It is a rare occasion where I meet with a client who does not have some amount of gut distress. I’ve always questioned whether an eating disorder (ED) is caused from someone struggling with functional gut disorders (any symptoms such as irritable bowel syndrome (IBS), constipation, diarrhea, bloating, pelvic pain or gastric reflux) and therefore, they’re trying to ease their gut distress by way of ED behaviors or if one’s gut issues are caused by having an ED. Numerous studies support both theories. One study evaluated women diagnosed with an eating disorder and showed that 98% of them had functional gut disorders; 31% reported bloating, 51% reflux, 52% IBS and 24% constipation.
We’ve discussed the microbiota in our gut, but I’d like to further expand on how food is digested and travels through our gut in hopes that this may shed some light on where the source of your gastric pain may be originating.
The first phase of digestion starts in our mouth. We need to break down our food thoroughly by chewing. Saliva adds special enzymes to the food to help to breakdown carbohydrates.
Food then passes into the stomach which is a muscular bag that churns the food and breaks it down further with acid it produces. It is very common for people who have struggled with an ED to have too little acid or too much acid. Either issue can lead to similar symptoms – acid reflux, heartburn, cramping, bloating, undigested food in stools, constipation, to name a few. It’s important to get checked by a gastroenterologist who can help to accurately diagnose this.
Also note that your stomach is a muscle. If you haven’t been working it out consistently by eating regularly, you will need to rebuild this muscle just like you would with any other muscles in your body. This can often feel uncomfortable.
Once food is squeezed into the small intestine, it undergoes further digestion as more digestive enzymes from the pancreas and bile from the liver are added in the mix. Nutrients are absorbed further down the lining of the small intestine. The lining is covered with finger-like projections called villi which contain many blood vessels to absorb the nutrients into. I tell people to think of their small intestine like a football field. As long as a field is nurtured and taken care of, the turf is green and thriving. If it’s not nurtured with water and nutrients, it’s patchy. All ED behaviors can lead to a patchy turf in our small intestine, which leads to malabsorption of nutrients and an array of functional gut disorders. We must renourish our body to get our gut healthy again.
What remains of nutrients goes into the large intestine where water and electrolytes are absorbed and balanced and the remainder is removed in our stool. The reason we tell clients to avoid laxatives is because laxatives do their work and damage in the large intestine. They force the gut to pump out stool with a lot of water and electrolytes. Not only does this disrupt one’s electrolyte balance, which can be deadly, but the intestines can become reliant on the mechanism of the laxatives to force food through and will no longer move food through naturally.
As discussed in a previous blog, our entire gastrointestinal tract contains helpful microbes but the majority of it is housed in our large intestine. This microbiota must be fed with carbohydrates including grains, fruits, and veggies to flourish.
This is how a healthy system works but throw in any type of ED behavior and this will disrupt the whole system. As the gut adapts to harmful behaviors it learns to adjust by food often sitting in the gut for longer than normal which can lead to microbacteria growth where it’s not supposed to, which can lead to the range of gut disorders, as listed above.
I’m going to reemphasize some of the goals from the last blog to help remind you how to nurture your gut back to health.
1. Sit down and chew food thoroughly.
2. Eat consistently, every few hours and adequate amounts.
3. Avoid eating disorder behaviors and erratic eating.
4. Drink plenty of water each day.
5. Eat variety.