Eating Disorders and Irritable Bowel Syndrome

Eating disorder patients commonly complain of gastrointestinal (GI) symptoms including bloating, abdominal pain, and constipation. This is, of course, not surprising. After all, disordered eating behaviours such as self-induced vomiting, laxative abuse, and restriction are bound to have negative effects on the digestive system.

But just how common are GI complaints and functional gastrointestinal disorders (FGIDs) like irritable bowel syndrome among ED patients? And is there more to the relationship than simply ED behaviours causing GI disturbances? Luckily, a growing number of research studies are beginning to shed some light on these questions.

In a study published in 2010, Catherine Boyd and colleagues examined the prevalence of FGIDs among ED patients admitted to a hospital Eating Disorders Unit. They found that out of the respondents (73 in total), 97% had at least one FGID (as evaluated using the Rome II questionnaire). More specifically, on admission, 73% of the participants had esophageal disorders, 32% gastroduodenal disorders, 81% had bowel disorders, and 33% experienced anorectal disorders. At 12-month follow-up, the numbers decreased to 34%, 18%, 66%, and 18%, respectively.

Overall, …

Nothing to SCOFF at: Screening for Eating Disorders in the Emergency Room

As many who have suffered from eating disorders know, these illnesses can often go unnoticed for years. Family members and friends might not be the only ones who don’t catch the signs and symptoms of EDs; doctors, too, may not identify the presence of an eating disorder. Whether or not sufferers desire to get help, the symptoms associated with eating disorders often lead many to present at doctors’ offices and emergency departments, suffering from “mysterious ailments.”

In a study by Dooley-Hash, Lipson, Walton & Cunningham (2012, 2013), 16% of youth 14-20 presenting to the emergency department screened positive for eating disorders. The researchers describe their study in two articles published in the International Journal of Eating Disorders in 2012 and 2013. For this post, I’ll focus on the 2013 article, which highlights the patterns of emergency department use of those who present with eating disorders.

Tetyana has previously written about common medical complications (and possible underlying causes) that eating disorders patients present with to the ER. In this post, I will focus on the reported reasons for which …

Diabulimia: A Dangerous Duet

EDIT: I want to apologize for an oversight in this blog entry. Shelly and I forgot to mention Diabulimia Helpline in our list of organizations that help raise awareness and support sufferers with type 1 diabetes and eating disorders. Diabulimia Helpline is the only non-profit in the US dedicated to “education, support, and advocacy for diabetics with eating disorders, and their families.” I also want to highlight some services that Diabulimia Helpline offers: “a 24 hour helpline available via (425) 985-3635, an insurance specialist to walk clients and/or their parents through the complicated world of getting insurance to cover eating disorders, and a referral service to help people find the treatment centers, doctors, therapists, and counselors that would be a good fit for them on their road to recovery.” – Sincerely, Tetyana


Type 1 diabetes (DMT1, or T1DM) is a lifelong disease often diagnosed in children or adolescents. Though causes of DMT1 are complex and not fully understood, it results from the body’s immune system destroying its own insulin-producing cells. This drastically lowers insulin levels and leads to …

Avoiding Refeeding Syndrome in Anorexia Nervosa

Refeeding syndrome (RS) is a rare but potentially fatal condition that can occur during refeeding of severely malnourished individuals (such as anorexia nervosa patients). After prolonged starvation, the body begins to use  fat and protein to produce energy because there are not enough carbohydrates. Upon refeeding, there’s a surge of insulin (because of the ingested carbohydrates) and a sudden shift from fat to carbohydrate metabolism. This sudden shift can lead to a whole set of problems that characterize the refeeding syndrome.

For example, one of the key features of RS is hypophosphotemia: abnormally low levels of phosphate in the blood. This occurs primarily because the insulin surge during food ingestion leads to a cellular uptake of phosphate. Phosphate is a very important molecule and its dysregulation affects almost every system in the body and can lead to “rhabdomyolysis, leucocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death.”

I’m not, however, going to go into too much detail on RS as there are pretty good sources available here, here, and here. Instead, I …

Medical Complications of Purging in Bulimia Nervosa

[Note: This post has been translated into Croatian, link here.]

Eating disorders are mental disorders with physical complications. Sometimes lots of them. I’ve blogged before about medical complications that are likely to come up in an emergency room setting, but that was a while ago. So I thought today I’d focus specifically on medical complications  that occur in bulimia nervosa (BN) as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).

