One of the most common complaints I get at my full time NP job and in private practice as an RD has to do with GI upset…aka gastrointestinal problems. I also get several emails a week on the topic so I thought it was about time for a blog post.
Now, before I go any further I do want to say loud and clear. One, the generalized info/advice I write here does not replace the one on one relationship you have with your doctor. And two, please go get a full workup by a GI doctor to rule out any underlying pathology that could be causing a more serious issue. Once everything more serious is ruled out (celiac, colitis, gallstones, ulcer, etc etc) and you know that what you going on is not serious…..then keep reading š
The body is very complex and dynamic. And figuring out the root cause of digestive issues can take a lot of digging and searching. I find GI issues to be the hardest to pinpoint and heal because there are so many factors that can cause digestive issuesĀ and it’s really hard to isolate one factor in order to pinpoint the culprit. Typically, these issues are multifaceted. I know, annoying. Hang with me.
There are broad two categories of digestive issues (aside from medically diagnosed conditions) that I come across on a daily basis in practice. One set are those that arise when recovering from an eating disorder. The second set are those that arise in otherwise healthy women that don’t have a history of an eating disorder. I’m going to try to address both in this post in the most understandable way I know.
When we don’t take care of ourselves over a period of time – either through restricting calories or food groups, over exercising, laxative abuse, binging, binging/purging and other similar behaviors our bodies take a while to heal. It’s not that there’s something pathologically wrong, it’s just that your body is trying to learn how to function properly again. I find that it takes a Ā lot of reassurance from me to help women realize that there isn’t anything “wrong” with their body. Their body is just moving through the healing process, putting back together all the damaged pieces and learning to work properly again. And after months or years of treating your body poorly, this healing process can take aĀ long time.
Typically (not always) what you’re experiencing is a functional problem versus an anatomical issue. Some GI problems you might experience if you have or have had an eating disorder OR disordered eating include…
heartburn
bloating (which can mild or severe)
become full quickly
nausea
abdominal distension
constipation
gas/cramping
In the case of restrictive eating or other disorders behaviors, almost all of these symptoms manifest because of gastroparesis – which in essence is delayed stomach emptying caused by decreased stomach motility. This is caused when your vagus nerve (a super important nerve in your body connecting your brain to your colon) is damaged and therefore the stomach doesn’t contract and move food out like it should. These symptoms also arise because the gut microflora is impacted by what you eat. Food restriction can cause intolerance to foods that were once tolerated likely due to a disruption in your flora and alterations in the production of your digestive enzymes. So when you try to increase the amount of food you are eating or the diversify the types of food you eat…you end up with a lot of discomfort. Your gut flora is shifting and trying to adapt to the altered intake and it takes some time for your GI system to learn how to digest properly again. With time, normalizing and diversifying your food intake and decreasing anxiety/stress, these symptoms typicallyĀ do resolve. High emphasis on theĀ time factor. Which is why support and reassurance on the treatment team end is so so important.
It’s a double edged sword though because often there is a lot of emotional distress that comes with recovery…anxiety, OCD tendencies, worry etc and your gut is basically your second brain. It’s what we call the enteric nervous system. Your gut brain isn’t capable of thinking and feeling, but it does control the physiological processes of your digestive system and it is highly affected by feelings like anxiety, depression, stress etc. So while some symptoms are in fact caused by disruptions in your gut from unhealthy eating and exercise habits…they can become exacerbated (or manifested entirely) from anxiety and stress. It’s not that your symptoms aren’t real (they so are!) it’s just that there are phycological factors vs a purely physiological cause. Make sense?
Before we go further, I think it’s important to note that intermittent bloating and gas is totally normal. Its the body just doing it’s thing and we will have little quirks and sensations from time to time because our body is so dynamic. Some of this is normal. I get bloated for about 15-20 minutes after I eat a salad at lunch. Then it goes away. It’s my body digesting all the fiber. I get gassy (tmi? nah.) from time to time, I don’t entirely know why. But it goes away. Our bodies are just doing their thing sometimes.
