Tummy Troubles?

Tummy Troubles? Here is what to expect as you change your eating habits.

On Gastrointestinal distress, re-feeding, normal eating and metabolic recovery.

If you’re in recovery from an eating disorder, then chances are that you are probably experiencing A LOT of digestive issues and overall “gastrointestinal distress.” It’s super common to experience these symptoms: stomach aches, bloating, constipation, diarrhea, excessive gas, nausea, acid reflux, indigestion and premature fullness, also known as delayed gastric emptying. It’s important to know that feeling gastrointestinal distress is actually ‘normal’ as you begin to learn to eat ‘normally’ again. This is often called re-feeding.

Delayed gastric emptying and subsequent symptoms are indicators of a sluggish metabolism caused from inadequate nutrient and caloric intake. Simply put, not eating enough food (aka calories) causes your metabolism to decrease. When this happens, all body processes slow down but you will notice this as intestinal upset as the food is moving through the GI tract at a slower than normal rate if you had an otherwise normal metabolism.

Most people who are in treatment for any type eating disorder, regardless of diagnosis, will struggle with these behaviors: restricting, bingeing and purging. These behaviors cause the muscles lining the entire digestive tract from the esophagus to the anus to become de-conditioned and “shrink,” so food empties very slowly. Food will literally hang out in the stomach or bowel for hours, causing gas, bloating and pain.

Digestive enzymes that help break down food and healthy bacteria in the gut are reduced, so extra gas is produced as bacteria “ferments” partially digested food that is hanging out in your digestive tract.

Why does your body do this? Simple answer is that your body is just trying to keep you alive and if you are slowly starving it of vital nutrients, it will down regulate everything as it becomes more efficient with a lower intake of energy (calories). By the way, calories produce heat in your body, so you might also feel colder than most people too, especially if you are restricting energy intake.

Also, important to note, that if you are purging (throwing up after eating) this creates even more distress on your stomach and additionally decreases your metabolism. It’s estimated that one purge a day can reduce the metabolic rate by 13%! Purging really confuses your body into thinking it’s going to starve. What most people don’t realize is that by the time they purge, over 50% of those calories have already been absorbed. Yep, you heard me right. Once you start eating anything it starts to digest rapidly (starts in the mouth), and by the time the food reaches the stomach, 50% of those calories have already been absorbed. So, in reality it’s not the most efficient way to “get rid” of calories. People think bulimia helps with weight loss, but over time, weights of those who purge usually go up because of the metabolic toll it takes.

If you are purging then you will most definitely suffer from delayed gastric emptying; this means the food hangs out in the stomach longer than ‘normal’ causing severe stomach pain, bloating, indigestion, acid reflux, and consequential constipation.

How do I feel better and relieve the GI distress?

This is where the poison is the medicine so to speak. The only way to feel better is to EAT MORE = follow the meal plan. When you first begin to follow a meal plan, you may feel more bloating than normal. This is an unfortunate reality, as gas combined with food will cause distention in the abdominal region. You may notice that your belly protrudes; this is due to weakened abdominal muscles as well. Have patience — this will resolve with regular meals and snacks. Wear comfy stretchy clothing and drink plenty of water.

The best treatment for gas, pain and bloating is to continue eating at regular intervals. Follow your meal plan as outlined by your dietitian/nutritionist. This entails eating at regular intervals throughout the day as well as eating from all the food groups: carbs + proteins + fats.

·      Start with breakfast within the first hour of waking and snacks and meals are spaced about every 3-5 hours apart. 

·      Fiber rich foods combined with plenty of water. Fiber in foods will help alleviate constipation but needs to be taken with water throughout the day. Both soluble and insoluble fiber sources are important:  whole grains, nuts, seeds, fruits and vegetables.

·      Fiber and water need to be combined to promote absorption and increase metabolism; it’s generally recommended to drink 8 (8oz) cups daily.

