07/29/2026
The brain-gut connection
Research on the gut-brain connection has soared over the past decade, fostering a better understanding of the gut microbiome, immune system involvement, and the impact on physical and mental health. “The gut-brain axis can be considered as a multidisciplinary team,” explains Rebecca Boswell, PhD, director of Penn Medicine Princeton Center for Eating Disorders and administrative director of Psychiatric Services at Princeton Medical Center.
“Mental, nutritional, and gut health are all intertwined, and changes to one system impact the others.” In turn, a multidisciplinary clinical team at Princeton Medical Center, including providers at Princeton Center for Eating Disorders, is shedding a light on this connection as it relates to eating disorders, nutrition parameters, and gastrointestinal (GI) patient care.
At the 2025 iaedpTM Annual Global Symposium, Dr. Boswell shared insights together with Anish Sheth, MD, chief of gastroenterology and director of the Center for Digestive Health at Princeton Medical Center, and Jenna Deinzer, RD, lead dietitian at Princeton Center for Eating Disorders, during a multidisciplinary panel on Collaborative Approaches to Gut-Brain Health in Eating Disorder Treatment.
Working together, this team is broadening the understanding of how GI symptoms contribute to disordered eating, how disordered eating and its treatment can cause GI symptoms, and interventions that promote more balanced gut-brain health and eating disorder recovery. Nearly 100% of patients at Princeton Center for Eating Disorders have at least one disorder of gut-brain interaction. GI symptoms are a common component of eating disorders due to the effects of malnutrition, binge-eating, vomiting, laxative use, and poor hydration. In addition, the refeeding process itself is uncomfortable, as it aims to recondition the GI system and rebuild muscle and tissue that has been lost. Based on these parameters, the team integrates psychological, nutritional, and medical interventions to reduce pain and discomfort among patients. Because they all work at Princeton Medical Center, the team can see patients together when needed.
Beyond general psycho-education and psychotherapy, Princeton Center for Eating Disorders offers two evidence-based treatments targeting GI symptoms. GI cognitive behavioral therapy (GI CBT) provides specialized education about disorders affecting the gut-brain connection and strategies for building a better relationship between the two.
“Our collaboration helps us better assess symptom presentation and create the right treatment plan that incorporates each discipline’s expertise,” says Deinzer. “With multiple interventions available, the result is more individualized care. Including relaxation-based techniques to calm both systems and cognitive approaches to address anxiety and challenge distorted thoughts. In gut-brain hypnosis, trained practitioners – including Dr. Boswell – help patients achieve a deep relaxation “flow state” in which they can teach the brain and body how to reduce the intensity of the pain experience through visualization and breathing exercises. “There’s an incredible base of evidence for positive change using these practices,” says Dr. Boswell. “Patients in both eating disorders and outpatient GI settings have benefited in as little as eight to ten sessions.”
From a dietitian’s standpoint, various personalized interventions can help minimize GI discomfort. Deinzer may recommend softer foods or liquid nutritional supplements, limiting high-fiber foods, and distributing
foods more evenly across meals and snacks. She ensures adequate hydration and employs creativity in adding calories to meal plans without extra volume. Enteral or parenteral nutrition is an option if needed. She also reminds patients that as weight restoration progresses, GI symptoms often ease.
In addition to the placement of a nasogastric or endoscopic feeding tube when necessary for severe malnutrition, medical interventions from the GI team include specialized
medication management of eating disorder-related GI symptoms and the diagnosis and treatment of any
underlying gastric conditions, such as irritable bowel disease. Likewise, GI symptoms can sometimes
lead to eating disorders due to such issues as restrictive eating and food avoidance to minimize discomfort, and the team’s collaboration has helped to identify underlying eating disorders among patients at the GI clinic.
“Traditionally, gastroenterologists are trained to focus on what’s happening in the GI tract, but clearly sometimes there’s a behavioral component,” says Dr. Sheth. “Our work together speaks to the importance of engaging colleagues who consider issues from different perspectives. Collaboration is key in using all the resources we have – and as we learn from each other, we move patient care forward.”
