Digestive Issues in Eating Disorder Recovery: A Complete Guide

I have yet to meet someone in recovery that has not experienced digestive issues. Bloating and other gastrointestinal issues are a very difficult part of the eating disorder recovery process, especially if you’re also autistic. But stomach issues can be healed! In this guide, I'll share both my personal experience and practical solutions for managing these symptoms during recovery.

Common Gut Problems in ED Recovery: You're Not Alone!

One of the most frequent questions I get asked from people in eating disorder recovery is how to deal with digestive issues. These often include:

• Gas and bloating
• Diarrhea or constipation
• Acid reflux
• Frequent bowel movements
• Indigestion
• Feeling uncomfortably full

As someone who has experienced every single one of these symptoms, I understand your struggle! Stomach issues are incredibly challenging, especially when you're already working so hard on the mental aspects of recovery. Not only are gastrointestinal issues painful, but they can be inconvenient and oh so embarrassing. However, along with weight gain, gut problems are a way in which your body is adjusting to achieve energy balance. For me, understanding the science and knowing I wasn’t alone made my healing journey so much easier.

What Causes Digestive Issues in Eating Disorder Recovery?

As I explain in my book How to Beat Extreme Hunger, the body will slow down or shut down processes that are nonessential to life when it perceives scarcity. Each and every part of your body requires fuel to function, which means that a lack of adequate fuel equates to inadequate functioning. If you are not eating enough, your body doesn’t really need to digest a lot of food, so why would it waste its precious energy on digestive processes? Your body will slow gastric emptying to conserve energy, using the limited energy it has available for more essential processes such as respiration and pumping your heart.

When you are in energy deficit, your body turns to your internal organs for fuel. To ensure your survival, your body will leach energy from your organs and muscles – including your digestive muscles. While actively restricting, you may not experience the effects of weakened digestive muscles because your digestive system doesn’t have much to digest. When you start eating more and providing your body with evidence that food is abundant, however, that’s when you start to feel like you’re being kicked in the pants. So what exactly is causing all these uncomfortable symptoms? There are three main reasons for digestive issues in anorexia recovery: weakened muscles, gut dysbiosis, and nervous system dysregulation.

1. How Anorexia Affects Your Digestive System

Your body digests food through the process of intestinal peristalsis – a series of wavelike muscle contractions that move food through the digestive tract. When these muscles are too weak to contract as they normally should, food may sit in your stomach for a longer period of time. This is called gastroparesis or delayed gastric emptying. Of course, you only experience the symptoms accompanying gastroparesis – nausea, cramping, bloating, farting, etc. – when there’s an abundance of food sitting in your stomach. Thanks eating disorder recovery!

Speaking of the stomach, this organ is also weakened after prolonged periods of restriction. Known as functional dyspepsia, the elasticity of the stomach decreases when you eat too little. So when you start eating more in recovery, the stomach can’t expand to its full capacity, resulting in feeling overly full and bloated.

The intestines and stomach aren’t the only muscles affected by malnutrition. At one point in my recovery from an eating disorder, I was diagnosed with GERD: gastroesophageal reflux disease. Someone with GERD will experience unintentional vomiting, reflux, and/or heartburn after they have eaten. At the time, I was grateful my problem had a label – I knew what was wrong! But looking back with the label-free perspective I have now, my doctor’s almost instantaneous diagnosis of GERD without inquiring about my health history goes to show how fucked up the healthcare system is. As a result of that appointment, I was sent home with two prescriptions for antacids and the recommendation to “not eat at least three hours before bed.”

With my current knowledge of the human body and how it responds to stress, I am shocked by the way that doctor (and many others) handled my situation. I didn’t have too much stomach acid, I had too much stress and too little muscular strength. The real cause of unintentional vomiting during recovery from restriction has to do with the mind-gut connection (more on this in a moment) and the lower esophageal sphincter (LES).

