Gut problems like bloating, gas and constipation are some of the most common complaints experienced by individuals recovering from eating disorders like anorexia, bulimia and ARFID.
In fact, up to 98% of all patients with eating disorders or histories of chronic dieting also have functional gut disorders! In other words: If you feel constipated or bloated, you’re not alone!
The biggest reason why bloating and constipation occurs is because ideal digestion gets out of whack! Certain foods (or lack of entire food groups—like carbs, fats or proteins) can also cause issues.
In this article we will discuss:
#1. How ideal digestion SHOULD work
#2. Why bloating and constipation happens in anorexia, bulimia and chronic dieting, and;
#3. 8 hacks to kick bloating and constipation in recovery for good
How Ideal Digestion Should Work (No Bloating or Constipation)
To fully understand why bloating and constipation happen in anorexia, bulimia and chronic dieting or binge eating, it’s important to FIRST understand how ideal digestion should work.
Step 1: Think About Food
Digestion is a north to south process.It starts in your mouth and ends in your butt. In fact, digestion begins with the production of saliva in your mouth when you simply THINK about food (even before a single bite of that Cesar salad).
Step 2: Chew & Pass Food to the Stomach
As you chew your food, it’s broken down and packed into mushy balls known as boluses that then travel down the esophagus into the stomach. There they land in an acidic mosh pit as digestive juices, stomach acid and digestion hormones go to work. It’s crucial you have plenty of stomach acid, or hydrochloric acid (HCl) to aid in the digestion of protein-rich foods such as chicken, beef, and salmon. Low levels of stomach acid is the reason why some people feel like they have a brick in their stomach when they eat meat, and also why food can move to the next step without completely being broken down.
Step 3: Small Intestine Time
After about an hour or two, all food in the stomach is then passed to the small intestine where it spends about 3 to 6 hours. The small intestine is over 20 feet long—about three-and-a-half times the length of your body—and it is the primary action site of digestion.
Once food enters the small intestine it also stimulates the liver, gallbladder, and pancreas to go to work—accessory organs that release digestive enzymes; get rid of excess toxins and pathogens; utilize your fats, carbs, and proteins appropriately; and create waste to once more pass along, this time to the large intestine.
Clinical Pearl: Chronic dieters who experience constipation and bloating often have low stomach acid, low production of enzymes and/or a sluggish and congested liver and gallbladder making their gut more susceptible to pathogens.
Step 4: Large Intestine Clean Sweep & Poo
Last but not least, any remaining undigested food enters the large intestine where it spends 12 to 40 hours going through a final clean-sweep. Your large intestine is also where the majority of your gut bacteria—about 90%—should reside, along with short-chain fatty acids(“post-biotics”)— gut bacteria byproducts that act like fire extinguishers and protectors of a healthy gut ecosystem, defending and eliminating toxins, fighting inflammation, and keeping things peaceful and serene.
If you have a variety of healthy gut bacteria that are well fed with nutrient-dense foods, then digestion usually goes swimmingly, and within 12-24 hours of your meal, you’ve experienced the “golden poo”—elimination.
However, if you’re not eating a wide variety of nutrient-dense foods or if you had several kinks and snags in your digestive mechanics—such as low stomach acid, a sluggish gallbladder or low digestive enzymes—then Houston, you have a (gut) problem!
The Big Idea: A healthy gut and proper digestive mechanics are crucial for helping you digest your food and prevent bloating and constipation.
The Gut-Chronic Diet Connection
Food restriction and binge eating are not your gut’s best friends!
Like poking a wasp nest, both extremes disturb the health of your inner eco system and hijack your body’s natural digestive mechanics and appetite hormones, leaving your gut in a state of unrest.
What Restrictive Eating Does to the Gut
Restrictive eating kills the gut microbiome. A healthy biome requires more nutrients—not less. When you don’t eat—or eat enough—gut bacteria naturally die off, as if a famine or drought had happened. This is why anorexia patients have significantly lower amounts of total gut bacteria and higher prevalence of specific bacterial strains, which may also result altered metabolic capacity resulting from the disorder as well as cause cravings for odd foods (like rice cakes with tuna, or skinny pop popcorn and fat free gummy bears) and eating the same foods every single day.
Consequently, the less healthy and diverse the gut biome, the more likely bloating and constipation happens.
Food restriction can also cause the muscles and tissues in the digestive tract to physically atrophy, or weaken, which can lead not only to constipation and bloating due to trapped stomach gasses, but also gastroparesis—delayed stomach emptying and other gut pathologies such as SIBO, GERD, intestinal permeability, and dysbiosis.
