Eating Disorders & Disordered Eating

Eating disorder recovery: Is your gut making it worse?

November 14, 2023

Written by Chandana (Chandy) Balasubramanian

Medically reviewed by Rita Faycurry, RD

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Key Points

  • An eating disorder can wreak havoc on your mental and physical health
  • In turn, poor gut health can make your eating disorder worse 
  • Bacterial imbalance in your gut can affect appetite, increase anxiety and symptoms of depression, making recovery harder
  • Your eating disorder treatment plan needs an integrated approach, which includes personalized nutrition to improve digestive health

Recovery from an eating disorder is rewarding, but it is complex. During the process, existing mental health conditions like anxiety, depression, substance abuse disorder, and others can get worse before they get better. One reason is that it is hard to re-learn new habits and address the psychology at the root of your disordered eating. But did you know that your gut may be holding you back?

Eating disorders and mental health

According to the STRIPED 2020 report:

  • Eating disorders are the second most deadly mental illnesses; the first is opioid overdose
  • About 30 million Americans will have an eating disorder in their lifetime
  • Women are two times more likely to have an eating disorder
  • Eating disorders affect people of all ages, including children as young as five

And according to the CDC, more than 1 in 5 adults in the US live with a mental illness. There is a definite overlap between these two groups.

Years of food restrictions, purging, binging, or other such behaviors can impair the stomach, intestines, and digestive tract, simply known as ‘the gut’. As a result, people with eating disorders often experience symptoms like:

  • Abdominal pain
  • Gas
  • Bloating
  • Acid reflux
  • Nausea
  • Constipation
  • Diarrhea or other gastric issues

However, what’s less known is that a weakened gut strongly affects how we feel.

Rita Faycurry, an experienced Registered Dietitian Nutritionist, says, “The state of our digestive system is a huge influence on our mental health. For instance, over 90% of Serotonin, the chemical that regulates happiness and satisfaction, is made in our gut. An imbalance here is linked to a higher risk of anxiety, depression, stress, brain fog, memory loss, sleep-related disorders, and many other chronic issues. So, addressing gut issues and nutrition is a vital part of the eating disorder recovery process.”

At the heart of the issue lie trillions of bacteria lining the digestive tract—the gut microbiome.

How eating disorders affect the gut microbiome

The gut microbiome (or gut flora) regulates our immune system, keeps inflammation at bay, and protects against diseases. They also produce messenger chemicals called neurotransmitters that travel to the brain and back, sending signals about our health. Serotonin, the “happy hormone,” is one such neurotransmitter.

The delicate balance of this gut flora keeps us healthy. On the flip side, an imbalance or overgrowth of “bad” bacteria can disrupt the entire system. Here’s how different eating disorders may affect the digestive tract:

  • Anorexia and irregular eating can cause gas and bloating from undigested food that ferments in the stomach and intestines
  • Purging in bulimia causes stomach acids to rise up the digestive tract, eventually leading to inflammation, ulcers, and damage to the gastrointestinal lining
  • Binge eating disorder (BED) can cause bloating, pain, and even low energy and sleepiness after a binge. Binge eating can lead to irritable bowel syndrome (IBS), constipation, and other gastric issues
  • Eating disorders can disrupt neurotransmitter signaling in our gut that tells the appetite center in our brain when we are full. This is a vicious cycle where you can feel hungry and continue to eat even when your stomach is full, aggravating the issue

The good news is that, over time, the gut microbiome can be nursed back to health through evidence-based nutrition therapy. According to the National Eating Disorders Organization (NEDA), treatment for eating disorders must include nutritional counseling, education, and monitoring of nutritional choices.

Fay can help you find a registered dietitian who can meet with you in person or virtually and create a custom nutrition plan for your needs.

Healing your gut needs a personalized approach

Eating disorder nutrition therapy needs a custom approach because every one of us is unique, and so is the composition of bacteria in our gut. We inherit our gut flora when we are born, and our diet and lifestyle play a role in maintaining a healthy balance. But an eating disorder can turn this balance on its head.

Unfortunately, there are tons of social media influencers and wellness gurus peddling the latest ‘snake oil’ supplements, probiotics, or highly-restrictive diets that claim to solve all your digestive problems.

According to Faycurry, “It’s best to be skeptical of unqualified advice about pills, supplements, probiotics, and highly-restrictive diets. Probiotics and supplements can have a place in recovery, but you only need what’s right for your health issues. For instance, if you do not know what bacteria is out of balance, you may take probiotics that help the ‘bad’ bacteria grow instead of the good. This may do more damage in the long run and delay recovery. Also, highly restrictive diets can be triggering for people battling eating disorders.”

Treatment for eating disorders is most effective when the issue is detected early. However, NEDA notes that even people with long-standing eating disorders do recover. This means the sooner you reach out for help, you faster you can begin your recovery.

Tackling eating disorders requires an integrated approach with licensed therapists and dietitians who are experienced in nutrition therapy and counseling for disordered eating. Fay can help you find a board-certified, registered dietitian nutritionist near you to design custom nutrition plans and support your eating disorder recovery.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.


Fay Nutrition has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

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Chandana (Chandy) Balasubramanian

Written by Chandana (Chandy) Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network and has a Master’s degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

Rita Faycurry, RD

Medically Reviewed by Rita Faycurry, RD

Rita Faycurry, RD is a board-certified Registered Dietitian Nutritionist specializing in clinical nutrition for chronic conditions. Her approach to health is centered around the idea that the mind and body are intimately connected, and that true healing requires an evidence-based and integrative approach that addresses the root cause of disease. In her books and articles, Rita offers practical tips and insights on how to care for your body, mind, and spirit to achieve optimal health and wellness.