Normally, the LES opens as you eat and then closes to prevent stomach contents from traveling back up. However, what happens to muscles when you’ve been malnourished? That’s right: they weaken and do not expand and contract as they should. This is the same with GERD: the LES weakens, meaning it won’t expand and contract as it should. So, when you start fueling yourself adequately, you are much more likely to experience GERD-like symptoms.

2. Eating Disorders and Food Intolerances: The Gut Microbiome Connection

My GERD diagnosis was only one of multiple. During my eating disorder, I was also diagnosed with irritable bowel syndrome (IBS). I was advised to follow a low-FODMAP diet, which is a protocol that limits the amount of FODMAPs an individual consumes. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAPs are short-chain carbohydrates (sugars) that have an osmotic effect (increasing the amount of water in the bowel) and are easily fermented by bacteria, meaning high consumption can lead to bloating and gas.

Understanding IBS and the Gut-Brain Connection in Anorexia

Just like GERD and gastroparesis, IBS falls under the umbrella of functional gastrointestinal disorders (FGIDs), also known as disorders of the gut-brain interaction. As the name suggests, FGIDs correlate to dysfunctional communication between the brain and gut – in scientific terms, dysfunction of the gut-brain axis.

In simple terms, the gut-brain axis (GBA) is the two-way biochemical signaling that takes place between the gastrointestinal tract and the central nervous system. The axis consists of multiple connections, including your gut microbiome, your immune system, and your vagus nerve. This means that dysregulation in any of these pathways can result in digestive problems.

When you consume a limited diet, the diversity of bacteria in your gut decreases. Countless studies have demonstrated that the more diverse your diet, the more diverse your gut microbiome and thus the more resilient it is to perturbations. So can you imagine what happens when you restrict? Your gut automatically becomes more sensitive when you start reintroducing foods in ED recovery.

Can Eating Disorders Cause Food Intolerances?

For a long time, I was convinced that I was intolerant to a vast array of foods. Gluten, dairy, eggs – they were all on my "bad" food list. I told myself I was intolerant to them so that I wouldn't have to fight the mental battle of whether or not to eat them. By putting them on the bad list, I could simply push those foods aside and only eat the foods I had labeled as "good."

Whenever I ate these "bad" foods, I experienced all the symptoms of an intolerance to them. This confirmed my belief that I was doomed to lifelong digestive issues and just would have to avoid these foods at all costs. However, something wasn't adding up. Why was I suddenly intolerant to all the foods I was perfectly capable of digesting prior to my eating disorder?

When I finally made the commitment to fully recover, I started approaching life from a place of curiosity rather than judgment. Allowing myself to be curious about the root cause of my digestive issues rather than judging certain foods as "good" or "bad" allowed me to understand that my negative reactions were largely founded on the belief that these foods were causing harm.

Now you may be thinking: “But I actually feel better when I cut out certain foods!” Although you may find some relief by eliminating certain foods or food groups from your diet, growing evidence shows that this relief may not even be due to the actual removal of the food. What do I mean? You’ve likely heard of the placebo effect: a beneficial effect produced by a placebo or “dummy” treatment, indicating that the changes are a result of the patient’s belief in the treatment rather than the treatment itself. There’s also the nocebo effect, which is the opposite of the placebo effect. As you can likely conclude, the nocebo effect takes place when a patient develops negative side effects or symptoms from believing that the nocebo is causing harm. In the case of gut issues and elimination diets, certain foods are the nocebo and the elimination diets are the placebo.

Of course, I’m not here to invalidate legitimate allergies or intolerances. All I’m saying is that eating disorders will come up with the sneakiest of ways to support restriction, and that healing takes time.

3. The Nervous System’s Role in ED Recovery Digestive Issues

Aside from weakened muscles and gut dysbiosis, unintentional vomiting and other digestive issues are impacted by the state of your nervous system. The nervous system is the electrical information highway of the body, and is the foundation of not only how we experience stimulation, but it plays a key role in internal processes such as digestion. You’ve likely heard of “fight-or-flight” mode and “freeze” mode before. They are responses to stress or danger, regulated by the autonomic (= automatic) branch of the nervous system.

