Imagine this: you’re undergoing an elimination diet to determine what dietary components are triggering your IBS. In this process, you start to restrict further and further. Trying to cut back on whatever you suspect may be playing a role in causing you to feel so terrible. Then you start to rigidly weigh out all foods, to ensure you’re sticking to low FODMAP portions. You avoid eating out with friends. You prepare separate meals from your family. Food slowly begins to consume your life. The anxiety then starts to worsen. You can’t eat anything if you don’t know what is in it, out of fear of a flare-up. Your gut issues may feel improved, but your relationship with food is rapidly deteriorating. You know you need to reintroduce foods to identify what specifically triggers your symptoms. However, you can’t bring yourself to complete any food challenges. The anxiety and fear are too unbearable.
Unfortunately, this story isn’t uncommon in the world of food intolerances and IBS. Many individuals set out to figure out what their dietary triggers are and end up on a path of overly restrictive or disordered eating. So, what do we know about IBS and eating disorders?
How common are eating disorders in those with IBS?
In Australia, eating disorders in combination with disordered eating are estimated to affect 16.3% of the population. Approximately 1 in 5 Australians suffer from IBS. Unfortunately, the available research is limited for how common eating disorders are among those with IBS and food intolerances. However, it has been shown that disordered eating may be more common in those with gastrointestinal conditions. This includes medically diagnosed IBS, Coeliac Disease, and Inflammatory Bowel Disease (IBD).
Which issue comes first?
The age-old question of which comes first, the chicken or the egg? In this case, we don’t yet know whether symptoms such as abdominal cramping, bloating, nausea, diarrhoea, constipation and excess wind are a cause of the disordered eating behaviours, or whether the disordered eating behaviours lead to gastrointestinal symptoms.
In this situation, we know the scenario can go both ways. For example, an individual may experience IBS and go on an elimination diet, such as a low fodmap diet, to improve their symptoms and determine dietary triggers. They may then have an experience like the one mentioned at the beginning of this article, and end up with disordered eating, or in some cases a clinical eating disorder. On the other hand, an individual may experience disordered eating or have a diagnosed eating disorder and end up with gastrointestinal symptoms as a result. This may lead them to believe the symptoms are due to food intolerances. In some situations, food intolerances can be used as a reason to cover up restrictive eating, so that others don’t question eating behaviours.
What are some red flags to look out for?
There is a range of red flags to look out for when it comes to disordered eating behaviours. Some of these include:
- Skipping meals or consuming small portions at regular meals
- Preoccupation with food and/or weight
- Significant fluctuations in body weight (up or down)
- Increasing list of restricted foods, with no plans to reintroduce or challenge foods
- An increase in concern of the health of foods, and minimal ability to eat foods that are not ‘healthy’
- Menstrual irregularities – such as missing your period
- Sleep disturbances and/or fatigue and difficulty concentrating
- Withdrawal from friends or usual social activities
What do you if you’re concerned?
It is important to note that elimination diets, such as the low fodmap diet, are generally not appropriate for someone with a history of disordered eating. If you are considering exploring an elimination diet and have a history of disordered eating, please consult with a dietitian experienced in both of these areas before proceeding.
If you have concerns about your own eating behaviours or those of someone you care for, then it’s very important to reach out for help – the earlier the intervention, the greater chance of success. As the first point of call, see your GP to discuss your concerns with your relationship with food and possible disordered eating behaviours. Eating disorders and disordered eating require a multidisciplinary team approach, which includes, at a minimum, a GP, dietitian, and psychologist. You can also contact the Butterfly Foundation on 1800 334 673.
Written by Amanda Smith