Use of Dietary Supplements in Eating Disorders Care

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An Evidence-Informed Guide for Dietitians and Therapists

Leah Graves and Anne Marie O’Melia

Introduction

Nutrition and health information is now easy to find, but not always easy to evaluate. Many people with eating disorders encounter supplement recommendations through social media, wellness influencers, podcasts, online forums, and direct-to-consumer advertising before they enter treatment. They may arrive already taking one or more products and hoping these will improve recovery, gastrointestinal symptoms, mood, bone health, or overall wellness. Although many supplements are marketed as natural or evidence based, the quality of supporting evidence varies widely. Patients and eating-disorder professionals are often left to sort through conflicting messages.

Clinicians caring for people with eating disorders are increasingly asked whether specific supplements are helpful, unnecessary, or potentially harmful. These conversations belong within the multidisciplinary treatment team. Registered dietitians can assess intake and nutritional adequacy, identify possible deficiencies, evaluate the benefits and risks of supplementation, and integrate recommendations into the nutrition care plan. Therapists can help patients examine how supplement use relates to anxiety, certainty seeking, food avoidance, body surveillance, compulsive research, or rigid rules. Physicians and Advanced Practice Providers contribute medical assessment, dosing guidance, and review of contraindications and interactions. Collaborative decision-making helps ensure that supplements support comprehensive eating-disorder treatment rather than distract from it.

This review distinguishes among three categories that are often conflated:

• Dietary supplements: Vitamins, minerals, botanicals, probiotics, amino acids, powders, and other products intended to supplement the diet.
• Oral nutrition supplements: Liquid nutrition products or shakes used to support energy and nutrient adequacy as part of nutritional rehabilitation.
• Medical foods or enteral formulas: Products used under medical supervision for specific clinical circumstances.

This distinction matters. The concerns outlined in this article about unnecessary supplement stacks, unsubstantiated claims, and compensatory use should not be interpreted as discouraging clinically indicated oral nutrition supplements or enteral nutrition.

The purpose of this narrative review is to summarize current evidence regarding dietary supplements commonly encountered in eating-disorder care and provide practical guidance for therapists and dietitians. The review distinguishes supplements used to address nutritional deficiencies or inadequacies, products used for symptom management, and interventions proposed to influence eating-disorder symptoms or recovery. It also addresses online nutrition claims that may promote dietary restriction, moralized food rules, weight stigma, or overreliance on biologically plausible but clinically unproven mechanisms. The literature search emphasized English-language systematic reviews, meta-analyses, randomized trials, clinical guidelines, and eating-disorder-specific publications from 2020 through 2026, with earlier landmark studies included when contemporary evidence was unavailable.

Dietary supplements may correct a documented deficiency or reduce a specific symptom, but they do not treat the core psychopathology of an eating disorder. In practice, the more difficult task is often separating a targeted, time-limited intervention from wellness messaging that increases food fear, body surveillance, or rigid rules. The sections that follow summarize the evidence, identify common safety concerns, and offer language clinicians can use when patients bring nutrition claims from social media into treatment.

Key Clinical Conclusions

• Use supplements for a defined indication, with a dose, duration, monitoring plan, and stopping rule.
• Do not infer deficiency from diagnosis, body size, or appearance. Dietary history, medical risk, physical findings, medications, and laboratory assessment should guide testing and treatment.
• Nutritional rehabilitation and an adequate, varied eating pattern remain foundational. Supplements should not become substitutes for meals, exposure work, psychotherapy, or indicated medical care.
• Thiamine during refeeding is a medical-safety intervention for patients at risk, not a general wellness supplement. Protocols should follow the treating program’s medical refeeding guideline.
• High-risk products, including laxatives, detoxes, diuretics, stimulant-containing products, and “fat burners,” may function as compensatory behaviors and require direct assessment and medical coordination.
• Evaluate whether a product or nutrition rule is reinforcing eating-disorder symptoms. A biologically plausible mechanism is not evidence of clinical benefit.

