Digestive Issues in Eating Disorder Recovery: The Gut-Brain Connection

Written by Talia Cecchele, Founder & Lead Dietitian

Digestive issues are one of the most common side effects of eating disorders and disordered eating, regardless of diagnosis, body size, or weight. In fact, research suggests over 90% of people with eating disorders experience co-occurring gastrointestinal (GI) symptoms.

Recovery from disordered eating or an eating disorder can feel so much harder when the very thing your body needs most (more nourishment), can cause so much discomfort and distress. 

The good news? Many digestive symptoms improve significantly with nutritional rehabilitation, nervous system support, and evidence-based strategies.

You can listen to Talia and Marci Evans on the Food Is Food podcast where they talk about the complexities of digestive issues and eating disorders. 

Digestive Issues in Eating Disorder Recovery

Digestive issues experienced by people with disordered eating and eating disorders include:

• Gastroparesis (slow stomach emptying). Food moves slowly through the stomach, causing extreme fullness, nausea, reflux, and discomfort after meals.

• Early satiety Feeling full very quickly, even after small amounts of food.

• Bloating & abdominal distention Bloating refers to the uncomfortable sensation of pressure or fullness. Distension refers to visible swelling of the abdomen. You can experience one without the other.

• Constipation Often caused by slowed digestion, under-eating, dehydration, laxative misuse, pelvic floor dysfunction, or inadequate nourishment. Constipation is characterised infrequent bowel movements (generally fewer than three times a week), hard or lumpy stools, and straining or pain during defecation 

• Diarrhoea due to food travelling too quickly through the gut without enough time for proper absorption of nutrients. Diarrhoea loose, watery stools, usually three or more times in a 24-hour period 

• Flatulence (wind) which can often cause discomfort

• Abdominal pain

• Nausea & reflux

• IBS-type symptoms including food intolerances such as transient (temporary) lactose intolerance (note: it is not recommended to follow a full elimination diet during nutritional rehabilitation - we need to give the gut nutrition, not restrict it further).

Why Do Digestive Issues Occur?

Digestive issues that are experienced due to disordered eating are complex and often involve multiple overlapping factors. One of the biggest misconceptions is that digestive symptoms are always caused by food. While food can influence symptoms, digestion is also heavily impacted by the nervous system, anxiety, stress levels, digestive health and movement.

The Gut-Brain Connection

The gut and brain are constantly communicating through the nervous system. Stress, anxiety, hypervigilance, and emotional distress directly influence digestion.

This is why anxiety before meals can increase symptoms such as:

• Nausea / feeling sick

• Abdominal pain

• Bloating

• Urgency to use the toilet

• Feeling full 

Research now shows that many digestive disorders are better understood as disorders of gut-brain interaction rather than simply “food problems.”

People with eating disorders often have higher rates of anxiety, perfectionism, rigidity, and nervous system dysregulation, all of which can amplify digestive symptoms.

This is also why non-food interventions, such as gut-directed hypnotherapy, diaphragmatic breathing, grounding techniques and yoga can significantly improve symptoms alone (i.e. without making any changes to nutritional intake).

Pre-existing Digestive Concerns

Digestive issues in eating disorders and disordered eating can be related to pre-existing gastrointestinal conditions such as irritable bowel syndrome (IBS), coeliac disease, inflammatory bowel disease (IBD), reflux, or chronic abdominal pain may contribute to restrictive eating patterns over time. This can then develop into disordered eating or an eating disorder.

Clinicians often describe the relationship between eating disorders and digestive disorders as a “chicken or egg” situation - sometimes the eating disorder worsens digestive issues, and sometimes digestive conditions contribute to the development of restrictive eating behaviours.

Starvation and Malnourishment

When the body is undernourished, the cave man brain doesn't want to spare a single bit of energy on digestion because normal digestion isn't a priority for human survival (see our blog post on the Starvation Syndrome). 

This slowing of digestion can lead to bloating, pain, nausea, fullness, constipation, reflux, and feeling “overly full” after small amounts of food. These symptoms are influenced by:

• Stomach emptying slowing down (gastroparesis)

• Intestinal movement becoming sluggish

• Digestive enzymes production decreasing

• The muscles of the digestive tract weakening

• The gut microbiome becomes disrupted

Compensatory Behaviours

Purging behaviours such as self-induced vomiting, laxative misuse and overexercise can significantly disrupt digestive functioning.

Vomiting may contribute to reflux, oesophageal irritation, delayed stomach emptying and abdominal pain. While laxative misuse can lead to constipation, bloating, electrolyte imbalances, bowel dysfunction and loss of loss of normal bowel function over time.

