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.

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Karen Louise Scheuner, MA, RDN

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