Intuitive Eating and IBS Part 2: Non-Diet Strategies for Managing IBS Symptoms
If you struggle with IBS, before cutting out or eliminating foods (especially ones you love!) read this blog post to learn non-diet approaches that can help manage your symptoms.
In part 1 of my series on Intuitive Eating and IBS, I introduced what IBS is, some of the possible causes/factors that contribute to IBS symptoms, and how intuitive eating and a non-diet approach, especially when combined with medical nutrition therapy, can help support IBS management. I also broadly discussed commonly recommended therapeutic diets for IBS, and some of the potential pros/cons of elimination diets. Give it a read if you haven’t, but essentially the takeaway was that IBS is a very individual diagnosis, and there’s no single “right” way to treat it. What helps one person may not work for another, and may even cause harm.
In part 2, I am sharing specific non-diet tips and strategies for managing IBS. As I mentioned in Part 1, there may be some cases where reducing or eliminating a food is indicated, but that’s a lot less common than Dr. Google makes it seem! For most people, I recommend using non-diet strategies before trying an elimination diet or giving up a food you love. I’ll note, a few of these non-diet strategies pertain to food, but they’re more about increasing intake and eating patterns, so I still consider them to be non-diet.
Non-Diet Strategies for Managing IBS Symptoms
Deep breathing before eating.
Because there is a strong connection between the brain and the gut, there is a strong relationship between anxiety and IBS. The vagus nerve runs from the brain down through the gut and is involved in regulating everything from breathing to heart rate to digestion (i.e. the autonomic nervous system). Most people are familiar with the “fight or flight” stress response (also called the sympathetic nervous system), which is part of the autonomic nervous system. In this state, digestion slows and blood flows away from the gut towards the extremities. As you might guess -or perhaps have experienced personally! - when you are in a constant state of sympathetic activation, IBS symptoms ramp up.
Another part of the autonomic nervous system, which is regulated by the vagus nerve, is the parasympathetic nervous system. Another name for our parasympathetic nervous system is “rest and digest.” In this state, blood is directed to go the gut to assist in digestion and absorption of nutrients, and helping the muscles in the gut move things along.
To help activate your parasympathetic nervous system, it can be helpful to give yourself a moment for deep breathing before eating. Any breathing technique that helps you feel calm is great, but I like to recommend diaphragmatic breathing, which stimulates the vagus nerve. Here’s a helpful description and demonstration of diaphragmatic breathing. Even just taking 10 seconds to slowly breathe can be helpful! Another meditation/breathing exercise I recommend is progressive muscle relaxation, which I find is especially beneficial for people who hold tension in their gut.
Aim to eat every 3-4ish hours throughout the day.
One of the biggest IBS triggers I see among my clients is a chaotic eating schedule. Eating on an irregular schedule, going long periods of time without eating then eating larger amounts, can cause a lot more discomfort than any individual food. In fact, I often find when clients eat on a regular schedule, they can tolerate foods that used to trigger symptoms. While there’s no need to follow a strict eating schedule, having a consistent flow with eating is helpful, as it gives your gut a chance to get into a predictable rhythm. I’ll note, the 3-4ish hour recommendation is a general one to help prevent going too long without eating, but some people may benefit from eating more frequently, and occasionally there may be someone who does better going longer periods.
Aim for balance at meals.
By balance, I mean aiming to include a source of protein, fat, and carbohydrate at meals, ideally along with some produce. Similar to as I described above, by aiming for balance at meals, it allows your body to expect consistency in how you’ll be feeding it. Also, each of the macronutrients stimulates the release of different digestive enzymes, which is helpful for digestion. Dietary patterns that are inadequate or excessive in one or more of the macronutrients can lead to digestive symptoms. Aiming to include different foods at meals helps ensure you’re not getting too much or too little of any one thing.
Try gut-directed hypnotherapy.
Gut-directed hypnotherapy is a kind of hypnotherapy, but for the gut. The hypnosis is nothing like the sort of sensationalized depictions you often see in media, but rather a therapist helping a client achieve a state of deep relaxation, then using guided imagery and meditations, as well as education about how the gut works. Sounds kinda “woo,” but there is research showing that it can reduce symptoms by up to 80%, and is similarly effective to a low FODMAPS diet. Here’s a helpful article on the treatment if you’d like to learn more, and here’s a list of providers who are trained in gut directed hypnotherapy. If you can’t find a provider, I’ve had clients who have found good success with Nerva, a gut-directed hypnotherapy app.
Consider supplements.
There are a TON of supplements out there that get thrown at people at IBS. I’m pretty cautious about recommending supplements, as often they aren’t backed up by rigorous research, and can do more harm than good. Regulation of dietary supplements in the US is also a bit of a crapshoot. Just because something is natural doesn’t mean it’s harmless. Most medications originally come from a natural source, and if something has a medicinal effect in your body, that means there’s potential side effects too. I suppose the good news is that most supplements actually don’t do what they say, and the most likely effect is what we like to call “expensive pee!”
That said, there are some supplements that may be beneficial for some people. Please note, these are not individual recommendations, and if you do choose to try a supplement, please do so under the guidance of your doctor or a dietitian with experience in IBS.
- Probiotics - Different strains have different functions, so before grabbing whatever you find at CVS, do some research. Better yet, work with a dietitian or doctor to identify a type of probiotic that's best for you. This clinical guide to probiotics is helpful.
Iberogast - Iberogast is a liquid supplement made from plant extracts that’s helpful for promoting gut motility. I like it for those who experience trapped gas, bloating, and abdominal pain, and for post-meal indigestion. It’s a type of digestive bitter, so if you don’t like this one there are many other brands/types available.
