Intersection between Functional Gastrointestinal (gut) disorders and Eating Disorders (ED)

Functional Gastrointestinal Disorders (FGID) are a group of disorders characterised by chronic or recurrent gastrointestinal (GI) symptoms (e.g. constipation, diarrhoea, stomach pain, IBS, reflux, etc).

There is no objective or biological marker - diagnosis is based on symptoms using the ROME criteria. In essence, everything looks normal but doesn't function properly.

It is important in this condition to be aware of the relationship between mind and body. These conditions are considered a disorder of the gut-brain axis. There is a communication breakdown between our autonomic nervous system

Problems occur when:

• Nerves or muscles along any portion of the GI tract aren't communicating in a coordinated fashion

• Intestinal nerve sensitivity is impaired, impacting how the brain controls functionality

What is interesting is that there is a HUGE intersection between FGIDs and EDs. The table below highlights up to 98% of people living with a diagnosed ED have a FGID and up to 44% of people living with a FGID have disordered eating.

There seems to be two things at play:

1) psychological co-morbidity such as anxiety or depression (sensitive people)

2) disordered eating (restriction, purging, laxative abuse etc) - loss of body trust

Both ED and FGIDs are largely underpinned by living with depression or anxiety

What does this tell us?

• ED symptoms alter GI sensitivity and function

• FGIDs & EDs share similar underlying mental health emotional presentation (e.g. anxiety or depression)

• ED and other psychiatric disorders tend to be linked in self-perpetuating circles (meaning these symptoms reinforce each other)

• ED + anxiety/depression lay the foundations for FGIDs to develop

• They are literally creating the physiological vulnerability for the development of a functional gut disorder

How do ED behaviors create GI symptoms?

• Restriction of food creates delayed gastric (stomach) emptying and early fullness

• Lack of regular food intake and/or purging results in constipation

• Chronic purging results in GERD (reflux) due to a weakened esophageal sphincter

• Increased stomach pressure in response to anxiety

• Laxative abuse results in decreased and/or impaired colon function

• Chronic constipation may result in the translocation of bacteria into the small intestine (SIBO) which leads to increased bloating, gas, pain, and decreased appetite.

ED behaviours create a problem with the normal communication patterns of the digestive system

How do Gut symptoms increase the risk to develop an ED?

Restrictive elimination diets can set the stage for the development of an ED

• Low FODMAP diet

• Specific carbohydrate diets

• Elimination diets

• Gastrointestinal pain that may lead to avoidance of eating to manage symptoms

These diets and restrictive behaviours can create fear of food and/or perpetuate binging episodes.

Treatment approaches:

Step 1: A thorough assessment needs to be performed by a dietitian to become clear on the symptoms and condition. Each functional gut disorder needs an individualised approach. The dietitian may include; food prescription, supplements and/or medication to treat your symptoms.

Step 2: Generalised approach and integrative treatments

1. Manage the disordered eating behaviours through regularity and adequacy of food

2. Soothe the nervous system with yin/restorative yoga, meditation, breathwork and being in nature

3. Gut-directed hypnotherapy

Ultimately, we want to try and soothe our nervous system to support the communication pathway between the gut-brain axis.

If you are struggling with an eating disorder or a functional gut disorder, please get in contact with us. We would love to help you resolve these symptoms to help improve your quality of life.

We offer a free 15 minute discovery call, you can book one through our booking tabs. With kindness,

Brent