Helpful Nutritional Guidelines for People in Recovery from Bulimia

CCI Certified Eating Disorder Recovery Coach and Co-Founder of Conquering Bulimia, Merrit Elizabeth, had the pleasure of talking to Registered Dietitian and Certified Eating Disorder Specialist, Rebecca Jaspan, for an exclusive in-depth interview with nutritional guidelines for people in recovery from bulimia. Rebecca Jaspan, MPH, RD, CDN, CDCES specializes in anorexia, binge eating disorder, and bulimia, as well as disordered eating and orthorexia. She is also an expert in gastrointestinal health, sports nutrition, diabetes, and PCOS as a Certified Diabetes Care and Education Specialist.

Rebecca was the clinical administrative dietitian at Montefiore Medical Center where she directed the outpatient nutrition program at Montefiore’s ambulatory hospital. Rebecca also has a special interest in sports nutrition and works with athletes to improve their performance through nutrition. She has presented at New York Road Runners and USA Track & Field about nutrition for long-distance runners. 

She has had articles published in VeryWell Fit, The Kitchn, and Health.com. She regularly engages in public speaking for New York University and Dietitian Central. Rebecca uses the Stages of Change model to work with clients no matter where they are in eating disorder recovery, whether they might categorize themselves as being in a pre-contemplation stage or a maintenance stage.

Rebecca is LGBTQ-affirming and creates a safe place inclusive of all ages, genders, races, sexual orientations, regardless of body size or body shape. She practices with a non-judgmental, non-diet, all-foods-fit approach. She is a trusted healthcare provider able to work virtually with clients in recovery from bulimia in New York.

A registered dietitian plays a crucial role in the treatment team as they establish the treatment plan for nutritional recovery. It is important to distinguish between a registered dietitian nutritionist, and a nutritionist. A registered dietitian is a recognized medical professional who has completed specific education and licensure requirements, while a nutritionist may not have formal training in the field.

Anyone can identify as a nutritionist, regardless of education. It is imperative that people with eating disorders consult a registered dietitian who specializes in eating disorder recovery.

"RDs are integral members of treatment teams and are uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status." (Ozier, et al. 2011). 

Arguably the most important step in the recovery process is finding someone who can identify your eating disorder behaviors and help replace them with nourishing eating habits. A registered dietitian also plays a crucial role in providing a safe space to share information on the medical complications resulting from the binge-purge cycle. Dietitians provide effective treatment in eliminating restricting, binge eating, purging, and ultimately helping you find a healthy weight.

Individuals who are working toward full recovery at home or on campus and not under the direct supervision of a registered dietitian often struggle with knowing what, when, and how much to eat in order to help them feel satiated, especially after following strict rules dictated by their eating disorders for so long. With the understanding that nutrition advice is best when it is customized, are there any kind of general guidelines you can offer to medically stable individuals in at-home recovery?

While individual nutrition recommendations are important, some general guidelines that I like to give are making sure that meals and snacks are balanced, so including a protein, carb, and fat at each meal and two out of the three food groups at snacks. It's a little formula I like to give my clients for meal planning. I would also say staying on a schedule in the beginning is really important for keeping blood sugar stable and helping more accurate hunger and fullness cues to return. 

I usually recommend eating every three to four hours, but this can be individualized as well.

How do you feel about supplementing with vitamins, minerals, pre or probiotics during the bulimia recovery journey?

Supplements and probiotics definitely have a time and a place. It's best to get individualized recommendations based on what the person's eating and their blood work. I always have my clients get labs so that I can make recommendations according to any deficiencies we're seeing or information based on a DEXA scan for bone density and things like that. 

Vitamins and probiotics also won't be as effective without adequate food intake. I always take a food-first approach. For example, if you're not eating enough fat, then the fat-soluble vitamins won't be as well absorbed. 

Many people also look to probiotics for quick fixes for their gut health, but the reality is that until adequate and regular food intake is achieved, those gut health issues might continue to persist. 

GI distress including bloating, constipation, diarrhea, and general discomfort is very common in individuals during recovery from bulimia, particularly during the early stages. Learning to incorporate new foods in order to replenish the gut and improve transit time can be quite intimidating no matter how strong the individual’s commitment to doing this hard work. Will you please walk us through some foods that are easier to digest without discomfort in the early stages of bulimia nervosa recovery, and then guide us through other foods as the individual continues to make progress in their daily life?

Some easier-to-digest foods might include ones that are lower in fiber and higher in protein. Too much fiber and roughage can cause and contribute to bloating and both constipation and diarrhea. So some people don't realize that too much fiber can actually cause constipation, not fix the problem. 

It's really important that people aren't pounding their system with tons of fiber, which I've definitely seen. Some good foods to start out with might be things like Greek yogurt, sourdough or whole wheat bread, avocado, and cooked veggies. Eating enough throughout the day helps also to get the digestive system moving and helps improve that transit time. 

This can definitely be an uncomfortable process, and I always remind clients of that. And we can come up with strategies to help to sit with that discomfort. Also working closely with the doctor is important because they can sometimes prescribe different medications to help speed up that transit time and make this process a little bit more comfortable, and also make sure that the refeeding is medically safe. 

Some people also like using protein shakes or supplements to help them meet their protein needs. Sometimes that can be a little bit easier. And then as the individual progresses, adding foods, protein foods like chicken or meatballs, things that are kind of already broken down or pre-chewed food, nuts and nut butters, and expanding carbohydrate variety based on the person's tolerance.

How long does it take before clients start feeling less bloating, discomfort, and constipation in bulimia recovery?

