One of the most common frustrations of the eating disorder clients I work with is gut problems. Bloating, diarrhoea, constipation, nausea, and abdominal pain are frequent points of discussion in session. At times, healthcare providers have been dismissive of these symptoms- assuming they are an excuse to restrict. There is a growing body of evidence, however, that supports what clients have been experiencing all along.
Nestled in with the expected risk factors for eating disorders such as gender, weight concerns, and a negative self-evaluation is a rather surprising one- gastrointestinal problems. (Jacobi, et al) One study shows that 16% of those with functional gastrointestinal disorders have eating disorders. (Janssen, 2010)
The connection between IBS and eating disorders
The connection between IBS and eating disorders feels very much like the chicken-or-the-egg relationship.
Could IBS Cause Disordered Eating?
When symptoms associated with IBS start, the first thing people blame is food. To relieve symptoms, they cut out a specific food. If that doesn’t work, they may try eliminating an entire food group. While it seems to make sense, attempting an elimination diet without proper assessment and guidance can result in a dangerously poor relationship with food and little symptom relief.
Fear of food triggering uncomfortable IBS symptoms and restrict-binge cycles can often snowball into disordered eating behaviours. Imagine if eliminating wheat products seemed to improve your bloating. Wouldn’t that lead to you to think of more foods that might be causing your diarrhoea as well? This is how disordered eating patterns can start.
Or Do Eating Disorders Cause IBS?
Up to 98% of people with eating disorders have GI symptoms. (Janssen, 2010). Many of these are IBS-like symptoms in the lower gut. Anorexia, binge eating disorders, and other eating disorders all have the potential of affecting our GI system.
As food intake becomes less and less, constipation can become a problem. In turn, constipation itself can cause other symptoms such as bloating, gas, and pain. Also, there can be damage to the colon with laxative abuse.
While many of these symptoms overlap with IBS, they may not be caused by IBS. The process of being diagnosed with true IBS is a long one as it is based on ruling out several other potential diagnoses such as celiac, colon cancer, endometriosis, etc. If you think you might have IBS, it is worth getting the full workup rather than self-diagnosing.
Will IBS go away with eating disorder recovery?
Will bloating and pain go away once eating behaviours have improved into a more intuitive eating pattern? Unfortunately, there are not a lot of studies on this.
There is one, though, looking directly at the question of symptom remission. It suggests GI symptoms will likely persist after recovery, though they may change. (Boyd, 2010). For example, if an eating disorder client enters treatment with abdominal pain, they could leave with no pain but might now be experiencing bloating instead.
Anecdotally, I have had some clients with complete symptom relief. It is very hard to predict what will happen, though.
While there may be some challenges ahead with healing gut issues, these symptoms can be managed. There are treatments showing great success that don’t involve cutting out foods at all. Gut-directed hypnotherapy has just as high of a success rate as the most popular IBS diet. Cognitive behavioural therapy for IBS is another great option.
If you have an eating disorder and are experiencing GI symptoms, let your treatment team know. They can help you find ways to manage the symptoms, while still working on your eating disorder recovery. Letting symptoms go unchecked can become an obstacle to recovery.
If you have IBS and you feel your anxiety with food getting worse, talk to a professional. Whether you book in with me or someone in your area- do not let shame stop you. This is a common struggle and trying to manage it alone is not worth the risk.