Gut Feeling: The Link Between IBS and Eating Disorders
On the surface, gastrointestinal (GI) disorders and eating disorders share many things in common. They can both cause physical symptoms like cramping, bloating and sharp stomach pain. They also may create feelings of anxiety when eating certain foods – or when eating almost anything.
For these reasons, the relationship between GI conditions and eating disorders is complicated. While many clinical studies have explored the effects of eating disorders on the GI tract, less is known about the way GI disorders like irritable bowel syndrome (IBS) and celiac disease can trigger eating disorders.
Let’s explore emerging research, how to untangle the symptoms of GI disorders and eating disorders when it feels like something is off, and what our experts recommend.
The connection between GI disorders and eating disorders
A 2022 review [1] revealed that, overall, eating disorders are more prevalent among people who have GI disorders than those who do not. A 2019 review stated that about 23% of people with GI disease had disordered eating habits versus 10% for people without GI disorders.
Investigations show correlations between specific types of GI conditions and eating disorders, as shown in the following examples.
IBS and eating disorders
Up to 90% of individuals with IBS associate their symptoms with specific foods [1]. As a result, about 15-25% of adults with IBS [2] are more likely to engage in disordered eating behaviors versus 3% of the general population. These behaviors can include skipping meals, eating meals at irregular times or not eating when hungry.
GI disorders, ARFID and orthorexia
According to a study of 317 patients screened in an outpatient GI clinic, 19% of adults with a GI disorder met the criteria for avoidant/restrictive food intake disorder (ARFID).
“People with GI disorders may reduce their intake of perceived ‘safe’ foods and develop an increased fear of a harmful outcome from eating, which can lead to the development of ARFID,” explains Adee Levinstein, MS, RD, LD, CEDS-C (she/her/hers), clinical dietitian training specialist with Eating Recovery Center (ERC). “In addition, significant rules around eating only ‘right,’ ‘healthy’ or ‘clean’ foods can cause someone to develop disordered patterns aligned with orthorexia.”
Celiac disease, gluten allergies and eating disorders
A study of nearly 18,000 women with celiac disease in Sweden [3] found a positive association between celiac disease and anorexia. Women diagnosed with celiac disease before age 19 were 4.5 times more likely to also have a diagnosis of anorexia. Women age 20 and over had nearly twice the risk of developing anorexia after an initial diagnosis of celiac disease.
Why GI disorders can lead to eating disorders
Now that we know about the strong connection between GI disorders and eating disorders, our next question is – why?
One reason is that both conditions involve the gut-brain axis, which links a person’s mental health to their gut health. Another is that people with GI conditions often make well-intentioned changes to their diet to reduce their risk of GI-related symptoms. Restricting food or entire food groups can be a slippery slope to disordered eating and eating disorders.
“This can cause people to become hyperfixated on food out of necessity, whether perceived or warranted,” Levinstein explains. People with celiac disease, for example, will learn to avoid foods containing gluten out of necessity.
On the other hand, individuals with IBS might be encouraged to begin a “low-FODMAP diet,” which is highly restrictive and meant to be a short-term intervention to identify which foods are causing GI distress. However, many people don’t understand that they’re supposed to reintroduce food, so they remain on a restrictive diet that is nearly impossible to maintain.
“Patients who require a modified diet to manage their GI symptoms need to read labels, understand how their food was made and trust that they receive the right information,” explains Stacey Dipalma, MD, an adolescent medicine physician at ERC. “So, they may have anxieties about eating outside the home. They may wonder if they can obtain information about the ingredients in their food and whether they’ll be able to eat any of the items on the menu.”
These are behaviors we commonly see with orthorexia, ARFID and other eating disorders. And for individuals diagnosed with a GI disorder of an unknown cause, those anxieties can grow exponentially.
“They may experience frequent fears about whether eating a particular food will cause their pain to return, trigger a bout of diarrhea, or cause them to vomit or choke,” Dr. Dipalma says.
How to spot an eating disorder
So, how do you know when a GI disorder has snowballed into an eating disorder? Here are some signs and symptoms:
- Significant mood shifts related to the food an individual has consumed
- Avoidance of social settings and increased feelings of isolation
- Significant weight loss (whether intentional or unintentional)
- Anxiety that impacts an individual’s school or job performance, activities of daily living, self-care and other crucial responsibilities
- Signs of malnutrition or starvation, such as missing or absent periods, a slow heartbeat (bradycardia), cold intolerance and memory problems
Eating disorder treatment with a GI disorder
Because there is such a strong overlap between symptoms, it can be difficult for people to untangle whether they are dealing with a GI disorder, an eating disorder or both. What’s more, people may miss the early signs of an eating disorder altogether, which is why awareness is an important first step.
“Early unintentional weight loss is often met with positive feedback from peers,” Dr. Dipalma says. “This can encourage further intentional weight loss caused by worsening eating disorder behaviors.”
The key to getting help is to reach out sooner rather than later. Dr. Dipalma recommends that someone who is struggling seek out a multidisciplinary team of providers that can treat them as a whole person – both mind and body.
Learn more about whole-person care here.
Our nutrition approach for GI disorders and eating disorders
Individuals who seek treatment for GI-triggered eating disorders at ERC will receive care from an expert team that uses the latest data-informed approaches to eating disorder treatment.
From a nutritional standpoint, individuals will receive guidance to normalize their eating patterns, achieve nutritional adequacy, and improve gut and digestive health. As a person’s relationship with food begins to heal, our team will continue addressing the root causes of their GI distress.
“It can take time to tease out which symptoms are related to the eating disorder and which ones are related to the underlying GI disorder,” Levinstein says. “But with open communication and compassion, we work with our patients to figure out what will support them the best.”
Learn more about our nutrition approach.
Get matched with the exact support you need
If you’re living with a GI disorder and concerned it may be impacting your relationship with food, help is available.
“Everyone deserves a peaceful relationship with food and to experience food freedom,” Levinstein shares.
Reach out today so we can match you with the exact support you need.
Related Resources
Sources
- Hedrick, T. (2022, August). The overlap between eating disorders and gastrointestinal disorders. Practical Gastroenterology, 32-46. (Nutrition Issues in Gastroenterology, Series #224).
- Harer, K.N. (2019, May). Irritable bowel syndrome, disordered eating, and eating disorders. Gastroenterology and Hepatology (N.Y.), 11(5), 280-282. PMID: 31360143; PMCID: PMC6589841.
- Mårild, K., Størdal, K., Bulik, C.M., Rewers, M., Ekbom, A., Liu, E., & Ludvigsson, J.F. (2017). Celiac disease and anorexia nervosa: A nationwide study. Pediatrics, 139(5), e20164367. doi: 10.1542/peds.2016-4367.
Written by
Written by
Adee Levinstein, MS, RD, LD, CEDS-C