The average I've seen is about four to six weeks. The clients will start to feel some changes, but this is super individualized based on the severity and longevity of symptoms.

What do you think about taking anti-bloat supplements or food enzymes after meals in the ongoing process of bulimia recovery?

These types of products probably won't hurt, but I'm always a little bit skeptical about them because there isn't a ton of research done. And, also, I want clients to become reliant on them. They may offer some relief or even a placebo effect. 

And if that motivates the client to continue eating their meal plan, then that's a net positive. But I also like to offer other techniques to help with bloat, like breathing exercises, maybe a hot pack, and other therapeutic techniques like journaling, and really get into how the gut-brain connection works and how you're doing different things in the body can actually help change how you feel physically and then when you're digesting food.

In the last decade, we have seen incredible advances regarding the brain-gut connection and how food is integral to our mood and mental health. What types of food do you recommend for enhancing mood and decreasing anxiety and depression in recovery from bulimia?

A lot of research shows that omega three fatty acids as well as other healthy fats are important for enhancing mood--so foods like salmon, avocado, ground flaxseeds, and walnuts. Also eating foods with those prebiotic fibers that feed the probiotics, those gut bugs, things like lentils and dark leafy greens. 

Unfortunately, there isn't going to be one food or food group that's going to be the silver bullet. So adequate nourishment is still really important for optimal brain functioning and production of dopamine and serotonin, those feel-good hormones.

As a private eating disorder specialist who also has a master’s degree in public health, you have a unique lens of depth and breadth into the field of eating disorders. How would you like to see eating disorder prevention and nutrition education on the large scale in healthcare and schools implemented?

Unfortunately, I hear all the time about fear-mongering and negative messaging around foods that kids get in school. So if health and nutrition are going to be taught in schools, I would love for it to come from a more neutral perspective without demonizing or creating shame around eating any particular foods. I also think it's important for certain healthcare providers to stay in their lane when it comes to nutrition recommendations. 

While doctors can give some advice, it's best if they leave more of the specifics up to the dietitians who can really work with the little ones and their parents and families on creating a positive relationship with food. 

Is there anything that you would like those struggling in recovery from bulimia to remember most about food, especially those who feel it has been a long process?

I think it's really important to remember that food is your medicine just like you might be taking psychotropic medication and participating in therapy. It all goes together to help you on your journey. And when your brain is nourished, you'll make even more progress in other areas of your recovery. As challenging as it may seem in the beginning, it does get better, and food can and food can ultimately only be one important part of your life rather than feeling like it takes up so much of your brain space.

Key Takeaways:

1. Dietitian's Crucial Role: Registered dietitians play a central role in creating personalized treatment plans that shift the focus from harmful to nourishing eating habits. Research shows they are a crucial element of the treatment team for those in recovery from bulimia.
2. Balanced Meals and Snacks: A foundational strategy involves the promotion of balanced meals and snacks. This approach aids in stabilizing blood sugar levels and reinstating accurate hunger and fullness cues—critical aspects of the recovery journey.
3. Supplements: While acknowledging the potential benefits of supplements and probiotics, Rebecca advocates for their supplementary role. Individualized recommendations based on eating habits and blood work are crucial, emphasizing a "food-first" approach.
4. Gradual GI Distress Management: The common challenge of GI distress during recovery is addressed by gradually incorporating easily digestible foods. This process, though uncomfortable, underscores the individualized nature of progress in overcoming this hurdle.
5. Skepticism Towards Anti-Bloat Supplements: Anti-bloat supplements are met with skepticism due to limited research. Rebecca encourages alternative techniques like breathing exercises and hot packs, cautioning against reliance on such supplements.
6. Understanding Brain-Gut Connection: The evolving understanding of the brain-gut connection highlights the significance of omega-three fatty acids and prebiotic fibers for mood enhancement. Rebecca stresses the absence of a singular "silver bullet" food and underscores the importance of overall nourishment for optimal brain functioning.
7. Neutral Nutrition Education: In broader implications, Rebecca advocates for neutral perspectives in nutrition education, criticizing fear-mongering around foods, especially in schools. A balanced approach is suggested to foster positive relationships with food.
8. Dietitians in Nutrition Education: The interview underscores the importance of dietitians in nutrition education, urging healthcare providers to stay within their expertise. Dietitians can work closely with individuals and families, creating positive relationships with food.
9. Practical Meal Planning Formula: Rebecca introduces a practical meal planning formula, emphasizing a balanced composition of meals and snacks. This formula incorporates protein, carbohydrates, and fats, aiding both nutritional goals and fostering a healthy relationship with food.
10. Hope in Recovery: Despite initial challenges, progress is attainable, and food can become a balanced aspect of life alongside psychotropic medication and therapy in recovery from bulimia.

Good news, Rebecca is taking new clients! Take the first step and get the professional help you deserve here. Don't let diet culture fool you into engaging in any more harmful behaviors.

With her holistic approach, Rebecca will take into account your individual circumstances and assist with decreasing eating disorder behaviors, improving low self-esteem and body image issues, and eventually moving toward an intuitive eating model. Take the first step in building your support network now.

Author: Merrit Elizabeth

Merrit Elizabeth is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and has years of experience working with women with eating disorders.

Posted on February 29, 2024

Works Cited

Ozier, Amy D., and Beverly W. Henry. “Position of the American Dietetic Association: Nutrition Intervention in the treatment of eating disorders.” Journal of the American Dietetic Association, vol. 111, no. 8, Aug. 2011, pp. 1236–1241, https://doi.org/10.1016/j.jada.2011.06.016