Why This Topic Matters

Patients encounter supplement recommendations through clinicians, peers, social media, podcasts, wellness marketing, and direct-to-consumer advertising. Products may be described as natural, detoxifying, hormone balancing, anti-inflammatory, or gut healing. These labels can sound medically precise while obscuring uncertainty about dose, purity, interactions, and clinical benefit.

In the United States, dietary supplements are regulated differently from prescription drugs. The Food and Drug Administration does not determine whether dietary supplements are effective before they are marketed. Manufacturers are responsible for evaluating safety, manufacturing quality, and truthful labeling before marketing, while FDA action is often postmarket. A product’s availability for purchase therefore does not mean that it is effective, accurately labeled, or appropriate for a particular patient (U.S. Food and Drug Administration [FDA], 2024; National Institutes of Health, Office of Dietary Supplements, 2023).

Eating-disorder care adds another layer of risk. Advice that divides food into morally “clean” and “toxic” categories, encourages continuous glucose or body monitoring, or promises control through elimination can strengthen overvaluation, avoidance, and compulsive reassurance seeking. Social-media exposure has been associated with body-image concerns, eating-disorder psychopathology, and orthorexic tendencies, although much of this literature is cross-sectional and does not establish causation (Dane & Bhatia, 2023; Segado-Fernández et al., 2025). Clinicians therefore need to assess both biomedical risk and the psychological function of supplement use.

A Practical Framework for Evaluating Supplement Use

Clarify the target. Ask what problem the patient expects the product to solve and how success will be measured. Vague goals such as detoxification, balancing hormones, reducing inflammation, or healing the gut deserve careful unpacking.

Assess the eating-disorder function. Determine whether the product reduces flexibility, replaces food, permits avoidance, supports compensatory behavior, or increases checking and reassurance seeking. Supplement use may function as a safety behavior, ritual, body-monitoring practice, or substitute for addressing distress directly.

Review safety. Record the exact product, ingredient list, dose, frequency, duration, source, allergies, medical conditions, pregnancy status when relevant, and all medications and supplements. Involve the prescriber or pharmacist when interactions, contraindications, or dose concerns are possible.

Match evidence to the claim. Separate evidence that a nutrient corrects deficiency from evidence that it improves gastrointestinal symptoms, mood, attention, or eating-disorder outcomes. Evidence in another population may not generalize to malnourished or medically unstable patients.

Plan monitoring and discontinuation. Document who will follow symptoms or laboratory values, the reassessment interval, and when the product will be stopped. Prefer a single targeted change over supplement stacks.

Protect access and autonomy. A food-first approach should mean restoring adequacy, flexibility, variety, culture, pleasure, and accessibility, not enforcing a supposedly perfect diet. Assess food access, affordability, sensory needs, cultural practices, and practical meal-preparation constraints before interpreting a limited food pattern as resistance or nonadherence.

Five Questions Before Keeping, Starting, or Stopping a Product

1. What exact product is being used, and what is the complete daily dose?
2. What problem does the patient believe it solves, and how will benefit be measured?
3. Is there a documented deficiency, a clear medical indication, or a defined symptom target?
4. Does it increase food avoidance, monitoring, compulsive research, body checking, or compensatory behavior?
5. Who will monitor benefit, adverse effects, interactions, and the stopping rule?

What the Evidence Supports

Micronutrient abnormalities occur in anorexia nervosa, but prevalence varies by population, nutritional pattern, prior supplementation, and laboratory definition. In a cohort of 374 severely malnourished inpatients, zinc and vitamin D abnormalities were prominent, while other deficiencies were less consistent (Hanachi et al., 2019). A 2026 pediatric referral-center cohort similarly found heterogeneous abnormalities rather than a uniform deficiency pattern (Iordan et al., 2026). ARFID may create highly specific risks based on the foods omitted, but diagnosis alone does not identify which nutrients require replacement. These findings favor individualized assessment rather than routine high-dose panels of supplements.

For patients with ARFID or highly selective eating, dietary pattern is more clinically useful than diagnosis alone when considering potential nutrient concerns. For example, very limited intake of animal products may raise concern for vitamin B12 or iron; minimal fruits and vegetables may increase risk for vitamin C inadequacy; and avoidance of dairy, fortified foods, seafood, eggs, or iodized salt may warrant closer review of vitamin D, calcium, or iodine intake. These patterns guide assessment; they do not establish deficiency or automatically justify high-dose supplementation (Schmidt et al., 2021; Yule et al., 2021).

