Eating Disorders: A Guide to Medical Care and Complications Dr. Mehler
Page 111 – 113, review Bloating:
“With pure food restriction, once a weight loss of approximately 10-20 pounds occurs, there is almost universal development of gastro issues.
This refers to the delayed emptying of the stomach, bloating is the main symptom, and it may be severe and uncomfortable.
(The recommended tests to ensure there are no additional issues – require fasting and delay recovery further )
Abdominal X-Ray, is recommended
” The bloating can be worsened by a high-fiber diet, such as the vegetarian diet that many of these patients often resort to, to treat their slow gastrointestinal transit, or by increasing a fiber-based diet or use of laxatives. Once this state has developed the reflux, nausea, bloating and even vomiting can occur and it’s no longer self induced, it’s happening as a condition of the gut.
“Heartburn may occur too, as a result of acidic reflex in the stomach…
“Although the bloating improves with weight restoration, improvement often takes 4-6 months and even as long as a year to be fully recovered, with the tummy having no bloating.
Therefore it is crucial to offer reassurance to these patients and instruct them to avoid legume type foods, which promote gas and distention, as well as excessive fiber or bran products which induce similar symptoms. This will enable them to understand that their symptoms will pass with time and that they are not “causing” the pain by eating. Likewise, patients should be in formed that refusal to eat and regain normal weight will only delay the improvement in their symptoms.
Useful approaches to this problem specifically in patients recovering from anorexia include the following:
- 1: Liquid food supplements, as half of the daily calories (Smoothies)
- 2: Gastric emptying of liquids is unimpeded by the gastric issues with solid foods
- 3: Use liquid food sources earlier in the meal, so these are in the tummy before solid foods, (ie: Soups and Stews)
- 4: Keep the food intake to multiple small meals and often, 6-7 times a day, and start the food intake daily within 30 minutes of getting up
- We are bringing the system back on line, it’s going to take time. If you find your inner coach is taking you over to raw foods, or off proteins, get back on track
- Use a food journal, not to count calories or anything like that, but to ensure you are getting enough protein in daily.
- It’s easy to get off track with this, and suddenly stuff is happening and when you look back, “Ah, there, no protein today”
Gastroparesis is a disease of the muscles of the stomach or the nerves controlling the muscles that causes the muscles to stop working. Gastroparesis results in inadequate grinding of food by the stomach, and poor emptying of food from the stomach into the intestine. Gastroparesis induced by weight loss will generally improve with weight restoration. This, even severe bloating initially complained of, which will often present in a patient from eating an adequate meal, and progressively improves for patients over time.
A significant improvement often occurs with a weight gain of 10-15 pounds and in general largely resolves completely with weight gain back to 80-90 percent of ideal body weight.
(Each time there is restricting of foods the patient will re-experience the same bloating symptoms as the first weeks in recovery – so the FASTING for any treatments will create a setback)
Remember when you are first in recovery eating much more salmon & eggs – This is protein and will give you less gas and bloating than raw veggies, salads etc. Here a food journal helps you look back to days when the body was doing great. Colour code the food journal, perhaps PINK for positive days, and GREEN for gassy days; etc.