Tips for Dating with IBS

One story I hear again and again on Instagram is how embarrassing and stressful dating can be when you have IBS. Both men and women have told me stories about how they are terrified to date, and end up isolating themselves because of their symptoms. Sound familiar?

This is a topic I know I needed to write about, but didn’t want to only give you my story. Instead, I will share a few stories, good and bad, about others’ experiences with dating and what they have learned. Starting with my own story, I can relate to all of the emotions and fears listed above.


When I was younger, I still didn’t understand IBS, so dating with it was kind of odd, but I lived at home with my parents so I always had a time and space boundary to keep my symptoms to myself. In college, that wasn’t always the case. I live with IBS-C, which is honestly a little easier to deal with in relationships, because you can hide it. When I dated in college, I was so embarrassed by my symptoms. I was ashamed of the bloat, and struggled with insecurity. I don’t have any overly embarrassing stories, but I can look back and see the connection of my IBS to how insecure and shut-off I was. Needless to say, no relationship from that time of my life actually lasted. Fast forward to post-college adulthood… I began managing my symptoms much better after college. I knew most of the things that would cause my symptoms and developed strong routines to keep things moving and prevent the constipation. The bloat and insecurity reared its head at times, but overall I had a plan. Problem was, I never felt comfortable talking about it and found myself laying on bathroom floors during dates praying for the gas to release. When I met Alex, now my husband, I slowly began opening up about these issues. I trusted him early on and we spent a lot of time together. When I was in pain from constipation and gas, I would explain how I felt and he respected my needs to go home, lay down, or give me space. When we got married, I had already shared so much with him and he respected me enough that the fear of a shared bathroom slipped away. I don’t like talking about my poop or passing gas in public, so it’s not something I openly joke about. I still get embarrassed, but when I do have gas or loud poops, Alex knows to give me space and not bring it up. It took time for me to trust him with this side of me, but as he continued to show his support for me, I began to trust him more and be less anxious about myself. Now, if we are in a public place or traveling and I am having problems, I can talk to him about it and he helps me find space and resources to deal with the symptoms. He also understands how certain foods affect my body and is fully supportive to avoid those foods at home with me.


Tip # 1 : If they don’t support you, drop them. It may take a while to test this out, since you may not be talking about poop on the first date. But, if you do start sharing small pieces of your struggle with IBS and they start to shame you, make fun of you, blow you off, or pressure you… drop them fast. Trust me, that’s not who you want to give your time and energy to, so it’s better to end things early on. When you do find someone who supports you, like I found in Alex, you’ll be grateful for all the ones you let go.

Tip # 2 : Work on your relationship with yourself before getting into a relationship with someone else. If you are insecure and feel disconnected from your body, you will have a hard time finding confidence in dating. Living with IBS is hard and symptoms can quickly lead you to being frustrated with and not trusting your own body. While it’s not fair that you have those symptoms, you are the only person who can decide how you treat yourself. Your body is still worthy of care and appreciation, even if it’s bloated or stuck on the toilet for hours. One way you can start repairing your relationship with yourself is to find what actually triggers your symptoms, and develop habits that help prevent them. This is the ultimate version of self-care. You can work with someone like me, or anyone you trust, to do this. Another thing you can do is start changing your self-talk. Journaling and positive affirmations are a step, but it may be helpful to work with a therapist to dig deep in this area.


Here’s a story from Lou (@loucaludiaa) : My boyfriend has always been supportive of my IBS. When we went to Bali for his birthday in November, I didn’t know I had IBS yet. I had the worst diarrhea of my life, which started on the plane ride over (19 hours, ew!). Whenever I go to the toilet, I fart a lot, as I always seem to be bloated. I was having to go to the toilet like 7 times a day and he could hear all of it! At one point, I even had him look at it to see if it was normal. We were only together 5 months at this point…and we’ve just hit 1 year and 1 month, so I guess he really does love me after seeing my projectile diarrhea.

Here’s another story from Melanie (@melllaaa) : I knew my boyfriend was a good one when he looked up low FODMAP so he wouldn’t cook things that would make me feel ill. I knew he was THE one when he said “you’re still the hottest girl in the world when you’re farty.”

