Yes, there are some Non-diet interventions for IBS that don’t involve automatically cutting out foods! Let’s dive in.

Oh, IBS. What a joy. IBS stands for Irritable Bowel Syndrome. IBS is a common gastrointestinal disorder (functional syndrome rather than a disease) causing uncomfortable symptoms (hello bloating, constipation, diarrhea) with no obvious abnormality. Usually it’s a diagnosis of exclusion, meaning gastroenterologists (Doctors specializing in GI disorders) rule out other causes before diagnosing IBS. Typical automatic treatment recommendations for IBS include a Low-FODMAP diet, which is a short-term yet intensive elimination diet avoiding foods high in certain fermentable carbohydrates that may contribute to symptoms. But often when given as a one-size-fits-all approach, it can do more harm than good. Eliminating foods can often lead to even more stress and disorder around food, which is a perfect storm for IBS symptoms. Yes, a low-FODMAP diet can work wonders for some people, but it’s worth trying other evidence-based treatments first to see if they help before jumping into restricting any foods. Luckily there are plenty of non-diet interventions for IBS!

What causes IBS?

First off, IBS is super common, unfortunately. It will affect 20% of Americans at some point in their lives. That’s 1 out of every 5 people! There isn’t just one known cause of IBS (especially since it can look different in different people), but some proposed causes may include:

• Certain Lifestyle Factors ( certain eating patterns, sedentary lifestyle)
• Environmental Stressors (emotional/financial/social/occupational stressors)
• Pre-existing psychosocial factors (depression, anxiety)
• Pre-existing atypical gut motility
• Food intolerances or dietary imbalances (such as too little fiber)
• Altered serotonin levels/production in the gut (which is why some treatments may include SSRIs, or Selective serotonin reuptake inhibitors )

*Did you know? 98% of people with an eating disorder struggle with a functional gut disorder. Oftentimes, my clients who struggle with their relationship to food also have GI distress, and it often improves once their relationship to food improves!

What are the symptoms?

You may have some, a mix, or all of these symptoms if you struggle with IBS. There are 3 types of IBS, IBS-C (constipation predominant), IBS-D (diarrhea predominant), or IBS-M (mixed).

• Abdominal pain
• Bloating
• Cramping
• Diarrhea
• Constipation
• General altered bowel movements

How is it diagnosed?

IBS is a diagnosis of exclusion, meaning they have to rule out GI conditions that involve abnormalities first. There’s no one test to definitively diagnose IBS.  Typical testing may include testing to rule out:

• Celiac Disease
• Inflammatory Bowel Disease (IBD) i.e. Ulcerative Colitis and Crohn’s Disease
• Diverticular Disease
• Certain cancers
• Endometriosis
• Pelvic Floor Disorders
• Hormonal Disorders (such as thyroid disorders)
• Bile Acid Malabsorption

Then, your doctor may diagnose you based on the Rome Criteria: which include abdominal pain and discomfort lasting on average at least 1 day per week in the last 3 months, associated with at least 2 of the following factors: Pain and discomfort in relation to defecation, the frequency of defecation is altered, or stool consistency is altered.

Testing may also include lab work (such as ruling out thyroid issues or anemia), stool tests (checking for infections, bacteria, etc.), or a colonoscopy or upper GI endoscopy (usually used to rule out Celiac disease).

How is it treated?

IBS is typically treated with a mixture of medications (if applicable) as well as lifestyle changes. These may or may not include:

• Medications (per your MD)
• Stress Reduction 
• Physical Activity
• Being mindful of potential trigger foods
• Hydration/Fiber modification

What are some non-diet interventions for IBS?

