Why does anorexia bloating occur?

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Bloating is something that can occur in the gastrointestinal (GI) tract and cause your abdomen to temporarily swell. The swelling is not because you have eaten too much food, but because of gas. 

Bloating can be mild and usually passes on its own. However, there may be situations where bloating requires urgent medical care. As an example, bloating could occur if the gallbladder contains a lot of stones and is about to burst, or if there is an infection within the GI tract such as SIBO (small intestinal bacterial overgrowth), and these are times where a medical doctor needs to treat you. Thus, it’s always prudent to rule out any other causes of bloating in the abdomen first before you start making changes on your own, especially if you have an eating disorder.

Your GI tract is considered a ‘tube’. If the contents of the ‘tube’ are now collecting more gas, the tube will distend to accommodate the gas. This causes physical bloating to occur. Symptoms you are feeling with bloating are real, not imagined.

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What is anorexia bloating?

Bloating is the uncomfortable feeling of fullness, or tightness in your abdomen, or stomach due to food, or gas. “Anorexia bloating” is a term that refers to bloating experienced by people with anorexia nervosa (AN). Bloating may happen at any time during the day, or after a meal. Anorexia bloating is usually mild, but can occasionally become more severe. Bloating is sometimes accompanied by nausea, or pain in the abdomen.

When bloating occurs in individuals with anorexia nervosa it is something that may be accompanied with additional distress. Many people report feeling constipation in addition to anorexia bloating. When speaking with your doctor about your condition, after other GI disorders have been ruled out as the cause of anorexia bloating, other factors may be taken into account. For example, bloating is an expected side effect of the refeeding process for people with anorexia, so if you are undergoing refeeding, this is to be expected.

What does bloating have to do with gut flora?

Your GI tract contains 500+ different bacterial species that are all working together for digestion to occur. These bacterial species in the gut have also been found to improve mood, reduce the chance of getting different diseases, reduce allergies, alleviate diarrhea and constipation, and a lot of other positive benefits. 

Now we know that gut flora shouldn’t be expected to be healthy automatically. We have to properly nourish ourselves for the bacteria in our GI tract to be healthy. Of those 500 different species, some may cause disease in increased amounts– and these must be kept in smaller numbers by the other species. Thus, you need Lactobacillus bacteria, for example, to keep the disease-causing bacteria suppressed. When the numbers of gut bacteria are not in the right balance, or when they are lowered due to the use of antibiotics, medications, or not consuming foods that promote healthy GI bacteria the result can be bloating. 

Foods such as grains, dairy products (raw), nuts and seeds, meats, and fruits and vegetables provide a spectrum of good bacteria that feed your gut. Fermented foods, such as yogurt or kefir milk, contain many different strains of healthy bacteria for the gut. All these strains are contributing to health – which includes health of the GI tract – and potentially minimize bloating. Some other fermented foods are kimchi, cider, apple cider vinegar , miso, tempeh, sauerkraut and kombucha.

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What causes anorexia bloating?

When someone with anorexia nervosa experiences abdominal bloating, there are many potential contributing factors, including inadequate consumption of food containing the bacteria the GI tract needs. 

Yet, there are studies that show that the right probiotics can reduce bloating symptoms. (1) Lactobacillus acidophilus and Bifidobacterium lactis are two of them in this category. Knowing the dosage and the different strains and having a protocol is what your healthcare team at Within Health has expertise in.

Bloating is also caused by what’s happening physically in the GI tract from not having enough calories each day. When the body shifts over to burn muscle for energy, muscles weaken, including those in the GI tract. And this in turn may be a cause of bloating.

How does anorexia affect the stomach and digestion? 

Bloating can be the result of a delay in the emptying of food in the stomach. This means that the food takes longer to process through the body, an effect seen often in people with eating disorders.. Acid reflux or vomiting can occur which suggest a need to work on nourishing your body so these symptoms are minimized.

When someone restricts their intake, digestion is often delayed. Stomach acid production decreases because there is no reason to have more acid when there’s not adequate food to use it on. 

The muscles of the GI system can weaken when there’s not enough food eaten during the day and over long periods of time. When these muscles weaken, they atrophy and emptying the stomach takes a longer time to happen. This is a condition called gastroparesis. 

The good news is that each part of your body has the capability to heal. You’ll have to go slowly during the healing process and proceed with guidance and wisdom when you are working to heal from bloating caused by an eating disorder. Your team of health specialists are trained in nutrition (2) at Within Health and work with patients with anorexia nervosa that show GI symptoms. They know what it takes to start healing the gut, and that some types of strategies for healing the gut may or may not help alleviate the bloating.

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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. Ringel-Kulka, T., Palsson, O. S., Maier, D., Carroll, I., Galanko, J. A., Leyer, G., & Ringel, Y. (2011). Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. Journal of clinical gastroenterology, 45(6), 518–525. https://doi.org/10.1097/MCG.0b013e31820ca4d6
  2. Malczyk, Ż., & Oświęcimska, J. M. (2017). Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa. Powikłania gastroenterologiczne i zasady realimentacji pacjentów z jadłowstrętem psychicznym. Psychiatria polska, 51(2), 219–229. https://doi.org/10.12740/PP/65274

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