One of the hardest parts of recovering from an eating disorder is enduring mental, emotional, and physical discomfort—and while it’s not often talked about, a big source of discomfort is digestive distress. The relationship between eating disorders and gastrointestinal (GI) problems is complex, because one can trigger the other and they can have a reinforcing dynamic. In fact, one 2023 research review of studies showed that digestive issues and eating disorders have a bidirectional relationship: sometimes symptoms show up before the eating disorder starts, and other times, they appear afterward, making the eating disorder worse or helping to sustain it. Today, let’s look at how digestive problems can lead to disordered eating or eating disorders, how eating disorders impact the GI system, and how such concerns are addressed during eating disorder treatment.

Why GI issues can contribute to disordered eating

Of course, GI issues don’t automatically cause disordered eating or eating disorders, but they can be a significant contributing factor. According to lifestyle medicine physician Nneoma Oparaji, MD, 2025 research shows that irritable bowel syndrome (a common GI condition that can include chronic abdominal pain, bloating, diarrhea, and constipation, and is often referred to as IBS) is associated with a higher risk of developing disordered eating and full-blown eating disorders in young people compared to young people without IBS.

This correlation can be attributed to a number of different factors. Here are a few reasons why digestive and GI issues can lead to disordered eating, and sometimes even eating disorders:

GI symptoms can cause you to avoid food.

The same IBS study showed that participants with IBS were at higher risk of dietary restraint and increased concerns about eating. “Chronic GI issues can turn our everyday meals into food avoidance, which over time can cause distress, anxiety, and restrictive food habits,” Oparaji explains. “This can happen because GI symptoms such as nausea, bloating, and pain can lead people to avoid and restrict the foods that trigger these symptoms.” It’s an understandable tendency: when you’re dealing with ongoing GI distress, it can feel tempting to try and avoid certain foods or food groups, eat smaller portions, delay eating, or even skip meals altogether to try and feel better.

“At first, those changes feel practical, but over time, they can become rigid,” says dietitian Kristine Berube, RD, LDN. “When nourishment becomes inconsistent, digestion often slows further, which can actually worsen symptoms and reinforce fear around food.”

Your body might feel like it needs to be controlled.

When your body feels like it requires close management, disordered eating or an eating disorder can take hold more easily than if it feels trustworthy and reliable. That’s because your digestive system and brain are interconnected through what’s known as the gut–brain axis, a bidirectional pathway between the GI tract and the central nervous system (which includes the brain and spinal cord). Research from 2022 showed that disordered eating was particularly prevalent among adults with digestive issues caused by disorders of gut-brain interaction.

Oparaji points out that such disruptions can impact hormones that throw off hunger and fullness perception, which can then increase anxiety around eating. Berubes adds that “the gut and brain are deeply connected. When digestion feels unpredictable, the nervous system often tightens, and that tightening can show up as hypervigilance, food rules, or restriction.” In short, digestive issues can increase your desire to control your body, especially if you already have predisposing traits associated with disordered eating, such as perfectionism or anxiety.

While GI issues can contribute to any eating disorder, there’s increasing evidence showing a connection between ARFID and gut-brain disruption, with GI issues causing ARFID-like restriction (meaning the restriction is based on fear of negative outcomes or sensory sensitivities, rather than body image issues). This restriction, in turn, makes GI symptoms worse.

You may be guided towards restriction by a healthcare provider.

Unfortunately, people with GI issues seeking help may be misguided to cut out food unnecessarily—often based on what’s called an IgG test, which is not recommended for diagnosing food allergies, sensitivities, or intolerances. This can be a slippery slope into disordered eating or an eating disorder.

“This recommendation could lead the patient to start restricting certain foods that they may not have to be restricting, which can then lead them down a rabbit hole of food being labeled as the issue,” explains Equip dietitian Slava Kharitonenkov, MS, RDN, CEDS. “With my cases, I have seen what can happen when patients begin to cut out the foods, and aren't working with a trained professional with eating disorder knowledge to reincorporate foods back into their diet—adding any new food could feel like fighting through a tsunami of overwhelm.”

How eating disorders affect the digestive system

Although digestive problems and eating disorders have a bidirectional relationship, the most recent research, including a study from 2024, suggest that eating disorders usually come first. This makes sense, given that eating disorder behaviors directly impact the digestive system, as do frequently co-occurring issues like anxiety, depression, and stress. Below, we’ll go through how certain specific disordered behaviors impact the digestive system.

