After I was diagnosed with IBS I thought, “Yes! Finally! Some answers.” I was mentally resigned to the fact that my diet may have to change forever. I’d find out that all along it was this one food I was eating all the time that was ruining my life (probably something delicious that I love like cheese or rice or sugar and my sweet tooth would be forever unsatisfied). No matter how much I loved that food, I vowed never to eat it again so I would never feel sick and horrible and expanded or full of poo. Never again would I feel like my pants were trying to cut me in half or have to rush to the bathroom with the urgency of a firefighter when the bell rings. It would be glorious!
What I did not expect was that I would have more questions than ever before and that my IBS journey was only really just beginning, even though I’ve had it for at least 10 years. At first this felt disheartening. Why is it so complicated? I was willing to give up cheese! But no. It wouldn’t be that easy.
Let’s be clear here, there is still much to learn about IBS and how different people experience it, but I want to take you on a bit of a deep dive into what’s going on in your gut and why just eliminating a trigger food may not be enough. (Even if you were willing to give up your favorite food - the ultimate sacrifice - in exchange for a little digestive peace and quiet.)
A quick recap of 7th grade science
Your body is working full time, all the time. Taking care of all sorts of things going on inside you that you never have to think about because it just knows how to do its thing. (Which is super convenient because we have enough going on, amiright?) For all the time you don’t spend consciously making your heart beat, you can thank your autonomic nervous system. It runs your basic body functions like breathing, heart rate, and digestion. One of the many things your body is handling right now is a constant stream of communication between your gut and your brain along what’s called the vagus nerve, part of the gut-brain axis. The gut-brain axis is a network of highly sophisticated communication that runs back and forth sending signals via neurons and hormones about what’s going on and coordinating a response through the sympathetic and parasympathetic nervous systems.
If you’re thinking, “Did I accidentally stumble upon a middle school science teacher’s blog?” Have no fear. I’m here to break it down for you.
Sympathetic Nervous System (SNS): This baby is your fight-or-flight manager. It’s what gave our ancestors the boost of energy they needed to run from danger or the strength required to fight back when attacked. This system shuts down in the body what isn’t necessary and cranks up what is with one goal in mind: survive. In modern times it’s what makes you sweaty when you’re nervous or what gets your heart all fluttery and your breathing all quick when you’re stressed. That’s right friends: the system that helps us get moving or defend ourselves when we feel we’re in danger is constantly on standby even when “danger” has changed from “there’s a bear standing right in front of me” to “I have a meeting this afternoon with my boss and I haven’t finished that big project yet”.
Parasympathetic Nervous System (PNS): This is the super chill sib of your somewhat tightly wound SNS. PNS is responsible for the rest-and-digest side of life. When you’re not being chased by a tiger or trying to meet a deadline, this system helps your bod focus on digestion and slows your heart rate down. Very zen.
What does this mean for IBS?
When you have IBS your gut-brain axis is a little wonky. Your SNS is at the wheel and can be a little over active, while your PNS - tranquil little B that she is - is sitting in the back seat, probably on her phone, not really paying attention.
So when you realize you’re coming up on a deadline or bills are due and your checking account isn’t exactly overflowing or your to do list gets longer every day or there’s a global pandemic or whatever it is that stresses you out - your SNS is inside you screaming that it is in charge and your PNS has to wait its turn. Your SNS sucks up all your energy and adrenaline and keeps your heart beating fast, your breathing quick and short, and your body ready to pummel that to do list to the ground or sprint in the opposite direction of your checking account as fast as possible. Meanwhile your PNS is just waiting in the wings for when things are safe again. What your SNS doesn’t realize is that these stressors don’t require the level of attention or energy that it's giving them and meanwhile your gut is suffering because your PNS isn’t allowed to do its thing. Your gut is thrown into and out of its regularly scheduled digestion every time your SNS overreacts to your everyday life and this is a huge problem.
When you have IBS your gut-brain signals getting crossed can sometimes even be traced back to the symptoms themselves in a frustrating, vicious cycle of fear/anxiety/stress causing symptoms then the symptoms causing more fear/anxiety/stress about potential symptoms or another flare up. Before you know it your fear of symptoms is causing or exacerbating your symptoms and you’re stuck in an endless cycle of stress caused by symptoms caused by stress.
