Are you one of the favoured few who are living with an autoimmune condition and struggling with disordered eating at the same time? If so, you may have pondered why you are battling with both when your friends may have never experienced either. Running a health coaching practice and working through my own health issues with both conditions has grated me an intimate view of the complex relationship between autoimmune diseases and disordered eating. Surprisingly, these seemingly independent conditions share a bidirectional relationship that significantly influences both physical and mental well-being. It is no surprise and certainly no accident, that we often experience both at the same time.
What are autoimmune diseases?
Autoimmune diseases comprise a diverse group of conditions in which our immune system, which is designed to protect our body from harmful invaders, turns against us. The result is chronic inflammation that can affect various organs and systems, leading to a range of symptoms and complications. The prevalence of autoimmune diseases is on the rise, affecting millions of people worldwide. Conditions such as rheumatoid arthritis, lupus, multiple sclerosis, and Crohn’s disease are part of this complex spectrum.
Apart from their physical challenges, autoimmune diseases can significantly impact emotional health. The chronic nature of symptoms, uncertainty regarding prognosis, and the need for constant monitoring can contribute to heightened stress levels and emotional distress. This emotional toll often forms a feedback loop, as stress and emotional turmoil can further exacerbate autoimmune symptoms due to the intimate connection between our mind and our body.
Disordered eating and eating disorders
Disordered eating describes a wide spectrum of harmful behaviors and attitudes toward food. The medical community recognises eating disorders as serious and clinically diagnosable mental health conditions characterised by persistent and severe disruptions in eating behaviors, body image, and emotions. Examples include anorexia nervosa, bulimia nervosa, and binge eating disorder.
However, the broader term of “disordered eating” includes irregular or unhealthy eating patterns that may not meet the criteria for a formal eating disorder diagnosis. It involves behaviors such as restrictive dieting, occasional binge eating, or preoccupation with food and body image. Orthorexia, for example, though not officially recognised as a clinical disorder, refers to an obsession with eating only “healthy” foods, often leading to restrictive behaviors affecting nutritional intake. While not clinically recognised, disordered eating can still impact physical and mental well-being.
Disordered eating patterns often stem from a complex interplay of psychological, social, and physiological factors. Low self-esteem, body dissatisfaction, societal pressures, and distorted body image contribute to the development and perpetuation of disordered eating behaviors. It is believed that disordered eating represents a way of coping with emotional distress, aiming to regain a sense of control.
One affects the other
Despite their apparent disconnection, autoimmune health and eating disorders are intricately connected. When grappling with autoimmune diseases, we may develop disordered eating patterns due to the impact of symptoms on our body image, medication side effects, and the desire to regain a sense of control over our bodies. Chronic pain, fluctuating weight due to medication, and the physical changes brought about by autoimmune conditions can trigger body dissatisfaction, low self-esteem, and an intense focus on weight and appearance. As a result, some of us may resort to restrictive eating patterns, excessive exercise, or other disordered eating behaviors in an attempt to gain a semblance of control over our bodies.
Conversely, disordered eating behaviors can contribute to immune system dysregulation, thus impacting autoimmune health. Nutritional deficiencies, common among individuals who have struggled with disordered eating for a longer time, can compromise immune system function. For instance, inadequate intake of essential nutrients such as vitamins and minerals weakens our body’s defense mechanisms, making us more susceptible to infections and exacerbating autoimmune symptoms. Moreover, the chronic stress induced by disordered eating behaviors triggers a cascade of physiological responses, including the release of stress hormones like cortisol. These responses can lead to inflammation, a hallmark of autoimmune diseases, thus further aggravating symptoms.
What they have in common
Several underlying factors contribute to the bidirectional relationship between autoimmune health and disordered eating. One key factor is stress. Both autoimmune diseases and disordered eating behaviours are associated with heightened stress levels. For those of us struggling with autoimmune conditions, the stress of managing a chronic illness, dealing with symptoms, and facing uncertainty can become overwhelming. In the case of disordered eating, the emotional toll and societal pressures associated with these behaviors generate significant stress.
Genetic predispositions also play a role in the development of both autoimmune diseases and disordered eating. Research indicates a genetic component in the susceptibility to autoimmune conditions, often involving multiple genes. Similarly, genetic factors can contribute to our vulnerability to disordered eating behaviors, with certain genes influencing traits such as perfectionism and emotional regulation.
Furthermore, the role of inflammation emerges as a unifying thread that connects both conditions. Inflammation is a central feature of autoimmune diseases, driving tissue damage and exacerbating symptoms. In the context of disordered eating, chronic stress and the physiological responses it triggers can lead to systemic inflammation, which further worsens autoimmune symptoms and complicates disease management.
How it works in practice
In my health coaching practice, I see evidence of the intricate interplay between autoimmune health and disordered eating all the time. Many of my clients who are using medication to manage their severe symptoms suddenly start to experience weight fluctuations due to their side effects. Changes in our appearance can trigger body image concerns, leading us to spiral into disordered eating patterns. We may become fixated on controlling our food intake and obsessively exercise to maintain a certain weight. Unfortunately, this restrictive behavior compromises our nutritional intake and exacerbates our immune system dysregulation, leading to increased inflammation and flare-ups.
