What is bulimia bloat?

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Bulimia bloat refers to the distended belly that commonly occurs in people who are struggling with or in recovery from bulimia nervosa (BN). Bulimia bloat is usually caused by excess gas in the digestive tract and constipation and can be very painful. It can also be troubling to experience, evoking negative emotions around body image, food, and eating. But bulimia bloat is treatable, with symptoms typically lasting for just a few weeks until eating patterns stabilize and the digestive system heals. 

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Causes of bulimia bloat

Bulimia bloat is common, with 68% of participants who had bulimia in one study reporting bloating and flatulence, as well as other gastrointestinal symptoms. (1) Below are some common causes of bulimia bloating. (2)

  1. Restricting eating followed by binging and purging

This cycle strains the GI tract and disrupts digestion. When food cannot be broken down properly, the flora is disrupted and unhealthy bacteria preside, causing production of large amounts of gas. Binging and purging leads to electrolyte imbalance, which causes additional complications.

  1. Constipation

When someone with bulimia purges food eaten, the food never has the opportunity to make it down through the entire GI tract. Likewise, using laxatives on and off confuses the GI tract about when food is coming into the digestive tract. Constipation occurs when there is a lack of regularity with food coming into the GI tract and fermentation of the food that has not come out of the GI tract. This leads to bulimia bloating.

  1. Highly processed food and insufficient nutrients

Processed and devitalized food lacks the proper flora the digestive system needs to feed its army of helpful probiotics. Improper flora means unhealthy bacteria gain predominance and produce gas that contributes to bulimia bloating.

  1. Food allergies or intolerances

When the gut isn’t working properly, spaces may appear between the cells that allow food proteins to leak into the bloodstream. Once this happens, food sensitivities or allergies may develop. Once the reactions to these food proteins occur, bloating may result. 

  1. Inability to digest food properly due to lack of enzymes

Malnutrition can lead to the inability to produce enough enzymes to digest food. This occurs because, when food intake decreases, cells make changes to decrease normal enzyme output. When someone then suddenly binges, the number of enzymes produced simply cannot handle the amount of food to digest. Bloating occurs, along with other symptoms.

  1. Inability to digest lactose, fructose, and other sugars

Eating foods high in lactose causes bloating in those who cannot digest this sugar. The same thing is true with fructose and different types of fake sugars (sorbitol, xylitol, lactitol, maltitol, mannitol).

  1. Eating too many high fiber foods in a short period of time

Eating high fiber foods one day and then not the next can be tricky. The digestive system thrives on normal routines. Fiber draws water to itself, which can be responsible for abdominal swelling. 

  1. Water retention

This is common in those with bulimia, and it often accompanies the bulimia bloat. When starting to eat again after a period of not eating, there will be water retention. Foods containing carbohydrates attract water to themselves.

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How does bulimia bloat differ from regular bloating? 

While bulimia bloat refers to something that happens in those who have bulimia, it is similar to regular bloating, as gastrointestinal symptoms in people who have eating disorders likely represent the same GI complications that occur in people who do not have eating disorders. (1)

Regular bloating may occur in a person who does not have bulimia for many of the same reasons mentioned above – constipation, highly processed foods, food intolerances, lack of digestive enzymes, inability to digest certain substances, too many high fiber foods in a short period of time, and water retention. 

How to treat bulimia bloat and ease discomfort?

The body gets rid of gas by burping or by passing it out through the rectum, which will ease discomfort naturally. There are also many other natural ways to eliminate the gas in bulimia bloat, including drinking mint tea and taking probiotics. 

However, it is best to seek help from professionals who specialize in eating disorders to address underlying psychological issues driving the disordered eating behaviors, as well as treat the physical complications.

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. Abraham, S., & Kellow, J. E. (2013). Do the digestive tract symptoms in eating disorder patients represent functional gastrointestinal disorders? BMC Gastroenterology, 13, 38. https://doi.org/10.1186/1471-230X-13-38 
  2. Forney, K.J., Buchman-Schmitt, J.M., Keel, P.K., Frank, G.K. (2016, March). The medical complications associated with purging. International Journal of Eating Disorders; 49(3):249-59. doi: 10.1002/eat.22504. Epub 2016 Feb 15. PMID: 26876429; PMCID: PMC4803618

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