Disordered Eating and IBS
Disordered eating includes unhelpful behaviours, thought processes and feelings around food and eating.
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Disordered eating and IBS are a bit of a chicken and egg situation. Research shows that if you have IBS you are more likely to develop disordered eating behaviours and vice versa, but it can be difficult to figure out which came first. Either way, it's important to understand and identify disordered eating behaviours as part of your IBS detective work.
To find out more about the link between disordered eating and IBS...
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​Watch the video
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Click on links in the white box
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Just scroll down!
Eating Disorder v.s. Disordered Eating
Eating disorders (EDs) are diagnosable mental health disorders. Disordered eating sits on a continuum somewhere between body and food acceptance and an ED. Disordered eating can include the same symptoms and behaviours as an ED, but they are less intense, occur less often and are not as disruptive to normal life.
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Someone with an eating disorder may have disordered eating behaviours, but not all people with disordered eating will be diagnosed with an eating disorder. But both conditions can have serious health consequences.
What is an Eating Disorder (ED)?
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EDs are serious and potentially life threatening mental illnesses
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Characterized by disturbances in behaviours, attitudes and feelings about food and eating and/or body weight and shape
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Classified into different types e.g. Bulimia Nervosa, Anorexia Nervosa
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Suicide is a major cause of mortality for people with EDs​
For more information:
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National Eating Disorders Collaboration (Australia)
If you think you may have an eating disorder, please see your doctor and get screened!
What is Disordered Eating?
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Disordered eating lies somewhere between normal eating and an eating disorder
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Behaviours and symptoms could be similar to EDs, but occur less often and/or are less severe
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Motivation for behaviours may be different than ED
Disordered eating may include:
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Restrictive fad diets or obsessively counting calories
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Restricting to compensate for eating "bad foods"
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Compulsive or binge eating
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Irregular patterns and skipping meals
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Rigid rules about food and eating
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Use of laxatives/diet pills or purging for weight loss
Disordered eating and dieting key risk factors for the development of a more serious eating disorder.
Disordered Eating and Dieting
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Dieting is one of the most common forms of disordered eating
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Can lead to unhealthy behaviours and an unhealthy relationship with food
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Risk factor for developing an eating disorder
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Dieting cycle shows how severe disordered eating or EDs can develop
Ready to break the diet habit and feel better about your body?
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Go to the Intuitive Eating section
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Discover Food Freedom with the Intuitive Nutritionist
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Check out the book Health at Every Size (HAES)​
Disordered Eating and IBS
Disordered eating and IBS are a bit of a chicken and egg situation.
Research shows that if you have IBS you are more likely to develop disordered eating behaviours and if you have disordered eating behaviours you are more likely to develop IBS.
There is a connection, but it's not clear if one condition actually causes the other.
There are also some similarities between EDs and IBS. Both are more common in women and are often linked to mental health issues like anxiety and feelings of self-blame and low self-esteem. Trauma, genetic predisposition and sensory processing issues can also be common factors.
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ARFID and Orthorexia Nervosa may be of particular interest for IBS, because they are not characterized by unhappiness with body shape or weight, but by food restriction and anxiety about food choices.
ARFID
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Avoidant/Restrictive Food Intake Disorder involves severely restricting variety and volume of food. Unlike many EDs, it's not caused by a distorted self-image or desire to lose weight.
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IBS patients are twice as likely as non IBS to screen positive for the disorder, especially those with IBS-D.
Could be a learned fear response with eating, because the brain makes a connection between IBS symptoms and specific foods. But these associations aren't always correct and can get out of control, possibly leading to the disorder. Conversely, the disorder could increase IBS symptoms.​
Orthorexia Nervosa (ON)
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​ON is an obsession with healthy eating with restrictive behaviours. It hasn't been formally recognized as an ED and few studies have been done.
Like ARFID, the disorder is not caused by body/image or weight concerns, but rather a strong anxiety about food choices and has been linked to mental health disorders like anxiety and to IBS.
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Diet culture often encourages these excessive "clean eating" behaviours, which can make it easier to slip into unhealthy and anxiety driven eating patterns.
IBS
Disordered Eating/ED
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Many people with IBS relate their symptoms to food. Many also change their diets and meal habits to avoid or prevent symptoms. Sometimes these changes lead to disordered eating behaviours. For example, skipping meals at work to avoid bloating, pain or diarrhea.
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If IBS symptoms are associated with eating, a conditioned or fear-based food aversion can develop. The fear of eating a wide variety of foods can cause the diet to become very restricted. This anxiety around eating causes stress, which can actually increase symptoms of IBS.
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Food restrictions are often used as therapy to control IBS symptoms. Used correctly, preferably under supervision by a Registered Dietitian, this can be very helpful. But it can place some people at risk for disordered eating behaviours if food restrictions continue past an appropriate point.
Disordered Eating/ED
IBS
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​Research shows that people with IBS have significantly more irregular meal habits than people without IBS. Disordered eating could lead to disturbances in colonic motility (muscular movement of intestines) and increase IBS symptoms.