High levels of exercise in the absence of adequate nutritional intake can also place additional stress on the body and cause digestive symptoms.

Pelvic Floor Dysfunction

One often overlooked contributor to digestive symptoms is pelvic floor dysfunction.

Undernourishment, chronic stress, excessive exercise, trauma histories, and prolonged restriction can all affect the pelvic floor muscles. When these muscles are not functioning well, symptoms may include:

• bloating and distension

• constipation

• incomplete bowel movements

• abdominal pain

• pressure and discomfort

Pelvic floor physiotherapy can be an incredibly valuable support in recovery, particularly for persistent constipation or bloating that does not fully improve with nutrition alone.

A Note On Food Intolerance Testing

Many people that I support in clinic have completed online intolerance testing involving hair samples or saliva tests. These usually create a large list of foods, which are recommended to avoid. It is really important to know that these tests are not validated or evidence-based and can unnecessarily increase dietary restriction.

If allergies or intolerances are suspected, it is important to work with a qualified medical professional using validated testing methods.

Similarly, elimination diets such as the low FODMAP diet should be approached with caution in eating disorder recovery, as further restricting your food variety can strengthen the eating disorder and worsen gastrointestinal symptoms.

How to manage digestive issues in recovery

Digestive discomfort during recovery is real, valid, and often exhausting. But restricting food further usually prolongs symptoms by keeping the gut undernourished.

In early recovery, eating often needs to happen consistently and regularly, even when hunger and fullness cues feel unreliable.

Practical strategies that may help

Support nervous system regulation

• diaphragmatic breathing before meals

• grounding exercises

• meditation

• gut-directed hypnotherapy

• gentle yoga

• slowing down at meals

Reduce physical discomfort

• wear loose-fitting clothing. Clothes that fit tightly around your stomach or even tight leggings can increase bloating and abdominal pain

• use a heat pack or hot water bottle

• Use a weighted blanket

• sip peppermint or ginger tea

• avoid lying flat immediately after meals. Let gravity help move things along

• try gentle movement or gut-directed yoga poses after eating if appropriate

• Avoid filling up on too many fluids with your meals, sip them in between

• Engage in distracting activities such as conversation, listening to music, calling a friend, knitting, watching a movie or any other activity

Medication

Alongside proper nourishment, your doctor or dietitian might recommend medication to ease the discomfort from gastroparesis or constipation. Medications like metoclopramide, fibre supplements or stool softeners (not stimulants) can be helpful temporarily.

Build a support system

Digestive discomfort can easily trigger eating disorder thoughts. Speaking openly with trusted supports, your treatment team, or recovery community can help challenge urges to restrict.

Review eating disorder behaviours that may worsen symptoms

Some behaviours that commonly increase GI discomfort include:

• excessive caffeine intake

• chewing large amounts of gum

• overconsumption of diet foods or artificial sweeteners

• carbonated drinks

• inconsistent eating patterns

Healing Takes Time

Many digestive symptoms improve substantially with consistent nourishment and nervous system support. However, for some people, especially those with pre-existing GI conditions, symptoms may persist to some degree long term.

That does not mean recovery is not worth it.

Recovery allows a person to nourish their body with flexibility, in a way that best serves them. Even when digestive conditions remain, they are often far more manageable once the body is nourished.

If you are struggling with digestive symptoms, avoid self-diagnosing or removing foods unnecessarily. Seeking support from an eating disorder-informed healthcare team can make a huge difference

Need Support?

A multidisciplinary team apporach mght be required to support your digestive heath (in addition to your recovery). This might inclide a dietitian, gastroenterologist, psychologist and/or pelvic floor physiotherapist.

If you need dietetic support in your recovery, we offer 1:1 nutrition counselling at the TCN Clinic to help you overcome food rules, support digestive issues due to restrictive eating and build a more positive relationship with food. You can find out more about how we can support you here.

Talia Cecchele

TCN Director and Lead Specialist Dietitian

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References:

[1] Kessler U, Rekkedal GÅ, Rø Ø, et al. Association between gastrointestinal complaints and

psychopathology in patients with anorexia nervosa. Int J Eat Disord. 2020;53:802–806. https://doi.org/10.1002/eat.23243

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Talia Cecchele Nutrition (TCN) is a virtual clinic with a team of registered dietitians specialising in eating disorders and disordered eating. Our services include 1:1 consultations, group meal support and group programs to support you to break free from food rules and chronic dieting and find food freedom. Talia and her team work by incorporating a compassion-led, non-diet and weight inclusive. To enquire about a private consultation please fill out a contact form.