Lost and confused, no foods feel good

You may have found this page because you or someone you know is struggling with a lot of gastrointestinal (GI) issues. These may feel like bloating, excess gas, diarrhea, constipation, abdominal cramping, early fullness, maybe blood in your stool or severe abdominal pain. Gastrointestinal issues can be very distressing – I’ve been there too. They can decrease our appetite for food, our motivation to be social or active, and really impact our overall mood. There are a lot of mixed messages out there about the best approaches to take when you’re feeling this way. As a trained gastroenterology dietitian who works with eating disorders and intuitive eating, I hope to summarize the best recommendations with your holistic health and relationship to food in mind.

Maybe you’re here because you want to find the quickest way to get these GI symptoms to go away. Understandably, so. They can definitely get in the way of living a good quality life. Before we jump to that, I’d like you to take a second and think about your relationship with food. Do you avoid eating certain foods? For what reason? Are you open to changing some of the ways you eat such as challenging food rules or beliefs? Are you open to working on improving your nutritional status and liberalizing your diet in an effort to help your GI tract and body get stronger?

I ask these questions because there has been a growing number of co-occurring GI and eating disorder diagnosis. GI symptoms can exacerbate ED behaviors due to a natural response to hyper fixating on the food that goes into the body and leads to symptoms. Additionally, Chronic restriction of food or other prolonged eating disorder behaviors can impair GI tract function and contribute to IBS-like issues. It is also estimated that 35-40% of people with IBD have reported IBS symptoms, demonstrating the complexity of management.

When working with these two closely linked issues, we need to take a step back and differentiate between things that might advertise to find “solutions” quickly but may not lead to sustained long term health and wellbeing, and things that may take more effort initially but will ultimately help the body heal and feel better in the long run. When looking at this crossover in the context of gastrointestinal disorders, we often see food sensitivity tests advertised as well as elimination diets. While those most likely sound appealing at first glance, it is important to think about how these will have long term impacts on your body and if those are really addressing the root cause. As mentioned earlier, eating disorders/disordered eating can impair gut function. Thus, it is imperative to work towards healing the eating disorder to make the gut stronger and work more effectively. Approaches for GI issues, such as elimination diets and food sensitivity tests, can lead to further restriction of beneficial foods and make recovering from an eating disorder much much more difficult.

Here are some recommendations to start working towards a better functioning gut:

1. Strive for adequate nourishment! Everyone’s nutritional needs are different based on their body size, composition, physical activity and metabolism so it’s encouraged to work with a dietitian to ensure you are getting the proper nourishment that your body needs
2. In addition to adequate amounts of nourishment, aim to fuel consistently throughout the day with meals and snacks. Aim to not go longer than 3-4 hours without eating if possible. This will help your GI tract to keep moving appropriately and prevent larger meals that may be more difficult to digest.
3. Aim for variety in your diet. Fibrous foods such as fruits, vegetables, grains, seeds and legumes help to feed the good bacteria in our intestines. The mediterranean diet which is rich in fruits, vegetables, whole grains, and healthy fats has demonstrated equal effectiveness in research for IBD symptom management as other restrictive diets out there. However, depending on your diagnosis and status of your condition, certain fibers may be harder to digest. Talk to your dietitian about the most tolerable way for you to consume fiber based on your condition. It may be best to start off with modified texture such as fruits/vegetables that are cooked soft without the peel and work your way up in consistency gradually over time.
4. Be mindful of how elimination diets could impact your relationship with food and your gut. There are many approaches out there nowadays that claim to help you find the foods that are triggering all your GI issues and involve cutting out a large number of foods. But what if we can make your gut and overall body stronger to handle the food you eat? And find foods to add in that will help you feel stronger and less symptomatic? Cutting out a lot of foods can leave you feeling very restricted and limited in your food options. Restrictive diets can also make it harder to meet your daily nutritional needs. One approach may be slower but will definitely lead to a better long term outcome and quality of life. If you recognize that you have an underlying eating disorder that was there before your GI issues started or one that has started since developing GI issues, let your doctor know and seek assistance from a trained eating disorder/GI dietitian!
5. If you’re struggling with constipation- consider a stool under your feet to help with proper toileting position and lead to easier to pass bowel movements
6. Try peppermint oil capsules/tea to soothe GI symptoms and bloating and ask your dietitian about other supplements that demonstrate good effectiveness for supporting your GI condition
7. 7. Aim for 6-8 cups of water or non-caffeinated beverages per day to help your bowels move more regularly

In addition to the above recommendations, I recommend seeing a doctor. I encourage you to not make drastic changes to your eating without first seeing a board certified Gastroenterologist to help you figure out what could be going on. They will be able to help diagnose what the issue is, address the severity and potentially provide medication recommendations that will help with symptoms or disease management.

Secondly, get a dietitian on board before you start making any extreme changes to what you eat. I emphasize the second part with sincere care for your overall long-term well-being. Many doctors are not trained in nutrition and taking your whole body into perspective when making diet or nutrition recommendations. I would encourage you to even go to the point of making sure you find a dietitian that can help maintain/restore your relationship with food. GI issues can interfere with how/what/why we eat, and having someone that can help you look at the whole picture will be invaluable to helping you to feel good about food and your body in the long term, especially when dealing with a condition that can do the opposite.

Thirdly, bring awareness to the gut-brain axis. This is the bidirectional connection between your gut and your brain which is connected by the vagus nerve. This not only means that your GI issues affect the brain but your brain also affects your gut and can exacerbate GI symptoms. As we start thinking about how to help your gut function better, we must take into account this gut-brain axis. Improving our stress levels can help our guts to be less stressed, thus functioning with less problems! Some things that may help with this are diaphragmatic breathing, going to mental health therapy, yoga, meditation, gut-directed hypnotherapy, setting boundaries, movement and time outdoors.

Hope this helps you start to find some healing! Reach out to us if you want to dive deeper!

Sara Szatkowski, RD

Alo Nutrition’s Gastrointestinal and Eating Disorder Dietitian