Improving Digestion Without Obsession

May 23, 2018 General Interest

Crystal Longo Savoy wrote this post on digestion while interning with me.

You can follow her on Instagram.

Marci has written about the intersection of digestive disorders and eating disorders previously in this blog post.  Because they are so closely intertwined and prevalent in the Eating Disorder (ED) population, we wanted to give you some simple strategies for alleviating digestive discomfort/pain.  Please know, you are 100% valid in your struggles, it’s not all in your head! This is a well-known barrier to treatment and recovery and supported by the evidence:

• In one study of ED patients, 96% reported postprandial fullness, 90% abdominal distention, and more than half complained of abdominal pain, gastric distention, early satiety, and nausea.
• In the same study, family history of GI disorders was present in 48% of the patients.
• In other studies, AN patients tended to complain of early satiety, postprandial discomfort or recurrent vomiting, severe constipation, and bowel obstruction. BN patients tended to experience bloating and flatulence, constipation, decreased appetite, abdominal pain, and nausea.
• 41-52% of patients with EDs also have IBS, with 68.8% of BN patients diagnosed with IBS.

It is also important to rule out other causes of GI discomfort/pain such as Small Intestinal Bacterial Overgrowth (SIBO), celiac, lactose intolerance, and Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis).  If you experience severe satiety, nausea, and distention and feel as if food sits in your stomach like a lead balloon, talk to your dietitian and primary care doctor as these are potential signs of gastroparesis.

Figure: Gastrointestinal disorders of patients with eating disorders, Sato and Fukudo, 2015

Below we address some simple strategies to implement into your daily routine for alleviating GI symptoms.

Stress:

Stress is so underrated when we think of digestion.  I’m sure you’ve heard of the link between the gut and the brain.  In fact, our gut is now thought of as our “second brain”. The gut and brain are directly connected via the vagus nerve.  So, when you are anxious, angry, sad, etc. these emotions can all affect digestion. One way to calm this gut-brain connection is to reduce stress via some techniques outlined below.

• Hypnotherapy has beneficial effects in improving gastrointestinal symptoms of patients with IBS.
• Yoga not only reduces stress but improves body image and mindfulness and the gentle movement gets your digestive juices flowing!

• Sarah Patten, RD, LDN, RYT is now offering individual yoga sessions, click here for more info!

• Try out this Mini Me Meditation to help with anxiety and feelings around food.

• Deep breathing – try this whenever you are feeling particularly stressed and right before meals.
• Essential oils can be very calming, particularly lavender, rose, sandalwood, and tea tree.  Try rubbing 1-2 drops in your hands and inhaling prior to/during/after a meal as needed.
• Acupuncture may reduce stress and improve digestion.
• Sometimes less is more.  Reduce stress on the body by refraining from intense exercise – studies have linked increased intestinal impermeability (leaky gut) during exercise.
• Not catching enough zzz’s can really mess with our whole body’s system so put together a relaxing bedtime routine and rest up! This article has some great ideas.

Food:

When experiencing GI upset, it is common that the first reaction is to blame it on the food.  Does “It must be something I ate.” or “I ate too much.” sound familiar? This can not only heighten anxiety but lead to more GI pain.  This ultimately exacerbates the problem because many of these common issues can be avoided with proper nourishment.

• Essential Fatty Acids (EFAs) are very healing for our gut lining.  EFAs can be found in foods like: avocado, olive oil, fatty fish (salmon), and eggs.
• Bone Broth is also healing as it contains a variety of minerals and amino acids.
• Sometimes eating raw fruits and vegetables can be hard on our digestive tract because it takes more effort to break down.  Instead of a raw salad, try boiling or roasting veggies. Fruits like apples are known to cause bloating and discomfort.  If you notice a particular fruit or veggie upsets your stomach, talk to your dietitian about how to navigate these challenges while also healing your relationship with food.
• Prebiotics feed the healthy bacteria and probiotics are the healthy bacteria. Prebiotics include a variety of fruits, veggies, and whole grains.  Probiotics are mainly found in fermented foods like yogurt, kefir, kombucha, and kimchi. These two are essential for a happy gut and digestion.
• Butyrate repairs the lining of the intestine.  Fiber rich foods that produce butyrate include: whole grains, fruits & veg, cheese, and butter.

Supplements:

Sometimes supplements are needed for supporting digestive health and may provide relief from certain symptoms.

• Iberogast is a well-researched and safe herbal supplement that may alleviate a variety of digestive symptoms.
• Digestive enzymes may also help support digestion.
• Magnesium/Natural Calm help to alleviate constipation and stress.
• Probiotics may be helpful – VSL#3 and Culturelle are two well-known brands.

Beverages:

• Ginger tea or putting fresh ginger into hot water for homemade tea is known for alleviating nausea and increasing gastric motility.
• Peppermint oil has been shown to alleviate IBS symptoms, including abdominal pain.  It can be consumed as tea or taken as a supplement.
• Drinking warm water before and after a meal may aid in digestion.
• Apple Cider Vinegar may improve digestion, mix 1-3 tsp with a glass of water and drink 15-20 minutes before a meal.

Other:

• Using a heating pad after meals may ease stomach pain.
• Avoid eating too fast, straws, gum, and carbonated beverages which may bring air into the digestive tract and increase bloating and gas.

Don’t feel as though you need to implement ALL of these suggestions at once.  Doing all of the things can in and of itself trigger stress and/or anxiety so choose 1-2 realistic strategies that you can implement and see how you feel.  Trust your body to know what works for you and utilize your team for support.

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References:

Herpertz-Dahlmann B, Seitz J, Baines J. Food matters: how the microbiome and gut–brain interaction might impact the development and course of anorexia nervosa. European Child & Adolescent Psychiatry. 2017;26(9):1031-1041. doi:10.1007/s00787-017-0945-7.

Lee HH, Choi YY, Choi M-G. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Journal of Neurogastroenterology and Motility. 2014;20(2):152-162. doi:10.5056/jnm.2014.20.2.152.

Salvioli B, Pellicciari A, Iero L et al. Audit of digestive complaints and psychopathological traits in patients with eating disorders: A prospective study. Digestive and Liver Disease. 2013;45(8):639-644. doi:10.1016/j.dld.2013.02.022.

Sato Y, Fukudo S. Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol. 2015;8(5):255-263. doi:10.1007/s12328-015-0611-x.

Shen Y-HA, Nahas R. Complementary and alternative medicine for treatment of irritable bowel syndrome. Canadian Family Physician. 2009;55(2):143-148

Załęski A, Banaszkiewicz A, Walkowiak J. Butyric acid in irritable bowel syndrome. Przegla̜d Gastroenterologiczny. 2013;8(6):350-353. doi:10.5114/pg.2013.39917.