These complications are particularly important because patients with BN often appear healthy and can thus more easily hide their disorder, meaning that treatment is often initiated many years after disorder onset, and the duration of BN is often long, with recovery rates far lower than they should be (in one study, the 5-year recovery rate was a little more than 50%), which means that these complications can persist for many years.

I’ll go through some of the complications of self-induced vomiting, laxative abuse, diuretic abuse, and briefly mention some complications in patients with type 1 diabetes.


Oral complications of

Weight Restored, Eating Well, But No Menses in Sight? Huh?

It is to be expected that the Diagnostic and Statistical Manual of Mental Disorders, at least when it comes to anorexia nervosa, relies heavily on measures that are hard to quantify and measure objectively. The big exception is amenorrhea: the absence of menses (commonly known as “periods”) for three consecutive months. As I’ve mentioned before, this criterion will be removed from the next edition of the DSM, thankfully. But for now, it is still there.

Perhaps because it is easy to measure objectively, the resumption of menses is often taken to be a marker of “health” and “recovery.”  It is a common goal in treatment for patients to reach a “menstruating weight.”

[Conversely, not losing one’s menstrual cycle is often perceived by the patient that they are not “sick enough.” Their eating disorder is not legitimate because clearly they are eating enough for their menstrual cycle to continue, and thus they should “snap out of it” or they “don’t deserve treatment,” which is of course not true.]

I often run into questions online with individuals in recovery …

Should Anorexia Nervosa Patients Get the Flu Shot?

Is getting the flu shot a good idea if you have anorexia nervosa? Is it safe?

To be honest, I’ve never asked myself that question before. Last year, when I was underweight, I got a flu shot mainly because the laboratory where I am doing my graduate degree is in a hospital–the same hospital that was at the centre of the SARS epidemic in Toronto–and I didn’t want to put patients at risk. Sure, I spent most of my time staring at worms through a microscope (true story) but in the rare event I ventured outside for a coffee, I didn’t want to cough on newborn.

So I was kind of excited to find out the answer when someone asked me this question earlier today on tumblr. As expected, I didn’t find much information, but I did find one relevant paper published online in 2011 by Arne Zastrow and colleagues. I thought I’d make a quick post about it to make the information available to others.

As you probably know, getting the flu vaccine is especially important for individuals …

Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.

Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”

eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.

As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder not otherwise specified (EDNOS). A problematic catch-all diagnosis that makes up the majority of those diagnosed with eating disorders. I’ve discussed some of the problems with the EDNOS diagnosis elsewhere

History of Anorexia or Bulimia Nervosa? Are You Putting Your Unborn Child At Risk?

[Note: This post has been translated into Croatian, link here.]

You know how you are not supposed to get on the topic of kids on your first date? Well, I did. Clearly I wasn’t good at following social rules (in my defense, this was many years ago). “It would be cool to be surrogate mother,” I said. And then I thought about it. “But that would probably be difficult, who would want me to carry their child?” Needless to say, my date was confused. I thought, surely having had an eating disorder and a long history of amenorrhea would put me at an increased risk of complications during pregnancy?  

So this made me wonder, what is the effect of having had an eating disorder on pregnancy? And more specifically, are women who’ve had eating disorders more likely to experience perinatal and delivery complications?

Like with a lot of things, the information out there is mixed. (This is why one study is never enough and replication is crucial.) Early studies seemed to have suggested that women with EDs face …

Diabulimia: Disordered Eating in Type 1 Diabetic Patients

Type 1 diabetes mellitus (DMT1) is a lifelong chronic disorder that occurs when the body is unable to produce enough insulin – a hormone that is required for carbohydrate metabolism. Patients must learn to manage their disorder by monitoring their blood sugar levels on a regular basis, carefully selecting the foods they eat and how much exercise they do. Before insulin was extracted and purified (at University of Toronto!), type 1 diabetes, which usually occurs in children and adolescents, would very quickly lead to death – the body, unable to take in the very thing it needs to survive.

Unfortunately,  patients with type 1 diabetes are at increased risk of developing eating disorders or disordered eating behaviours. Diabulimia refers to an eating disorder in patients with DMT1 who reduce or skip insulin doses to reduce their weight.

The exact prevalence rates vary study by study, depending on the population sample, how disordered eating/EDs are defined and a multitude of other factors. But, nonetheless, some numbers are helpful.

Kelly et al. provide a nice overview of the prevalence studies. I’ve …