home points for you to consider.

Key Take Home Messaging

 There are many non-harmful interventions to try with clients.

Most if not all behavioral interventions that support ED recovery will also support digestive health. Root out remaining ED behaviors as most will reinforce negative GI symptoms.

• Sensitive systems require CONSISTENCY & BALANCE.
• A stressed out person will likely have a stressed out gut. Help clients embrace hypnotherapy, meditation, deep breathing, guided relaxation.
• The relationship between head brain and gut brain is REAL!
• Food variety improves the gut microbiome and is a key ingredient to ED recovery.
• The goal is to include as many foods as possible for mental, emotional, and psychological well-being.
• Integrate the use of digestive enzymes, probiotics, and well-researched supplements to help manage symptoms.
• Fuel healthy bacteria by integrating fermented foods and drinks.
• Incorporate a stool or squatty potty for more anatomically supported elimination (ie the squat position makes it way easier to poop!).
• Eliminate “diet foods” as they contain a lot of additives that worsen digestive symptoms and are often a culprit in the ED
• Play with changing the texture of foods rather than eliminating them all together

One Last Request

Training Program for Clinicians

If you want to bring more to your clients with digestive issues, Lauren Dear and I have teamed up and developed an online training to build your confidence working with those challenging clients who have eating disorders and digestive disorders.

You can learn more about the course, Digestive Disorders & Eating Disorders: A Complicated Mix on my Food and Body Image Healers Training Institute.