Managing IBS in Eating Disorder Recovery?

Originally published July 5, 2017

Content Warning: eating disorders

Question: How do you treat IBS and other digestive issues while following an Intuitive Eating approach in eating disorder recovery?

More and more of my clients have been asking me questions about two topics. The first is intuitive eating. The second is gut health. So I’m absolutely looking forward to answering this question!

Intuitive eating is complicated. If you’ve struggled with an eating disorder or disordered eating, getting back to a place where you can listen to your body’s internal cues is tough work.

Adding on a medical condition on top of that already tough work may feel impossible.

I’m happy to answer this question on how to apply intuitive eating in a situation where your digestive system may be sending you mixed signals.

First off, when I work with a client who has IBS, one thing I always want to work through with my clients is how the IBS could be related to the eating disorder.

ED behaviours can cause a huge disruption in normal digestion and the body’s ability to send signals regarding hunger and fullness levels.

Perhaps it would be a good idea to explore the following questions with your dietitian:

How often am I engaging in behaviours (if I am)? If I increase or decrease behaviours, do I notice a change in my hunger/fullness or my digestion? And how so? I have definitely had clients whose IBS symptoms dramatically improved once they started nourishing properly.

Sometimes, that is the first line of defence in preventing or decreasing GI symptoms. That being said, that’s not always the case! And I’ll talk more about this later in my post.

Secondly, let’s define what intuitive eating is.

We often hear that intuitive eating is “eating when we’re hungry, and stopping when we’re full.” While that’s true, eating intuitively is so much more than just that. It’s about listening to a wide variety of your body’s signals, like when it’s time to rest vs move, or when you want a bigger meal vs a smaller meal, or if you want veggies vs no veggies, or taking some more food vs leaving food behind, or generally eating what you’re in the mood to eat.

I’d recommend reading the book Intuitive Eating by Evelyn Tribole and Elyse Resch. But, please check with your treatment team first to make sure it makes sense for where you are in recovery!

Related: What I Ate When I Started Intuitive Eating

Now it’s time to address some of the gut stuff.

In prep for this blog, I actually re-listened to a Food Psych Episode 175: The Truth About Digestion and Gut Health with Marci Evans. There’s tons of great information in here. And if you’re struggling with gut health as well as a past or current diagnosis of disordered eating/eating disorder, consider taking a listen.

In this podcast episode, Marci Evans discusses the research she’s reviewed for her Digestive Disorders/Eating Disorders training for clinicians.

Let’s discuss a few points that stood out to me:

1. Many people with Eating Disorders/Disordered Eating also have some type of digestive disruption.

Some surveys show that up to 98% of people with an eating disorder also have a concurrent GI disturbance. I wanted to point this out to show how prevalent this relationship is!

And it makes SO much sense when you think about how ED behaviours impact the amount and the availability of food. Ultimately, that will affect the way our digestion works.

2. Disrupted gut/brain connection.

Marci also discussed how the communication between the brain and the gut is “disrupted” in a “functional gut disorder.” A functional gut disorder is a gut issue in which the symptoms cannot be explained by a structural or tissue abnormality. IBS falls into the category of a functional gut disorder, whereas Celiac disease does not. (That’s because in Celiac disease, gluten triggers an autoimmune response in the body, which can cause damage to the small intestine).

How can this communication between the gut and brain become disrupted? Typically by some type of stress response, which can be either physical or psychological. So yes, anxiety can cause a disruption in this communication. And it may result in things like acid reflux, bloating, gassiness or diarrhea.

On the physical side of things, this connection could be disrupted by undereating, over-exercise, laxative use, or bingeing. And it goes both ways! GI symptoms often cause stress and anxiety via the same connection. Someone may be feeling really anxious about how/when/if their GI system will act up.

3. Gut Directed Hypnotherapy.

Many times, clients are often recommended to go on an elimination diet, like low FODMAPS. One big problem with these types of diets is that they are extremely restrictive, which means they are not appropriate for eating disordered clients. And, for those who do not have a history of an eating disorder, I personally hesitate to put these clients on an elimination diet for fear that it could trigger disordered thinking that may not have existed previously.

There is up-and-coming research that suggests that gut-directed hypnotherapy may be just as effective as elimination diets. I thought that is so fascinating! And I am looking forward to seeing the new research on this.

4. “IBS” or other digestive symptoms might persist after recovery.

What many clinicians are trained to tell their clients is the GI symptoms will lessen or completely go away after ED behaviours are no longer present.

While this may be true for some clients, it’s certainly not true for everyone. What we are finding is that the GI disruption can exist independently of the eating disorder.

What this means is that clients may still struggle with GI symptoms even after they’re recovered. Why? Marci speculates it’s for a few reasons: The eating disorder disrupts the GI system’s functionality and sensitivity. Plus, having a diagnosis of IBS or an eating disorder may mean you’re already hypersensitive to symptoms compared to someone without IBS or eating disorder.

Additionally, many people with eating disorders have a concurrent mental health diagnosis, which could contribute to anxiety and/or depression. So these 2 things, the physical and emotional side, allow the functional gut disorder to persist. I wanted to point this out in case there are readers who have experienced this.

So what does this mean for intuitive eating?

Eliminating foods:

Well, I’m not a huge fan of eliminating foods unless absolutely necessary, and sometimes it is.

Sometimes intuitive eating might mean not eating a certain food because you know it’s going to make your body feel awful. Other times, you might just really want to eat said food, knowing you might not feel great after, and that’s okay too.

Eating when not really “feeling it”:

Eating when not hungry is important for all people, whether in ED recovery or not. Oftentimes, emotions (like anxiety, sadness, stress, and excitement) can lower appetite.

Part of intuitive eating is recognizing when emotions might decrease appetite and having a plan to still eat anyway, even though difficult.

Food diversity:

We have more cells and genes in our microbiome than we have other “human cells,” some of which control the production or hormones that make us feel good and happy. Also, about 70% of our immune system is in our gut. That’s amazing!!

So, we need to make sure we are giving our bodies a wide range of food to feed our gut microbiome. I’ve heard from multiple gut experts that a decreased variety can actually cause gut disturbance. And by increasing the number of foods we eat, over time we can see improvements with digestion.

Think about it, if you’re eating the same things every day, that doesn’t give your body many nutrients to work with!

Stress management:

Lastly, we know that emotions, especially stress and anxiety, cause a physiological effect in our bodies, especially our digestion.

That being said, working through emotions and stress can support gut health. I’d recommend seeing a therapist if you’re not already. Or trying things like meditation, deep breathing yoga and/or getting enough sleep.

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Alex Raymond, RD, LD, CEDRD

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Alex Raymond is an eating disorder dietitian in private practice in College Park and Columbia, MD. Alex specializes in treating individuals struggling with anorexia, bulimia, and binge eating disorder. She practices from an intuitive eating model and enjoys working with individuals to improve body image. She is a passionate Health at Every Size © advocate and anti-diet dietitian. Alex provides eating disorder nutrition counselling in College Park and Columbia, MD. Alex's College Park office is within walking distance from the University of Maryland.