How purging impacts the digestive system

Purging—compensatory behaviors used to “get rid of” or “make up for”—food eaten is a dangerous behavior associated with several eating disorders, including bulimia and anorexia binge-purge type. It impacts the digestive system in several different ways, including:

• Digestive tissue damage, heartburn, and disrupted colon. Purging in the form of vomiting or using laxatives or diuretics disrupts the digestive system’s normal process and damages tissues, according to Oparaji. “Acid from frequent vomiting can lead to heartburn, and chronic laxative use damages the nerves and muscles of your large intestine, which can make the colon incapable of moving stool on its own,” she explains. This often leads to symptoms like constipation, discomfort, and pain.
• Esophageal issues and oral damage. Regular self-induced vomiting impacts esophageal functioning, which can lead to GI issues like gastroparesis (delayed stomach emptying) and early fullness. It can also damage your throat and esophagus, which can cause serious, long-term health issues, such as Barrett’s esophagus, a condition where the lining of your esophagus is damaged by acid reflux. “It can lead to blood in vomit caused by mucosal tears,” Kharitonenkov says, “and the weakening of the muscle will also lead to the body developing a sensitive gag reflex, which can cause spontaneous vomiting or regurgitation to occur when someone isn't planning to.” Repeated exposure to stomach acid can also lead to oral infections, because the acid erodes tooth enamel and irritates soft tissues, creating an environment vulnerable to bacterial growth.
• Nutrient loss, electrolyte changes, and exercise-related pain. “Purging will cause some of the nutrients consumed to not be processed, while also expelling many key vitamins and minerals,” Kharitonenkov says. Plus, purging can cause abrupt and sometimes deadly electrolyte shifts, which can worsen GI issues like constipation, slowed gut motility, and abdominal cramping. Excessive exercise (another form of purging) may be linked to GI issues like abdominal pain, nausea, and diarrhea, according to a 2025 study.

How restriction impacts the digestive system

Food restriction is a key part of most eating disorders, and also a somewhat normalized behavior in the context of diet culture. While it might seem relatively harmless on the surface, it can lead to a cascade of physical and mental health issues, including gastrointestinal problems. Here are some ways restriction affects your digestive system:

• Slowed digestion and energy conservation. Food restriction slows your body’s processes, including your digestive system and your stomach’s motility (the automatic, coordinated movements of the muscles in your digestive tract). “Digestion takes energy,” Berube explains. “When the body isn’t getting enough fuel, it conserves energy and digestion downshifts.” A 2020 review showed that malnutrition and weight loss from undereating can indeed slow the GI tract, leading to overall digestive dysfunction, which can cause conditions like gastroparesis, constipation, reflux, heartburn, bloating, and diarrhea. Berube adds that restriction can cause feelings of early fullness and nausea, too. Thankfully, such symptoms are often temporary effects of gastroparesis, and go away once your body gets used to adequate nourishment.
• Reduced enzyme production and swallowing difficulties. Since the body doesn’t have enough energy to perform its regular processes during periods of starvation, restriction may also reduce the production of digestive enzymes needed to properly break down food. This further worsens GI symptoms, and can even lead to muscle loss and weakness in the throat, which can cause dysphagia, or difficulty swallowing.
• Impaired nutrient absorption and difficulties eating enough. Restriction can compromise nutrient absorption thanks to side effects like digestive hormone disruption and reduced food and nutrient transport throughout your GI system. In fact, one 2022 review showed a connection between severe food restriction in anorexia and carbohydrate malabsorption specifically. This is compounded by the fact that restriction makes it more difficult to eat enough food in the long-term. As Kharitonenkov explains, “the more that restriction occurs, the body adapts to a starvation state, and it will become harder to eat an adequate amount of food.” That’s because the body goes into conservation mode, which usually means a combination of side effects like slower digestion and disrupted hunger and fullness hormones—making it especially challenging to eat enough food, even aside from the eating disorder thoughts.

How binge eating impacts the digestive system

Binge eating is defined as eating an objectively large amount of food in a short period of time, while feeling a lack of control. It’s a behavior associated with several different eating disorders, including binge eating disorder, bulimia, and anorexia binge-purge type. Here are a few of the many ways bingeing can disrupt your digestive system:

• Reflux, distension, and indigestion. Bingeing can cause GI issues typical across eating disorder diagnoses, like reflux, abdominal pain, and abdominal distension. One 2023 research review showed that stomach emptying and accommodation may be affected by eating large volumes of food in short periods of time, which may explain why people with binge eating disorder often have functional dyspepsia, or chronic indigestion that causes frequent stomach aches and bloating after eating.
• Heartburn, regurgitation, and altered fullness. “Bingeing will lead to the body having an influx of nutrients in a short period of time,” Kharitonenkov explains. “This will lead to unintentional heartburn and regurgitation due to the stomach being full past capacity.” He adds that bingeing can alter fullness perception, since your body might adapt to larger quantities of food over time.
• Lower GI issues, stomach ruptures, and gut microbiota changes. After food passes through the stomach, there can be more digestive issues, Kharitonenkov explains. “The load will be difficult to manage or regulate, which can lead to diarrhea, incontinence, and fecal urgency,” he says. Bingeing can also lead to potentially life-threatening stomach ruptures caused by reduced blood flow after a binge episode (although it’s rare). Lastly, recent research from 2025 suggests that binge eating disorder (along with bulimia) are linked to disruptions in gut microbiota, or bacteria living in your digestive system that help with digestion, immunity, and generally keeping your gut healthy. These disruptions can compound any existing digestive problems, as well as other health issues.

