Eating Disorders & Gut Health
By Noor Dabbas, Graduate Student & Mental Health Advocate
Eating disorders threaten the mental health and physical wellbeing of millions of adolescents and young adults worldwide. And now, recent data suggests that eating disorders may have lasting damaging effects, even after recovery, that can be even more catastrophic to the health of eating disorder sufferers. Medical professionals are only now beginning to take notice.
The stark rise in eating disorders over the past decade is no surprise. The rise coincides with popular online platforms, such as Instagram and TikTok, where commenters mercilessly criticise every physical aspect of app users. In our airbrushed social media era, young people grow up hating their bodies when all they see online are airbrushed images without an unseemly pocket of fat in sight. Unrealistically flawless content distorts our bodies’ true value, which is the sum of much more than just our looks.
Our bodies are the only vessel through which we can experience the beauty of the world. We use our bodies to hug loved ones, to hike up the highest hills and watch the sun rise, to dance the night away. Yet many of us become obsessed with making them look a certain way. We begin to mistreat the very bodies that make it possible for us to exist on this earth and live a healthy, fulfilling life.
Newly discovered consequences
Over the past three years, new research has emerged revealing a link between eating disorders and gastro-intestinal and neuro-muscular disorders. Specifically, there has been an undeniable rise in diagnoses of gastroparesis, a condition that inhibits the stomach’s ability to empty food normally, in individuals who currently suffer or have suffered from eating disorders in the past, according to a study published in The American Journal of Gastroenterology (2018)
Gastroparesis is especially problematic because, when food is left sitting in the stomach for too long, it causes a variety of health problems that only escalate if left untreated. Such issues include causing those afflicted with the condition to feel very full too soon after they begin eating a meal, which often makes it easier for current eating disorder sufferers to continue their restrictive relationship with food, and is detrimental to the recovery process of eating disorder sufferers who are trying to unlearn their unhealthy relationship with food. According to Cedars-Sinai, a nonprofit academic healthcare organisation, gastroparesis and other similar gastric emptying disorders may lead to the food that is left sitting in the stomach to create blockages in the gastrointestinal tract. This causes unbearable pain, uncontrollable vomiting, and, in extreme cases, can stop food from passing into the small intestine, leading to malnutrition and the necessity for a feeding tube.
Since the link between gastroparesis symptoms and disordered eating behaviours is a fairly new discovery, many gastroparesis and eating disorder sufferers have endured years of pain and emotional turmoil from being totally unable to eat, and exhausted from the lack of food and water without even knowing why. Many doctors have classified these seemingly sourceless symptoms as resulting from mysterious circumstances upon attempting to treat the patients who complain of them.
Sufferers recount experiences of going to the emergency room before being diagnosed in an effort to get treated for the excruciating pain they experienced as a result of a particularly bad gastroparesis episode. All too often, they are turned away while experiencing pain so excruciating that they couldn’t even stand up. Doctors, for example, who don’t spot anything in the ultrasound or CT scan conclude that constipation is the culprit.
Many eating disorder sufferers are unaware of the possible life-long consequences. Feeling ill without knowing why is scary, but finding out that the reason why you have been feeling so terribly for years is because of your battle with self-image issues and disordered eating habits is both horrifying and shameful. Such circumstances may lead to those who suffer from both eating disorders and gastroparesis to develop even more complicated negative feelings towards themselves and their relationship with food.
What are eating disorders?
