Exploring the Link: Irritable Bowel Syndrome (IBS) and Eating Disorders
There is an undeniable link between Irritable Bowel Syndrome (IBS) and Eating Disorders. Similar to the question I posed in my article exploring ADHD and Eating Disorders, here I also will ask and explore the question of which came first. Did the eating disorder cause symptoms of IBS? And therefore, will eating disorder recovery alleviate symptoms? Or did the symptoms and discomfort of living with IBS create disordered eating patterns?
What is IBS?
Irritable Bowel Syndrome, or IBS, is a chronic gastrointestinal condition that causes a significant amount of pain and discomfort in the individual. It is associated with abdominal pain, cramping and bloating, diarrhea and constipation. With IBS (Irritable Bowel Syndrome), different from IBD (Irritable Bowel Disease), these symptoms are present without any visual signs of damage or disease in your digestive tract.
The most common IBS symptom is abdominal pain, often related to the individual's bowel movements and changes in their bowel movements.
Other IBS symptoms include:
Cramping
Bloating
Distention
Fullness
Burning sensation
Diarrhea and/ or constipation
Emotional stress and a negtaive affect on quality of life
Increased urgency and/or frequency of bowel movements
While there is no one test to diagnose IBS, if you suspect you have IBS and are experiencing IBS symptoms, your doctor will review your symptoms, medical history and family history, perform a physical examination, and perhaps order additional testing (such as a colonoscopy, blood tests, etc.) to rule out any other health concerns.
How could IBS lead to disordered eating?
Disordered eating is often seen in individuals diagnosed with IBS and there is certainly a relationship between eating disorders and IBS. The individual struggling with IBS symptoms, often will remove foods from their diet in an attempt to alleviate symptoms. This may also lead to fear around foods and avoidance of food and mealtimes, as eating is often linked to pain and discomfort as well as unpredictable bowel movements.
Food manipulation is common amongst individuals diagnosed with IBS, as symptoms of IBS can be responsive to various dietary changes. There is often immediate feedback between food and symptoms for the individual suffering from IBS, though sometimes that is physical and sometimes psychological depending on the level of stress, fear and discomfort the food removed provided the individual, and why. In addition to self driven dietary changes, many practitioners one sees for IBS (Nutritionists, Naturopathic doctors, Gastroenterologists, Functional Medicine Doctors, etc.) will also recommend dietary changes (as well as lifestyle changes, possibly medications, probiotics, and mental health support as there is a very strong gut + brain connection (which I will speak more about below!)).
It is not difficult to see how someone suffering from IBS could develop fears around food, dietary restrictions, food rules and rigidity, and increased discomfort around eating socially. However, there is most definitely a difference between disordered eating and eating disorders…
What is the difference between disordered eating and eating disorders?
The difference between disordered eating and eating disorders distills down to the severity of the behaviors one is engaging in with food and body, what is driving the behavior (what is their motivation?), and the negative effects caused by their behaviors (physical, psychological, social).
Disordered Eating:
Disordered Eating refers to disrupted or atypical eating patterns or habits. It is a broader umbrella term that references one's relationship to food, body and exercise. Rather than being a diagnosis in and of itself, disordered eating is a term used to describe behavior patterns in someone who does not fit diagnosis criteria for a specific eating disorder. Many disordered eating patterns symptomatically look like those of clinical eating disorders (binge eating, restricting, purging, overexercising), however, not all individuals who engage in disordered eating behaviors have an eating disorder.
It is important to note here, that disordered eating can become a clinical eating disorder. Just because it begins as, for example, disordered eating patterns triggered by the physical symptoms of IBS, it does not mean that it cannot develop into a serious eating disorder with broader psychological, physical and social implications.
Eating Disorders:
Eating Disorders are a serious, and potentially fatal illness. Eating disorders are characterized by severe and persistent disturbances in eating behaviors, as well as very distressing thoughts and emotions. They are a serious mental illness requiring intensive treatment and support, and are absolutely not a choice. There are different types of eating disorders: Anorexia Nervosa (subtypes include: restrict type and binge-purge type), Bulimia Nervosa, ARFID (Avoidant/Restrictive Food Intake Disorder), Binge Eating Disorder, and OFSED (Other Specified Feeding and Eating Disorder).
Though there is usually a focus on food and nutrition when it comes to treating IBS (regardless of the type of practitioner one sees), we often forget that how we feel emotionally has a direct impact on how we feel physically. And nowhere in our body do we feel this more than in our gut.
