From the Guidelines
Eating disorders can cause bloating through disrupted digestive function, particularly due to irregular eating patterns, compensatory behaviors, and potential food sensitivities or intolerances, as supported by recent studies 1.
Mechanisms of Bloating in Eating Disorders
The digestive system is significantly impacted by conditions like anorexia nervosa, bulimia nervosa, and binge eating disorder. Key factors include:
- Irregular eating patterns leading to weakened and slowed digestive muscles, resulting in delayed gastric emptying.
- Compensatory behaviors such as purging, which disrupt electrolyte balance and damage the digestive tract.
- The cycle of restriction followed by overeating, causing the body to produce excess gas when processing food after periods of starvation.
- Development of food sensitivities or intolerances due to gut damage.
- Psychological stress triggering the gut-brain connection, worsening bloating symptoms.
Diagnosis and Management
Diagnosing the cause of bloating in individuals with eating disorders involves considering factors such as food intolerances, particularly to fructans, and the potential for aerophagia, as noted in recent clinical practice updates 1. Management may include:
- Dietary restrictions, such as a low-FODMAP diet, under the guidance of a trained gastroenterology dietitian or provider.
- Recognition and treatment of underlying eating disorders, with careful planning to avoid malnutrition.
- Potential use of central neuromodulators, like antidepressants, to reduce visceral sensations and improve psychological comorbidities.
- Brain-gut behavioral therapies, including hypnotherapy and cognitive behavioral therapy, to improve overall quality of life and reduce symptoms.
Treatment Approaches
Treatment should be tailored to the individual, considering the complexity of eating disorders and their impact on digestive health. A multidisciplinary approach, including medical, dietary, and psychological interventions, is crucial for managing bloating in the context of eating disorders 1. This may involve:
- Gradual reintroduction of regular eating patterns under medical supervision.
- Addressing food sensitivities or intolerances.
- Utilizing central neuromodulators or brain-gut behavioral therapies as needed.
- Monitoring for and managing potential complications, such as electrolyte imbalances or gut damage.
From the Research
Eating Disorders and Bloating
Eating disorders such as anorexia nervosa and bulimia nervosa can cause bloating due to various factors. Some of the key points to consider include:
- Delayed gastrointestinal transit times, which can lead to constipation, bloating, and abdominal pain 2
- Abnormal gastrointestinal motility or transit, which can cause symptoms of constipation, bloating, and abdominal pain 2
- Postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, which are common gastrointestinal disturbances in patients with eating disorders 3
- Altered esophageal motility, which can sometimes be seen in patients with anorexia nervosa 3
Underlying Causes
The underlying causes of bloating in eating disorders can be complex and multifaceted. Some possible factors include:
- Delayed gastric emptying, which can cause symptoms of postprandial fullness, early satiety, nausea, vomiting, bloating, and abdominal pain 4
- Disordered gastric motility, which can contribute to symptoms of bloating and abdominal pain 4
- Dietary restriction behaviors, which can impact binge eating frequency and contribute to bloating 5
- Restricting food intake, which can lead to more frequent binge eating episodes in some individuals 5
Gastrointestinal Symptoms
Gastrointestinal symptoms are common in patients with eating disorders and can include:
- Constipation, bloating, and abdominal pain 2
- Postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation 3
- Acute gastric dilatation and gastric perforation, which can occur as a result of binge eating 3
- Dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance, which can occur as a result of self-induced vomiting 3