Table 1. Nutrients Used to Address Deficiency or Refeeding Risk

Product or nutrient	When to consider it	Key cautions	Clinician action
Multivitamin with minerals	Temporary support when intake is insufficient or multiple inadequacies are likely	No evidence that a multivitamin treats eating-disorder psychopathology. Avoid duplicating nutrients across products; review upper limits.	Use as short-term support when indicated. Reassess once meals and variety are improving.
Vitamin D	Documented deficiency or strong clinical risk; support bone health	Corrects vitamin D status, but supplementation alone does not restore bone health or treat an eating disorder. Excess dosing can cause toxicity.	Check level when clinically indicated. Dose and monitor according to age, risk, and local protocol.
Calcium	Meet age-appropriate requirements when dietary intake is inadequate	Bone health also depends on adequate energy, endocrine recovery, resistance or weight-bearing activity when medically appropriate, and other factors. Excess supplemental calcium may cause adverse effects.	Estimate usual intake first. Fill the gap only when food sources are insufficient or not yet realistic.
Iron	Confirmed iron deficiency or iron-deficiency anemia	Fatigue is nonspecific. Iron can worsen constipation and gastrointestinal distress; overload is harmful.	Confirm deficiency before supplementing. Monitor response and constipation or gastrointestinal side effects.
Zinc	Documented deficiency or compelling clinical concern	Small older studies do not establish zinc as a routine appetite or weight-restoration treatment. Excess zinc can cause nausea and copper deficiency.	Use a defined dose and duration; monitor prolonged or high-dose treatment.
Vitamin B12, folate, vitamin C, or iodine	Dietary pattern or laboratory findings suggesting risk of inadequacy	Risk depends on the foods omitted, medical history, and laboratory findings. Empiric high-dose use may be unnecessary or harmful.	Assess dietary pattern and medical context; coordinate testing and replacement when indicated.
Thiamine	Prevention or treatment of deficiency during refeeding in patients at risk	Medical refeeding protocols commonly include thiamine prophylaxis for patients judged to be at risk. Dose, route, and duration vary by medical risk and protocol. One adolescent audit found that a multivitamin providing 10 mg/day was adequate within that program’s supervised nutritional rehabilitation protocol; this should not be generalized to all refeeding-risk presentations (da Silva et al., 2020; Parker et al., 2020).	Follow the medical refeeding protocol. Give before or with nutrition when indicated; do not delay nutrition while awaiting a level.
Phosphorus, potassium, magnesium, or other electrolytes	Medical management of electrolyte abnormalities or refeeding risk	Electrolyte replacement requires medical assessment and monitoring. These products should not be self-directed by patients or managed independently in outpatient psychotherapy or nutrition care without medical oversight.	Coordinate promptly with the medical team.

Gastrointestinal Symptoms and Symptom-Directed Supplements

Gastrointestinal symptoms are common during restriction and early nutritional rehabilitation. They often improve with consistent nourishment and time, but persistent or severe symptoms require medical assessment. A supplement should not be used to avoid adequate portions, feared foods, or indicated evaluation.

Restrictive dietary treatments for gastrointestinal symptoms warrant particular caution in patients with current or past eating-disorder symptoms. Broad elimination diets may increase anxiety, nutritional inadequacy, food fear, and social impairment when poorly implemented or prolonged. If a dietary intervention is medically indicated, it should be time limited, nutritionally adequate, and coordinated with the eating-disorder treatment plan (Simons et al., 2022).