·      Eat enough FAT: be liberal with added oils, nuts, avocado, seeds, butters, etc. Fats will help get your bowel moving more regularly. They provide the essential lubricant for good bowel movements to happen. Fats also increase the rate at which you metabolize fats. Contrary to popular fears, eating fat does NOT make you fat!  

·      Reduce or cut out your intake of sugar-free gum, mints, candies and excessive quantities of raw fruits and veggies. Another contributing factor to “belly bloat” is sorbitol and fructose, natural sugars that are found in sugar-free gum and mints, as well as raw fruits.

·      Your doctor might recommend medications such as Reglan and or Creon to help food move through your system faster.

·      When you start eating more regularly, you may have frequent bowel movements and even diarrhea. It’s helpful to add soluble fibers such as, oatmeal, chia seeds with applesauce, rice, etc.

·      Digestive enzymes such as papaya, bromelian and lactase may help with gas and bloating. These natural enzymes are depleted with food restriction.

·      Peppermint oil (sold in capsules) and mint tea have been shown to have to antispasmodic effects to help with abdominal discomfort. These compounds seems to help slow the natural peristalsis of the gut by calming muscle contractions in the stomach and intestines. (Not advised if you have acid reflux.)

·      Acid reflux remedies: try one tablespoon of apple cider vinegar or lemon juice before meals to restore balance.

What about IBS, Irritable bowel syndrome, and food allergies?

Digestive distress can show up and might indicate IBS or potential food sensitivity or even an allergy. This can be a slippery slope as avoidance of foods is contraindicated in the recovery process. If you start eating gluten or dairy again after having avoided these foods for a while, you might feel some discomfort, but that is not always because of the gluten or lactose. Many with eating disorders will claim gluten or dairy is the cause of their GI upset, but it is often the rules of the eating disorder at play so that these foods can be restricted. It’s important to eat all foods containing gluten and dairy to normalize the metabolism, as well to encourage the process of making peace with all foods via the legalization process. If some foods still cause gastric distress even after weight and metabolism have been restored, then this would be the time to possibility experiment with eliminating some foods. If it is done in the early stages it will reinforce the eating disorder and diet mentality that those foods are ‘bad’ and need to be avoided to feel good.

The good news is that for most everyone recovering from any type of eating disorder, all GI upsets will completely resolve over time. It can take about a month of “normal” eating for symptoms to improve. So, as always, patience is key.  

Nutrition Therapy: Indicators in the Recovery Process

Nutrition Therapy: Indicators for Recovery

Metabolic Recovery via meal plan: your individual meal plan is designed to correct any nutritional imbalances, increase/restore your metabolism to “normal”, reduce food cravings, decrease anxiety driven hungers, improve sleep patterns and thermoregulation (not feeling cold), stabilize weight to genetic set-point.

Weight: ability to maintain weight within a healthy range by eating a wide variety of foods. Restoration of menses without hormones. Discontinuation compulsive weighing oneself, and other external methods of tracking “progress.”

Consistent eating patterns throughout the day: Eating in regular intervals (every 3-5 hours). Eating regular meals helps protect against urges to engage in restricting behaviors, binging, purging, and other ritualistic eating behaviors. Avoid grazing and night eating.

Flexibility with all foods: ability to eat all foods without knowing the exact calorie/nutritional content without fear of weight gain. Ability to eat a wide variety of foods without fear, anxiety, guilt or the use of compensatory behaviors. Incorporation of feared foods on a regular basis. Expansion of all foods to meet protein, essential fatty acids, carbohydrates, vitamin, mineral, water and other nutrient needs.

Social Eating: Feeling comfortable eating out socially at restaurants and with family/friends. Feeling comfortable with ‘spontaneous’ eating situations.

Joyful Movement: activity levels are appropriate without feeling compulsive. Learning how to move body for fun/joy not just to ‘burn calories.’ Sense of physical well-being.

