Tackling the Gut

Karlee Pinto, RD, LDN

Sometimes I think of the gastrointestinal (GI) tract as this large dance party. There is a lot going on. Everyone is spinning around on the dance floor. All different dance styles and music. Unique and individual wardrobes and personalities. So much is happening at once. The night is constantly evolving. OK, bear with me here…we don’t have a dance party in our bellies (although sometimes it may feel like it), but the GI tract is incredibly complex and intricate. It feels like we have been researching the GI system forever, yet we still have so far to go. But this is the true beauty of it. There is so much to learn and so many unknowns to discover.

            Because this system is so intricate and a hot topic to study right now, it receives a lot of attention, specifically when addressing food and its effect on the GI tract. Think about it. When you have an upset stomach, a lot of gas, or some abnormal bowel habits, often the first thing you think is “ohh…what did I eat today??” Certainly, some medically diagnosed conditions—such as an allergy or intolerance—relate specifically to a certain type of food. If you feel that you may have an allergy or intolerance, please consult your general practitioner. But in this post, I hope to provide you with a little more knowledge to help you understand just how complex this system is and how many factors impact our GI health.

            Often, when we are presented with some sort of GI issues, the immediate recommendation is an elimination diet. For those unfamiliar with elimination diets, here’s a brief overview. Individuals experiencing GI distress keep a detailed food log and deeply analyze and study the specific GI symptoms that they experience to try to link them to a specific food or food group. Depending upon the specific protocol, foods and food groups that are more common allergens and intolerances are strictly removed from the diet and then gradually added back, one by one to determine which ones could be causing the GI symptom. This may seem like a no-brainer protocol, however the restriction has the potential to be harmful and triggering to someone who has a history of dieting, an eating disorder, or disordered eating. There is a fine line between reasonable intention to take care for one’s own body and using elimination as a vehicle to manage other aspects of our well-being. Maybe it is that inner factor that thrives on controlling all aspects of the diet. Or maybe we are searching for stability in our live, so we seek this through our experiences with food. In these moments, we need to take a step back and take a look at the bigger picture. The sole focus may not necessarily be on food itself.

            Our digestive system is intricately connected to the nervous system. Our thoughts and feelings can transform into a very real, physical experience or sensation. Have you ever been super-stressed before an exam and your breakfast just didn’t sit too comfortably? Or you had a meal just prior to experiencing some unpredicted stressful situation and suddenly a wave of nausea hits? Our GI system is heavily impacted by emotions, such as stress, anxiety, fear, depression, and so forth. Surely, we could be having some other co-occurring physiological symptoms that exacerbate the feelings of GI distress and discomfort. However, add in some other strong emotions like anxiety and stress around eating, and you can see how we fueling the fire. Thoughts and emotions live in our bodies and deserve to be acknowledged while we try to understand and decipher this mind-gut connection.

            Gastroparesis is a fancy term that can be easily defined as delayed emptying of food from the stomach into the intestines. This process is caused by decreased stomach motility, or movement. In some cases, the vagus nerve, which controls the stomach muscles, is damaged. This interferes with your stomach’s ability to naturally contract and move food along the GI tract. Another possible determinant to gastroparesis could be a change in the gut microflora, which could be triggered by restricting specific foods or food groups. There could also be changes in the production of digestive enzymes. In simple terms, this variation could impact how certain foods are broken down and digested. Once restriction barriers are taken down and food is reintroduced back into one’s routine, some GI discomfort could potentially arise.

            So how do we begin to calm down this gastrointestinal dance party? How do we wind down and relieve some of this chaos? What follows are a few simple steps to help work through some of these GI issues:

Balance and Regularity

Our bodies love routine. In fact, our digestive tract prefers meals every 4 hours or so. Things may seem to pass along more smoothly when we honor our bodies’ natural rhythm. Make it a priority, and care for your body by eating balanced meals and snacks every few hours. Bring mindfulness and awareness to this need. Just as someone with the diagnosis of diabetes mellitus is more mindful of the impact of carbohydrates on their blood sugar, perhaps you may need to be more mindful of routine eating patterns to aid in the digestion process.