Table 2. Symptom-Directed and Mechanism-Based Supplements

Product	Reason patients may ask	Evidence snapshot	Use in practice
Ginger	Nausea	Reviews across several populations suggest possible benefit, but evidence quality varies and eating-disorder-specific trials are absent (Li et al., 2024).	Consider only as an adjunct, not a substitute for regular nourishment or medical assessment. Ask prescriber or pharmacist about bleeding risk or interactions when relevant.
Enteric-coated peppermint oil	Irritable bowel syndrome-type pain or bloating	Meta-analysis supports benefit in IBS, not specifically in eating disorders (Ingrosso et al., 2022).	Confirm an IBS-type symptom pattern. Avoid presenting peppermint oil as treatment for malnutrition-related delayed gastric emptying. Monitor reflux.
Magnesium products	Documented deficiency; selected clinician-directed constipation regimens	Evidence for magnesium in anxiety or sleep does not establish efficacy for eating-disorder symptoms. Different magnesium salts and laxative doses are not interchangeable.	May be appropriate within a clinician-directed constipation regimen. Diarrhea, electrolyte disturbance, renal impairment, medication interactions, and misuse as a purging agent require attention.
Probiotics	Selected gastrointestinal indications	Eating-disorder evidence is preliminary and heterogeneous; strain, dose, and outcome matter (Bahari et al., 2024; Dhopatkar et al., 2023).	Do not use a generic gut-healing rationale. Use caution in severely ill or immunocompromised patients, those with central venous catheters, and critically ill patients.
Omega-3 fatty acids	Meeting nutritional needs; selected non-ED medical indications	Mechanistic plausibility has not translated into sufficient evidence for routine treatment of eating-disorder symptoms.	Food sources may support adequacy and exposure goals. Supplements may cause gastrointestinal effects; review use with the prescriber or pharmacist in patients receiving anticoagulants or with bleeding risk.
Fiber powders or appetite products	Constipation, fullness, or appetite regulation	May be useful in selected circumstances but can worsen bloating or be used to suppress appetite or delay eating.	Assess timing, dose, fluid intake, and function. Avoid allowing fiber products to substitute for meals or reinforce fear of hunger.

High-Risk Products and Eating-Disorder Functions

Some products are particularly important to assess because they may function as compensatory behaviors, increase medical risk, or reinforce restrictive and weight-control beliefs (Puckett, 2023; Roerig et al., 2010). Use direct, nonjudgmental questions about the product’s purpose, frequency, dose escalation, and relationship to eating, exercise, weight, or shape concerns.

Table 3. High-Risk Products Commonly Encountered in Eating-Disorder Care

Product category	Why this raises concern	What to do next
Laxatives, “detox” teas, senna, cascara, colon cleanses, or magnesium misuse	May serve a purging or weight-control function and contribute to dehydration, electrolyte disturbance, and delayed medical assessment.	Ask directly about purpose, frequency, dose escalation, and bowel-related fears. Coordinate medical evaluation when indicated.
Diuretics or “water-loss” products	May be used to purge or influence weight or body shape and can increase dehydration and electrolyte risk.	Clarify exact product and use pattern; involve the medical team promptly when misuse or medical symptoms are suspected.
Stimulants, pre-workout products, energy drinks, caffeine powders, guarana, or green tea extract	May suppress appetite, worsen anxiety or insomnia, reinforce compulsive exercise, or contain undisclosed ingredients.	Review the exact product and ingredients. Encourage prescriber or pharmacist review; do not frame these products as benign wellness tools.
“Fat burners,” thermogenics, metabolism boosters, ketone products, or appetite suppressants	May reinforce weight-control beliefs, restriction, and body checking; multi-ingredient products may have uncertain contents.	Explore the behavioral function and assess for eating-disorder escalation. Discourage reliance on products with unclear ingredients or no defined indication.
Activated charcoal, “binders,” detoxes, or cleanses	May interfere with medications, increase food fear, and reinforce beliefs that ordinary foods are toxic.	Identify the underlying concern and redirect toward symptom assessment, adequate nourishment, and indicated medical evaluation.
Proprietary blends or supplement stacks	Total ingredient exposure, duplication, interactions, and contamination risk may be difficult to assess.	Prefer a single-ingredient product with a defined indication, monitoring plan, and stopping rule.

