Eating disorders and food intolerance
(ED - anorexia nervosa, bulimia nervosa, binge eating disorder BED)

carstock - scales

Reader reports
Scientific references
Further information

Keywords: eating disorder, bulimia, binge eating



Eating disorders have increased considerably since the widespread introduction of highly processed foods1. Management of food intolerance is not usually considered in the treatment of eating disorders, but perhaps it should be. When a young woman with a six year history of eating disorders avoided additives in an attempt to get rid of a possible Ribo Rash*, she was surprised at her improvements. Two months later she wrote:  

“My eating disorder - it was currently Bulimia 1-5 times a day and Binge Eating everyday - has been completely stopped.” 

A review of the medical literature shows recent links between eating disorders and gluten intolerance2,3 and amine intolerance4. It has also been known for over 50 years that increasing doses of salicylates as acetylsalicylic acid (aspirin) produce increasing anorexia and loss of body weight5. The side effects of salicylates in aspirin can also occur in sensitive people due to salicylates in foods6.  

There is strong evidence that the common symptoms of food intolerance occur more frequently in people with eating disorders, suggesting a shared cause: anxiety7, OCD7, migraines8, irritable bowel symptoms9, ADHD10, eczema and asthma11. As these symptoms often precede eating disorders,  researchers suggest that conditions such as anxiety and migraine may be a risk factor for anorexia nervosa and bulimia nervosa7,8.

We always recommend a supportive and experienced dietitian to supervise the RPAH protocol, particularly if there are food disorder issues. Elimination and challenge is a diagnostic protocol, not a lifestyle, and it is important to liberalise diet to your limits. Ask for RPAH’s liberalising advice This email address is being protected from spambots. You need JavaScript enabled to view it.

Reader reports

The food chemicals implicated in eating disorders in the case studies and reader reports below include MSG, preservatives, salicylates, amines and gluten singly and in combination but everyone is different. If there are any symptoms of food intolerance, the best and fastest way to find out which food chemicals are causing problems – possibly including eating disorders – would be a trial of the RPAH Elimination Diet12 (avoidance of additives, salicylates, amines, glutamates and optionally dairy/gluten) preferably supervised by an experienced and supportive dietitian. You can request our list from This email address is being protected from spambots. You need JavaScript enabled to view it..

[1116] My eating disorder (Bulimia 1-5 times a day and Binge Eating every day) has stopped (July 2012)

I am 23. I led a high achieving, healthy active lifestyle until about 6 years ago when Bulimia slowly introduced itself into my normal, happy life,  I nearly lost my scholarship and it ruined my VCE which I was unable to complete and was continued by many months of incredible ups and downs.

It then progressed to Severe Bulimia, Binge Eating Disorder, Anorexia, hospitalisation and long stays in inpatient facilities for people with similar issues. Everything seemed like a temporary fix, a week after finishing programs I was back to my old habits.

About 18 months ago, with my barely manageable eating disorder, I moved by myself to a new town ...  I needed a new start, fresh faces and thought a change of scenery would help and it did :) I met my current partner after the first month of being here and he's been nothing but supportive of all my issues. To look at and meet me I'm you're average bubbly, blue eyed, blonde hair, healthy looking girl and I think it was quite a shock when he first he learned what the "other me" was like.

After 6 months however things started to go downhill with my health - my asthma, hay fever and eczema went crazy - which had only ever happened occasionally over my life (but never all at the same time) as I've had them all since I was a baby.

What really bothered me was a rash on my face that I had never experienced before - swollen lips, eyelids, dark red blotches underneath my skin, which turned to swelling, my skin flaking off and incredible itchiness!! As my self-esteem wasn't that great anyway, this was a huge blow. I quit work, uni, and it ruined my social life.

I thought it may have been the natural environment around me, new town, new plants, pollens etc as it was sometimes accompanied by sneezing. My crazy eating habits were another likely culprit. 

I went to the Doctor, he gave me some steroids which cleared it up but kept coming back. Then turned to allergy testing, cutting out certain foods through a nutritionist , gluten,  all the usuals etc. Useless. Used all natural makeups, moisturizers, cleansers etc. Useless again …. 

I've always known that preservatives aren't good for us, always eaten well in the past and thought of myself as fairly educated about food (that might sound strange when someone has an Eating Disorder but it's very common) but because additives had never been a problem in the past it never occurred to me that they could be the cause.

I found your website by chance whilst researching the issue on the net and along with your website's helpful info, photos and testimonials I knew I had found what I was looking for. I started cutting out the 600 number flavour enhancers and the 200 number preservatives (I wasn't aware that dried fruit could be so delicious but deathly for my skin!! I’d always make sure there was no added sugar but that's all I worried about) ... Anyway, instant recovery!!!!!! ... now I'm trying to cut out the rest of the nasties too - in both foods and makeup.