Fiber supplements - Be careful about what types you use. Fermentable fiber supplements, often marketed as prebiotics, can cause painful bloating for IBS sufferers. Focus on soluble fibers, like psyllium, which form a gel in liquids that can make stools easier to pass while providing bulk.
IB Gard - IB Gard is a peppermint oil supplement that is often recommended for IBS, and there is some reaserch suggesting it may be helpful for reducing abdominal pain.
Beano - There's all sorts of expensive digestive enzymes on the market, but the one I recommend most often is regular 'ole Beano!
Consider fermented foods and/or prebiotics.
Fermented foods, like yogurt, kefir, miso, and kimchi, have a long history of use in many cultures for both culinary and therapeutic reasons. These foods are a source of beneficial probiotic bacteria, and have been a popular recommendation to support digestive health. This is definitely one of those cases of what’s helpful for one person may not be helpful for everyone! While fermented foods can support a healthy gut microbiota, and there is some research showing benefits for IBS symptoms, they can also trigger gas and bloating for others. In my experience, fermented foods can be really helpful for some people, and for others they pretty immediately cause discomfort. If you’re in the latter camp, don’t force yourself to eat them just because they’re supposedly “healthy!”
Get adequate sleep.
Did you know that both gut microbiota and gut motility are partially regulated by the circadian rhythm? Getting adequate sleep is incredibly important for managing IBS symptoms. If you struggle with anxiety, depression, PTSD, or other medical issues that impact sleep, I know it’s not as easy as just practicing good sleep hygiene. At the same time, practicing good sleep hygiene is something that you can do that is often overlooked in discussions of health, which alway seem to focus on diet and exercise. Try to get to bed at a similar time each night, be mindful of smoking, alcohol and caffeine use, and consider setting up a relaxing nighttime ritual, like turning off the TV and reading in bed.
Go to therapy, and consider medication.
If your IBS is related to anxiety (a Venn diagram I suspect is almost a circle), trauma, or depression, consider therapy if you have access to it. There’s also nothing wrong with using mental health medications, and some have been shown to improve IBS symptoms as well, mainly tricyclic antidepressants, which seem to be more beneficial for IBS-D, and serotonin reuptake inhibitors (SSRIs), which seem to be more beneficial for IBS-C.
Try yoga for digestion.
Yoga can be helpful both for it’s stress relieving benefits, and to help promote gut motility. Consider movements that stretch, twist, or compress the abdomen, as this helps improve blood flow to the gut, and mechanically moves things along. Here’s a list of yoga poses for digestion that may be helpful.
Limit alcohol.
While research shows moderate amounts of alcohol do not seem to trigger IBS symptoms, drinking larger quantities in a short period of time ((more than 4 drinks in a day) can worsen symptoms. Yes, the beer shits are a thing. Long term alcohol use can also impact gut motility, gut permeability and reduce nutrient absorption. If you have IBS, it is recommended to limit alcohol to 1 drink a day for women and 2 drinks a day for men, and to have at least 2 alcohol free days a week.
Get some physical activity, but let’s not go overboard!
Exercise can be helpful for IBS, but too much of a good thing can cause harm. Vigorous, sustained cardiovascular exercise can exacerbate symptoms, as it directs blood flow away from the gut and towards the extremities. The clients I’ve worked with who struggle with compulsive exercise and IBS often find that healing their relationship with movement makes a big difference in reducing their symptoms. If you’re someone who does a lot of intense exercise (whether it’s related to disordered eating or not), you might benefit from doing more gentle movement versus vigorous physical activity. Check out this post on gentle movement I’ve been loving lately for some ideas.
Purchase a squatty potty.
If you struggle with constipation or incomplete bowel movements, try a squatty potty, which is a kind of stool you can place in front of your toilet to raise your feet when you go to the bathroom. This allows for you to better access your gut muscles for more complete bowel movements.
Hydrate!
Fluids are important for digestion and having easy to pass bowel movements. There’s no right amount of water to recommend to everyone, as fluid needs can change quite a bit day to day. For example, on an active, hot day, you’ll need a lot more fluids than usual! The pee test is generally a pretty good one. Make sure your urine is clear or light yellow, otherwise drink some more liquids. Also, remember that while water is one way to hydrate, other fluids (and food that contains fluids!) help hydrate too.
Talk to your doctor about medications.
There are medications that may be helpful for managing your IBS, both over the counter and prescription. This website has a helpful list of commonly prescribed/recommended medications for IBS. As a heads up, if you have a history of disordered eating or are actively struggling, stimulant laxatives are something you’ll want to avoid or only use under close supervision.
If you are someone who struggles with IBS, I hope reading this provides you with some ideas for managing your symptoms that don’t involve dieting or restriction. Of course, as I mentioned in part 1, changes to food and nutrition can be a useful tool in navigating life with IBS. For most people, it’s a combination of nutrition, lifestyle, mental health, and medical interventions that improve their quality of life.
Generally speaking, I think it’s useful to look at these tips and strategies before turning to dietary elimination. I hope this post shows you that there’s a lot we can do to find relief without cutting out foods or following a strict diet. If you’re looking for support in navigating food with IBS, with work with clients both in person in Columbia, SC, where my associate dietitian Kate is located, and virtually throughout the US. We’re also in network with BCBS, so depending on where you live, we may be able to work together at no charge to you! We’re also happy to recommend a dietitian in your area if you’d like to see someone locally. Read more about our practice philosophy here, and reach out if you’re interested in working together!
If this blog post on non-diet strategies for managing IBS symptoms was helpful, you might also like:
Intuitive Eating and IBS Part 1
Disordered Eating & IBS
Intuitive Eating and IBS Part 4: A Personal Narrative