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Irregular eating patterns, like the binge/restrict cycle, can lead to constipation, diarrhea, bloating, distension, slow or stop emptying of the stomach into the small intestine (gastroparesis).
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Restrictive eating patterns may negatively impact the gut microbiome and intestinal function by changing the communication pathways along the gut/brain axis.
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Restrictive eating can lead to malnutrition. If your GI tract is not getting the nutrients it needs, digestion will suffer.
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Purging behaviours like self-induced vomiting and use of laxatives can worsen IBS symptoms
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For people with body image issues and disordered eating behaviours, bloating can often be confused with "feeling fat". This can cause more anxiety around eating and increase severity of IBS symptoms.
Disordered Eating and IBS Strategies
Together disordered eating and IBS can create a vicious cycle. Unhealthy eating behaviours can make IBS symptoms worse and avoiding or trying to deal with symptoms can lead to unhealthy eating behaviours. And so on.
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And this cycle comes with a whole pile of stress. Worry about eating the right food or gaining weight or digestive woes can, of course, also make your IBS symptoms worse.
So check out some of these strategies and tips to get your eating habits back on course to help manage your IBS symptoms.
IMPORTANT!​
If you think you may have serious disordered eating behaviours or an eating disorder, please see your doctor and get screened.
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Advice in this section "Disordered Eating and IBS Strategies" may be helpful, but it is mainly directed at people who have some unhealthy behaviours or suffer from milder forms of disordered eating.​
Focus on Adequacy, Consistency and Balance
Eat enough to satisfy your hunger. Aim to eat regularly through the day - 3 meals and some snacks. Don't skip meals. Be sure to have some healthy fats, protein and carbs. Eat a variety of different foods.
For more on balance go to Healthy Eating Strategies.
Honour Your Hunger
Often people with IBS will try to control their symptoms by not eating, even if they're hungry. Most of us aren't at our best when we're hungry, but it can be a double whammy if you have IBS, because hunger can lead to pain in a hurry if you have a hypersensitive gut.
So eat if you're hungry. Try small amounts more often if you like.
Lower Food Anxiety
Many people relate their IBS symptoms to food, so eating can be stressful. For some tips on destressing at meal times check out the Mindful Eating section.
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Anxiety and IBS are definitely linked and can form a cyclic pattern. Anxiety about food triggering symptoms can lead to dietary restrictions, which can lead to stressful thoughts and obsessive behaviour around eating and so on.
Often people equate symptoms with a particular food, but they aren't always right as many factors can feed into IBS symptoms. This unfounded "food fear" could lead to more and more unnecessary restrictions, so it's super important to pinpoint your trigger foods and test foods more than once before putting them on your no go list.
Be Mindful with Food Elimination Therapy for IBS
Some food restrictions can help with IBS symptoms, but your goal should always be the elimination of as few foods as possible while still managing symptoms. If you remove something from your diet, make sure you are still getting all your essential nutrients. Make additions if necessary.
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The FODMAP diet is a strict elimination diet that's used to discover foods that trigger IBS symptoms. However, it's restrictive nature can do more harm than good, especially for "food fear". It should be done under the guidance of a trained dietitian and is not recommended for people with eating disorders or more severe disordered eating behaviours.
Remember that everyone's IBS is different. What works for someone else won't always work for you.
Be Wary of Diet Culture
Dieting is the most common form of disordered eating. Many dieting behaviours have become normalized in our culture, so here are a few that may affect IBS symptoms.
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Diets add stress to the eating process and that's a no no for anyone with IBS. Ditto with counting calories. Most diets aren't sustainable and it's easy to fall off and straight into a binge. Feeling hungry or too full can trigger IBS symptoms.
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Using coffee as an appetite suppressant can trigger cramping and diarrhea. Excessively chewing gum or drinking carbonated beverages to curb hunger pangs means you're swallowing lots of air that could lead to bloating and pain. Many sugar free foods are made with sugar alcohols that could lead to diarrhea and bloating.
Fasting and IBS - Weigh the Pros and Cons
Fasting, especially if it involves skipping meals, could lead to a reduction in your gastro colonic reflex. This reflex kicks in after a meal in response to your stomach stretching and tells your lower GI tract to get moving. If the reflex isn't strong enough, it could lead to constipation. Breakfast really is the most important meal of the day if you suffer from constipation, as it is the meal most likely to stimulate a bowel movement.
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Intermittent Fasting is all the rage these days, but the jury is still undecided about its role in digestion and IBS. Research is limited, but some scientists do suggest that it may help improve the gut microbiome and therefore digestion and IBS, while others say that eating smaller meals more frequently may improve IBS symptoms.​
The International Foundation for Gastrointestinal Disorders still recommends eating smaller meals more frequently. Intermittent Fasting may lead to people eating fewer, but larger, meals. Large meals could overstimulate the gut and the following fasting period could cause feelings of hunger. Both can cause pain if you have IBS, because you may be more sensitive to sensations in the GI tract.