Many of us even accidentally slip into disordered eating patterns when trying to manage our autoimmune condition without wanting to control our weight or body image. Gastrointestinal conditions, such as inflammatory bowel diseases, or other autoimmune conditions with strong food triggers often inadvertently cause disordered eating when we try to manage our symptoms by restricting certain foods. By relying on “safe” foods and limiting our range of dietary options, we may trigger compulsive behaviors and signal our brains that we are afraid of food.
Conversely, anyone struggling with eating disorders often suffers from the intense emotional and physical stress that comes with those conditions. Over time, this chronic stress – often paired with nutritional deficiencies – takes a toll on our immune system, leading to heightened inflammation. This, in turn, makes our body susceptible to autoimmune disease. In fact, researchers found that individuals who have been diagnosed with an eating disorder have a 114% increased risk of being diagnosed with an autoimmune disorder in the following year.
What the research says
While this area of research is still new, medical professionals have started to recognise the profound impact of the bidirectional relationship between autoimmune health and disordered eating.
Stephanie Zerwas, PhD, a psychologist and therapist, and her team were able to associate autoimmune diseases are associated with increased risk for eating disorders. They advocate that “ultimately, understanding the role of immune system disturbance for the etiology and pathogenesis of eating disorders could point toward novel treatment targets.”
Maria M. Sirufo from the Department of Life, Health and Environmental Sciences, University of L’Aquila in Italy, and her team found evidence of a bidirectional relationship between autoimmune diseases and anorexia nervosa. However, they highlight that further research is needed and criticises a lack of systematic studies able to precisely investigate the links between autoimmunity and eating disorders.
Anna Hedman from the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Sweden, and her team have conducted the largest study to date on eating disorders and autoimmune diseases to date, confirming a strong bidirectional relationship between eating disorders and various autoimmune diseases in women. They hypothesise that the bidirectional nature of the relationship between both conditions could be due to dysregulated immune function.
A holistic approach that addresses physical, emotional, and psychological aspects seems to be essential for managing both conditions effectively. Collaborative efforts between specialists in autoimmune diseases and eating disorders can lead to comprehensive and personalised treatment plans that consider the unique challenges of these intertwined conditions. Health coaches and other professionals who understand both conditions can help clients to shift their awareness to restrictive patterns and help with sustainable lifestyle changes.
Strategies for managing both conditions
Effectively managing both autoimmune health and disordered eating necessitates a comprehensive approach that acknowledges the complexities of these conditions. Holistic self-care stands as a cornerstone. This involves prioritising balanced nutrition to provide our body with essential nutrients required for immune system function. Mindful eating practices can help us tune into our body’s cues, promoting a healthier relationship with food.
Stress reduction techniques play a pivotal role in mitigating the impact of stress on both conditions. Practices such as meditation, deep breathing exercises, and mindfulness can help regulate our body’s stress response, thereby reducing inflammation and improving immune system function. Engaging in regular physical activity not only supports overall well-being but also aids in stress reduction and immune system optimisation.
Addressing emotional well-being through therapy, counseling, or support groups is crucial. These resources provide individuals with tools to manage emotional distress and develop healthier coping mechanisms. Open communication with healthcare providers is equally important. Sharing the experiences and challenges of managing both autoimmune health and disordered eating enables providers to tailor treatment plans that consider the interconnected nature of these conditions.
Navigating the intricate terrain of both disordered eating and autoimmune disease daily in my health coaching practice has granted me an intimate view of their intertwined relationship. Clients often feel overwhelmed by the physical and mental effort to manage both conditions, accepting them as two separate health concerns while overlooking the effects one has on the other.
Today we know, that the emotional toll of managing symptoms can trigger disordered eating patterns. Weight fluctuations brought on by medication side effects can easily lead us down a path of body dissatisfaction and an unrelenting desire for control. These disordered behaviors, however, usually worsen our autoimmune symptoms, fueling a cycle of inflammation and exacerbation. Conversely, disordered eating exposes us to the impact of nutritional deficiencies and chronic inflammation on our immune function. The toll of restrictive eating and stress-driven behaviors further compromises our immune system’s resilience.
When we embark on a path of healing, we often realise that we cannot address both conditions in isolation. Instead, we need a holistic approach that harmonises emotional well-being, balanced nutrition, and stress management. If we know one thing, it is that physical and mental health go hand in hand.
Xenia Brandstetter is an Autoimmune Protocol (AIP) and Functional Medicine Certified Health Coach. At Xenia Brandstetter Health Coaching, she empowers women with autoimmune conditions to make peace with their disease, regain their lost energy, and take back control of their life. She uses learnings from her own autoimmune journey to help her clients feel like themselves again and create the life they dream of.