IBS and Disordered Eating Patterns

Welcome to episode 24 of the Inside Knowledge with me Anna Mapson.

Today I want to talk about something a little bit different. It’s not specifically about IBS and how to treat it, but it’s more a reflection of some of the ways I see my clients eating that are affecting their digestive health.

But are either based on borderline eating disorder patterns or habits, but maybe they aren’t as significant. It’s not affecting their health, their weight, their mental health to such a severity, but it could be impacting on their digestion.

Common eating patterns affecting IBS

1. The first pattern that I commonly see is under eating, so not eating enough food.
2. The second one is over eating, but eating in order to gain muscle. This is more in men who are eating to hit their protein macros often, and calories. To make sure that they are in a position to gain muscle.
3. The third pattern is chaotic eating or erratic eating, like with no regular routine, sometimes doing fasting, sometimes not, skipping meals.
4. Then the fourth pattern is fear of food. This is bordering on an eating disorder. Maybe you’re very worried about food and what it can do to you because of negative prior experience. That means you’ve got a very restrictive diet. This can sometimes be associated with sensory processing disorders.
5. And then the fifth area is orthorexia, which is not always recognized as an eating disorder in the same way that something like anorexia or bulimia is. However, it is commonly seen. This is associated with people who are very into ‘clean eating’. A preoccupation with being healthy, which foods are safe, and cutting foods out on the basis of health. But it’s not just about being healthy because it’s escalated into such strict rules and a lot of rule bound eating.

I’m just going to go through each one of those five and then talk about what is the issue with this type of eating, and then very briefly what you can do about it.

Eating disorder classification

I’m not going to be delving into how to work with people who have a defined eating disorder. That really requires specialist management and a fully multidisciplinary team. Including doctors, psychiatrists, psychologists, and dietitians, and a lot of people who are really supporting somebody who has got very ill.

However, the way that they are defined is there’s something called the DSM 5, which is a Diagnostic and Statistical Manual of Mental Disorders.

And there’s really strict criteria for each type of eating disorder. But there’s also a category called Feeding and Eating Disorders Not Elsewhere Classified, (FEDNEC). People may present with some of the behaviours around eating disorders, but they might not meet all the criteria. For example, they might have some of the symptoms of being anorexic but might not be in a very small body. Or they might do binging, but they don’t do it enough to meet the criteria for binge eating disorder.

Two way relationship between gut disorders and eating disorders

There’s a real two way relationship between gut disorders and eating disorders. It’s quite common among people who have eating disorders to also have digestive issues. And some gut issues stem from disordered practices of eating. So that’s what I’m going to talk a little bit today.

What is normal eating?

When I mention abnormal eating, like, what does it even mean to eat normally?

What would you describe normal eating as? This is something that you might like to think about. I would suggest it’s something around that

• you’re eating, a balanced, varied diet.
• Without a lot of emotional attachment to the food.
• It’s proportional to the needs of your body.
• And you feel healthy, you feel good when you eat. Your body’s in a healthy state.
• Also that you can stop when you’ve had enough.
• And you eat enough that you’re not always really, really hungry.

But all of these things are really subjective. So it’s important to think about your experience of food. And your health conditions.

What works for somebody won’t work necessarily for somebody else.

You might eat a lot more or less than the partner that you live with. And to have some flexibility I think is also really, really important.

I’m just going to delve specifically into how these affect your IBS.

How under eating affects IBS

I’ll start with the under eating. If you aren’t eating enough food, you can sometimes get constipation. This is due to not enough food coming through your gut causing the need to want to go. This can lead to slow and sluggish digestion.

If you’re not eating enough food, you might not have enough content in there to kickstart your digestion. So we have something called gastrocolic reflex. Which is where when you start eating, it normally kickstarts your body to make room. It moves food through your gut. If you’re not eating enough food, it can slow down the process.

You might also feel very full when you do eat and feel very bloated because you’re not used to having enough food in your system.

A normal amount of food could make you feel full

So when your intestines are often empty, that means you could feel more bloated when they have got food in them. Which doesn’t necessarily mean you are bloated. It’s just that you’re noticing your body is a little bit fuller than it was before.

Fuelling your body to deal with IBS

And the other thing about not eating enough food is that you might be lacking in nutrients in order to get better. To support your immune system. So not only to fuel your day, to make sure you can concentrate at work. Make sure you can sleep properly, that your skin is in good condition. All of these things require a good variety of nutrients, including minerals, vitamins, fibre. All of these things.

So when we’re not eating enough food. It’s not only that we’re feeling hungry, we’re just literally not providing our body with enough content and enough nutrients to keep going.

How to eat more food with IBS

Some of the key things I would work on with somebody in that kind of situation is to start increasing your calorie intake. I try to start with low FODMAP fibres.

Increase low FODMAP foods

So these are foods that are less likely to cause more bloating. If you are constipated, we do need to get that moving. And maybe depending on your history with laxatives it might be appropriate to use laxatives. Not appropriate for everybody. But there might be other things you can do to try and encourage a regular bowel movement.

