Eating disorder recovery can be a long and tumultuous journey. All aspects of a recovery plan are so incredibly important, from dietetics to counselling to peer support and recovery groups. But what is often overlooked, or not even addressed, is gut health.
Dysbiosis, leaky gut syndrome, pre-existing food sensitivities or allergies, low stomach acid, a lack of digestive enzymes and/or bile production, and gut inflammation can be major barriers to treatment. In the case of anorexia nervosa, re-feeding can be met with not only unwelcome or ruminating thoughts but also indigestion, gas, bloating and an overall feeling of digestive upset. Starting any patient on the road to recovery from an eating disorder on a gut healing protocol should be encouraged and can potentially even help with patient compliance, recovery rates and limit the number of chronic disease conditions that can develop after treatment, like autoimmune disease and thyroid conditions to name a few.
Chronic gut inflammation can lead to a number of disruptions in how well we digest and assimilate our food. Cells of the digestive tract, called enterocytes, can become sickly and unable to carry out their functions of proper breakdown and absorption of food particles. This can lead to improperly digested food particles being passed into the blood. Some of these food particles are even considered to be neurotoxins, exhibiting neurological disruptions such as depression, anxiety and even psychosis in some. Improper breakdown of food can also lead to various immune responses, which can manifest themselves as food sensitivities and certain autoimmune reactions.
It is now commonly known that gut flora not only has an impact on how well we digest and assimilate food but also on the functioning of our brains and mental health. A number of emerging research papers within the past five years can attest to the gut-brain axis as well. Evidence of intestinal dysbiosis in anorexia nervosa shows an association between mood and the gut flora of this patient population. In a 2015 study published in Psychosomatic Medicine, it was shown that varying levels of depression, anxiety and eating disorder psychopathology were shown to be inversely associated with levels of gut diversity of the intestinal microbiota.
Lastly nutrient deficiencies, particularly zinc can lead to depletion of digestive enzymes and stomach acid. Since zinc is a cofactor for the production of these enzymes, not having enough zinc leads to an inability to properly digest and assimilate other nutrients from food. Therein lies the vicious cycle: zinc deficiencies leading to other nutrient deficiencies causing muscle wasting, brain shrinkage, mood disorders and fatigue to name a few.
The take home: treating all aspects of digestion is incredibly important with eating disorders. Having a happy gut can go a long way in supporting the road to recovery and more light needs to be shone on the significance of proper digestive health in the treatment and management of a number of subtypes of eating disorders. Finding a qualified health care practitioner who is knowledgable about optimal gut health will be an incredibly helpful addition to your recovery team.
Campbell-McBride, N (2010). Gut and Psychology Syndrome. Medinform Publishing: Cambridge, UK.
Kleiman SC; Watson HG; Bulik-Sullivan EC; Huh EY; Tarantine LM; Bulik CM; Carroll IM. (2015 Oct 1). The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology. Psychosom Med. [Epub ahead of print].
Su JC, Birmingham CL. (2002 Mar). Zinc supplementation in the treatment of anorexia nervosa. Eat Weight Disord. 7(1):20-2. PMID: 11930982