The Symptom Cycle
Learning to manage stress will help you manage your symptoms and avoid this cycle of pain. The challenge here is learning to consciously influence an unconscious system, but there are tons of ways we can do that. Non-symptom related benefits of stress management will also help improve your overall quality of life. Less stress can lead to better sleep and better sleep can lead to less stress. (This is a cycle we want to be in.)
Beyond just this unfortunate cycle of doom, the prevalence of depression and anxiety is high in people with IBS. And it’s no wonder! We’re constantly worried about a flare up or triggering symptoms and that worry can be a self-fulfilling prophecy. We start to limit what we eat, where we go, who we see… all to potentially avoid symptoms or the ensuing embarrassment brought on by experiencing symptoms in public. Our life choices become determined by the answer to one question: “How can I avoid this awful feeling?” and if we choose to stay in on a weekend, avoid trying new foods, stop dating or seeing friends and family thinking it’s the best way to manage our symptoms… our mental health suffers.
There are several stress management techniques we can employ in our daily lives. I’m sure you’ve heard of many of these before, but I want you to really put thought into the last category of techniques and see if you can use those to decrease your stress and manage your symptoms.
Stress management techniques you’ve probably heard of
- We know that moving our bodies makes them happy. We feel better, we sleep better, it can jumpstart our digestive systems (which is why it’s also important not to overdo it, especially if you suffer from diarrhea)... in general these are all good things that can work in our favor for symptom management.
- Moving around slowly and gently (in the case of Hatha yoga, for example) can help you regain control of your breathing and also forces your gut into new positions that may help aid in digestion. Have you ever done yoga and then heard your belly rumbling? That’s why.
- Allowing your mind the space it needs to stop thinking about all the things you need to do today, all the things you forgot to do yesterday, all the things waiting for you to do tomorrow and just do nothing and focus on right now. You don’t have to renounce your current life and become a Buddhist monk (or hey you know, give that a try… you do you). You don’t even have to meditate for that long to reap the benefits. I’m new to meditation and I try to do at least 2 minutes every day. Sometimes that happens when I wake up or in between meetings at work. Sometimes it happens in the 2 minutes before I fall asleep at night. Life is busy. Do what works.
If you’re new to meditation or are maybe looking to try something new, check out these apps: Calm, Insight Timer, and Headspace.
- When you feel the stress monster sneaking up on you (or if you’re like me and it's less of a sneak and more of an ambush) close your eyes and breathe. If you don’t, your SNS will override everything thinking your stress and quick breathing is a cry for help and your poor little PNS will be shoved to the side to make room. Aim for 4-6 breaths per minute and be sure you’re breathing into your belly (doing the shoulder up-and-down kind of breathing can trigger your SNS so pay attention to your airflow), in and out through the nose or in through the nose and out through the mouth.
Stress management techniques maybe you’ve heard of but haven’t tried
Cognitive Behavioral Therapy
- Cognitive behavioral therapy (CBT) is a type of psychological treatment that is used to manage a range of problems.
- One small way to think about this in the context of your IBS is to give yourself time to think about what is actually likely to happen or not. If you are nervous about going somewhere because you may have a flare up or may not be able to get to a toilet… actually stop to think through the scenario and don’t spiral out into the worst case scenario. Ask yourself, “What happens next?” and answer with a positive spin.
- In a study conducted in the Netherlands, it was found that “up to half of people who had individual or group hypnotherapy had adequate relief from their symptoms compared with less than a quarter of people who only had education and support.”
- You can check out The Calmer You for resources, a podcast, individual coaching, and more on hypnotherapy.
Stress management techniques you haven’t heard of
Front load the work
- You may think this sounds like a luxury, only for people with hours to spare every week, but in reality it’s attainable for anyone if you make it a priority. You can shift your time around to set yourself up for success instead of spending the week feeling like you’re drowning in responsibilities.