We have always eaten loads of fruit and veg and always go organic when we can afford to but it's hard trying to buy food that both my boyfriend and I will be happy with as he's an eating machine who's affected by nothing and never puts on weight ;) We're getting used to it ... we're happier.

I myself have SO much more energy it's unbelievable, I'm sure it neurologically changes something in your head. My eating disorder - it was currently Bulimia 1-5 times a day and Binge Eating everyday -  has been completely stopped. 

It's been nearly 2 months - I feel so free. Where it used to be constant, I now rarely have my crazy OCD thoughts filling my head with foods, food info or body image. I know it’s only early days but I'm optimistic and am going to try my absolute hardest ... I honestly haven't felt this good in years.

I've never seen any research or info about the links between food additives and Eating disorders - I definitely intend to research this further.

Thank you so much for being a revolutionary voice and caring enough to share your knowledge with the rest of the world. You have seriously changed my life and inspired me to take action. - Jayne, by email

[963] Depression, social phobia (& eating disorders): diet a lifesaver (October 2010)  

I can't tell you how happy I am to have found out about FAILSAFE (by accident). It's only day three and I feel like a different person. However, I will be aware of any withdrawal symptoms over the next few days or weeks.

If this diet works, as I'm sure it will, you will have literally saved my life. I was on the brink of giving up. I felt my life was over. Words can't describe how ill and depressed I had become. Life was miserable. No doctor wanted to help, couldn't help or just didn't believe me. One doctor told me my symptoms were all psychosomatic.

I went to the shops today and didn't have social phobia. That in itself is a miracle. My depression has lifted. My nerves are calm and my tummy is happy. It's not a chore in any way to eat the foods recommended and avoid the others.

Update after one month - Overall, the depression is the best it's ever been. Of course, there have been days where I've felt down and discouraged. Even then, I handled a relapse of chronic fatigue more positively than I have ever done before. My daughter noticed this too and told me so. I just took one day at a time and listened to my body. Many days were spent flat on my back, which is the best thing I could have done anyway.

The social phobia is long standing (since about 8yrs old). Looking back at my childhood, I think that there were many foods that were affecting me. I had terrible shyness, was afraid of everything, had constipation, tummy aches, migraines, bad breath, heat intolerance, fluctuating weight and eating disorders (binges and starving). 

Update after six months – I am happy to report ongoing improvements in overall mental, emotional and health conditions. I have had around 40 people now, tell me how amazing I am looking (I must have looked terrible before). They ask me what's my secret? I am happy to tell them- FAILSAFE!! I will never go back to eating the way I was. This diet is for life. - Liz, NSW 

From [782] Eating disorder, other symptoms in mother and children due to diet (June 2009) 

We only found out about "Fed Up" when a Maternal & Child Health nurse suggested we look at a possible problem with food chemicals for our youngest child’s (14 months) eating disorder. Read more

[1114] A link between additives/salicylates and anorexia (July 2012)

Is there a link between food additives or salicylates and anorexia? Our youngest daughter while off diet is seriously disinterested in food. Between the ages 3 - 9 she was in the lower percentiles weight wise. With the diet partially sorted out her relative weight for her ages has gone up. There were also some indications of her being obsessed with low weight and being skinny. We did the diet for her behaviour - fighting with siblings and extreme jealousy that could not be redirected by anything: force, reason, removal of privileges or ignoring. That fits in with my own experience recently when feelings were controlling and consuming me totally and logic did not have any place in my life. It was very uncomfortable to say the least and it was due to salicylates. – Peter, SA 

From [723] One-liners (February 2009) Depression, eating disorder, mood disorder

Your book and your website have saved us the agony of months (perhaps years) of trial and error. Our beautiful 8-year-old is back to normal after a year in the wilderness where we wondered if she was depressed, had an eating disorder or a mood disorder.  I am certain that you have heard this story a hundred times over. – by email, Qld

From [1115] PDD, ADHD, anxiety disorder, borderline anorexia nervosa (July 2012)

I happened upon your site last year while searching for help for my eldest son who was diagnosed with PDD, ADHD, anxiety disorder and high level language disorder as well as bordering on anorexia nervosa all at the ripe old age of 10.  Doctors were not helping and all the drugs they threw at us weren't helping either. I was at a loss as to how to help him as his behaviour escalated out of control and my husband and I nearly split up because of the stress on both of us.  It was a nightmare trying to manage all his problems as well as look after our other three children.  His behaviour was so extreme that I didn't think diet could help but remembering that I was a Feingold kid for many years myself I figured it certainly couldn't hurt and I had been only too willing to make him take drugs because it was an "easy" option that didn't require a lot of effort on our part.  We started FS in January before school went back and now only a couple of months later my son looks and acts like a "normal" child – by email, Qld 

Scientific references

1. Hoek HW, Vandereycken W. [Eating disorders; 25 years of research and treatment]. Tijdschr Psychiatr. 2008;50:85-9.[Article in Dutch] Eating disorders occur mainly in young females. The incidence of anorexia nervosa in Dutch females aged 15 to 19 doubled between the 1980s and the 1990s.