Reduce methanogens to tackle constipation

One of the things that can be helpful is to reduce down the methanogens. That’s methane producing microbes, because this also slows down your gut. So we might use some things like fibre supplements or PHGG. That’s partially hydrolysed guar gum to feed the good bacteria try and crowd out any Methane producing bugs. Really slowly starting increasing low FODMAP fibres.

Appetite sensitivity training

And also I like to do some work on appetite sensitivity training.  That is just helping you to feel the hunger. Understanding where do you feel the hunger? What does it feel like? How hungry do you get? Do you let yourself get completely starving before you eat?

So appetite sensitivity training can be really helpful. And that is just. Thinking about how hungry and full you are after and before each meal. Which gives you a bit of a sense of whether you’re eating enough. So, there’s lots we could say about this. But under eating is definitely a cause of IBS and don’t think that it’s just about what you’re eating, just about the food, because it’s not always.

Eating to your macros can cause digestive discomfort

Now the opposite of this is over eating. I’m not talking here about binge eating, but One of the most common presentations I see of people eating in a abnormal way is people who are trying to bulk up for the gym.

So over eating in order to meet macronutrient requirements set either by a personal trainer at the gym or set by an algorithm on an app like MyFitnessPal or something similar.

This is where people will be eating beyond their appetite to get into a calorie excess in order to stimulate muscle growth.

Eating calorie excess to stimulate muscle growth

This could be eating more than 2500 calories a day. Or something like aiming for 150 grams of protein a day. You’re eating when you’re not hungry. This can lead people to feeling very bloated, getting a lot of heartburn, reflux, and also struggling to eat vegetables.

Another common aspect of this is people who are doing meal preps, following meal plans online. And literally just eating the same foods every day. Because they’re safe foods, they’re quick, and they get into meal prep containers. And then they won’t go off or go funny.

So people tend to eat just like broccoli, sweet potato, turkey, on repeat. Because these are low fat foods that can help you meet your calorie targets.

Muscle dysmorphia

To an extreme, there is a mental health condition called muscle dysmorphia. Where you are completely obsessed with muscle growth. The people I’ve worked with have not had that level of disordered eating or preoccupation with their body size.

However, they have definitely been eating to the macros. And not listening to their body’s own sensations. So again, the appetite sensitivity training is really important here and can be very, very helpful. So in a very similar way to the people who are under eating, this is about getting up your sensitivity to when are you full and actually.

How hungry do you get before a meal? Do you ever get hungry? Are you always completely stuffed because you’re eating way more than you actually need to?

Stop tracking your food intake to improve your digestion

What I would do is stop tracking. That is my first bit of advice. And try to eat three good solid meals a day. By all means, take protein supplement if you want to. You can take things like creatine, which also helps to stimulate muscle growth.

But if you are taking supplements that are ‘gym supplements’, then check the ingredients because some of the things in there can also add to gut symptoms like diarrhoea and bloating and just feeling very, very uncomfortable. That could be things like artificial sweeteners. Which for most people are completely fine, by the way, but it’s just for people who get IBS can be really, really sensitive. Often added to muscle building products to make them taste nice. So check the ingredients of any products that you’re taking. Really scale back your overeating so that you are honouring your appetite.

Eat when you’re hungry, sure, but don’t force yourself to eat a lot of food when your body is not receptive to it.

Remembering how to eat – eating patterns for IBS

The thing that might be helpful is to get your body in the state to eat by really concentrating on how to eat. If you go back to episode Two, and episode three, which cover how to eat, including mindful eating practices, and also when to eat.

There’s some great tips in there about how to help your gut brain connection, and really thinking about how to support your digestion. Get yourself in that rest and digest state, which can help you digest more food.

Chaotic eating pattern can contribute to IBS

The third type of eating that I was talking about is that erratic eating pattern. So, you never really know when you’re hungry.

Sometimes you go for days just having one meal a day. Maybe you do intermittent fasting, but not consistently. Sometimes you just nibble on things all throughout the day.

This is a problem because you may find that you’re eating too many FODMAPs in one go, like a large meal with a lot of fermentable fibres. Or you’re having a lot of fats in one meal, which can trigger diarrhoea.

Digestion works best on a routine

You also won’t be giving your body a chance to regulate its digestion. Our body works best when we do the same things at the same time each day. Which might sound boring. But it really helps your body to process food. To be able to switch off from food overnight. So, some of the things that you can do, if that’s you, if you feel like you’ve got a really erratic eating pattern, is

Eat three meals a day

First of all just have three regular meals a day. Try and get them at the same time every day.

For some people, an overnight fast will be helpful. That can just start with 12 hours of not eating from dinner to breakfast. It doesn’t have to be a long fast.

Regulate your sleep cycles as well

I’d also suggest like working on your sleep quality. Making sure you get a regular bedtime as well. Just thinking that actually routine isn’t boring.

It allows you to feel better and feel good so that you can get on and do more interesting things. I know I’ve worked with people in the past who felt like going to bed early was just making them feel really boring. But actually if they wake up the next day with lots more energy, then you’ve got more time to enjoy your life.

How do you do self-care?

And the other question for these people, if this is you who has got a very chaotic eating pattern is how do you look after your body in other ways? Are you doing any regular exercise? A question for you? Is there an issue with allowing yourself to take care of your own body? Do you need some time to invest in self-care.