But what about if you haven’t had an eating disorder or disordered eating? In the absence of normal nuances or circumstances related to eating disorders, there are a slew of other things that could be causing inflammation that in turn cause gastrointestinal issues. At the root of all this is inflammation. And because of that you experience the same common symptoms – bloating, gas, constipation, diarrhea etc. Usually doctors chalk it up to IBS (irritable bowel syndrome)…which often is true.
But what I find happening (and this is my observation) is that people end up eliminating a lot of foods in order to feel better. Which one, doesn’t take care of the root issue (which can take some time and effort to find out) And this extreme elimination ends up being a catch 22 because when you eliminate more and more foods for longer periods of time your body forgets how to digest those foods. I’m not saying this approach isn’t helpful for symptom relief – I think being in touch with your body is super important and learning what feels good and what doesn’t is one of the cornerstones of intuitive eating. But that still doesn’t take care of what’s causing the digestive problems in the first place, because food isn’t solely to blame. I think we overlook some important things to address and resort to eliminating all these foods way too quickly.
Are you eating rhythmically and overall “balanced” meals? Meaning three meals a day with some snacks and including a variety of food groups?
Are you stressed? Anxious? –> this is almost always a huge contributing factor and one I focus on the most with clients/patients. how can you take care of yourself to decrease stress and anxiety? mediation, deep breathing, yoga, going on a walk, journaling are all good things.
Are you eating a ton of high fiber, raw, “clean” foods? –> too much of a good thing isn’t a good thing. you don’t need to eating 15 servings of vegetables and quinoa and beans and hummus for every meal because hell yes, you will be bloated. Holy fiber overload.Ā EspeciallyĀ recovering from an ED or disordered eating, you gut actually doesn’t have the capacity (due to insufficient digestive enzymes and poor gut integrity) to digest all that roughage. Eating more refined foods (because they are already partially broken down before they enter your mouth) is paradoxically what your body needs right now so your gut doesn’t have to do so much work. I find it’s really hard for people to wrap their minds around that concept because aren’t vegetables and quinoa and beans good for you? Yea they are…but perhaps they aren’t what your body needs right now. Your body needs easy to digest energy and then you can move on to other foods. But that’s hard work…because often these more refined, gentler foods, are anxiety inducing to eat because they have been feared for so long. Things like ice cream, white rice, white potatoes. But on the positive side, you’re killing two birds with one stone….conquering food fears and your digestive system feels better. I know it’s much easier said than done, but it’s a win win š
Do you eat quickly? Does eating feel chaotic? –> this causes bloating and gas and to an extent emotional distress
Are you eating past fullness? (this excludes those with eating disorder as your hunger cues are not fully reliable) –> eating large meals where you feel overly full can be hard on your digestive tract. Is it the end of the world if you do? NO, you’re human and I am too. We will overshoot our fullness sometimes and that’s okay. Become curious to figure out why it happened and what you can change next time instead of going into a rabbit hole of judgement, shame and guilt.
Are you eatingĀ more often forĀ emotional reasons thanĀ physical reasons? Food is suppose to be pleasurable! And eating for emotional reasons is okay, we need to do that sometimes. You just don’t want food to be your only coping mechanism because when it is, we completely numb out our feelings which only creates more emotional distress (again, your gut is your second brain) and we dissociate from our bodies so we don’t listen to when our body says, “okay, that’s enough.”
Are youĀ sleeping enough? Are you exercising too intensely in a way that doesn’t leave your body feeling good? These are both huge sources of stress. And stress has a profound impact on your digestive health.
Based on the fast that I’m almost 2000 words into this post and could write a whole lot more, you can see that these things are complex. I think the thing I hope you remember is that it’s okay if you feel bloated and gassy from time to time. And that GI discomfort during recovery from an eating disorder or disordered eating, most of the time, is a normal and expected part of the process. And while I know it sucks, hang in there. It will pass. <3
Thank you Miss Robyn! I hope you know how truly encouraging your words are. What a blessing this post was tonight… I pray your day is blessed.
thank you so much summer š xo
Thank you for sharing this Robyn! I love love love reading all of your posts. You make things so clear and easy to understand. Having a background in Nutrition and Dietetics, I love reading about all of this stuff and still always learn something from you, so thank you!!
aw thanks lindsay for your kind words and for reading!
