While the Low FODMAP Diet can have a huge impact on improving IBS symptoms for many people, some people may find they are having a poor response to the diet. This could be due to a variety of reasons. The Low FODMAP Diet is a complex dietary strategy to follow, which is why it is important to work with an experienced dietitian to help you understand the diet and find out your IBS triggers.
There are many things to consider when it comes to triggers of IBS symptoms, including triggers outside of FODMAPs. For IBS Awareness Month, we have investigated a series of what other management strategies can help improve IBS symptoms if the low FODMAP isn’t working.
Read on to discover other evidence-based strategies for IBS.
1. Gut-directed Hypnotherapy
Interestingly there is some great scientific research to support the use of gut-directed hypnotherapy for managing IBS. In fact, one study found that it was as effective as the Low FODMAP Diet for improving IBS symptoms including abdominal pain, bloating and bowel habits. The improvement in symptoms from gut hypnotherapy appears to last long-term (at least 6 months).⠀
So what is gut-directed hypnotherapy?⠀
As the name suggests, it involves hypnosis by a trained hypnotherapist to alter ones state of consciousness. The hypnotherapist suggests control of gut symptoms to the subconscious mind. The recipient is lead to envisage a positive symptom response. When having an IBS flare up, you can use the positive gut association as a tool to help. The exact mechanism of gut hypnotherapy is unclear, however it is understood to work through changes to the gut-brain axis (the communication pathway between the brain and the gut). Hypnotherapy has also been shown to help reduce feelings of stress, anxiety and depression.⠀
If haven’t had much relief from the strict Low FODMAP diet or are looking for alternative IBS management, why not try out gut-directed hypnotherapy?
2. Consider Fluids
While it might seem quite obvious that drinking enough water is good for our health, how many of us are really drinking enough? For people with IBS, the amounts and types of fluids consumed can make a huge difference on their symptoms.⠀
Water is a particularly important fluid for hydration and to prevent the effects of dehydration such as lethargy, low energy levels, headaches and electrolyte imbalances. For those with constipation-predominant IBS (IBS-C), having adequate fluid intake will help to keep gut motions regular. In diarrhoea-predominant IBS (IBS-D), it is important to drink extra water and potentially electrolytes as well, for preventing dehydration, which can occur with loose bowel motions.⠀
Caffeine and alcohol are other types of fluid that are important to consider too. Caffeine (in coffee, energy drinks, tea etc) and alcoholic drinks are considered gut irritants. Caffeine acts as a diuretic and stimulates gut motility, making food move through the digestive system quicker. In people with IBS-D, caffeine may worsen their symptoms, while for people with IBS-C, caffeine (like a cup of coffee) may help to keep them more regular. Alcohol has been shown to flare up IBS and contribute to stomach pain and diarrhoea. Limiting your intake on alcohol could have a positive impact on your symptoms as well as general health. Lastly, it is important to consider that carbonated drinks, such as sparkling water, can contribute to bloating. This is due to the extra gas (bubbles) ingested when carbonated drinks are consumed.⠀
How much fluid should you drink?⠀
The answer to this will vary for each individual based on factors such as size and activity levels. A general target is to aim for 8 cups or 2L fluid over the course of the day.⠀
3. Gentle Movement
In general, doing regular activity is great for overall health. Exercise increases physical strength, cardiovascular fitness, can support mood and mental health from the release of endorphins and promotes long term health. Not all types of exercise have the same impact, especially in IBS. The best types, intensity and duration of activity will vary for each individual. When you are feeling well and on-top of your IBS, there should be no problem in engaging in whatever exercise you enjoy.⠀
However, if you are experiencing a period of flaring IBS symptoms, intense and endurance exercises (such as HIIT, running and CrossFit) may aggravate gut discomfort. This is because intense and endurance exercise are forms of stress on the gut. During exercise, blood flow is diverted away from the gut and towards the working muscles and organs (such as the heart and lungs). The reduced blood flow to the gut may interrupt the digestive process and increase gut permeability. Together this may lead to increased symptoms such as cramping, abdominal pain and diarrhoea.⠀A caveat is that those with constipation-predominant IBS (IBS-C) may benefit from a small amount of intense exercise to help speed up gut motility.⠀
During a period of worsened IBS symptoms, gentle movement such as walking, yoga, swimming, light cycling and tai chi can provide a great amount of relief on the gut. These more gentle forms of exercise have the benefit of relieving both mental and physical stress on the body, which can help reduce symptom severity in IBS.
4. Limit Alcohol
Many people experience uncomfortable gut symptoms after drinking alcohol, whether or not they have IBS.
Alcohol is considered a gut irritant. This means that even if you choose a low FODMAP alcoholic drink, it can still be an IBS trigger and lead to worsened gut symptoms. Alcohol increases the speed at which food moves through the gut (gut motility). As a result, there is less time for water to be absorbed from food matter in the colon (large intestine) and proper digestion in the gut becomes affected. This can result in loose bowel motions and diarrhoea. Alcohol is also a diuretic, causing the body to excrete more water through urine. Drinking large amounts of alcohol can therefore contribute to dehydration and may even lead to constipation as there is less water available to soften the stools.⠀
Drinking large amounts of alcohol can also alter the gut microbiome (community of microorganisms living in the gut) and damage the gut lining, leading to inflammation of the gut.⠀
The National Health and Medical Research Council advise to drink no more than two standard drinks per day and to have two alcohol-free days per week. A standard drink is equivalent to 375ml of mid strength beer, 100ml wine or a 30ml of spirits. Guidelines for IBS recommend reducing intake of alcohol and fizzy drinks, which can also contribute to bloating and distention.⠀
If you decide to have a drink, stick to low FODMAP types such as beer, wine (except sticky wines) and plain spirits (except rum). Be aware that mixers can be high in FODMAPs. Ensure to also hydrate with water when having your alcoholic drink. If you’ve IBS has been flaring up, try to have a few alcohol-free days each week and see if your symptoms improve.
Other Important Things To Consider
While the Low FODMAP Diet is effective for 75% of people with IBS, there are still some people (the other 25%) who do not respond to the Low FODMAP Diet. Many people still attribute their gut symptoms to food they have eaten. This may be due to a non-FODMAP dietary trigger, as in the case of alcohol. It may also be in a the case of a food chemical intolerance or even an allergy. If these are suspected, it is very important to work with an expert dietitian to determine specifically what it is causing your symptoms.
Furthermore, changes to stress and sleep can also greatly impact the gut. Not getting enough sleep and having increased stress levels may also contribute to exacerbated gut symptoms.
If you are not sure what the main triggers are for your IBS symptoms, working with doctor and dietitian is a great way to start. Their expertise can help guide you in the right direction for management strategies that are right for you.
You may also like to think about the strategies listed above and trial incorporating these into your IBS tool kit.