Eating disorders have long been mysterious but now, like everything else, a gut connection has been made. I have worked with several people who have either had anorexia nervosa or were in the middle of having it. That may seem like a strange thing to say, but one client who came to me “in remission” was literally sliding back into anorexia right in front of my eyes.

It was a heartbreaking situation and hard for me to understand how such a beautiful, smart, funny girl could not see herself as everyone else saw her. She was so self-destructive. She cut her arms and legs to prevent herself from purging her food and then started purging to stop herself from cutting.

This is after two stays at an eating disorder clinic plus she was seeing a therapist twice a week.

I did not know what I know now about the gut. But as I read the new research, it provides another piece of the puzzle.

Researchers at the University of North Carolina have determined that people with anorexia have far less gut bacteria in total and much less diversity. This makes sense. The quantity and quality of bacteria is dependant on what we eat. If a person doesn’t eat, then what is going to feed the bacteria.

Previous research had also made the connection between dysbiosis and anorexia and this study adds to the data
The researchers speculate that the brain-gut connection is involved. Depression and anxiety are usually present in those who suffer from anorexia nervosa and these two conditions have already been linked to dysbiosis in the gut.

French researchers have also discovered that specific bacteria regulate appetite which may be playing a role in those with anorexia.

It also shows the failure of the of the conventional system in recognizing that anorexia is not just a psychological problem – it’s a physiological problem with an emotional connection.

Like all brain-gut conditions – it is hard to say which comes first – the psychological conditions that leads them to forgo eating which then affects the gut. Or does problems with the gut cause the emotional issues that lead them to stop eating. Whatever the case, they are intertwined now. 

If we really want to help those with anorexia, a more comprehensive program is needed that includes balancing the physical system and fixing the gut – easier to say than do.

The next step for the researchers is to take the gut bacteria from anorexics and put them in germ-free mice to see what happens to their behavior. This may lead to good information but there is a down side to this. There is also talk of using antibiotics to “cure” anorexics which will not help their gut and their health overall in the long term.

In the meantime, we can encourage a healthier approach for anorexics which should be implemented while they are receiving treatment and continued after. They should be fed foods that are high in nutrients that may be deficient.

The following steps may be the best approach that we have now:

1. Digestive enzymes and probiotics to aid digestion and absorption of nutrients as well as help the gastrointestinal tract function better. Depriving their system for so long of good quality foods as well as purging and/or using laxative is going to mean their whole GI tract is messed up.

2. Soothing bone broth and aloe vera gel will help aid repair of the GI tract. Aloe also promotes the growth of beneficial bacteria.

3. Nutrient dense foods such as prebiotic dairy products, grains, legumes, nuts, seeds, fruits and vegetables, including fermented foods should be introduced into their diet to build the residential good bacteria. This may need to be done slowly – everyone is different and it always wise to go carefully.

4. Further gut repair may be needed but this is a good start.

5. Psychological treatment must be part of any plan. Whether the psychological preceded the gut problems or the gut led to the psychological issues – they are now influencing each other and a strategy for both is needed.

PS: Bulimia and other eating disorders are also being researched but don’t be surprised if they find a dysbiosis connection and also don’t be surprised if the problem-causing bacteria is different than those found in anorexics since the symptoms and eating habits are different.


  1. The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology, Susan C. Kleiman et al, Psychosom Med. 2015 Nov-Dec; 77(9): 969–981
  2. Gut Dysbiosis in Patients with Anorexia Nervosa, Chihiro Morita et al, December 18, 2015
  3. Role of the gut microbiota in host appetite control: bacterial growth to animal feeding, Sergueï O Fetissov, Nature Reviews Endocrinology 13(1), September 2016