Stress Management

Work with members of your treatment team to develop skills and tools to tackle and manage stress. Remember, the nervous system feeds into the gut. A stressed-out mind can lead to a stressed-out gut. Consider how an emotion might be affecting your digestion just as you would question the impact of food.

The Squatty Potty

Well, I guess this is happening—I am indeed going there. Because of the body’s natural physiology, the rectum and anus are located at the end of the digestive tract. You have a muscle that sort of ropes around the rectum, kinks, and contains the stool so that you can go about our life. Using a squatty potty allows our knees to rise above our hips, mimicking a natural squat. The muscle that loops around the rectum loosens up, making it much easier to go to the bathroom.

Fibrous Foods

Are you eating a lot of raw produce or fiber-enhanced foods, such as protein bars or crackers? Highly fibrous produce can be taking a toll on our GI system as it may not have the capacity to digest all of this roughage. Allow your gut to relax. For ease of digestion, try to cook some of the produce that you believe may be triggering GI distress and see if this helps to alleviate gas and bloating.

            Most importantly, give this process time and grace. If you are experiencing GI distress and discomfort, let your treatment team know as each member can contribute something meaningful to help improve your digestive health. Allow them to provide you with that support and guidance while you patiently explore your own, individual digestion. 

Karlee is a staff nutritionist at The Awakening Center. To schedule an appointment, call 773.929.6262.

Putting the Cleanse Fads in Perspective: An interview with Michel Harris, MS, RD, LDN

By Lily Bowen

Recently, I walked into a new juice bar that opened on my street. The menu board claimed that some of the juice options could “cleanse” my body of “toxins.” I was curious about what this meant, so I asked the cashier. Far from providing answers, our conversation left me more intrigued. I decided to interview The Awakening Center’s Staff Nutritionist, Michel Harris, MS, RD, LDN, to learn more about the research behind these cleanse fads.

Let’s start with the basics. Michel explained that our bodies already have a built-in cleanse system: a bowel movement. Seriously! It’s not any more complicated than that. In other words, your body doesn’t need any extra help to detox. Other organs (like the liver) also sift out anything your body can’t use, and your bowel movement does the actual cleansing. So any company (or infomercial) that claims to eliminate the toxins that hide in your colon has no medical research supporting it. Michel emphasized that those claims are false.

Although your body doesn’t need any extra help to cleanse itself (you don’t need to train your body to have a bowel movement) some do experience constipation. Michel noted that moderately increasing fiber in a diet will support your body’s built-in process. There are two kinds of fiber: soluble and insoluble. Insoluble fiber—found in foods such as wheat bread, fruits, and vegetables—helps move food and waste through the digestive track. Soluble fiber—found in oatmeal, beans, and other foods—actually binds with cholesterol, and helps remove it from the body.

All the talk about “cleansing” suggests that eating any diet will leave behind something “bad” (or toxic). Recently, I spoke with someone who had completed a 14-day cleanse that involved eliminating a few food groups. I asked Michel if there are any possible nutritional benefits to this practice. Short answer? No! There are no benefits from removing a food group from your diet, even temporarily. All foods are OK, and our bodies require variety. Now some folks actually experience allergic reactions to certain foods. Or might display sensitivities. If you suspect that might be your situation, then consult with your physician and a nutritionist.

I asked Michel if there are any harmful side effects from completing one of these cleanses. She emphasized that even for those without a history of an eating disorder, eliminating food groups can increase the risk to developing one. Many experience temporary water weight loss from a cleanse, which can trigger additional ED behaviors for someone who might be vulnerable. And the individual who chooses to complete a cleanse is more likely to set up the body for a nutritional deficiency. Michel emphasized that eating a variety of foods from all the food groups is nutritionally valuable. For example, a person completing a cleanse might cut out dairy suddenly and leave them vulnerable to calcium deficiency. Ironically, following a “cleanse” diet may make it more difficult to stay healthy.