1. Eat regularly, every 3-4 hours or so to mimic the gut’s natural rhythms. Do you feel like your eating is all over the place and chaotic? This can certainly fuel IBS. Eating regular meals and snacks (even if you don’t feel like it due to symptoms) helps promote gut motility. So avoid the temptation to skip a meal or snack, as this may only make you feel worse in the long run.
2. Try Gut-directed hypnotherapy. This is a specific form of hypnosis or meditation that has shown to reduce symptoms in up to 76 % of IBS patients. Since IBS can also be thought of as a disconnection between the brain and the gut, you can think of gut-directed hypnotherapy as helping to reconnect this link. It essentially acts on the central nervous system to reduce the sensitivity of nerves in the gut. There are plenty of free youtube videos, just search “gut directed hypnotherapy! Here is a list of clinicians by state that offer this treatment.
3. Try yoga, journaling and meditation, or your favorite form of stress-reduction! Ever heard of the gut-brain axis? Or the phrase to have “butterflies in your stomach”? Our brain and guts are very closely linked, so if you struggle with any form of stress, anxiety, or depression, it can greatly affect your gut and cause symptoms. Therefore, by managing our stress, we can manage symptoms.
4. Incorporate probiotics and certain prebiotics. Probiotics help replenish the “good” bacteria in our gut microbiome, and prebiotics help “feed” the good bacteria that are there. Both are important for gut health! We can get these in either food form, or supplement form. I always say “food first” if you can. Try incorporating fermented foods, as these are packed with probiotics. And remember, before taking any supplement, ask your doctor first – plus, different strains are more or less effective depending on type of IBS and symptoms (for example, one probiotic may work great for IBS-C, but not so well for IBS-D). There is also a chart here you can refer to that can be helpful.
5. CBT (cognitive behavioral therapy) and therapy/counseling. Both are fabulous therapeutic tools for managing stress, which once again, can help with symptom management. Talk it out with a trusted therapist.
6. Engage in mindful eating. Ever eaten so quickly you got a bad stomachache after? Yeah, been there done that. By practicing mindful eating and setting goals to eat with less distractions, we are able to tune in to our hunger and fullness, eat more slowly, and have more pleasure in our eating. Practice using more of your senses while eating (look at the food, smell the food, savor the food). Try turning off the TV or your phone, and actually sit at the table to eat (I know, I know…eating on the couch is wayyyy more fun). In turn, eating mindfully helps improve digestion and can alleviate symptoms.
7. Work on your relationship to food. Struggle with a restrict, binge mentality? Anxious around certain foods? Do you go too long without eating, only to then overeat at your next meal and have worse symptoms? These can all trigger your IBS symptoms. By normalizing all foods, working on listening to hunger & fullness, as well as other intuitive eating principles, you can help ease symptoms of IBS. Reach out for support to go through this process together!
8. Engage in Mindful Movement. Getting active in ways you enjoy has been recommended to help with symptoms of IBS. Do what makes your body feel good! If a gentle walk helps ease digestion, go for it. If a long run causes your symptoms to be worse, ease back. Sometimes, vigorous exercise can make you feel worse, so listen to your body. This is a great time to work on your relationship to exercise, and just do activities that make your body and your mind feel good!
9. Practice gentle nutrition. By tuning into your body and how food makes you feel (versus choosing foods based on morality or “good” vs “bad”), you’re more likely to be able to tune it to which foods make you feel best, and which foods may aggravate symptoms.

Does Gut Microbiome testing work?

In short, no. Not yet. The research just isn’t there yet to support the gut microbiome test offerings currently on the market (such as Viome). Not only do our gut microbiota change throughout the day (meaning you just get one brief snapshot of your bacteria makeup in time), but even if it does test our bacteria accurately, we still do not know the “perfect” levels of bacteria for optimal gut function. Plus, it’s completely individualized as to what is the “best” gut microbiome for each person. So take these tests with a grain of salt. ESPECIALLY if they tell you to avoid certain foods based on your results! This will likely just cause more stress to your relationship to food, and it has no science to back it.

Do you struggle with IBS?

Reach out for individualized nutrition counseling. Relief is possible!