4.Anorexia Recovery: Gut Microbiome Redevelopment

Emerging research highlights the critical relationship between gut health and brain function, known as the gut-brain axis. This bi-directional communication system connects the gastrointestinal system with the brain through neural, hormonal, and immune pathways (1). In anorexia nervosa (AN), this connection plays a pivotal role in both the development and recovery from the disorder (2). Addressing gut health during recovery becomes essential to support both physical and psychological healing (3).

How Anorexia Affects the Gut

Altered Gut Microbiome

Impact on Recovery: This dysbiosis perpetuates gastrointestinal symptoms such as bloating, pain, and discomfort, reinforcing fears around eating certain foods (4). The imbalance further triggers systemic inflammation, negatively impacting mood and cognitive function (1).

Prolonged malnutrition and restrictive eating patterns significantly alter gut microbiota composition, reducing microbial diversity and increasing the growth of pathogenic bacteria such as Bacteroides wadsworthia (3). A decline in beneficial bacterial strains like Lactobacillus and Bifidobacterium is commonly observed, contributing to gut dysbiosis (2).

Gut Permeability (Leaky Gut)

Malnutrition weakens the gut barrier, making it more permeable and allowing harmful substances to enter the bloodstream (3). This increased permeability contributes to systemic inflammation, which can exacerbate anxiety and depression (1).

Impaired Digestive Function

Anorexia compromises digestive efficiency by lowering stomach acid production, slowing gastric motility, and impairing enzyme production (5). As a result, many individuals experience symptoms such as nausea, constipation, and diarrhea during early recovery (2).

Strategies to Rebuild Gut Health

Gradual Reintroduction of Nutrient-Dense Foods

Given the impaired digestive function during early recovery, the gradual reintroduction of diverse foods is necessary to support the adaptation of the digestive system and enzyme activity (5).

Important Consideration: Foods high in saturated fats may initially exacerbate gut inflammation by feeding harmful bacteria like Bacteroides wadsworthia. These foods should be reintroduced slowly and with careful monitoring to prevent setbacks (3).

Incorporating Probiotics and Prebiotics

Restoring a healthy microbiome involves the strategic reintroduction of beneficial bacteria and supporting their growth through prebiotic fibers (2).

• Probiotic Sources: Yoghurt, kefir, sauerkraut, and kimchi (4).
• Prebiotic Sources: Bananas, oats, garlic, onions, and asparagus (3).

Anti-Inflammatory Diet

Reducing gut inflammation helps support microbiome healing and improves overall gut function.

• Omega-3 Fatty Acids: Found in fatty fish such as salmon, omega-3s help reduce gut inflammation (4).
• Turmeric and Ginger: Known for their natural anti-inflammatory properties (3).
• Leafy Greens and Sweet Potatoes: These nutrient-rich foods promote gut healing (2).

Supporting Gut Barrier Repair

Certain nutrients aid in strengthening the gut lining and reducing inflammation.

• L-Glutamine: This amino acid, found in bone broth and eggs, helps repair the gut lining (5).
• Zinc: Supports tissue repair and reduces inflammation; available in seeds, nuts, and shellfish (4).
• Vitamin A: Essential for maintaining the gut’s mucosal barrier; found in carrots, spinach, and sweet potatoes (2).

The Gut’s Role in Brain Recovery

Neurotransmitter Production

The gut produces a significant portion of neurotransmitters, including serotonin, which influences mood and emotional regulation (1). Dysbiosis impairs neurotransmitter production, contributing to mood instability often seen in AN (3).

Cognitive and Emotional Regulation

Gut-brain axis disruptions are linked to cognitive impairments such as poor decision-making and memory deficits (4). A balanced gut microbiome supports brain health and emotional stability (1).

Hunger and Satiety Regulation

Gut health influences the production of hunger and satiety hormones such as ghrelin and leptin. In individuals with AN, restoring gut balance can help normalize appetite cues, promoting recovery (5).

The Long-Term Benefits of Gut Health in Recovery

Investing in gut health during recovery promotes long-term benefits, including:

• Improved Nutrient Absorption: Essential for physical recovery and energy restoration (5).
• Enhanced Cognitive Function: Reducing brain fog and emotional instability (2).
• Lowered Inflammation: Reducing the risk of chronic health issues such as autoimmune diseases (3).
• Relapse Prevention: Addressing physical symptoms that reinforce restrictive eating behaviours (1).

Bridging the Gut-Brain Connection for Comprehensive Recovery

Addressing the gut-brain axis is crucial for holistic recovery. By focusing on gut health, individuals with AN can support not only physical recovery but also emotional and cognitive resilience (4).

A Personal Note:

I want to remind readers that I am not a medical professional. I am someone who has experienced anorexia and is currently in recovery. This article is not intended to provide medical advice, but rather to share the insights and information I have gathered during my own journey. My hope is that by exploring the complexities of this disorder and the recovery process, I can help raise awareness and offer support to others who may be going through similar struggles. Please consult with a qualified healthcare provider for guidance and treatment if you or someone you know is struggling with anorexia.

References:

1. Ghenciulescu, A., Park, R. J., Burnet, P. W. J., 2021, The gut microbiome in anorexia nervosa: friend or foe?, Frontiers, accessed 10 January 2025, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.611677/full
2. Ruusunen, A., Rocks, T., Jacka, F., Loughman, A., 2019, The gut microbiome in anorexia nervosa: relevance for nutritional rehabilitation, Psychopharmacology (Berl), acessed 10 January 2025, https://pubmed.ncbi.nlm.nih.gov/30612189/
3. Zhao, W., Kodancha, P., Das, S, 2022, Gut microbiome changes in anorexia nervosa: a comprehensive review, Pathophysiology, acessed 10 January 2025, https://www.mdpi.com/1873-149X/31/1/6
4. Herpertz-Dahlmann, B., Seitz, J., Baines, J, 2017,  Food matters: how the microbiome and gut-brain interaction might impact the development and course of anorexia nervosa,  Eur Child Adolesc Psychiatry, accessed 10 January 2025, https://link.springer.com/article/10.1007/s00787-017-0945-7?fromPaywallRec=false
5. Marzola, E., Nasser, J. A., Hashim, S. A., Shih, P. A. B., Kaye, W. H, 2013, Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment, BMC Psychiatry, accessed 10 January 2025, https://link.springer.com/article/10.1186/1471-244x-13-290