So let’s put the current cleanse fads (Whole 30, juicing, etc.) in perspective. These are simply dressed-up versions of old trends. Remember the grapefruit diet? Or the cabbage soup diet? These days we laugh at these fads—who in their right mind thinks eating just cabbage soup is sustainable? We should be just as critical and dismissive of current cleanse fads. Resist the temptation for an easy fix, educate yourself and others, and remember to trust your body. It knows how to take care of itself.

Lily is a graduate intern therapist at The Awakening Center, finishing her master’s degree in Clinical Mental Health at Roosevelt University. In her free time, Lily enjoys reading poetry and playing the harp.

Tummy Turmoil

"Frozen Foods with String Beans," Irving Penn {c} Irving Penn Foundation

By Michel Harris, MS, RD, LDN, CDE

A significant part of the recovery process from an eating disorder involves adapting to a “normalized” eating pattern. However, many individuals experience one or more of the following gastrointestinal (GI) symptoms when they start the refeeding process: abdominal pain, nausea, bloating, constipation, diarrhea, and feeling uncomfortable full. Sometimes, healthy behavior changes make one feel worse in comparison to when he or she was practicing disordered behaviors like food restriction, binging, and purging.

            There are several reasons why these unwanted symptoms occur, and all relate to the physiological changes that occur with continuous disordered behaviors. The entire GI is composed of muscles that are stimulated to contract when one starts eating. Similar to the muscles in your arms and legs, if there is nothing to promote movement, these muscles become sluggish and weak. If one restricts his or her intake, either by eating very small amounts of food or going for long periods of time without eating, the muscles remain “under-exercised.” Laxative use for purging may cause diarrhea, constipation, and/or diarrhea. These symptoms tend to persist, even after discontinuing the use of a laxative.

            Unfortunately, these unwanted symptoms tend to encourage individuals to resume disordered behaviors because the mind-set of “why bother, when I am try so hard” sets in. However, these symptoms will resolve after a few weeks of consistent refeeding. In the meantime, the tips below can help reduce GI discomfort from refeeding.

·                 The refeeding process needs to occur gradually. One should never drastically increase his or her daily calorie intake because it could lead to serious medical complications (heart failure). If you are not in a medically supervised program, seek the help of a Registered and Licensed Dietitian (RDN) who can help with meal planning.

·                 An RDN will assist in creating a meal plan that includes foods from all groups. Avoid the inclination to fill up on high-fiber, low-calorie foods (fresh fruits and vegetables, whole wheat products); excessive amounts of fiber may contribute to diarrhea, abdominal discomfort, or constipation (if fluid intake is not adequate). Plus, you may feel too full to consume other nutrient-dense foods from the other groups.

·                 Eat smaller, more frequent meals to reduce the load on your GI system. This will gradually get an under-used GI system back into shape! The general recommendation is to eat something every three to four hours.

·                 Stay hydrated but don’t fill up on water. Fluid intake is important, but try not to drink too much with meals to avoid early satiety.

·                 Find options to ease your symptoms. There are over-the-counter medications to help with some of these GI symptoms, but you should consult with you medical doctor (MD) before purchasing any.

            No one needs to tell you that recovery is difficult! Keep in mind that your decision to seek treatment deserves much praise and continual encouragement. The discomfort felt at the beginning pays off in the future.

            On a final note, if after several weeks of following a recommended meal plan, persistent signs of abdominal pain, unintentional vomiting, bloating, diarrhea, constipation, nausea, and/or early nausea warrants a follow-up visit with your MD. He or she can assess your condition, and determine if a referral to a GI doctor is necessary.

Michel Harris a Registered and Licensed Dietitian and serves on the staff of The Awakening Center. She believes in the mindful approach to develop a peaceful relationship with food and exercise in the recovery process of eating disorders. To find out more or to set up an appointment with Michel, call 773.929.6262.