Is there a relationship between bulimia, acid reflux, and GERD?

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Acid reflux and gastroesophageal reflux disease (GERD) are medical conditions that often occur with bulimia nervosa (BN). (1) Also called heartburn because of the burning sensation it causes in the chest, acid reflux affects about 20% of Americans and is pretty common. (2) Not everyone with acid reflux has bulimia, but those who have bulimia often develop symptoms like those of acid reflux after prolonged episodes of vomiting.

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What causes acid reflux and GERD?

When acid reflux occurs, the acid that is in the stomach gets released and travels upwards into the esophagus (throat) and causes heartburn and a bitter taste. GERD is when acid reflux occurs more than twice a week for a prolonged period of time.

Vomiting in bulimia

Those with bulimia use compensatory behaviors, which may include excessive exercising, diuretics, laxatives, and vomiting, to purge. Vomit is partially digested food and stomach acids. Once these acids come into contact with the esophagus, they damage its lining. It starts to thin and gets inflamed, resulting in intense pain and burning.

Can bulimia cause GERD?

Some studies have found self-induced vomiting does damage to the esophagus and there seems to be a higher incidence of GERD-related symptoms. But a research review has concluded that, while there may be an association between bulimia and reflux-related symptoms, further investigation with more subjects and better study design is needed to to prove conclusively that bulimia causes acid reflux and GERD. (3)

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Getting help for GERD and acid reflux

Regardless of the exact relationship between bulimia and GERD and acid reflux, repeated vomiting damages the lining of the esophagus and causes pain. While there are treatments available to repair the esophagus, if the vomiting continues, the lining will not heal. Furthermore, this can lead to other complications and may indicate another very serious condition that must be addressed–bulimia. 

Medications are available to either neutralize or stop producing acid. But this also stops the absorption of valuable vitamins and minerals, such as calcium, magnesium, iron and vitamin B12, the body needs to function properly. And these deficiencies can also contribute to vomiting, as well as other complications throughout the body. Supplements are also available and can help replenish deficient nutrients. 

But consuming a variety of food is the best way for the body to get the fuel and nutrients it needs to function properly and heal itself. When a person has bulimia, their eating habits are disordered and food choices are restricted.

And most important of all, the symptoms will persist as long as the behavior that’s causing them continues. So it’s critical to understand that symptoms of acid reflux and GERD may point to something else that must be addressed–bulimia.

A multidisciplinary team of healthcare professionals with specialized expertise in eating disorders can diagnose and recommend an appropriate treatment plan for bulimia and associated conditions. 

Realizing there’s a problem and asking for help can be very hard. But help is available and healing is possible.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Mehler, P. S., & Rylander, M. (2015). Bulimia Nervosa - medical complications. Journal of Eating Disorders, 3, 12. https://doi.org/10.1186/s40337-015-0044-4
  2. Antunes, C., Aleem, A., Curtis, S.A. (2021 Jul 18.) Gastroesophageal Reflux Disease. StatPearls. StatPearls Publishing. 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK441938/
  3. Denholm, M., Jankowski, J. Gastroesophageal reflux disease and bulimia nervosa--a review of the literature. Diseases of the Esophagus. 2011 Feb;24(2):79-85. doi: 10.1111/j.1442-2050.2010.01096.x. PMID: 20659142.

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