Did you know there is a connection between gut health and eating disorders? Yup! Actually, a study in 2005 reported that 64.4 % of folks who have eating disorders also struggle with functional gut health issues. And since April is IBS awareness month, we wanted to dive deeper into this interesting topic!
Gastrointenstinal (GI) symptoms are very common amongst undernourished people, such as someone with an eating disorder, as well as people undergoing the re-nourishment process. Research has also found that bulimia nervosa and binge eating disorder are will experience IBS like symptoms, or maybe even develop IBS as a result of their eating disorder behaviours (Dejong, et al., 2011). BUT it’s not just a question of how the eating disorder affects IBS… There is also the question of how does IBS impact the development of an eating disorder? Which came first, the chicken or the egg?
Irritable bowel syndrome (IBS), is a “functional gastro-intestinal disorder characterized by abdominal pain, bloating and disturbed defecation” (Perkins et al., 2005, p. 57). In other words, it’s a condition where your stomach and your bowels behave abnormally, and it can have a significant impact on your quality of life.
IBS can begin anywhere from childhood to adulthood and it can even resolve itself for periods at a time, unexpectedly (Badgut, 2000). In Western nations, there has been a rise in IBS, yet the reason is still unknown (Badgut, 2000).
So to answer your question where does IBS come from? We still aren’t totally sure, however, we know that what and how you eat, as well as your mental health, play a big role!
Folks who struggle with IBS may experience different symptoms which makes this disorder very unique. Common IBS symptoms are:
– Abdominal pain
– Diarrhea or Constipation or Both
There is currently no test to diagnose IBS. In the past, IBS was considered a diagnosis of exclusion (meaning that IBS was diagnosed by ruling out other medical conditions such as Crohn’s disease, ulcers, digestive disorders, etc.). However, the Rome criteria have been developed as a tool to aid in diagnosing IBS.
The Rome IV criteria for IBS are (Badgut, 2016):
Experiencing recurrent abdominal pain on average at least one day/week in the last three months, and is associated with two or more of the following criteria →
– Related to defecation
– Associated with a change in frequency of stool
– Associated with a change in form (appearance) of stool
The relationship between GI symptoms and EDs is complex. There is an entire, detailed blog post where we talk more about the connection between GI disorders and EDs. You can learn more about this here: https://thebalancedpractice.com/2020/02/11/edandguthealth/, but for today, we are going to focus more on IBS specifically.
For many folks with IBS, their symptoms will be caused by food, therefore, given the dietary nature of their symptoms, this can cause food anxiety and people will self-impose food restrictions and doctors will prescribe certain food restrictions to alleviate the symptoms (Harer, 2019).
The symptoms can be really distressing for someone, and affect their daily routines. Many will avoid social settings, and may even avoid leaving the house altogether due to the unpredictability, and discomfort of their symptoms. In an effort to regain control over their symptoms and regain their independence, many will turn to food restriction as a way to manage their food induce symptoms, and thus, ease their food-related anxieties.
BUT, what we notice is not the nature of IBS that can translate into an eating disorder, but rather, the practices used to manage the symptoms, such as restriction, which can perpetuate an eating disorder. Doctor Kimberly Harer, a gastroenterologist in the United States, says that the consequences of these practices can be harmful and can lead to pathologies such as weight loss, inadequate nutrition, and significant psychosocial impairment (2019). In fact, a study conducted by Kayar & al. in 2020, concluded that individuals with IBS are at higher risk of developing an eating disorder. Other studies have reported that between 5.3-44.4% of patients presenting with gastrointestinal complaints, at least one ED is diagnosed (Satherley & al., 2015). This big gap is largely due to the wide variability between the type of disordered eating behaviours and GI symptoms the participants were experiencing.
Needless to say, because IBS symptoms are most commonly caused by food, the self-imposed go-to treatment is to remove food that is causing a symptom. BUT, as you can see, this can have severe consequences and symptoms should be assessed and managed with the help of a dietitian. Many people will seek support to alleviate their GI symptoms first, although their symptoms may be a result of disordered eating behaviours.
Many eating disorder behaviours, such as vomiting, laxative abuse, fasting and binge eating can result in impaired GI functions, such as bloating, early satiety, nausea, inflammation, intestinal wall damage, etc. (Boyd, C., 2005). When your body is not receiving enough nutrition, it’s lacking the tools it needs to make sure the body is running smoothly, so, as a result, certain parts of the GI tract will be impaired.
Think of it as a car!
If you don’t give your car enough gas, or don’t replace the oil, or maybe you don’t replace your windshield washer fluid. This all affects how the car will run, and how you can function when using the car. With time, if the car isn’t getting what it needs to get from point A to point B in a reasonable fashion, then parts of the car are going to break down or stop functioning as well as they used to.
On the other hand, it’s not only folks with anorexia and bulimia who experience GI symptoms, but folks with binge eating disorder report experiencing acid reflux, abdominal pain, cramping, and diarrhea (Cremonini et al., 2009).
Are you starting to see the overlap between IBS and EDs?
