Gastroparesis and Eating Disorders

Understanding Why Eating More Feels Impossible in Early Recovery

Failure hurts, but with help it doesn't have to

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If you have an eating disorder such as anorexia nervosa or avoidant restrictive food intake disorder (ARFID), you may experience the symptoms of gastroparesis. You may not feel hungry and may constantly feel that your stomach is full even when you’ve eaten very little.

You may feel uncomfortably full after eating only a small amount of food. This can feel confusing and make eating for recovery even harder. People around you may be frustrated and tell you to “just eat” and either dismiss your complaints of fullness or attribute your lack of appetite to disordered thinking.

If you are supporting a loved one with an eating disorder who is always full and complaining about stomach pains, you may struggle with how best to support them. You may be tempted to give in to their pleas not to require them to eat. You may even fear continuing to feed them when it seems to cause so much physical distress.

Gastroparesis is a condition in which the process of emptying the stomach slows down. It can be caused by a number of medical conditions. It is extremely common in those who have restricted their intake—intentionally or not—and experienced weight loss as a result. It can be seen in those with relative energy deficiency in sport (RED-S). It can occur in people of all body sizes—and even if you are in a larger body but have been restricting. It is, in fact, one of the most common physical symptoms of an eating disorder.

Health professionals who have not been trained in eating disorders often fail to identify gastroparesis as a sign of the eating disorder.

They may conduct unneeded tests, search for more exotic causes, or recommend ineffective solutions. As they do this they lose time to reverse the harm caused by the disorder. Understanding the root cause and mechanics of gastroparesis can be helpful in mounting a more timely response to and treatment of these symptoms.

Mechanics and Symptoms of Gastroparesis

When you swallow food, it travels from the mouth through the esophagus and into the stomach. The stomach has two primary jobs: first, to expand to accept food and liquid until you feel full, and second, to render the food and liquid into a semi-liquid mixture that continues into the small intestine where it will be digested.

Food typically spends about two hours in the stomach before contractions move it into the small intestine. In the case of gastroparesis, a good portion of one’s meal may remain in the stomach for four hours or even longer.

When nutritional intake has been reduced, this lag may be the body’s attempt to conserve energy by slowing down nonessential body functions. Just as a starving body slows down its heart rate and production of sex hormones, it slows down the contractions of the stomach and intestines, contributing to both gastroparesis and constipation.

But here’s the rub: when you’re following an eating disorder recovery meal plan, guess what you do within four hours after eating? You eat another meal!

This is why frequent eating for recovery can be so challenging: the person in recovery is likely still literally “full” from the last meal. Understanding this problem is a crucial step for knowing how to manage it. 

Symptoms of Gastroparesis

The symptoms of gastroparesis can include:

  • Early fullness
  • Bloating
  • Abdominal pain
  • Abdominal distension
  • Nausea
  • Vomiting

It is also the case that gastroparesis can exacerbate symptoms of an eating disorder—or even trigger one—if it were not there previously. Patients who report gastrointestinal (GI) complaints, including gastroparesis, are found to have high rates of ARFID.

This can become a self-reinforcing cycle: fear of GI symptoms causes them to avoid eating, which in turn intensifies the GI symptoms.

Other Causes of Gastroparesis

It should be noted that gastroparesis can occur in people for reasons other than restricted eating and weight loss.

These include disorder of gut-brain interaction—which is recurrent indigestion with no apparent cause—and diabetes. Gastroparesis can also be a side effect of certain medications including opiates and some antidepressants.

How Is Gastroparesis Diagnosed?

Gastroparesis is formally diagnosed through a gastric emptying study conducted at a radiology center. The patient first eats a meal, usually scrambled eggs or oatmeal that has been mixed with a safe medical radioactive material that emits protons.

Over the next four hours, a gamma camera conducts regular scans of the patient’s stomach to measure the amount of food remaining. During normal digestion, the stomach will empty all but about 10% of its contents within four hours of the meal. Gastroparesis is diagnosed when far more food remains in the stomach by the end of this time frame.

However, because gastroparesis is a common occurrence with weight loss and restricted intake,
the diagnosis is often made presumptively in people with eating disorders who exhibit symptoms of early fullness, bloating, and nausea without a formal gastric emptying test.

Managing the Symptoms of Gastroparesis

Fullness after eating very little can be very confusing if you have an eating disorder. It may also be very distressing. The primary treatment for gastroparesis in the case of an eating disorder is—not surprisingly—more food.

The increased intake will help awaken the GI tract but this will take time and consistent nutrition. This can be very difficult for the patient who is experiencing the physical and psychological distresses caused by the increased intake and their eating disorder.

While eating must continue, there are strategies that can reduce discomfort. Liquids will move more easily from the stomach into the intestines, so including more calories in the form of liquids, including nutritional shake supplements, can be helpful during the early phase of nutritional rehabilitation. High fiber foods including fruits and vegetables are harder to digest and may increase bloating and fullness so should be limited. Say "yes" to more fats and protein. It also helps to eat smaller and more frequent meals.

Certain medications can help treat gastroparesis by allowing faster emptying of the stomach. These medications—primarily metoclopramide (Reglan), erythromycin, and azithromycin—are intended primarily for short-term use.

It should be emphasized that these medications are not laxatives—rather, they may help the stomach more rapidly empty food into the intestines. Laxatives are not recommended treatment for gastroparesis.

The goal of medications is to allow for increased nutritional intake, which is still the primary treatment. These medications are all by prescription only, so discuss with your medical doctor whether they might be helpful for you.

If you are caring for a person with an eating disorder and gastroparesis, the first step is to validate their experience that eating is uncomfortable. Follow the dietary suggestions above and speak to their medical team about whether medications might be helpful. Sometimes a heating pad or hot water bottle after meals can reduce some of the physical symptoms. Distraction after a meal can also help reduce anxiety and guilt.

Keep in mind that these symptoms will get better with better nutrition and weight gain. Resist the temptation to reduce intake.

How Long Does It Take to Improve from Symptoms of Gastroparesis?

Research shows that delayed gastric emptying can often be significantly improved in about 8 weeks with nutritional rehabilitation—even without medication— if significant weight is gained. It can recur if weight is lost again.

A Word From Verywell

It’s not just in your head; the fullness is real! Gastroparesis often complicates recovery from eating disorders following decreased intake and weight loss. Nutritional rehabilitation and weight restoration are necessary to resolve gastroparesis that occurs in the context of an eating disorder.

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7 Sources
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