What is the gut-brain connection?
Have you ever heard of the enteric nervous system?
It is one of the three main divisions of the autonomic nervous system and consists of neurons that govern the function of the gastrointestinal tract. It is capable of acting independently of the sympathetic and parasympathetic nervous system, and as such is nicknamed our “second brain”. Yes, your gut is truly your second brain!
We have all experienced this connection without realizing it:
Having “butterflies” in your stomach when nervous for something.
Feeling nauseous or having an upset stomach when anxious, nervous, scared or angry.
Feeling like you can’t eat or digest your food when you are in the middle of doing something that is bringing up big emotions of any kind.
Needless to say, the gastrointestinal tract is sensitive to emotions and these emotions of all kinds can trigger different symptoms in our gut.
Our brain can influence our gut AND our gut can influence our brain.
This is relevant in this article, because while yes, the physical symptoms of IBS can most definitely make someone nervous or anxious to eat food and perhaps cause avoidance and restriction of foods and mealtimes…
Alternatively, someone feeling nervous or anxious to eat their food (such as someone struggling with an eating disorder where foods and mealtimes are quite distressing) can also trigger an upset stomach and IBS symptoms due to these feelings around eating.
How do eating disorders negatively affect digestion?
I have been working with individuals with eating disorders as a nutritionist for over 10 years. In that amount of time, I have never met someone with an eating disorder who did not also suffer from digestive discomfort to some degree. Most people I have worked with and supported nutritionally through their eating disorder recovery, have experienced many, if not all, of the symptoms associated with IBS.
There are many reasons for this.
Digestive Issues and Anorexia:
As I explain in more detail in my article on elevated nutritional needs in Anorexia Nervosa recovery, when someone is restricting their food intake, their metabolism slows down significantly. With so much less food being consumed than what the body needs to function optimally, the body rations the energy it does receive in order to sustain essential bodily functions (those we need to live) such as the heart and the brain. We do not need our digestive tract to function optimally in order to live…we just need to to function.
With Anorexia Nervosa, another way it can create digestive discomfort is that the limited amount of food intake (due to severe restriction) can cause delayed gastric emptying. This means that it takes a longer amount of time for the food to move from the stomach to the small intestine. This causes digestive discomforts such as bloating, pain, and nausea.
Digestive Issues and Bulimia:
People with Bulimia Nervosa struggle with binge eating and purging (such as self induced vomiting and laxative use). Self induced vomiting can cause acid reflux and stomach pain. Side effects of laxative use are stomach pain and cramping, bloating, nausea, and flatulence. Binge eating can cause stomach pain, bloating, nausea and diarrhea.
Bulimia can permanently damage your stomach and intestines causing other problems like constipation, diarrhea, and irritable bowel syndrome.
Digestive Issues and Binge Eating Disorder:
Those who engage in frequent binge eating episodes will experience many of the digestive discomforts associated with IBS. Binge eating leads to feeling very uncomfortably full and often feeling sick to your stomach. Common symptoms are bloating, abdominal pain, nausea, acid reflux, stomach cramping and diarrhea.
What is the best approach to support IBS and Eating Disorder Recovery?
The concern with an individual presenting with both symptoms of an eating disorder and IBS, is that one may get treated over the other. For example, someone may go to their medical practitioner to be treated for IBS, without that practitioner recognizing the role of the eating disorder (or disordered eating) in their IBS symptoms or even knowing that there is an eating disorder present. Without this practitioner being aware of the eating disorder as well as IBS, they could make recommendations (such as food rules or dietary restrictions) that may be triggering to the eating disorder. Additionally, the individual may not be able to properly alleviate their IBS symptoms if the eating disorder symptoms are part of what is causing the stomach pain and digestive discomforts. On the other hand, one's treatment team could over attribute their IBS symptoms to psychological causes and not take those physical symptoms seriously enough.
Like everything else in eating disorder recovery, navigating IBS and eating disorders requires nuance and a holistic and multi faceted approach. This is why we work in a circle of care here at The Holistic ED Recovery Center, as communication between all practitioners is imperative to provide the best possible care and outcome in your health and recovery.
All IBS symptoms cannot be attributed to the eating disorder or disordered eating, AND the eating disorder or disordered eating cannot be overlooked when diagnosing and treating IBS.