When Supplement Questions Require Medical Coordination

Therapists and dietitians can identify risk, assess behavioral function, gather product information, and coordinate care. The following situations warrant prompt communication with the medical team:

• Suspected laxative, diuretic, stimulant, “fat burner,” or detox-product misuse.
• Syncope, chest pain, palpitations, severe weakness, confusion, or acute dehydration.
• Vomiting, diarrhea, inability to maintain intake, rapidly worsening gastrointestinal symptoms, or severe constipation with abdominal distension or persistent pain.
• Possible refeeding risk, new edema, or signs of electrolyte disturbance.
• High-dose or prolonged use of iron, zinc, fat-soluble vitamins, magnesium, or multi-ingredient products.
• Pregnancy, renal disease, anticoagulant therapy, complex medication regimens, or significant medical comorbidity.
• A product that is clearly escalating food avoidance, compulsive monitoring, purging, or compulsive exercise.

Responding to Nutrition Claims From Social Media

A corrective fact alone rarely changes a behavior that is serving an emotional or eating-disorder function. Begin with curiosity, validate the understandable wish for relief or certainty, identify the implied rule, and offer a collaborative, time-limited alternative that protects nutritional adequacy and recovery goals. Avoid getting pulled into debating every biochemical detail. The aim is to reduce fear and restore flexibility while arranging medical evaluation when symptoms warrant it.

Table 4. What to Challenge and What to Say Instead

Online claim	Hidden message	Clinical concern	What to say instead
“Cortisol belly”	Abdominal shape or weight distribution proves cortisol dysfunction and can be corrected with detoxes or hormone-balancing products.	Stress can affect sleep, appetite, digestion, and eating patterns, but body shape is not a diagnostic test. The claim overstates a single mechanism and often sells restriction or products.	“Body shape cannot diagnose a hormone problem. But stress can affect the way our body functions. Let’s address sleep, regular nourishment, stress management, and any symptoms that need medical assessment.”
“Glucose spikes cause anxiety”	Normal post-meal glucose changes are dangerous and carbohydrates should be minimized or monitored continuously.	Post-meal glucose changes are a normal part of digestion and metabolism. Anxiety-like sensations after eating may reflect undernourishment, long intervals between meals, caffeine, anxiety, or conditioned fear of eating.	“Consistent meals and snacks that include carbohydrate, protein, fat, and fiber can support steadier energy. We do not need to fear normal changes after eating or use glucose monitoring without a clear medical indication.”
“Gut healing cures depression”	Probiotics, cleanses, or elimination diets can replace comprehensive depression care.	The gut-brain axis is relevant, but depression is multifactorial and microbiome interventions are not established stand-alone treatment.	“Gut symptoms deserve care, and nutrition can support health. Depression also warrants comprehensive assessment and evidence-based treatment.”
“Seed oils cause ADHD”	Common culinary oils are toxic or inflammatory and cause neurodevelopmental symptoms.	ADHD is a neurodevelopmental condition with strong genetic and developmental contributions. There is no established evidence that seed oils cause ADHD. The claim promotes avoidant rules without replacing ADHD care.	“ADHD is not caused by food and certainly not one food ingredient. Let’s protect adequate, flexible nourishment and address ADHD with appropriate clinical supports.”
“Clean eating”	Health requires avoiding processed, chemical, toxic, or inflammatory foods.	Moralized labels can intensify anxiety, shame, rigidity, and social avoidance. Processing is a continuum, and processed foods can be nutritious, accessible, affordable, culturally important, and essential to recovery.	“Food is not morally clean or dirty. A helpful pattern is adequate, varied, flexible, culturally responsive, accessible, and sustainable.”
“Protein treats ADHD”	Protein loading treats attention symptoms.	Protein is nutritionally important but is not an established ADHD treatment. Overemphasis may crowd out carbohydrate, fat, variety, and total energy.	“Protein should be part of regular balanced meals for everyone. ADHD care may also include accommodations, skills, therapy, and medication.”
“Elimination diets reduce ADHD symptoms”	Removing gluten, dairy, sugar, dyes, or multiple foods will help most patients.	Broad elimination is not routine ADHD care and may increase deficiency risk, family conflict, food fear, and eating-disorder symptoms. Selected sensitivities require individualized assessment.	“We should not remove broad food groups without a clear indication. If a pattern seems reproducible, we can document it and evaluate it with the medical and nutrition team.”
“Supplement stacks are better than medication”	Multiple products can replace evidence-based psychiatric or medical treatment.	Supplements may be useful for a defined deficiency, but stacking raises cost, duplication, interaction, contamination, and adherence risks. Natural does not mean harmless.	“Let’s review every product and its purpose. We can keep what has a clear indication and monitoring plan, and coordinate changes with the prescriber and pharmacist.”