Constipation is also nearly universal in restrictive eating, arising from a similar calorie-conservation strategy that causes gastroparesis—the body does not spend limited calories on nonessential functions. Consequently, in efforts to remediate this conundrum, dieting patients may consume high amounts of high-fiber foods (in the mistaken belief that fresh fruits and vegetables will improve bowel function or that these are “safe foods”), use laxatives daily, skip meals altogether, or turn to more exercise to keep things moving and feel less bloated. Any of these can lead to worse constipation and gas production.
Keep in mind that long-term laxative abuse can cause permanent damage to colon nerve cells and damage colonic motility.
What Binging & Purging Does to the Gut
Binging and purging do not play nice for the gut either.
First and foremost, stress wreaks havoc on a healthy inner eco system—often suppressing stomach acid and altering digestive enzyme production. Inhaling a box of cereal, a bag of plantain chips or a plate of cookies in one setting is stressful on the body and your digestive mechanics; just like purging it right back up is stressful too.
Interestingly, patients with bulimia have been shown to have increased levels of enzymes like salivary amylase, correlated with increased cravings for foods high in sugar.
Binging can do the same thing, as the gut microbiome is shaped directly by the foods we feed it. Gut dysbiosis (imbalance) is super common in binging and/or purging cycles. Certain gut bacteria, yeasts and bacterial overgrowths may also send ‘craving’ signals to the patient. In fact, since 80% of all communication to the brain comes from the gut, cravings can become overpowering until satisfied.
Purging also significantly affects the vagus nerve—the nerve that connects the gut to the brain/ The vagus nerve plays a HUGE role in digestion—from stimulating the migrating motor complex to push food through your digestive tract, as well as helping promote feelings of calm (vs. anxiety), regulate appetite and satiety, and controls the ‘gag’ reflex (prevents you from throwing up unless the body needs to get rid of a pathogen).
Unfortunately, in bulimia, the vagus nerve is often hijacked by the binge-purge cycle, suppressing its natural functions to digest naturally, and sometimes the body can even begin to naturally gag without even trying—seeing multiple foods as a foreign invader due to improper conditioning and neglect.
What Intermittent Fasting Does to the Gut
As for meal timing, eating at off times, skipping meals, or having no schedule at all has a powerful manipulative effect on the gut—sometimes for the better, but in chronic dieting, often for the worse. Circadian rhythms ensure that physiological processes occur at the most biologically meaningful time, unless they are thrown off. For example, intermittent fasting is really popular right now and has tons of proven benefits for allowing the gut to rest and digest for 12 to 16 hours and move food through the GI tract. But this practice can also throw off your rhythms. One study found that eating the largest meal later in the day—typical with people who do intermittent fasting— increased bacteria generally considered to be pro-inflammatory. This affected body weight, basal metabolic rate, blood-sugar balance, body temperature, and gut motility. In others, intermittent fasting can lead to habits such as increased binging, and accidental under-eating—not getting enough calories for the day, which can cause dehydration or lack of essential nutrients—as well as eating at odd times. All of these can impair or slow gut motility.
Stool consistency and frequency of bowel movements are directly related to what you put in your mouth, or what you don’t put in your mouth, as well as a schedule in line with your gut’s ideal timing. With regard to intermittent fasting in particular, people may suffer from constipation as a result of dehydration and poor dietary fiber intake—both water and fiber help your digestion function properly by both adding bulk to your stool and by making sure food passes through your GI tract with ease.
Additionally, digestion is a workout and if your bacteria and digestive juices are not exercised regularly like a muscle with repetitive fasting, motility slows.
Research shows that the longer we alter our schedules or restrict our food, our gut bugs adapt—learning to eat and digest only at certain times, as well as manipulating otherwise cyclical digestion patterns. This can also cause us to not have bowel movements first thing in the morning.
What Overtraining Does to the Gut
As for exercise: Overtraining also slows gut motility and causes bloating. Pounding the pavement for a 6 to 10 mile run or going full throttle in a CrossFit workout every single day diminishes stomach acid and digestive enzyme production, stalls digestion, and kills gut bacteria—including the healthy guys. This is perhaps why 50% of high-performing athletes experience IBS, many without reporting it, thinking it’s normal—it’s all they’ve known in their athletic career.
Dehydration from overtraining and other related factors like low water intake and low carbohydrate intake can also lead to mineral imbalances, constipation, and ischemic colitis—a medical condition characterized by reduced blood flow to part of the large intestine (colon). The diminished blood flow doesn’t provide enough oxygen for the cells in your digestive system, slowing motility and perpetuating delayed elimination.
8 Hacks to Kick Bloating & Constipation in Eating Disorder Recovery for Good
So what to do about bloating and constipation?
While many healthcare practitioners tell patients that gut problems will get better with eating disorder treatment, the reality is, this is not always the case. Several research studies show that while the gut can gradually improve by ceasing disordered eating behaviors, more pro-active measures may need to be taken.
This was my experience, but the good news is: bloating and constipation (and Miralax cocktails) don’t have to be your “norms” forever—especially with these 8 hacks to kick bloating and constipation to the curb.