When you’re engaging with an eating disorder, your body is constantly perceiving danger. Just think about it: food restriction is one of the greatest threats to human survival! Activation of the sympathetic nervous system, which triggers fight-or-flight mode, puts non-essential life processes on the back burner. If you were being chased by a wild animal, the last thing your body needs to focus on is digesting a sandwich! So improving digestion means getting out of your sympathetic nervous system and into your parasympathetic nervous system. There are multiple ways to do this, which we will cover in the next section about restoring gut health in eating disorder recovery.

How to Heal Digestive Issues in Eating Disorder Recovery

Now that you know the “why” behind your digestive issues in eating disorder recovery, you’re probably dying to know: “How do I get rid of my stomach problems?” The answer is simple: you’ve got to train your body to digest food again.

Think about building muscle at the gym. Your biceps only grow when you give them a reason to grow – by challenging them with weights. The same principle applies to your digestive system. Eating regular meals is essentially strength training for your gut! Just like you can't expect to lift heavy weights after months (or when it comes to restriction, often years) of not exercising, you can't expect your digestive system to handle normal portions perfectly after periods of restriction.

But here's the good news: just like muscles grow stronger with consistent training, your digestive system will adapt and strengthen when you give it regular practice. Every meal is an opportunity to build your "digestive muscles."

Sticking with our gym metaphor, think about how limiting it would be to only train one muscle group. A balanced workout routine targets different parts of your body – and the same goes for your gut health. Healing IBS and temporary food intolerances caused by anorexia requires expanding your food variety.

Each type of food is like a different exercise for your digestive system:

• Different foods feed different gut bacteria
• Various nutrients support different digestive processes
• Challenging fear foods is like progressive overload in strength training

Improving Digestion in ED Recovery: 3 Practical Techniques

Of course, healing digestive issues isn’t just a physical process – it's equally a mental game. If you’re reading this, chances are mealtimes cause you incredible anxiety. Biologically speaking, anxiety activates your sympathetic nervous system, which triggers the fight-or-flight response. So as I mentioned in the section on the nervous system, getting into rest-and-digest mode requires activating your parasympathetic nervous system. Here are three powerful techniques to calm your nervous system before mealtimes:

1. Using Deep Breathing to Improve Digestion in Recovery

Before meals, take 5-10 deep belly breaths. Deep breathing stimulates your vagus nerve, the superhighway that connects your brain to your digestive system. Taking slow breaths with longer exhales signals to your body that you're safe and it's okay to focus on digestion. Think of it as your pre-workout warm-up!

2. Nourishing the Mind-Body Connection with Mantras

Repeat positive affirmations like:

• "This food will nourish and strengthen my body"
• "My body knows how to digest food"
• "I trust my body's healing process"

The gut-brain connection is incredibly powerful. When we tell ourselves a certain food will hurt us, it most likely will. In contrast, when we tell ourselves a food will nourish us, we're much less likely to experience negative symptoms. This isn't "all in your head" – it's the real physiological impact of your thoughts on your digestive processes.

3. Mindful or Mindless Eating in Eating Disorder Recovery

Become curious about whether you prefer mindful eating or mindless eating. Despite what wellness culture preaches, there's no one-size-fits-all approach. For me as a neurodivergent person, eating with distractions like watching Netflix or answering emails actually helps reduce my anxiety around food. Others might find they digest better when eating mindfully without distractions. There's no right or wrong – what matters is discovering what helps YOUR nervous system feel safe during meals.

Remember: just like you wouldn't expect immediate results at the gym, healing your digestion takes time and consistent eating. While the symptoms can feel overwhelming, stomach issues are a normal response to prolonged restriction. Your body has an amazing capacity to heal when given consistent nourishment and patience. So rather than resisting the inevitable pain (if recovery was easy, no one would have an eating disorder!), focus on the progress you're making. Trust that each meal is strengthening your digestive system. If you need more support, I dive deeper into these topics in my course Extremely Hungry to Completely Satisfied.