As per usual, this is awesome. I personally feel blessed because my gut can take a LOT. My boyfriend has a horrible gut and always has issues. It is crazy how much stress can come into play here— I find that I do get some issues when im going through a stressful period.
it’s so closely related and we often forget the HUGE role stress plays in our health!
This is such an important message and the earlier people hear it, the better! My eating disorder history led me to having rectal prolapse and a subsequent surgical repair with a partial colectomy. I think what really did it and why I never really healed even when eating enough calories was eating way too much fiber/raw foods and using laxatives to fix the resulting constipation. My GI system is still not healed after eating normally for 4+ years but I’ve learned to manage the symptoms by avoiding certain foods high FODMAPs (i.e. apples, raw cruciferous vegetables). Sometimes a burger is a way better choice for my stomach vs a salad! It’s frustrating to be in a recovered state mentally but have the lasting physical effects, but that just goes to show how serious EDs are. I wish more medical professionals would get to know their patient’s habits before preaching “more fiber, more water, more physical activity”.
I wish more medical professionals would get to know their patientās habits before preaching āmore fiber, more water, more physical activityā.
^^ yes to that! it’s so important to take the time to truly understand someone. thinking of you kate!
This is incredibly encouraging hearing this. For a long time I struggled with really regular digestive issues after almost every meal except for maybe breakfast. This year I was so thankful that God brought a dietitian into my path who works specifically with GI issues. I think a lot of them were exacerbated by my ED and anxiety and too much stress. This year so many of the symptoms have gone way down, and I definitely attribute that to the Lord calming my mind and continuing to heal my body. All of this is so helpful. Thank you Robyn for investing the time and love into writing this.
I absolutely love your blog and read it all the time! Thank you for the work you do.
Okay. Wow. I don’t know how you knew;), but I seriously needed this today soooo badly!!!! I’m recovering from an ED, and have been extremely discouraged because of my daily stomach issues that I can’t figure out. Love this post and the information you shared. I needed the encouragement to continue healing and to be patient with my body! Thank you thank you thank you! ā¤ļøā¤ļøā¤ļøā¤ļø Love you tons!
hang in there Isabel! Thinking of you <3
I couldn’t agree with this part more! “So while some symptoms are in fact caused by disruptions in your gut from unhealthy eating and exercise habitsā¦they can become exacerbated (or manifested entirely) from anxiety and stress”
All my bloating problems disappear when I’m rested and don’t have too much stress in my life
Couldn’t agree with this part more! “So while some symptoms are in fact caused by disruptions in your gut from unhealthy eating and exercise habitsā¦they can become exacerbated (or manifested entirely) from anxiety and stress.
Love this! I’m an outpatient RD and it’s amazing how often I get IBS or gastro issues patients who report high levels of stress at work (and their doctors send them to me to “fix” this problem). It’s really hard to convince them that the stress might be the biggest problem.
Thanks for backing me up
it’s so hard because we want a quicker fix than the journey of learning to take care of ourselves š
I loved this post (as usual!!), Robyn. Your words are always so insightful and they definitely speak to my experience. This case is no different! Do you happen to have any advice for individuals who suffer the effects of gastroparesis and are trying to overcome them? I get extreme indigestion and GI distress whenever I try to incorporate vegetables (yes, any at all!) or high fibre legumes back into my diet. I keep trying, but the pain and discomfort is excruciating. I would love to be able to eat pain-free. Thanks in advance!
Hi Chelsie! It is so individual that we do a lot of that one on one work through Nutshell Nutrition. If that’s something that would be a good fit for you – email me. I totally hear and understand your frustration, hang in there! xo
NAIL IT!
