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Dear Lesley: How Can I Maintain Eating Disorder Recovery with Stomach Sensitivities?

Lesley Williams, MD, CEDS

Dr. Lesley Williams is a certified eating disorder specialist, family medicine physician, and positive body image advocate. She co-owns Liberation Center, an eating disorder treatment facility, in Phoenix, Arizona. Dr. Williams is dedicated to ensuring that all women and men who struggle with eating and body image issues receive the help that they need to overcome and live happy, healthy lives.

Dr. Williams regularly educates other healthcare professionals about the diversity and dangers of eating disorders. She has made several media appearances as an eating disorder expert and regularly speaks at national conferences. Her most recent body image advocacy project is writing the children’s book, Free to Be Me. It encourages young girls and boys to love their bodies, no matter the size.

I have a sensitive stomach. How can I maintain eating disorder recovery?

Regardless of the diagnosis, those struggling with eating disorders can experience multiple gastrointestinal (GI) symptoms and "stomach sensitivities." It is typical to have everything from pain, bloating, nausea, gas, and constipation to diarrhea. This can be a very frustrating experience when you are trying to navigate the recovery process. You can feel as though you don’t know what to eat because so many things make your stomach feel uncomfortable. If this scenario sounds familiar to you, don’t be discouraged; you are not alone and there is help available.

You must first come to terms with one of the harsh realities of recovery: it can take a while for your body to return to normal GI functioning. This can be a physically and emotionally uncomfortable process that makes you vulnerable to returning back to your prior eating disorder habits. Be strong. With the right help and guidance, you can get through this and enjoy all of the wonderful advantages of recovery without painful stomach symptoms.

Here are some strategies to help you maintain your ED recovery despite GI issues:

1. Follow your meal plan. 

When you have stomach discomfort, it is natural to want to avoid the pain by decreasing your food intake. This is dangerous when you are in eating disorder recovery! Trust the wisdom of your dietitian and try not to problem solve on your own. Oftentimes, the changes in how are bodies process and absorb food are caused by your disordered eating patterns. Restricting your intake can make things worse. Confer with your RD and medical doctor and seek their assistance prior to making changes. They can help make adjustments to your meal plan as necessary that support minimizing GI discomfort and maintaining your eating disorder recovery progress.

2. Restore weight.

The body does a lot to compensate when you are malnourished. One of the things it does is to slow down how quickly food moves through the GI system. This is done in an effort to improve the absorption of essential nutrients. Once you have achieved an appropriate nutrition level and the body feels that it is getting enough of the vital nutrients that it needs, it will begin to move food through more efficiently. If you keep your caloric intake and/or body weight low, it will slow down the healing process.

3. Avoid expensive, invasive tests when possible. I have countless patients that come to see me AFTER they have undergone extensive and invasive tests and procedures that have only made them feel worse and didn’t reveal any helpful information. Having experience working with patients with eating disorders and GI issues is helpful in avoiding these unnecessary interventions. Time, patience, and partnership are the best tools when navigating this process. 

Once I can explain to them what is happening with their bodies and what they can do to support the healing process, they are less inclined to undergo extensive testing. We will occasionally  add the conservative use of medications to decrease their symptoms and make the process more bearable.

4. Understand that not all abdominal pain is due to constipation.

A common misconception among those in ED recovery is that if their stomach hurts, they are constipated. This is not always the case. There are numerous causes for GI discomfort other than constipation and they all can feel the same. However, the treatments are very different. There are medications and methods that may be best suited to treat your specific issue, and you can explore them with your team. If we treat all GI discomfort as constipation we may be doing more harm than good.

5. Seek the guidance of your Eating Disorder treatment team.

Because of the overlap between eating disorder and GI symptoms, it is important that you seek guidance from professionals who understand eating disorders and the strong connection between the brain and the gut. Having physical pain and emotional distress can make it difficult to determine if everything you are feeling has an organic source or if there is a psychological component to what you are experiencing. Regardless of the origin, your pain is real and you need experienced help navigating it so that you don’t fall back into the old ED behaviors that you have fought so hard to overcome.

6. Set realistic expectations.

Your eating disorder didn’t happen overnight and all of the GI symptoms associated with it will take time to resolve. The GI system is unfortunately one of the last systems of your body to get back to normal during ED recovery. Be patient with your body, work with experienced eating disorder professionals, and heed the counsel of your knowledgeable dietitian. Together, you can formulate small incremental goals that support your eating disorder recovery as well as minimize your GI symptoms.

Stomach discomfort during eating disorder recovery is real and with help, you can overcome it!