- Once a week (or once a month, whatever works for you) decide what needs to be done and space it all out. There’s no reason you HAVE to clean your whole place all in one day. You could dust on Mondays, vacuum on Tuesdays, take Wednesdays off for your weekly happy hour with friends, etc. You’ll keep up with your responsibilities and you won’t constantly be trying to remember things you need to do which will free up your brain to focus on other things (ideally happier things) and won’t help your hypervigilant SNS plot a system takeover.
Meal prep falls into this category. Especially if you’re doing Low FODMAP or if you know your trigger foods, the less time you have to spend thinking about your food the better. Find some recipes you can make in bulk and freeze or pre-pack so that you don’t have to pack your lunch every night or make your breakfast every morning. The less time you dedicate to these things on a daily basis the more your time will free up for things you actually want to do, including giving you the time in your schedule that you need to incorporate some of those other techniques like establishing a regular exercise routine or carving out space to meditate.
- Think about what is stressing you out and how you can really establish ways to deal with it so you no longer have to think/worry about those things regularly. You can relieve your mind and your gut from this anxiety if you have an honest conversation with yourself about what causes you stress/anxiety in your life. Some of my stress triggers and systems are below to help get your juices flowing.
- I’m a money worrier. I used to spend tons of time looking at our bank accounts, bills, savings goals, debt, etc. But then I found a system that automates my money and now it’s something I don’t have to worry about. Did you hear that? I don’t constantly worry about money anymore. I’ve reallocated that time to things that help me manage my stress, instead of feeding the stress. (Can’t recommend this book enough.)
Chores/responsibilities around the house
- I am married. We have 2 cats and a dog and several plants. I am the house manager and it is exhausting. For a long time I took on all the responsibilities. I would delegate occasionally, but not nearly enough to maintain my sanity. I’ve been working on this for years and I know I still have room to grow. When I really started to take my stress management more seriously to better control my IBS I knew I had to really commit to offloading some responsibilities and giving my partner more to do to better balance maintaining our shared space and the life we’ve created. We’ve come up with a chore system that works for both of us. I still do most of the planning but my partner now knows more about what’s required to keep our house running smoothly and this allows me more time for my own mental management.
- What are you going to eat and when? This is a HUGE question for IBS sufferers and one that really never goes away considering, you know, we gotta eat every day.
- Identify your trigger foods and find replacements for them
- Have snacks on hand that you can always eat without pain/symptoms
- Write down meals and ingredients to make things at least one week ahead. Shop once. Write meals down or put them in your calendar so you don’t have to think about what you’re making or remember what you bought. When it’s time for dinner refer to your meal sheet for the week. Don’t think about these things every day anymore. Free up your time and make space for calm in your mind. Establish habits that will do the thinking for you.
Stress management is beneficial to everyone, but doing it right can have a hugely positive impact on IBS symptoms, whereas not doing it at all can exacerbate or even cause your symptoms. (No thanks!)
When you feel stress/anxiety creeping in (or when they suddenly show up), send yourself up into a positive spiral instead of down into a negative one by taking a moment to breathe deeply or finding space to get your body moving.
Set yourself up for success and reduce symptoms from the start by taking some time to think about what in your life causes you stress and make changes to how you approach those stressors to help manage symptoms. These should be positive changes that allow you to front load your work and create systems instead of scrambling to get everything done all week long. Do the thinking when things are calm so that later when things get hectic, the hard work is already done.
One last thought: Don’t take all this on at once. Start small or pick one thing that you think would make the biggest impact and start there. You want to form good habits that you can stick to and you definitely don’t want your stress management to become stressful. (I tried to take on meditation, yoga, running, and meal planning in the same week and I definitely felt the consequences of taking on too much. Two steps forward, one week without a BM.) If you find yourself thinking, “I can't make a meal plan because I’ve got yoga and meditation tonight and I still have to schedule a CBT session for next month…” then you’re not doing it right. Also be open to the idea that you may try one of these things and not really like it. Give something an honest go and if it doesn’t work for you, move on. Same is true of your systems. If you set something up and then find that it isn’t working, tweak it until you find a way to make your life easier, then commit to it. You deserve peace of mind AND peace of gut.