2. Leffler DA et al. The interaction between eating disorders and celiac disease: an exploration of 10 cases. Eur J Gastroenterol Hepatol. 2007;19(3):251-5. Celiac disease is an inflammatory disorder in which certain peptides from wheat and related grains trigger and maintain an immune reaction in the small intestine. Anorexia nervosa and bulimia nervosa are eating disorders that are morbid and, at times, life-threatening forms of psychopathology. Despite a large body of evidence describing the detrimental effects of eating disorders on the gastrointestinal system, information on the role of the gastrointestinal system in causing or mimicking eating disorders is scarce. To date, eating disorders, as a comorbid condition affecting individuals with celiac disease, has received surprisingly little attention with only a single report found in peer-reviewed literature. In this report, we describe a series of 10 individuals with both celiac disease and eating disorders. These cases demonstrate the complex ways in which celiac disease and eating disorders interact with important clinical implications for the diagnosis and treatment of both illnesses. Our findings suggest that clinicians treating patients with eating disorders or celiac disease should be aware of both conditions to provide optimum care.

3. Yucel B et al. Eating disorders and celiac disease: a case report. Int J Eat Disord. 2006;39(6):530-2. A 31-year-old single woman initially diagnosed with an atypical eating disorder (anorexia nervosa) was eventually diagnosed with celiac disease. 

4. Stolze I et al. [Histamine intolerance mimics anorexia nervosa]. Hautarzt. 2010;61(9):776-8.[Article in German] Histamine intolerance is a clinically heterogeneous disease. We present a woman who suffered from weight loss, diarrhea, abdominal pain, headache, flushing and bronchial asthma for several years. When placed on a low histamine diet, she experienced weight gain and improvement of other all signs and symptoms, supporting the diagnosis of histamine intolerance. Therefore, this disease should be included in the differential diagnosis of anorexia nervosa.

5. Boyd EM. Analgesic abuse: maximal tolerated daily doses of acetylsalicylic acid. Can Med Assoc J. 1968:26;99(16):790-8. Increasing doses of acetylsalicylic acid (aspirin) produce increasing anorexia and loss of body weight.

6. Swain AR et al. Salicylates in foods. J Am Diet Assoc. 1985;85(8):950-60. 

7. Kaye WH et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004;161(12):2215-21.Ninety-seven individuals with anorexia nervosa, 282 with bulimia nervosa, and 293 with anorexia nervosa and bulimia were assessed on standardized measures of anxiety, perfectionism, and obsessionality. Their ratings on these measures were compared with those of a nonclinical group of women in the community. The prevalence of anxiety disorders in general and OCD in particular was much higher in people with anorexia nervosa and bulimia nervosa than in a nonclinical group of women in the community. Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.

8. D'Andrea G et al. Is migraine a risk factor for the occurrence of eating disorders?  Neurol Sci. 2012;33 Suppl 1:S71-6. The eating disorders (ED), anorexia nervosa (AN) and bulimia nervosa (BN), are severe psychiatric and somatic conditions occurring mainly in young women. Although the aetiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. To understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected by ED is very high (<75 %). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients in respect to the control subjects. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that of ED patients shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

9. Dejong H et al. The prevalence of irritable bowel syndrome in outpatients with bulimia nervosa. Int J Eat Disord. 2011;44(7):661-4. There is evidence of a high incidence of IBS in outpatients with Bulimia Nervosa but the relationship between these conditions remains unclear. Future research should consider possible common risk factors.

10. Cumyn L et al. Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry. 2009;54(10):673-83. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia.

11. Erdur L et al. Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients. Biopsychosoc Med. 2012 2;6(1):4. Somatic comorbidity seems to be an important factor for anorexia nervosa outcome … Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact.

12. Hodge L et al. Food allergy and intolerance. Aust Fam Physician. 2009;38(9):705-7.

Further information

Introduction to food intolerance factsheet 

Ribo Rash factsheet   

Irritable bowel factsheet

Fed Up by Sue Dengate, available in libraries, bookstores and on this website

The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians 

© Sue Dengate update October 2021