Restored GI function: improvement of sluggish metabolism will improve constipation, diarrhea, bloating, and other gastric discomfort. Discontinued use of laxatives and diuretics. Ability to eat without feeling full too quickly (delayed gastric emptying).

Food & Body Image Preoccupation: decreased amount of time spent thinking about food and body weight to less than 20% of conscious time per day. Elimination of calorie counting, label reading, restrictive eating, food hoarding and other obsessive food behaviors. Ability to eat food that is not weighed or measured.

Mindful and Intuitive Eating: ability to recognize hunger and respond by eating promptly and adequately. Ability to understand normal levels of fullness and tolerate the feeling of food in your stomach. Eating with minimal or no distractions. Discontinued use of appetite suppressants.

Acceptance of Self: ability to accept one’s body size and shape and refusal to pursue dieting. Not allowing body preoccupation or shame to interfere with participation in social events and outings.


How long does it take to recover? Stages of Breaking Free.

How long does it take to recover? Stages of Breaking Free.

Stages of Breaking Free ~ Recovery Stages ~


I get asked a lot from clients, “How long does it take to get better? Is full recovery possible?

In the beginning, it is often hard to trust the process of letting go and surrendering to the unknowns of recovery. It is a long process to “get better” – remember that you did not fall into your eating disorder/disordered eating overnight- so you will not fall out of it quickly either. It took years of habits to form and the unconscious belief system has quite the hold on behaviors. Behavior change in general takes many months, or even years (for some). It is very helpful to work with a therapist who has ‘been there’ and ‘done that’ so that you know there is a way out of this suffering around food and weight worries. When I was breaking free from my own addiction to dieting, I attended a Geneen Roth workshop and found her stages of breaking free super helpful in my recovery process. It is so relieving to know that there is a predictable set of physical and emotional aspects to each stage of the process.

Although I find it still frustrating because we don’t know exactly how long each person needs to progress through each stage, it is however, almost a guarantee that one will progress and the struggle will eventually end. *Caveat here is: you gotta show up and keep doin’ the work in therapy. Journal your feelings. Feel them. Cry it out. Talk to your friends. Dance it off. Paint. Read. And so on. Or, as I like to say, “the only way out is through.”


Stage 1

Acknowledging that there is a problem, and that the problem is more complex than simply wanting to lose weight, and that dieting does not, and will never, resolve it.


Stage 2

Beginning/Rebelling Against the Years of Deprivation


Physical Aspects:

·      Eating mainly (what were previously) "forbidden" foods; eating all the time- not just when hungry and until satisfied.

·      Learning what hunger, satisfaction, and fullness feel like.

·      Learning what makes eating pleasurable (i.e., sitting, not reading or watching TV, eating slowly, etc.).

·      Possibly gaining weight.


Emotional Aspects:

·      Relief and exhilaration at not dieting.

·      Panic and fear that this stage will go on forever, and that because this looks like a binge, breaking free is no different from binging.

·      Sometimes there will be a feeling of hopelessness, a feeling that there is no end to compulsive eating.



·      Don't panic at the weight gain. It is not atypical, and it is a natural reaction to years of deprivation. You will not gain a hundred pounds.

·      Throw away your scales, or paste your ideal weight on them.

·      Try to distinguish between foods you think you want (because before you weren't allowed to have them) and foods that you really do want in the present moment.

·      This stage will end. Do not go on another diet because you are afraid the stage will never end.


Stage 3

"The Middle" Nitty Gritty/Learning-to-Trust-and-Befriend-Yourself Stage


Physical Aspects:

·      Eating without guilt.

·      No more bingeing.

·      Weight stabilizes.

·      Distinguishing foods you really like/want from those that were previously forbidden.

·      Ability to eat only a bite or two of chocolate.

·      Foods other than sweets begin to taste good - you learn what nourishes you.

·      You begin to have faith in body-wisdom as you see that you can eat what you want and not gain weight.

·      You eat when you are hungry although, often, don't stop at just enough.