How GI issues are addressed during eating disorder treatment

Although digestive distress is often a difficult part of eating disorder recovery, there are several ways a treatment team can support healing in your GI system. “In eating disorder treatment, we absolutely take digestive symptoms seriously,” Berube says. “And that’s not just because they’re uncomfortable, but because they can become a very real barrier to eating.” Here are some ways GI issues are addressed during eating disorder treatment:

Managing symptoms

When you’re feeling nauseous, your stomach hurts, or you’re experiencing another digestive issue, eating can feel impossible, so focusing on symptom relief and management is usually top of mind for healthcare providers. “That might include gradual fiber adjustments, hydration support, adequate dietary fat, gentle movement, warm beverages, or short-term medication use in collaboration with a physician,” Berube says.

According to Oparaji, examples of medications that can be used (temporarily) under close medical supervision are stool softeners and laxatives to relieve constipation without causing dependency, and antacids to help with reflux. Kharitonenkov adds that sometimes medications to inhibit nausea or stimulate appetite become part of GI symptom management. Your medical provider can also review your medications to make sure there’s nothing contributing to GI distress and adjust them if that’s the case. “The goal isn’t to push someone to ‘just eat through it,’” Berube explains “It’s to reduce discomfort enough that eating feels possible and sustainable.”

Additionally, research from 2023 suggests that having a trusted healthcare provider with whom you can discuss GI issues—receiving reassurance, empathetic validation, and clear explanations—is central to the effective management of such symptoms. Kharitonenkov recommends seeing a dietitian often when struggling with digestive issues. “It can be helpful to meet with this provider in a more frequent manner, as doctor follow-ups are generally spread out,” he adds. Your dietitian can also eventually help you re-integrate any foods you struggle to eat because of digestive problems, at a pace that feels manageable for you.

Focusing on nutritional rehabilitation and weight restoration

Since malnutrition and weight loss can cause GI problems, addressing these issues can bring harmony back to your digestive system. A 2021 review of individuals with anorexia suggests that nutritional rehabilitation (alongside other treatment interventions) may help improve GI symptoms by the end of treatment. “In many cases, symptoms improve significantly with consistent, adequate nourishment,” Berube says. “Regular meals, enough overall intake, and weight restoration when needed are often some of the most effective ‘GI interventions,’ even though that can feel counterintuitive at first.”

During eating disorder treatment, you’ll generally work with a dietitian who will develop an individualized meal plan or eating pattern to help you meet your energy and nutrient needs, and work with you to remove any barriers (including GI issues) that prevent you from doing so. Oparaji adds that restoring weight when necessary, eating enough food, and normalizing eating habits can “reset the digestive system,” she says. “This is important because refeeding gradually increases gut motility, which then resolves GI symptoms, such as bloating and constipation.”

Ruling out medical conditions while avoiding further restriction

Sometimes, it may be necessary for healthcare providers to test for other medical conditions that may be causing GI distress during eating disorder recovery, such as a true food allergy or intolerance. As I mentioned, it’s crucial for providers to be highly cautious when exploring such potential issues, to avoid unnecessary food restriction. “Even well-intended GI protocols can unintentionally increase rigidity or avoidance,” Berube explains. “The goal is symptom relief without sacrificing psychological safety—supporting both digestive function and a more flexible, trusting relationship with food.”

Healing the nervous system

One less obvious way to help heal GI issues is to work on nervous system regulation, or helping the body move out of a stressed state. Research from 2021 found that nervous system dysregulation is common in people with eating disorders. “The gut is highly responsive to stress, and when someone is anxious, bracing, or hyper focused on their body, digestion tightens,” Berube says. “When the body shifts out of fight-or-flight and into a more regulated state, digestion often improves.”

In her practice, Berube integrates diaphragmatic breathing, grounding techniques, and gentle yoga to help her clients regulate. Other ways to help heal your nervous system include increasing external safety (e.g. listening to calming music or wearing soft and comfortable clothing), using cold water, incorporating mindful movement, and checking in with yourself often. “Supporting eating disorder recovery means supporting nourishment, yes,” Berube says, “but it also means supporting regulation, rhythm, and self-trust.”

It can be extremely difficult to navigate GI issues in eating disorder recovery, whether they appeared before or after your eating disorder started. Know that you’re not alone in your digestive struggles, you’re not doing anything wrong, and—with patience, time, and the support and reassurance of an eating disorder specialized treatment team—your brain and body can find harmony.

“The body is adaptive, and if it has been undernourished or stressed, it takes time for digestion to normalize,” Berube encourages. “When regular meals return, when your breath slows, and when the nervous system feels safer, digestion often follows.”