Eating disorders develop when people’s concerns about eating, body-image, food and weight become excessive and distorted and behaviours become directed towards eating or avoiding eating. “People with eating disorders use food to deal with uncomfortable or painful emotions,” confirms Clinical Psychologist Rasha Salib, and gives the example of restricting food to gain a sense of control, while overeating or bingeing temporarily soothes and numbs intense emotions such as sadness, anger, or loneliness. “Over time, obsessions over food and weight come to dominate everything else,” she adds. These extreme efforts to control weight and shape (as Salib outlines here) can significantly interfere with one’s health and life:
Following rigid diets and strict dietary rules
Bingeing on food in secret
Hoarding and hiding stashes of high-calorie foods such as junk food and sweets
Throwing up after meals/laxative/diuretic misuse
Taking only tiny portions or specific low-calorie foods
Taking foods in certain orders, rearranging food on a plate, excessive cutting or chewing
Taking diet pills
Obsessively counting calories, reading food labels, and weighing portions
Compulsive, intense, excessive exercising
If you or a loved one suffers from an eating disorder, know that you are not alone. You can consult with a psychologist with clinical experience in eating disorders and/or get in touch with an online support group for support, such as Eatingdisorderhope.com/recovery/support-groups/online.
Words matter
Clinical Psychologist Rasha Salib shares what NOT to say to someone suffering from an eating disorder:
“You aren’t fat! You look great!”
See how often you comment on anyone’s body, weight, size or shape, then work on cutting out such references altogether. Unfortunately, women are conditioned to share a collective dissatisfaction over their bodies, and often I hear many women bond over body size, what they ate, how little they exercised and so on. If you wish to compliment your loved ones, focus on traits and qualities on the inside that really make a person attractive, such as their accomplishments, achievements, personality, smile or kindness –things that have nothing to do with their outward appearance. Avoid associating a women’s physical appearance to her self-worth by reinforcing or giving attention to changes in appearance.
“You are so skinny/thin/you lost so much weight, bravo! I envy you. What is your secret or diet? I wish I had your willpower and self-control!”
These statements validate the eating disorder and strengthen the dysfunctional eating habits and behaviours. You are sending a message to the people that their efforts are not only working, but that their underlying distorted belief that being thinner and smaller means that they are more worthy, more acceptable and more interesting. This kind of praise places emphasis on appearance and body image as a source of value and self-worth, reinforcing the distorted and faulty assumption that a smaller body is more valuable.
“You should cut out flour/sugar/carbs…” Or “Why don’t you go on a diet or try this new diet?”
The root of binge eating is restriction of food, because the body goes into survival mode in the face of deprivation, scarcity and starvation. Not only do such suggestions about food elimination and rules and regulations around food increase the feelings of guilt, fear and uncontrollability around food, but also, people with eating disorders most likely have already tried many diets. Dieting has been shown to be the strongest predictor of the development of an eating disorder.
“Why can’t/don’t you just eat? All you have to do is accept yourself”
Avoid offering simplistic, reductionistic, unhelpful and unrealistic solutions because more often than not, eating disorders have very little to do with food itself. Eating disorders are complex problems and involve multiple layers such as history of abuse or trauma, comorbidities with depression and anxiety, personality disorders, perfectionistic personality traits, body dissatisfaction, unhealthy family dynamics, difficulties with emotional regulation and low self-esteem.
“Isn’t that too much food? Do you know how many calories are in that?”
Do not comment on anyone’s food choices as it increases food preoccupation, their fear that their eating is being observed and is on trial, and feelings of self-consciousness about food choices in people who are already hyper-aware of their food choices.
Concerned for someone?
Clinical Psychologist Rasha Salib shares tips for what to say to someone you know or suspect is struggling with disordered eating issues:
“I am genuinely worried about you. I can tell things are tough for you right now. Is there anything I can do to support you?”
Explain why you’re concerned by referring to specific situations and behaviours you’ve noticed, and why they worry you, without lecturing or criticising, as this will only make your loved one defensive.
“Do you want to talk? I’m here for you if you want to talk”
Pick a good time when you can speak to the person at a time of emotional calm in private without distractions, other obligations or constraints.
“No one is perfect, go easy on yourself”
Set a positive example and be a healthy role model by eating nutritious and balanced meals. Be mindful about how you talk about your body and your eating. Avoid self-critical remarks or negative comments about others’ appearance or your own physical appearance and weight.
“Would you like to see someone who can help you through this?”
Ask if the person has reasons for wanting to change to see if they are willing to seek help.
“I love you no matter what”
Express your concerns about the person’s health, how you much you love them, and your desire to help.
