Disorder of digestive function in eating disorders: nutritional treatment
Abstract
Eating disorders represent complex psychiatric and metabolic conditions that, in addition to psychological and endocrinological consequences, significantly affect the function of the digestive system. Prolonged dietary restriction, episodes of binge eating, self-induced vomiting, as well as the abuse of laxatives and diuretics lead to numerous gastrointestinal disturbances, including delayed gastric emptying, bloating, abdominal pain, diarrhea, and constipation, which often persist even during remission of the disorder. These symptoms further complicate nutritional rehabilitation and may constitute a significant barrier to the recovery process.
The aim of this paper is to present the mechanisms underlying digestive function disorders in individuals with eating disorders, as well as to discuss the principles and importance of appropriate nutritional treatment in the management of these disturbances. The methods include a review of relevant scientific literature available in international databases, with a focus on clinical studies, systematic reviews, and guidelines addressing gastrointestinal complications and nutritional interventions in eating disorders. The results indicate that disorders of digestive function are common, multifactorial, and largely reversible when an appropriately guided nutritional treatment is implemented. Gradual increases in energy intake, tailored food selection, adequate intake of dietary fiber and fluids, as well as the use of probiotics and prebiotics, have been shown to be key elements in the restoration of gastrointestinal function. It is concluded that understanding digestive symptoms and systematically incorporating them into the nutritional therapy plan is essential for achieving successful and sustainable recovery in individuals with eating disorders.
References
Bulik CM, Ammerman S, Wade TD. Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects. Int J Eat Disord. 2006;39(4):319–26.
Riedlinger J, Schmidt C, Weiland S, Enck P, Mack I, Zipfel S, et al. Gastrointestinal symptoms and disorders in patients with eating disorders: a systematic review. J Clin Med. 2020;9(7):2208.
Jansson C, Norring C. Gastrointestinal symptoms and disorders in patients with eating disorders. Acta Psychiatr Scand. 2015;132(6):427–35.
Tack J, Deloose E. Complications of anorexia nervosa: gastrointestinal manifestations. Gastroenterology. 2014; 146(6):1464–73.
Bern EM, Woods ER, Rodriguez L, et al. Gastrointestinal manifestations of eating disorders. J Pediatr Gastroenterol Nutr. 2016;62(5):e125–e132.
Drossman DA. Functional gastrointestinal disorders: disorders of gut–brain interaction. Gastroenterology. 2016;150(6):1257–61.
Staudacher HM, Whelan K. Disorders of gut–brain interaction in eating disorders. J Eat Disord. 2023;11:20.
Gibson D, Mehler PS. Anorexia nervosa and the gastrointestinal tract. Nutr Clin Pract. 2019; 34(3):407–15.
Misra M, Klibanski A. Endocrine consequences of anorexia nervosa. Lancet Diabetes Endocrinol. 2014;2(7):581–92.
Mehler PS, Brown C. Anorexia nervosa – medical complications. J Eat Disord. 2015;3:11.
Monteleone P, Maj M. The role of appetite-regulating peptides in eating disorders. Curr Opin Clin Nutr Metab Care. 2008;11(6):651–6.
Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91.
Steinglass J, Walsh BT. The role of nutrition in the treatment of eating disorders. J Eat Disord. 2016; 4:19.
Schalla MA, Stengel A. Gastrointestinal symptoms and dietary management in patients with anorexia nervosa and bulimia nervosa. Nutrients. 2021;13(6):2023.
Godart NT, Berthoz S, Perdereau F, Jeammet P. Nutritional rehabilitation and gastrointestinal function in eating disorders: clinical recommendations. Eat Weight Disord. 2007;12(4):e109–e16.
Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and functional gastrointestinal disorders. Curr Gastroenterol Rep. 2017;19:27.
Clarke G, Stilling RM, Kennedy PJ, Stanton C, Cryan JF, Dinan TG. Minireview: gut microbiota: the neglected endocrine organ. Mol Endocrinol. 2014;28(8):1221–38.
Ford AC, Quigley EM, Lacy BE, et al. Efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2014;63:373–85.
Kelly JR, Borre Y, C OB, et al. Transferring the blues: depression-associated gut microbiota induces neurobehavioral changes in the rat. J Psychiatr Res. 2016;82:109–18.
Gibson GR, Hutkins R, Sanders ME, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14:491–502.
Puckett L, Grayeb D, Khatri V, Cass K, Mehler P. A comprehensive review of complications and new findings associated with anorexia nervosa. J Clin Med. 2021;10(12):2555.
Coudray C, Rambeau M, Feillet-Coudray C, et al. Study of magnesium bioavailability from ten organic and inorganic Mg salts in Mg-depleted rats using a stable isotope approach. Magnes Res. 2005;18(4):215–23.
World Health Organization, Food and Agriculture Organization of the United Nations. Vitamin and mineral requirements in human nutrition, 2nd edition. Geneva: World Health Organization; 2004 (pristupljeno 26. 2. 2026.). Dostupno na: https://www.who.int/publications/i/item/9241546123
Kennedy DO. B vitamins and the brain: mechanisms, dose and efficacy—a review. Nutrients. 2016; 8(2):68.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
Maggini S, Wintergerst ES, Beveridge S, Hornig D. Selected vitamins and trace elements support immune function by strengthening epithelial barriers and cellular and humoral immune responses. Br J Nutr. 2007;98(Suppl 1):S29–S35.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002; 21(6):495–505.
Blachier F, Mariotti F, Huneau JF, Tomé D. Effects of amino acid-derived luminal metabolites on the colonic epithelium and physiopathological consequences. Amino Acids. 2007; 33:547–62.
West CE, Jenmalm MC, Prescott SL. The gut microbiota and its role in the development of allergic disease: a focus on early life. Clin Exp Allergy. 2015;45:63–74.
Hemarajata P, Versalovic J. Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therap Adv Gastroenterol. 2013;6(1):39–51.
Van de Wiele T, Boon N, Possemiers S, et al. Prebiotic effects of inulin-type fructans on the human colonic microbiota. Gut. 2007;56:273–80.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375:583–93.
Misra M, Klibanski A. Bone health in anorexia nervosa and other eating disorders. Nat Rev Endocrinol. 2014;10:1–13.
Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009; 360:500–6.
Fairburn CG, Harrison PJ. Eating disorders. Lancet. 2003;361:407–16.
