Up to 98% of Eating Disorder Survivors Have Gut-Health Issues, But Treating Them Requires Extra Care

Photo: Getty Images / LumiNola
Eating disorders (EDs) are complicated; recovery, even more so. Not only can they be difficult to treat, but eating disorders (unlike some other mental health conditions) affect the body as well as the mind. I’ve experienced this firsthand, and I’ve had to heal my whole self in order to recover fully—including, surprisingly, my gut.

Throughout treatment programs, I’ve met fellow survivors with incontinence, who required low fiber diets, or who had been under doctor’s care for severe constipation. While my GI symptoms did not severely interfere with my daily life, I still needed to be prescribed medications for nausea and acid reflux.

Experts In This Article
  • Jaime Coffino, PhD, MPH, Jaime Coffino, PhD, MPH, is a clinical psychologist who specializes in the treatment of eating disorders.
  • Mario Tano, MD, Mario Tano, MD, is a pediatric gastroenterologist and the medical director of the GI division at Kidz Medical Services in Florida.
  • Theresa Shank, RD, Theresa Shank, RD, is a Philadelphia-based dietitian.

Research shows that I’m not alone. Up to 98 percent of people who have an eating disorder meet the criteria for Functional Gastrointestinal Disorders (FGIDs), conditions that affect the functioning of any part of the digestive tract. The most prevalent among ED survivors is irritable bowel syndrome (IBS), a catch-all for digestive concerns that don’t meet the criteria of conditions such as Crohn's disease or inflammatory bowel disease.

Gastrointestinal conditions can have many causes, but for people with EDs, their symptoms and habits over time can damage the entire digestive tract. Restricting food intake, bingeing, avoiding food groups, and purging—whether through laxatives or vomiting—all harm your digestion. Even if you’re not diagnosed with a full-blown eating disorder, the restrict/binge cycle often caused by chronic dieting can also cause harm.

How disordered eating can affect your gut

Pediatric gastroenterologist Mario Taño, MD, has witnessed the damage that disordered eating can cause in patients—even in young children. He says that when a person restricts their food intake (as with many forms of disordered eating), the gut immediately suffers. “We have two types of organs in our body: the vital organs and the non-vital organs,” he says. Your heart, lungs, and kidneys are considered “vital” (meaning you can't live without them), while organs like those in the GI tract are considered less so. “If you don't give yourself the appropriate amount of calories, there will be a prioritization of nutrients, and they go to the vital organs first.” Basically, severely restricting food starves your gut, which can lead to serious health problems.

Additionally, not eating enough food in general, or cutting way back on certain food groups, can disrupt your stomach’s good bacteria, says Philadelphia-based registered dietitian Theresa Shank, RD. This bacterial imbalance can affect one’s immune system and can contribute to symptoms of IBS or IBD.

According to Dr. Taño, behavior such as restricting or purging could lead to gastroparesis, where the stomach no longer properly contracts to break down food, delaying the digestive process. Gastroparesis can present itself as nausea or acid reflux after eating, or fullness well past a meal. Being malnourished can affect this, since your body is trying to preserve nutrients for more important functions, such as your circulatory system.

Further studies show that patients with eating disorders are also at risk for more severe conditions such as pancreatitis, ulcers, liver failure, colitis, and fatty liver disease. These conditions are often the result of malnutrition, purging, and consuming high quantities of fatty foods (as can happen when bingeing), which can be associated with anorexia, bulimia, or binge-eating disorder (BED). Another lesser-known effect of eating disorders is pelvic floor dysfunction, which is caused by chronic constipation associated with anorexia. Constantly straining to go to the bathroom can weaken the pelvic floor muscles.

What the healing process is like for the gut

Additionally, many people with eating disorders experience IBS-type symptoms even as they begin the recovery process. When GI issues appear during recovery, anxiety and stress are often to blame. And in these cases, the symptoms can trigger disordered behaviors, such as restricting food in an attempt to soothe the distress.

“It is quite common for a client to express that they feel better when they eliminate X, or X bothers their stomach so they avoid it. This often leads to veganism or a gluten- or sugar-free lifestyle," says clinical psychologist Jaime Coffino, PhD, MPH. However, these decisions may be an extension of one’s illness, and should only be made when fully recovered. Dr. Coffino often explains to clients, “There will be many times throughout treatment that they do not feel good, or have anxiety. We [the treatment team] explain that eating the food will help them get better, and avoiding the food will increase that anxiety.”

Compounding the problem for people with eating disorders is how the health-care profession commonly addresses gut issues in the first place. In many cases, doctors often recommend elimination-based diets to people with gut health issues to rule out foods that might be causing irritation. (For example, people with suspected IBS are often prescribed the FODMAP diet, which asks adherents to cut out specific food groups known to trigger IBS, then slowly reincorporate them one at a time to rule out which ones are bothersome). However, these protocols, which inherently involve restriction, are often adopted without consideration of the realities of disordered eating—which Shank says can undermine a patient’s eating disorder treatment. “The eating disorder and gut issues will both persist since the root cause—the eating disorder—was never treated properly, but rather made worse,” she says.

Instead of immediately implementing elimination diets, Shank recommends clinicians treating ED patients with gut health issues “take the focus away from the need to eliminate certain foods and rather educate clients on how they can fill their diet with healthier whole foods that are naturally gluten-free, refined sugar-free, or whatever they believe the culprit of the digestive issues may be. [The treatment team] should try to identify any disordered behaviors and help the client resolve them, as this will most likely resolve their GI symptoms as well. ‘Diet foods’ should be eliminated and food variety should be implemented.”

The good news about digestive disorders associated with eating disorders is that they are often reversible. If you are navigating recovery and are concerned about your gut health, a certified eating disorder dietitian or a primary care doctor knowledgeable about eating disorders should be your first stop, not an influencer pushing Whole30. For me, eliminating foods was not the solution to fixing my gut health issues. It took working with professionals to manage my anxiety and get back to eating foods that I enjoy, and my gut has thanked me for that.

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