The Connection Between IBS and Eating Disorders
There is an undeniable connection between irritable bowel syndrome (IBS) and eating disorders. Similar to the question I explored in my article on ADHD and eating disorders, here too we must ask: which came first?
Did the eating disorder contribute to IBS symptoms, meaning recovery may help alleviate digestive distress? Or did the discomfort and symptoms of living with IBS contribute to the development of disordered eating patterns and behaviours?
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 Can IBS Contribute to Disordered Eating?
Disordered eating patterns are commonly seen in individuals diagnosed with IBS, and there is certainly a relationship between IBS and eating disorders. Individuals struggling with IBS symptoms will often begin removing foods from their diet in an attempt to alleviate discomfort.
Over time, this can create fear around food and eating. Meals may become associated with pain, bloating, discomfort, or unpredictable bowel movements, which can lead to increased food avoidance, anxiety around eating, and restrictive eating patterns.
Food manipulation is common among individuals diagnosed with IBS, as symptoms can often feel closely tied to food intake and dietary changes. Many people begin adjusting, restricting, or avoiding certain foods in an attempt to reduce symptoms and gain a sense of control over their discomfort.
There is often strong feedback between food and symptoms for the person struggling with IBS, though that feedback may be physical, psychological, or both, depending on the individual’s level of stress, fear, and discomfort around the food in question.
In addition to self-directed dietary changes, many healthcare practitioners involved in IBS treatment, including nutritionists, naturopathic doctors, gastroenterologists, and functional medicine practitioners, may also recommend dietary modifications, along with lifestyle changes, medications, probiotics, and mental health support. This is in part because there is a very strong connection between the gut and the brain, which I will speak more about below.
It is not difficult to see how someone struggling with IBS could develop fear around food, dietary rigidity, food rules, and increasing discomfort with eating socially.
However, there is an important difference between disordered eating and a clinically diagnosable eating disorder.
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, 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).
Because eating disorders are mental illnesses, we cannot look at digestive symptoms and food behaviours through a purely physical lens. Our mental and emotional health has a profound impact on the body, and this is especially true when it comes to the gut.
Though there is usually a focus on food and nutrition when it comes to treating IBS, 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 highly relevant when discussing IBS and eating disorders because the relationship works in both directions. Yes, the physical symptoms of IBS can absolutely make someone anxious or fearful around food, potentially leading to food avoidance, restriction, and distress around meals.
But the reverse can also be true. Someone who feels significant anxiety, fear, or emotional distress around eating, such as an individual struggling with an eating disorder, may also experience increased stomach upset and IBS symptoms as a result of those emotions and the body’s stress response around food and mealtimes.
How Do Eating Disorders Affect Digestion?
I have been working with individuals with eating disorders as a nutritionist for over 12 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 far less food being consumed than the body needs to function optimally, the body begins rationing the limited energy it receives in order to sustain essential functions required for survival, such as the heart and brain.
We do not need our digestive system to function optimally in order to stay alive - we simply need it to function well enough for the body to survive.
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 when someone presents with both IBS symptoms and symptoms of an eating disorder is that one condition may be treated without fully recognizing the other.
For example, an individual may seek treatment for IBS without the practitioner recognizing the role that eating disorder symptoms or disordered eating patterns may be playing in their digestive distress, or without even realizing that an eating disorder is present. Without awareness of both conditions, recommendations such as food rules, dietary restrictions, or elimination diets may unintentionally reinforce or trigger the eating disorder.
At the same time, if eating disorder symptoms are contributing to the digestive discomfort, IBS symptoms may not fully improve without addressing the eating disorder itself.
On the other hand, there is also the risk of physical digestive symptoms being overly attributed to anxiety or psychological causes, resulting in the individual’s IBS symptoms not being taken 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 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.