Therapist-Specific Applications

Even when a supplement appears medically low risk, it may still matter clinically. Therapists can help patients explore what the product, food rule, or monitoring habit is doing for them emotionally and behaviorally. It may be serving as:

• A way to feel safer or more certain about eating.
• A ritual tied to control, purity, identity, or self-worth.
• A form of checking, reassurance seeking, or body surveillance.
• A way to avoid harder therapeutic work, such as sitting with distress, practicing exposure, grieving losses, or building emotion-regulation skills.
• An extension of compulsive health searching, ingredient checking, or social-media comparison.
• A way to keep avoidance in place while still appearing engaged in recovery.

This work can begin with curiosity: What does the patient fear would happen if the product were reduced or stopped? Does it make eating more flexible or more narrow? Does it support connection and daily life, or does it pull the patient further into checking and rules? When appropriate, therapists can use behavioral experiments, response prevention, and limits on health-content consumption to help patients test feared predictions in a supported way. The goal is not to dismiss symptoms or minimize health concerns. It is to help patients separate useful self-care from behaviors that keep fear, avoidance, or compulsive control in place.

Dietitian-Specific Applications

Dietitians are well positioned to assess intake, food variety, supplement duplication, and the relationship between supplement use and eating-disorder behaviors. Eating-disorder nutrition assessment includes review of medications, dietary supplements, potential interactions, and misuse or compensatory functions (Hackert et al., 2020).

In practice, dietitians can help by:

• Start with the person’s real-life context, including food access, affordability, culture, sensory needs, gastrointestinal symptoms, cooking skills, time, and other practical barriers that may shape what they are able to eat.
• Look for nutrient gaps by first understanding the patient’s usual pattern of eating, rather than jumping quickly to broad supplementation.
• Clearly separate medically indicated oral nutrition supplements from optional dietary supplements that may not be needed.
• Notice when a product is taking the place of meals, narrowing portions, or making appetite suppression feel safer or more acceptable.
• Frame food-first care as a path toward adequacy, flexibility, pleasure, culture, and access, not as pressure to eat “perfectly.”
• Bring the medical team in before starting elimination diets, supplement trials, or restrictive gastrointestinal protocols for patients with active eating-disorder symptoms.
• Keep the treatment team aligned so that supplement recommendations, meal planning, therapy goals, and medical care send the same recovery-supportive message.

Product Selection and Documentation

When a supplement is indicated, choose the simplest formulation that meets the clinical need and avoid proprietary blends that obscure ingredient amounts. Review the Supplement Facts label, serving size, total daily exposure from all products, lot information, expiration date, and storage instructions. Independent certification, such as USP Verified or NSF certification, can help confirm identity and manufacturing quality, but it does not prove that a product is effective or appropriate for a particular patient.

Clinicians should document:

• The indication and target symptom, deficiency, or medical concern.
• Exact product, ingredients, dose, frequency, and duration.
• Other medications and supplements reviewed.
• Potential adverse effects, contraindications, and interactions considered.
• The monitoring plan, reassessment interval, and stopping rule.
• The product’s observed or suspected relationship to eating-disorder behaviors.

Suspected serious adverse events can be reported through the FDA Safety Reporting Portal.

Conclusion

The clinically useful question is not whether supplements are good or bad. It is whether a specific product, for a specific patient, has a defined indication, credible evidence, acceptable risk, and a plan for monitoring and discontinuation. In eating-disorder care, that decision must also account for whether the intervention increases flexibility and nutritional adequacy or strengthens fear, stigma, and rigid control.

A targeted supplement can be appropriate when it has a clear purpose, monitoring plan, and stopping point. A supplement-centered recovery plan is not.

References

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