Expert: Joanne - 1/21/2008

Question
I am concerned about my 29 year old daughter's swollen abdomen. She has an eating disorder (says she is recovering) but she looks like a "Biafra baby."  She is neither anorexic nor bulimic. She eats  "healthy" food (lots of broccoli, salads, vegetables, & fruits), drinks lots of water, diet soda, Propel (for electrolytes  -- she got into trouble by drinking too much water a few years ago) whole grain breads, some meat & cheese. She also has a sweet tooth so does eat sugar. She  exercises regularly  -- possibly "exercise bulimia."   Her belly has looked swollen for over a year.  She thinks it's from chewing gum, which she does often.  Her Dad & I have had all sorts of medical tests done on her when she visits & everything has come back as normal, yet the swelling continues. I am beside myself trying to find an answer to this.  Even she is becoming aware of how odd she looks & is embarrased by it.  Is there anything you can recommend?  Can this be reversed so that she can once again look like the healthy athlete she once was?  I am aware that the eating disorder is still a factor in her life, but she lives 1,000 miles from us & there is little we can do.  However, since this one thing is bothering her, perhaps it would be the incentive to eat diffently if that is in fact the underlying problem.  Please respond.  I don't know where else to go with this.  Thank you.

Answer
Trish

Unfotunately as your Dr not managing to find a medical reason for this, I don't imagine I will be able to give you too much more help.

My first thoughts were simple bloating. Eating a lot of fruit, veg and legumes as well as drinking a lot of diet sodas can cause a lot of intestinal gas which can distend the abdomen.  But then I thought a bit more, and I wondered whether she isn't getting enough protein, which can cause fluid usually found in blood to leak out into tissues, cuasing oedema in the tissues, which causes distension.  This is known as Kwashiorkor which is a malnutrition due to lack of protein intake.  If she doesn't eat a lot of protein and exercises quite a lot, this could be a possible cause, but your Dr should be able to pick this up in blood and urine tests.

I would recommend maybe getting these tests repeated, and in the meantime, maybe encourage her to increase protein intake, makes sure that her food intake matches her exercise demands, doesn't drink too much diet sodas incase it is just bloating die to an over production of gas by GI tract.  And I think that she should be careful not to over do the water intake.  It is recommended that you drink about 2L of water a day, more is fine, its just if you take too much in, or take it in too quickly, she will cause herself problems.  If there is a problem with protein intake, etc, drinking too much may make her distension worse.

I think that you need to really push for further investigation, or she needs to herself.  It may be worth talking to someone who can check for any food intolerances as well, and maybe a dietician that could help her devise a meal plan that won't cause so much bloating if it is intestinal gas.  But keep pushing your Drs as you do this, just to ensure that there is no serious medical problem that could possibly be causing these symptoms.

Joanne