The Low Fodmap diet has gained a lot of popularity for the treatment of IBS and is often viewed as the first line of treatment. This is FALSE. Whether you have an eating disorder or not, the low fodmap diet is often the last intervention to reduce IBS symptoms. Other nutrition interventions for managing IBS symptoms include frequent meals, hydration, fibre intake, etc.
The term “fodmap” stands for Fermentable Oligosaccharides, disaccharides, monosaccharides and polyols. These are the fancy scientific terms for short carbohydrates that can cause irritation in the intestine for people who have IBS
If you aren’t familiar with the low fodmap diet, it involves identifying food sources of fodmaps, trigger IBS symptoms, by removing them for a period of 2-4 weeks. This diet can be very restrictive, and individuals must be followed closely by a dietitian to ensure they are not undernourished or risking any nutrient deficiencies throughout the process.
As discussed above, individuals with IBS should be screened by their clinicians for the risk of an eating disorder and find an alternative approach to communicating interventions for symptom management. (Harer, 2019). So no, the low fodmap diet (even just hearing it in the name), would not be supportive for someone with an eating disorder. The reality is that you will need to undergo a temporary period of discomfort to manage your symptoms.
So, which came first? The ED or IBS? This remains a matter of debate for many experts in the field, and the truth is, it really varies on the individual! At the end of the day, we know that there is a correlation between the two, regardless of which came first, and both need to be addressed simultaneously.
If you are experiencing any IBS symptoms, PLEASE CONSULT WITH A DIETITIAN FIRST! We want your symptoms to be managed in the safest way possible.
Eating Disorder Recovery Program
Recovering from an eating disorder is not easy, however it IS possible. With the high demand for eating disorder services, and limited access to acute care, we have developed a virtual, outpatient eating disorder program to increase accessibility to recovery from the comfort of your own home.
This program includes:
- Individualized session with a dietitian or psychotherapist (weekly)
- Group sessions (weekly)
- Meal support (weekly)
- Parent, Caregiver, Partner support group (weekly)
- Care coordination
Want to learn more about? Find more information on our website: http://www.thebalancedpractice.com/edprogram
The Balanced Practice is a team of health care providers specialized in eating disorder outpatient treatment, disordered eating and intuitive eating. Our mission is to help folks heal their relationship with food and their bodies so they can live happily outside of diet culture!
We strive to provide evidence based counselling to support you, or your loved one, in achieving full recovery. Schedule a connection call now.
Written By Joelle Ciccarelli, RD
Revised by Marie-Pier Pitre-D’Iorio, RD, B.Sc.Psychology
Founder of The Balanced Practice
Boyd, C., Abraham, S., & Kellow, J. (2005). Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders. Scandinavian journal of Gastroenterology, 40(8), p.929-935. Doi: https://doi-org.proxy.bib.uottawa.ca/10.1080/00365520510015836
Cremonini, F., Camilleri, M., Clark, M.M., Beebe, T.J., Locke, G.R., Zinsmeister, A.R., Herrick, L.M., Talley, N.J. (2009). Associations among binge eating behaviour patterns and gastrointestinal symptoms: a population-based study. International journal of obesity, 33(3), p.342-353. Doi: 10.1038/ijo.2008.272
Dejong, H., Declinspy Perkins, S., Grover, M., Schmidt, U. (2011). The prevalence of irritable bowel syndrome in outpatients with bulimia nervosa. International journal of eating disorders, 44(7), p.661-664. Doi: https://doi-org.proxy.bib.uottawa.ca/10.1002/eat.20901
Harer, K. (2019). Irritable Bowel Syndrome. Disordered Eating and Eating Disorders. Gastroenterology & Hepatology, 15(5). https://www.gastroenterologyandhepatology.net/archives/may-2019/irritable-bowel-syndrome-disordered-eating-and-eating-disorders/
Irritable Bowel Syndrome. (2000). BadGut Society. https://badgut.org/information-centre/a-z-digestive-topics/ibs/
Kayar, Y., Mehmet, A., Dertli, R., Kurtulumus, A., Boyraz, R.K., Onur, N.S. & Kirpinar, I. (2020). Eating disorders in patients with irritable bowel syndrome. Gastroenterology and hepatology, 3(10), p. 607-613. Doi: https://doi.org/10.1016/j.gastre.2020.03.011
New Rome IV Criteria for Diagnosing. (2016). BadGut Society. https://badgut.org/information-centre/a-z-digestive-topics/rome-iv/
Satherley R., Howard R., & Higgs S. (2015). Disordered eating practices in gastrointestinal disorders. Appetite, 84, p.240-250. Doi: https://doi.org/10.1016/j.appet.2014.10.006
Salvioli, B., Pellicciari, A., Iero, L., Di Pietro, E., Moscano, F., Gualandi, S., Stanghellini, V., De Giorgio, R., Ruggeri, E., & Franzoni, E. (2013). Audit of digestive complaints and psychopathological traits in patients with eating disorders: A prospective study. Digestive and liver disease 45(8), p. 639-644. Doi: https://doi.org/10.1016/j.dld.2013.02.022