Emotional Aspects:


·      The mind still wants more food than the body, which is a little difficult to accept.

·      A lot of joy in realizing that after all these years, your body can still get hungry.

·      A sense of power develops as you see that you can control food - it no longer controls you.

·      This is the hard-work stage: You can stop eating when you're not hungry, and the emotions that drove you to eat in the first place surface. If you are willing to work with yourself, you develop ways of dealing with your feelings other than using food. Some of these ways are:

o  Keeping a journal.

o  Being in therapy.

o  Talking with friends about your feelings.

o  Expressing your feelings as they arise.


You learn that food isn't all that's good or pleasurable about life. You learn many other ways of nourishing yourself:


o  Taking walks, baths, naps.

o  Reading.

o  Going to movies.

o  Meeting with friends.

o  Getting a massage.

o  Doing something you've always wanted to do.

o  Writing.

o  Dancing.


You begin to value things about yourself other than your body - and begin to realize that other people value you as well.


Your values about living change as you see that you can feel happy and satisfied without being thin; your inner life becomes important.



o  Weight loss might occur but this is not the predominant characteristic of this stage.

o  What is predominant is the shift you make from viewing yourself as an out-of-control human being to one who can make choices that will nourish yourself.

o  This stage is the most difficult one because of all the feelings that arise, and it takes "an ocean of patience" and renewed commitment to the Breaking Free/Recovery process. Remember that this is a stage, and that it will end.


The fear that often occurs in this stage is that if you deal with your compulsive eating and lose weight, you will no longer have an excuse (i.e., your fat) on which to blame all your "failures" - and that's true! But on the other hand, you'll have more available energy. You'll feel better about yourself, and you won't need an excuse.


Stage 4

The Joys of Breaking Free/Joys of Recovery



Physical Aspects:

·      Weight loss occurs - slowly!

·      You eat what you want, stop when you're satisfied.

·      What you want has drastically changed from Stage two. What you want now are usually nourishing foods with occasional or small bites of sweets instead of large amounts of sweets and occasional [healthy foods].

·      You enjoy your body. You accept your body, even though it is not perfect.

·      Food becomes delightful, rather than a source of pain.

·      When you're not hungry, you don't think about eating.

·      You can go anywhere; have any kind of food in front of you, without going on a binge/eating compulsively.


Emotional Aspects:

·      You ask for what you want as well as eat what you want.

·      You feel better about yourself than you ever imagined you could feel. You are self-confident, self-trusting.

·      This confidence and trust extend into many other areas of your life - your work, your relationships.

·      Since your life is no longer revolving around food, you have more energy with which to live.

·      You have many more skills with which to deal with problems.


o  Sometimes you, like anyone else, will overeat. But now you will not take it as a sign that you are a failure.

o  Your weight will fluctuate by five to eight pounds from season to season. Sometimes you will want to eat more than you do at other times. That's okay - sometimes your body needs more food.


Where Are You in the Recovery/ Breaking Free Process?


Some people are in Stage 2 and Stage 3 simultaneously; some people take a year to go through stage 1 and 2 and two months to go through Stage 3. Wherever you are is absolutely fine. And as long as it takes you to complete each stage is absolutely fine. Judgment has no place in any part of the recovery process.


I am in Stage ____. The food issues I am dealing with in my life right now are __________________________________ and ________________________________.

Wherever you are in the stages, acknowledge yourself for the effort it's taken to get there.

As always, be kind and nice with yourself for being wherever you are – at any stage. Know that you are on THE PATH, and that every day, every step, you will be getting closer and closer to freedom.

Lastly, the picture of the mannequin was taken at a tiny shop in Hanoi Vietnam where I traveled this past spring. The shirt says, NEVER GIVE UP. A great life mantra to follow!

Love, light and cupcakes to you ~ Karen





Adapted from: Geneen Roth's Four "Stages of Breaking Free"

from her book, Why Weight? A Guide to Ending Compulsive Eating

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