#1. Eat Mindfully
Digestion starts in your mouth and brain. The mere thoughts you have about food (positive or negative) can make your stomach curl and tie up in knots, or stimulate stomach acid and enzymes.
For example, can you think of a food you absolutely hate? When you think about Spam, or liver, or a food that gave you food poisoning, how do you feel? Chances are, not great. Your body already forms a defense mechanism against that food.
On the flip side, can you think about a food you love? How do you feel now? Chances are, more positive.
Your body senses the emotions and feelings and thoughts going on in your subconscious mind at all times (the brain-gut connection).
Hence a BIG part of improving digestion starts with improving your relationship and thoughts with the foods you eat: nourishing or threat? You decide.
The art of “mindful eating” also involves the practice of eating with intention. Some examples of mindful eating include:
- Chewing your food really well until fully liquified
- Putting your fork down between bites to notice how it tastes
- Eating undistracted (not looking at screens)
- Eating sitting at a table (not on the go all the time)
- Cooking your food
- Trying new foods—not eating the same foods/meals every day
- Eating foods in season or shopping local occasionally
#2. Incorporate Variety
If you eat the same chicken, broccoli and sweet potato every single day, your gut bacteria reflect this—diminishing in variety and vibrancy to help you with digesting other types of foods.
Consequently you can become more intolerant to other foods—even healthy foods.
The same thing happens when you cut out entire food groups—complete proteins, fats or carbs. By depriving the body of some essentials, your digestive mechanics can suffer. For example, low protein diets often lead to suppressed stomach acid, low fat diets can cause gallbladder sluggishness and congestion (since your gallbladder is the #1 organ to digest fats), and low carb diets can suppress digestive enzyme production and gut bacteria.
Ultimately, balance is the name of the game.
If you discover certain foods (like carbs, fats or proteins) make you feel more symptomatic, instead of blaming it on the food, consider supporting your digestion with some of the helpful hacks in this article instead and fixing the underlying gut imbalance to digest these foods better again.
#3. Cook, Blend & Soften
Cooking, sautéing, steaming, pureeing, blending, poaching, boiling, slow-cooking and softening aids in food breakdown. Whereas grilling, frying, roasting and eating raw veggies and fruits require more digestive fire.
Consider regularly incorporating bone broth with meals to support the digestive lining and healing leaky gut.
#4. Eat the Real Thing
In my dieting days I lived off fake foods—fat free mozzarella cheese, Diet Coke, Crystal Light, Lean Cuisines, fat free Jello, Special K cereal, fat free salad dressing, reduced fat peanut butter, bars, shakes and beyond.
One word: fillers. Fillers and additives like artificial color, gums, thickeners, cornstarch, natural flavors, artificial sweeteners and beyond do not play nice for good gut health when they constitute the majority of your intake. (Bring on the bloating).
#5. Boost Stomach Acid & Enzymes
As an extra bonus, if you feel bloated after most meals, try Atrantil, an awesome herbal supplement to bust bloating in its tracks.
#6. Love Your Gallbladder
Your gallbladder is like a muscle that helps your food move and groove along. It stimulates the production of stomach acid and the release of digestive enzymes, emulsifies and breaks down fatty acids and releases bile to kick wastes out the back door.
Many women with histories of dieting, anorexia, binge eating and bulimia have congested and sluggish gallbladders with symptoms such as: fatigue, skin breakouts or dry flaky skin, lower bowel gas, gut discomfort with fatty foods, clay colored stools, bloating and constipation.
Love your gallbladder by taking digestive bitters with meals in addition to your enzymes and stomach acid support.
#7. Get the Golden Poo
Move over miralax and laxatives, if you still struggle to go #2, consider implementing these constipation hacks:
- Drink enough water-at least 1/2 your healthy bodyweight in ounces—and add a pinch of Himalayan sea salt for natural minerals
- Take Magnesium Citrate at bedtime
- Try buffered vitamin C powder to bowel tolerance (1/2 tsp every hour until you go #2 would be your therapeutic dose)
- Support elimination with natural herbs like Colon Rx
#8. Test Don’t Guess
Health is an inside job. Bloating and constipation are often just symptoms of something going on under the hood. If you find that, after supporting your digestive mechanics consistently you continue to feel poorly, then it is worth digging deeper with a functional medicine practitioner who understands both eating disorders and gut health.
A functional medicine practitioner can help ensure you’re moving in the right direction for your body and unique needs—including food freedom and nutrition, supplements and possible lab testing.
Some potential lab tests to consider may include: SIBO breath testing, comprehensive stool analysis, autoimmune food sensitivity screening, functional blood chemistry, and DUTCH hormone testing.
The good news? You don’t have to go it alone and relief from bloating and constipation is possible!