Part 3: Just Plain Stressed Out

What if we could treat an eating disorder (ED) by healing one’s gut? This thought blows me away. Researchers recently started doing fecal transplants to treat different medical concerns and now psychiatric disorders such as anxiety and depression, Arthi Chinna Meyyappan et al. BMC Psychiatry. 2020. This entails taking microorganisms from someone who has a healthy microbiota and balanced psychiatric well-being and placing them into someone’s gut who is struggling with anxiety and/or depression. All studies showed that as the microorganisms grew and flourished, there were decreased symptoms of anxiety and depressive-like symptoms and behaviors.

Did you know that researchers say our gut has as many neurons as a cat’s brain? The gut is part of a bidirectional pathway where the brain sends signals to our “brain” in our gut and vice versa. The gut and brain are constantly communicating to control digestion, control swallowing, increase blood flow and release enzymes. Our gut and brain also produce neurotransmitters like dopamine and serotonin. Neurotransmitters are what keep us happy, motivated and have a mental feeling of well-being. This means that stomach problems are linked to anxiety and depression.

Have you ever felt nauseous when you’re feeling the blues, or felt gut wrenching pain when you’re anxious? This is your gut and brain communicating. This makes treating gut complaints that much more complicated but also means we need to focus on the mind and body when healing the gut. It often takes a lot of patience to get to the core of what is leading to your discomfort, whether food, mental health, or refeeding. Therefore, it’s recommended you work with a team who are specialized in eating disorders – a dietitian, doctor, and psychiatrist.

Here are a few ways to build a healthier microbiota by focusing more on mental health.

1. Sleep – it is important to practice good sleep hygiene so you can get adequate sleep each night. Our microbiota is on a schedule, just like our body is. You may have had experience before with going on a trip which results in your bowel movements getting completely off track. This is due to having a different schedule which throws the microbiota off.

2. Movement – I’m not talking about excessive or aggressive exercise as that has been shown to decrease blood flow to the gut which can cause its own source of problems. I’m talking about just moving the body in a gentle calming way. Research shows yoga is one of the best forms of movement.

3. Gut hypnotherapy – This is a new area of the field but is showing very promising results. It’s along the same lines as meditation as it’s mentally working on connecting and calming our mind and body. There are many meditation apps as well as an online gut hypnotherapy course you can take. https://www.mindsethealth.com/

4. Get outdoors – Time outdoors has been shown to destress the body. We’re also exposed to more bacteria outdoors which helps our immune system by diversifying our gut microbiome.

Part 2: Chicken or egg…or is it bread or apples?

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.

Part One: Bugs in my gut

I’ve been fascinated lately with the amount of research out regarding the gut microbiota. Now, before I lose you with these boring sounding words, ask yourself: Through the course of my eating disorder how often have digestive issues plagued me? Have these digestive issues caused so much distress that you struggle to get to a place where holding onto full recovery is attainable?

I would like to start tackling concerns I often hear about the gut by writing a series of blogs explaining the gut’s function and how we can heal and take care of it. The gut is incredibly smart and complex. Because of the guts complexity, it is a key component in achieving full recovery from an eating disorder (ED). Healthy happy guts help the body with maintaining accurate hunger/satiety (fullness) cues. Unhappy, unhealthy guts contribute to digestive concerns which often cause physical distress, increased emotional dysregulation, brain fog, and lower immunity.

Let me preface my future blogs by saying, although my current blogs are based on today’s research about the gut and eating disorders, the amount of research in this field is expanding rapidly, therefore we have exciting new research every day.

The framework for the gut will be helpful to go over as we move forward. Food goes into our stomach; this produces acid to start the breakdown of the food. From there, food goes through the intestines where trillions of microorganisms, known as the microbiota, help break down the rest of the nutrients to be absorbed in the body. We have about 4 lbs. of these organisms in our gut. The microorganisms in our gut help absorb and synthesize nutrients that are essential to keep our body running at its best, and help our bodies fight infections. Each one of these bacteria have different functions. The bacteria communicate with our brains to make sure specific functions happen such as moving food through our gut, breaking down and processing food, and having regular bowel movements, etc.

Now, as long as someone has a healthy balance of these microorganisms, their gut will run smoothly, and they will feel good. It has been shown that over 90% of those with eating disorders do not have a healthy balance of microbiota in their gut, and this leads to functional gut disorders. Functional gut disorders are identified as a series of symptoms, example: irritable bowel syndrome, constipation, diarrhea, bloating, pelvic pain, and gastric reflux.

The first step in having a healthy gut is making sure we have a healthy gut microbiota. There are many ways to help healthy bugs flourish in our gut. Here are a few of the most important things to start thinking about from a nutrition perspective.

1. Eat consistently, every few hours and adequate amounts. Our gut bacteria die when we restrict the variety and quantity of food. Just like us, our bacteria rely on food to keep them healthy and alive. The less you eat, the less bacteria you have in your gut, and the more digestive problems you’re going to experience.

2. Eat fermented foods. Fermented foods like active culture yogurt already have the healthy bacteria in them. Therefore, as we eat fermented food, the bacteria populate in our gut. Other options to eat are Keefer, Kombucha, sauerkraut or kimchi. I would only recommend eating these if you enjoy them though, as not everyone has the pallet for them.

3. Eat variety. It is recommended to try to eat 30 different types of fruits, veggies and grains each week. I know, I often sound like a broken record telling my client’s they need more variety. From the perspective of ED recovery, this is to avoid falling back into a pattern of only eating “safe” foods. From the perspective of making a healthy gut, we need a huge variety of food as different food feed different bacteria. Considering we have billions of different strains of bugs in our gut, we need lots of food variety to keep a diverse microbiota and therefore a happy gut. Sure, we need nuts, seeds, fruits, and vegetables but oh yes, we need all kinds of carbohydrates as well – oatmeal, pasta, rice, bread, quinoa, lentils, etc. These contain fiber and fiber feed our microbiota.

4. Drink plenty of water each day. The only way to lubricate and move food through the gut is by drinking lots of fluid.

5. Sit down and chew your food well. We live in a society which promotes eating on the run. It’s awful for our gut though. Proper digestion starts with breaking our food down into tiny pieces so our gut can finish the process. Swallowing large pieces of food are going to wreak havoc on your digestion and lead to lots of bloating and pain.