How has COVID-19 impacted living with IBS?

2020 has shaken up our everyday lives in ways that we wouldn’t have been able to fathom this time last year. Our normality has changed where it is not ‘normal’ to meet friends for brunch, work at a physical workplace or have big gatherings with friends and family. Adding a functional disorder such as IBS to the mix can be more distressing, so today on the blog we wanted to discuss some of the key ways that COVID-19 may be impacting your IBS. We’re going to explore approaches to stress, access to safe foods, immunity and managing an IBS flare during lockdown.

Stress

We know that there is a link between IBS and anxiety, so it is understandable if adding a global pandemic to the mix has heightened your perception of pressure and urgency. The mind and gut are intertwined via our gut brain axis. In the gut-brain axis, our thoughts, feelings and environmental cues can lead to the release of chemicals that cause our body to act in a variety of ways. With IBS, it is postulated that the body releases stress-related hormones and neurotransmitters to your gut which can make it feel more sensitive, ultimately leading to abdominal pain, cramps and abnormal bowel movements. With a heightened sense of anxiety during these times, it is normal to feel that your IBS symptoms have exacerbated.

Our top five tips for managing anxiety/stress with IBS:

1. Gentle exercise. Activities such as walking (outside if possible), swimming and light cycling may reduce stress and anxiety. Particularly for those with IBS-C (constipation), exercise can help your bowels contract and empty.
2. Mindfulness practices. Yoga has been shown to be particularly beneficial in patients with IBS.¹ There is even evidence to suggest that practising regular hatha yoga is just as effective  than alow FODMAP diet in managing IBS symtoms! ² Yoga typically addresses both the mind and body, with some movements helping in enhancing energy circulation around the intestines.  The focus on deep breathing during a yoga class activates the parasympathetic nervous system (the rest, digest and repair arm of our autonomic nervous system) which can be helpful in reducing stress and promoting muscle movement through the intestines
3. Plan meals ahead. For those with IBS, there can often be a sense of anxiety around meals if they are not planned to be low FODMAP in advance. You may find that sitting down on a Sunday afternoon and making a bit of a meal plan for the week does wonders for your stress levels.
4. Deep breathing. Dedicating time to breath each day can help your brain communicate to your gut that everything is OK, and that it is fine to rest and digest rather than be in fight or flight As previously mentioned the practice of deep breathing stimulates our parasympathetic nervous system by increasing the activity of our vagus nerve. Starting your morning with a five-minute meditation could be a great place to start.
5. Seek professional help where necessary. A psychologist can help teach you how to break the mind-body loop that may be worsening your IBS symptoms and help you get to the bottom of your triggers. Beyond Blue and Headspace are two fantastic resources for Australians that can connect you to support.

Access to food

COVID-19 has seen negative impacts on global food security. Whether it be through decreased income or limited food availability, our shopping experiences have likely changed over the past few months. For those with IBS, shopping for food can already be a difficult enough experience. During these times, you may find that going back to basics/staples really helps. What does this look like?

• Find recipes with a few simple ingredients instead of ones where you may have to shop at more than one place
• If you can’t access low FODMAP staples such as rice and oats, see if you can substitute for other, less well-known grains such as quinoa or even a different form of rice such as rice noodles
• Check out our Low FODMAP on a budget blog post for more handy tips

Immunity

We write this segment with the caveat that no specific food or supplement can prevent a person from contracting COVID-19. However, maintaining a healthy, balanced diet can support the normal functioning of our incredible immune systems. Most of the nutrients we already get in our everyday diet (vitamins C, A zinc & protein) are all involved in maintaining immune function. As a recap, here are a few low FODMAP food sources of each:
Vitamin C: strawberries, capsicum, citrus fruits, kiwifruit
Vitamin A: lactose-free dairy products, fish, carrots
Zinc: meat, poultry, fish, shellfish, legumes, seeds
Protein: meat, poultry, fish, eggs, legumes, lactose-free dairy

Managing an IBS flare in lockdown

Managing an IBS flare during this period may be tougher than usual as you don’t have the typical access to support. Linking to our earlier segment on stress, you may also be feeling a heightened sense of anxiety at this time. Hence, we wanted to finish with some helpful tips on managing an IBS flare during lockdown:

• Return to a low FODMAP safe diet. Even if it is for a few days, returning to ‘safe’ low FODMAP foods may help you manage your flare up and ‘re-calibrate’. By returning to a low FODMAP diet for a few days, you may also be able to pinpoint what the problem food was.
• Abdominal massage or heat. Rubbing the abdomen can relieve some of the pressure that is built up by trapped gas, and heat can help in this domain too.
• Drink some tea. We like to think of tea as a massage for your insides. It is greatly relaxing to sip on and helps increase your fluid intake which is important to ‘move things along’ the digestive tract. FODMAP Friendly favourites are peppermint & green tea.

In summary

Times are tough at the moment, and it is completely normal to feel a bit upside down. With all of these areas – whether it be stress, access to food, immunity or managing an IBS flare – a compassionate approach is important. We’re all doing our best and our brain is trying to keep up with large amounts of change, so it is OK to not be excelling in all areas of life. Have a go at enacting some of these tips, and be sure to reach out for support to a trusted health professional – whether that is your general practitioner, dietitian or psychologist, when needed.

1. Kavuri V, Selvan P, Malamud A, Raghuram N et al. Remedial yoga module remarkably improves symptoms in irritable bowel syndrome patients: A 12-week randomized controlled trial. European Journal of Integrative Medicine; 2015 7(6). p. 595-608
2. Schumann, D, Langhorst, J, Dobos, G, Cramer, H. Randomised clinical trial: yoga vs. a low‐FODMAP diet in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2018; 47. p. 203– 211

Written by: Charlotte Barber (Student Nutritionist)
Reviewed by: Sotiria Karatsas (Accredited Practicing Dietitian)