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Eating disorders wreak havoc on gastrointestinal health. Here are X things you need to know about changes in your GI health that can be caused by an eating disorder, and what to do about them.

A study by the University of Australia found that 98 percent of 101 anorexia patients met the criteria for diagnosis with some functional gastrointestinal disorder. Anorexia nervosa, bulimia nervosa, binge-eating disorder, and other eating disorders not specified can destroy gastrointestinal function (GI) throughout the entire GI tract, requiring diligent attention for recovery.

Here are six things you need to know about GI damage from eating disorders and what to do about them.

Eating disorders are usually accompanied by a variety of symptoms related to bowel movement

Two Australian researchers, Drs Suzanne Abraham and John Kellow, asked eating disorder patients in hospital a number of detailed questions about problems they have with bowel movements. In their study of 185 patients, the researchers found that:

  • 62 percent reported they had to strain to pass stool.
  • 61 percent reported they did not feel they had got it all out when they finished their bowel movement.
  • 58 percent reported pain before bowel movement.
  • 53 percent reported that they did not feel comfortable after bowel movement.
  • 48 percent report vomiting episodes.
  • 45 percent report they made themselves vomit.
  • 45 percent reported pain was relieved by bowel movement.
  • 43 percent reported different kinds of stool associated with different kinds of pain (for instance, painful, hard-to-pass stools followed by loose stools that relieve abdominal pain).
  • 33 percent reported that they felt bowel movement was a stressful event.
  • 31 percent reported a need to press down hard to force bowel movement.
  • 30 percent reported that abdominal pain stopped after bowel movement.

Some of these problems can be addressed by the use of a stool softener (which is not the same thing as a laxative). In some cases, the pain of bowel movement can be relieved with peppermint candies or peppermint preparations used to treat IBS.

Eating disorders are also associated with stomach problems

The same two Australian researchers found that 43 percent of in-patients for eating disorders had a problem with burping or belching, 36 percent had chest pain that was found to be esophageal pain (not heart pain), and 35 percent had heartburn. Because people who have eating disorders also tend to have nutritional deficiencies, calcium-based antacids may be helpful, but use under a doctor's direction.

Eating disorders make irritable bowel syndrome worse

About 50 percent of people who live with an eating disorder have irritable bowel syndrome (IBS), and the emotional stress of the eating disorder usually makes IBS worse. IBS can cause intense abdominal pain that is relieved by bowel movement as well as constipation, diarrhea, or both. IBS is notoriously hard to treat but sometimes peppermint candies or peppermint tea are helpful home remedies.

Both anorexia and bulimia may result in swollen salivary glands

Repeated exposure to stomach acid after vomiting injures the parotid (largest salivary) gland so that a common symptom of anorexia nervosa is puffed-out cheeks. Damage to the salivary glands affects appearance, of course, but it also makes it more difficult to chew and swallow dry foods and slows down the digestion of carbohydrates. It can also cause dry mouth, which has a variety of unpleasant effects:

  • Chronic bad breath.
  • Chronic rotten taste in the mouth. When the parotid glands become infected, they may release pus that runs down the throat.
  • Infectious mouth sores.
  • Tooth decay.
  • Dry eyes, due to loss of moisture in the mouth.

Warm compresses and sour candies can increase the flow of saliva. If the parotid glands are closed off by stones, they can be removed with a gentle squeeze (although the resulting release of odor will be unpleasant).

People living with eating disorders tend to be very sensitive to fructose and sorbitol

Fructose is a preferred sweetener for mass-produced food products in North America. Sorbitol is a naturally occurring sugar that is particularly abundant in apples, pears, peaches, and prunes. The combination of sugars draws water into the large intestine. This can cause bloating, gas, and diarrhea that are particularly severe in people who have eating disorders. It is important to be on the lookout for zero-calorie soft drinks and chewing gum that are sweetened with sorbitol. These products are just as irritating to the lower digestive tract as fruit.

Taking care of gastrointestinal problems for people who have eating disorders requires professional guidance

Even people who don't have other chronic health issues often find dealing with chronic constipation, obstruction of the salivary glands, heartburn, belching, bloating, and burping to be a challenge. People who live with eating disorders, even if they are making good progress, generally need professional input to manage gastrointestinal problems successfully. Registered dietitians, nurse practitioners, and doctors usually work together to manage the complex health diagnoses and multiple nutritional deficiencies that accompany eating disorders. Through cooperation with a healthcare team, it is usually possible to overcome any gastrointestinal disorder given enough time.

  • Abraham S, Kellow JE. Do the digestive tract symptoms in eating disorder patients represent functional gastrointestinal disorders? BMC Gastroenterol. 2013 Feb 28.13:38. doi: 10.1186/1471-230X-13-38. PMID: 23448363.
  • Kleiman SC, Glenny EM, Bulik-Sullivan EC, Huh EY, Tsilimigras MCB, Fodor AA, Bulik CM, Carroll IM. Daily Changes in Composition and Diversity of the Intestinal Microbiota in Patients with Anorexia Nervosa: A Series of Three Cases. Eur Eat Disord Rev. 2017 Sep. 25(5):423-427. doi: 10.1002/erv.2524. Epub 2017 Jun 6. PMID: 28586130.
  • Malczyk Ż, Oświęcimska JM. Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa. Psychiatr Pol. 2017 Apr 30. 51(2):219-229. doi: 10.12740/PP/65274. Epub 2017 Apr 30. Review. English, Polish. PMID: 28581533 .
  • Perez ME, Kapphahn CJ. Gastrointestinal Issues in Adolescents with Eating Disorders.Adolesc Med State Art Rev. 2016 Spring
  • . 7(1):155-76. Review. No abstract available.PMID: 27363239
  • Photo courtesy of SteadyHealth

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