Meg Salvia Nutrition | Blog

What causes bloating in eating disorder recovery?

[fa icon="calendar"] May 31, 2017 12:04:11 AM / by Meg Salvia, RDN, CDE

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Bloating is an uncomfortable physical symptom that can occur as you work towards normalizing eating patterns and intake in recovery from an eating disorder. It can be challenging on a physical, mental, and emotional level. Bloating after eating occurs after periods of restriction/starvation or purging. Understanding the reasons why it happens and framing expectations around the symptoms you're feeling can be helpful in coping with or managing discomfort.

Three reasons why bloating can be problematic:

  1. The physical discomfort is real. While the nutrition interventions are completely appropriate (adequate, consistent eating is absolutely necessary), there can be real physical discomfort that makes continuing with the plan or eating pattern more difficult.
  2. Bloating can lead to feelings of fullness that in turn lead to ending a meal or snack before you’ve had the chance to consume adequate nutrition. It can also lead to heightened awareness of the body, particularly the stomach area, which can increase anxiety, negative body thoughts, or distress during a meal.
  3. Bloating can feel like fluid retention, which people sometimes want to tackle by restricting fluid intake, leading to a decrease in hydration or risk of dehydration. Adequate hydration can actually be helpful in helping the body in recovery (and as we’ll see below, fluids can play an important role in managing symptoms).

What are some of the possible causes of bloating and why does it happen?

  1. Restricting energy or inadequate intake slows metabolism (and this is true for
  2. Functional gut disorders are common for people with eating disorders, and one such disorder, irritable bowel syndrome (IBS), can cause bloating symptoms with intake. Interventions aimed at improving eating disorder symptoms can also have a positive impact on IBS symptoms.
  3. Bloating is a common symptom of gastroparesis (delayed stomach emptying). The muscles that line our GI tract are responsible for propelling food through our system, but in gastroparesis, food moves much more slowly out of the stomach, causing pain, discomfort, and nausea. It’s important to note gastroparesis can be serious, so it’s worth investigating with your medical team.

What can we do to help manage uncomfortable symptoms?

There are several nutrition interventions that you can try in collaboration with your dietitian. Improved nutrition itself is one of the best strategies. Bloating and discomfort can improve with weight restoration and interrupting eating disorder behaviors (although it’s worth noting some GI symptoms, especially in the setting of functional gut disorders, can linger after eating disorder behaviors stop). This timeline usually encompasses 4-6 weeks. Difficulty achieving adequate, consistent intake or appropriate weight restoration can delay improvement in symptoms.

Specific nutrition strategies also include:

  1. Reducing the fiber content of meals and snacks. Bloating can be worsened by a high-fiber diet (which can further slow the digestion and movement of food out of the stomach). High-fiber foods include many fruits, vegetables, legumes, and whole grains (there can be too much of a good thing in this case). Managing fiber content can be especially challenging in vegetarian eating patterns, where a lot of protein sources come from high-fiber foods. High-fiber foods are also often eaten to help manage symptoms of constipation, but they can exacerbate bloating symptoms.
  2. Use liquids strategically because they are often better tolerated and cause fewer symptoms. Liquids can be a helpful tool for managing physical discomfort and can serve as a bridge to help achieve adequate intake as eating patterns and symptoms change.
    • Increased reliance on beverages or nutrition supplements can help reduce the physical discomfort experienced at meals. Liquids can help provide adequate nutrition because digestion and motility of fluids are usually normal or close to normal even with severe restriction.
    • Drink liquids before eating solids during the meal
  3. Have more frequent (and/or more substantial) snacks throughout the day to meet your nutrition needs. Eating more at snacks and at consistent intervals can help reduce the volume of food required at a meal (this eating pattern distributes nutrition more evenly throughout the day).
  4. Supporting the health of the gut’s microbiome can help manage GI symptoms. Increasing variety at meals and snacks is so important here.

Finally, getting appropriate care and support from your entire eating-disorder treatment team is important. Reducing anxiety and depression symptoms can also have an impact on GI symptoms. Medical providers can help assess symptom severity and suggest medications if they’re appropriate.

Key take-away messages:

  1. Bloating can be a symptom many people experience in their recovery. It’s worth paying attention to and discussing with your team, but be careful to not let it compromise your ability to achieve adequate and balanced intake.
  2. There are tools in a dietitian’s toolbox that can help manage symptoms: discuss an individualized plan that might help you feel better. Fluids and lower-fiber foods can be especially helpful.
  3. Symptoms of bloating can linger and cause physical discomfort even as you work towards recovery and make progress with adequacy of intake and weight restoration. While this can be frustrating, keeping intake at consistent levels remains an important step in recovery.

Topics: Eating Disorder Recovery, Nutrition, Probiotics