(…by “nail it” I meant “nailed it”) š
<3 <3
Just what I needed today. Thank you Robyn!
xoxo
Thank you Robyn for this post! I actually have experienced the GI issues you mentioned here in my recovery. I could definitely relate to the gastroparesis. I think my first really acknowledgement of this came when I realized there was a day I ate a sandwich for lunch at like 11 a.m. and then I literally felt STUFFED ALL DAY. I realized then that something wasn’t normal because in no way should I have been as stuffed and miserable as I felt. And this wasn’t the first experience, it was just the most significant. I felt miserable and it was like my body used to just not ever get hungry after lunch anymore. It was like I could have easily gone every day without eating dinner or snacks after lunch because of the many years of restriction prior. I definitely noticed after I started timing my food and making sure was eating more balanced, my hunger cues began to return and seemed to help with the digestive issues. But it DID TAKE TIME. Thanks again!
thank you for sharing Amber since I know many women can relate! And thank you for the strong emphasis on how it takes TIME. So important to be patient with our bodies!
I really enjoyed this post, Robyn. Even though I have been recovered from an ED for a few years, my digestive system is still a little messed up. I have noticed that when I don’t get enough sleep it is SO much worse. Your posts always encourage me that things will get better and help me to be more patient and compassionate with myself. Thank you!!
Sleep plays such a role and we can sometimes forget that! keep taking care of yourself š
Thanks for the insight. I really needed to hear this as I have been feeling so bloated and generally a bit weird stomach-wise which has had me wondering if the foods I am adding back into my diet are disagreeing with me. It’s good to know this is part of the process. You are always a fantastic resource when it comes to understanding my body!
Awesome post! I like how you touched on both physical syptoms and stress related issues. I had anorexia and restrictive eating for several years and was very discouraged when I started eating my I got Sibo. I know this can be common for those in recovery…. Unfotunately it took me two years to get diagnosed with sibo since doctors thought it was just digestive distress from and anxiety and new foods. I now have more nutritional deficiencies than when I was anorexic because of this aweful infection. I have finished my treatment for sibo and follow a low fodmap diet but would love to evetually eat more intuitive. Really hope as time goes on my motility will improve! thanks for the great post keeps me optomistic!
Wow your timing on this one is unreal. I’ve been reading about,the mind-body connection for a few years now and recently – more specifically – the gut-mind connection (literally just before your post I finished reading this article on the “second brain – https://www.psychologytoday.com/blog/the-fallible-mind/201701/the-pit-in-your-stomach-is-actually-your-second-brain).
I’ve been having so many strange, confusing and extremely frustrating stomach issues for quite some time now. I went to a doctor last week and her diagnosis was for me to go on the low FODMAP diet. Sigh. I do notice a difference now that I’m somewhat following its guidelines, but it is so restrictive… and I was really just getting to a place in my recovery where I was doing so well with having no foods off limits. I know this isn’t the place for me to really pick your brain, but I’m wondering if any of your clients have reported – or have you heard about people – experiencing tightness in their upper abdomen? Not so much gassy or cramps, but just really tight. …?
Thanks Robyn. Your posts as always are incredible.
I have this tightness all the time and it even bulges at times.
So I want to start by saying that I love your blog and that this is such important information for people with disordered eating or recovering from eating disorders.
I have to admit, though, I am a frustrated by the way my GI issues have been written off by some medical professionals because of my history of disordered eating. I have had significant GI issues since I was about 15 or 16–long before I had disordered eating or even knew what I calorie was. And some of my flare-ups have been debilitatingly painful; I’m not exaggerating when I say I’ve had stomach cramps more painful than the time I broke my finger. I responded to these symptoms by eating less, and less, and less…which of course made them even worse, which meant that I ate less. So I totally get what you’re saying here, but going low-FODMAP made a big difference for me and has actually helped me eat more normally and get my cycle back. But I do think it depends on the individual person, and I do wish researchers would consider the possibility that in some cases, GI issues may cause restrictive eating and not the other way around.
Great post! I can really tell a huge difference when I am stressed or anxious. I really have to watch my sugar intake during these times.
Pun intended in the last sentence (“And while I know it sucks, hang in there. It will pass.”)? š
Thanks for sharing another insightful post, Robyn! I’ve been thinking a lot about GI issues recently and was wondering if you have any thoughts/advice/resources on having a leaky gut and food sensitivities/allergies. My new dietician has recommended I go on a gluten-free diet (or even low FODMAP) to combat it. But as an ED recover-er, I really don’t want to restrict my food intake.