And I don’t mean self-care, just like taking a bubble bath and that sort of thing. I just mean really thinking about what your body needs.  And allowing yourself to give your body what it needs.

Severe food anxiety from IBS

The fourth type I wanted to talk about was severe food anxiety. The issue with this is that you have a really low level of diversity in your diet.

You have very restricted safe foods and often this can lead to low appetite as well because you’re eating the same foods all the time, it’s really boring and just really not enjoyable to eat repetitive foods.

Now this might have stemmed from severe IBS, might have been a problem with choking on a food or a bad experience of something you ate and gave you bad diarrhoea or bloating or pain. Obviously, you want to avoid that experience again. So you just restrict more and more foods and you end up with a very limited diet.

Working on the gut-brain connection to help anxiety

To address this is to very gradually bring foods back in again, starting with tiny nibbles. Depending on the extent to which this is affecting your mental health as well, we may need to do some work on the gut brain connection.

And I like to start with my clients really understanding how foods can affect you and how they won’t.

So some foods people say, oh I ate, I used to eat, I don’t know, chicken and now I don’t eat chicken because I had a bad experience. Well, is that really going to be any different to another food that eating?

My Gut Reset clients with restrictive diets

In the last year, I’ve worked with three clients who were literally eating a handful of foods.

Such restrictive foods. For everybody they were different. But they probably were not eating more than five things on repeat each week. And the way we worked was different, again, with each person. But talking to them about what foods they could try and doing it in such small doses that I was reassuring them it wouldn’t give them a gut issue and then gradually building their confidence up.

So depending on

• what symptoms you’re getting,
• depending on what your fear is and
• what foods you’re currently eating,

and that’s how we work out how to increase them.

Is your food restriction an eating disorder?

But this is something that can be ARFID, which is what I mentioned when it goes into a severe mental health disorder, which is Avoidant Restrictive Feeding Intake Disorder.

That is a condition that requires psychological support and isn’t just a nutrition issue. ARFID is classed as an eating disorder, but it’s different from things like anorexia or bulimia, binge eating disorder. Because it’s not affected by preoccupation with your body size and the weight. It’s not restricting your food with the purpose of losing weight.

It’s fear of food. The behaviours might be quite similar in terms of fear and avoiding eating and suppressing hunger. However, It’s based on this fear of food and what it can do to you. Because of prior negative experiences.

More common for children or people with autism spectrum conditions to develop ARFID.

It’s much more common when you have a real fear of certain textures to want to exclude those foods from your diet. There is an overlap with, some people who have autism.

Orthorexia – is your diet too ‘clean’?

The final common way that I see in your obsession or beliefs about food affecting your digestion is orthorexia. So this isn’t a formally recognized eating disorder.

It’s more about people who are conscious of being healthy to the extent that it becomes unhealthy. So you may find that you are increasingly concerned about the ingredients in food. And cutting out carbs, maybe all sugar or dairy or gluten.

Often people who have this are spending a lot of time online like researching Instagram accounts dedicated to clean eating or thinking about which foods are good for you, following a lot of blogs on social media and TikTok. Then really losing a lot of joy in eating.

Finding the enjoyment in eating again

So one of the ways to get back to this is to try and work out what foods you enjoy eating. Taking a step back and really thinking about the bigger picture. Health is much more than just what you put in your body. It’s also about how you feel about the food. How your gut brain connection works.

Again, so like thinking about your own levels of stress around managing these very tight rules about what is okay and what is safe and what is not.

Reduce your social media consumption

One of the ways to treat this, is to try to reduce down your social media consumption so that you’re really focusing in on yourself again and less on other voices around food.

Trying to expose yourself to enjoyable small portions of sugar containing cakes and a yoghurt, a normal yoghurt with dairy in it. Actually just noticing whether that does anything to your body.

In summary of this episode

So, all of these are different types but quite common ways that I see what I would call disordered eating practices affecting gut function.

They’re not at the level that you would class as an eating disorder, but still have got an impact on quality of life, your enjoyment of food, and your connection with your body. That’s why I keep coming back to a couple of things in this episode.

It’s been about trying to train your appetite sensitivity.

So really trying to get back in touch with your hunger levels think about when you’re hungry where you feel it in your body when you are hungry and How full do you let yourself get? Do you ever eat to the point of overeating and what would that mean to you? These are all interesting questions that I like to explore with my clients if these are some of the things they’re talking about.

And then the other thing is the gut brain connection. So you’re really spending time outside of eating moving away from food and trying to make sure you’re getting good sleep and good exercise. So you’re able to exercise and get some movement in.

Really trying to work on that whole lifestyle element that can also impact on your relationship with your body, your relationship with your gut and it’s one part of you working to manage your IBS symptoms so that you feel better for the long term.

So I hope this episode has given you something to think about. I wonder if you see yourself in any of those five types that I mentioned. If this is something you want to work with me on, then please get in touch. I am taking on people into my three month gut reset and we have lots of time together to explore these kind of things if this is something that you would find helpful.

Okay, I’ll leave it there for this week. Thank you. Bye bye.