Re-reading this post – love it! I was diagnosed with a herniated disc in my neck 4 years ago and ever since then Iāve had extreme anxiety about every ache and pain in my body… I can definitely see this manifest in my digestive system! Thankful for this blog!
Hi! I really need some advise. I am so glad I found your page. English is not my mother language, so sorry for my mistakes.
I was suffering with anorexia for about a year. It doesn’t really seems a long time compared to others who suffers with it for years. It all happened with me four years ago now, but i’m still struggling with these symptoms and things just get worse for time to time. In my anorexia I had 1 BM a week and that one happened with the help of glycerin suppositories (i was too affraid to take real laxatives). Then as I started to eat again my digestion was hell…I had and still have incomplete BM, lots of, lots of gas (which worsened, and which i am sure is because of the trouble with BM), and I am still stressing on eating (‘tho I froce myself to eat everything, deep down in me I have an uncontrollable stress). They found out that I developed lactose intolerance, delaying stomach emptying (They also said, I avhejust IBS, which I think means “we don’t know, sorry bro, deal with it”)I still monitor my digestion way too much (basically all day) and I just can’t stop with it. I think I am going crazy, I just can’t live a quality life. I don’t remember what it is like to poop properly, not having troubles with it. I just don’t know what to do. Please, give me some advise how to get over of it ( i never went to a psychiatrist, nor psychologist but i am thinking about it, however i am afraid, as nobody they also cannot help me). I just want to get the old me back again.
Thanks a lot,
Naomi
Will I ever get better? Does this dyspepsia go away? Iām scared.
Hi there, my name is Ellen and I am 20 years old. I had an eating disorder for a year whereby I was restricting and then decided to get help June 2019. Luckily I have no issue with gaining weight now, I was just stuck in a habit of not eating and what I was doing was in fact not healthy. Therefore, it was easier for me to go on a surplus and start eating again! Therefore, my increase in intake started and I was on a surplus everyday, making sure I got more than enough in even if I wasnāt hungry. Everything was going well and I was gaining weight without any issue or real severe symptoms that are worth noting. However it got to the end of October 2019. (I thought I had a lucky and easy escape) Then I started to experience a wide range of symptoms like acid reflux and have recently been told I have gastroparesis after a meal study š which is probably due to having had an eating disorder. I couldnāt understand how my body escaped these symptoms when I was gaining weight and getting better In recovery over the 5 month period and then all of a sudden just came on me. Donāt get me wrong it was still hard, I still got slightly bloated and felt full regardless but nothing crazily severe like now! The fullness is literally like I am about to burst! I was able to eat a surplus without any real digestive issues for the first 5 months in recovery! Due to getting these symptoms my intake has then decreased and I have lost some weight again (unintentionally) and Iām still nervous as we speak because Iām not at a healthy weight anymore. I can barely eat. I genuinely am trying so so hard. I am constantly full, even with water my belly explodes and I have constant reflux. It is so easy for food and water to just come straight back up. I have never experienced such a horrible thing in my life I am always in pain and find it hard to do normal things. (The hardest part was trying to let my family know that this wasnāt me making this happen to myself and it wasnāt me choosing to have this – that something inside me just wasnāt right which thankfully has been diagnosed and I wasnāt brushed off by a doctor saying āitās just her head, she has had a history of an eating disorderā) Iām just so nervous about my future and really hope that these symptoms because of my eating disorder donāt last forever and that Iām not always bursting full after a few spoonfuls of cerealšš I am only 20 and I am finding it so very tough. I just hope Iāll be able to go out to a restaurant one day with my friends again and choose whatever I want or have a pizza night. I can only pray this happens! I have read that with weight gain it can resolve the gastric emptying but Iām confused how I was fine for 5 months in recovery? If you have any advice or any guidance please let me know I would be forever grateful!! Thank you so much because I am finding it hard to see light at the end of the tunnel with these physical complications further making it harder for me. Itās very hard being mentally ready and recovered but physical reasons are holding you behind!