And one more from Audis (@audivela) : I’ve been dating my girlfriend for 11 months now. About 2 months in, I let her know about my IBS, which was surprisingly received with concern and interest in making sure I can eat well. I was worried that my bathroom breaks or diet restrictions would cause a riff between us, mainly because I get nervous to even let family know when I’m going to the bathroom. But, she’s been great in letting me know that she’s aware I must be cautious with what I put in my gut, so she’s actively looking for things I can eat when we go out. Since then, she’s been a great supporter, and even her family has been understanding!


Tip # 3 : Teach them. IBS is pretty common, but it can still be confusing for those who don’t live with it. You can’t expect your partner to be supportive and understanding if you never take the time to teach them how. Now, I personally wouldn’t start with showing them your actual poop, but you can start with explaining what IBS is and how certain foods or activities lead to symptoms. You can teach them what foods make your symptoms worse, and how to make substitutions that are still enjoyable. If you take the time to teach them, you will find that you don’t have to spend so much time making excuses to run to the bathroom or explaining why you can’t have certain foods. You also give them a chance to actually support you. If they don’t? Refer back to tip # 1.

Tip # 4 : Everybody poops. While everyone may not have the same symptoms you do or feel controlled by their pooping schedule, everyone does still do it. It’s helpful to remember that, because if you feel ashamed about going to the bathroom or about that awkward moment when you pass gas loudly on the toilet and know the other person can hear it through the wall, know that they have probably done the same thing at some point too. If they are respectful, they’ll most likely never bring it up and call you out for it. Instead of shaming yourself and letting fear of those moments hold you back, embrace the truth that we all poop and it’s okay to do it, even if you’re together. If you’re fearful about an issue at their house, be proactive about inviting them to yours instead, until you’re able to trust them enough with those details. And if they are a jerk and make fun of you for pooping, they’re clearly not a great fit, so refer to tip # 1.


Here’s a story from Hannah : Dating, in general, seems to be focused around food and drink, particularly in the early stages. When I was first diagnosed, dating was terrifying and any options for a date were usually met with a no, even if I did want to go out with the person. I think over time, you start to own your disclaimers and feel empowered by speaking out for what you need. Eventually, I started being brutally honest to people and anyone could laugh at me replying to a “wanna go out for ice cream?” with “not unless I can eat it sitting on the toilet because I will be pissing out my a**” was the first sign of a keeper. We’ve all got our issues, and being embarrassed about something with someone you may spend a lot of time with wastes so much energy and doesn’t help anyone. Ultimately, I found that you decide how accepting you want a partner to be, and if it’s fully accepting, you have to be fully open yourself.

The other positive in this is you get to be more creative with how you plan your dates. “Wanna go out for coffee?,” “No, but we could go cuddle puppies at the SPCA or do a high ropes course!” It’s so much more fun this way because you don’t have to put yourself through as much anxiety. There’s always an alternative in dating and if anyone has an issue with it, they’re probably not right for you.


Tip # 5 : If you’re anxious about restaurants, suggest something else. Like Hannah mentioned, non-food dates can be more creative and may leave you both with a better story from your first few dates, versus the traditional food or drink date. If you do want to go out for food, suggest a place that you know has options for you. It’s okay to simply say “I have a sensitive stomach” or “I have some food intolerances, but this place is really accommodating.” Most people won’t think twice about that, and may even appreciate you being involved in the planning process.

Tip # 6 : It’s okay to say no and set boundaries. You don’t have to push through situations that you know will cause symptoms. This can mean saying no to dinner for the first date, saying no to drinks, waiting to spend time at their place (especially overnight), setting boundaries on which activities you can and can’t do, and speaking up if you’re feeling pressured and anxious in a situation. I know none of us want to feel like we are being “high-maintenance,” but I’m here to tell you that you have every right to set your boundaries. If they’re not respected, get out.


A story from Erica (@e.davisxo) : After my boyfriend of 5 years ended things, I was nervous to get back in the dating scene. In addition to IBS, I struggle with socialized anxiety disorder. The idea of being out in public on dates terrified me, besides that I now had to eat in front of these people! My first “first date” in almost 7 years was going smoothly… until I felt those stomach gurgles. I got so nervous and just tried to breathe through it. But my date could tell something was wrong. No sooner than he could say “are you okay?” I ran (yes, ran, in a crowded restaurant) to the bathroom and threw up my meal! I stayed in the bathroom an additional 15 minutes emptying my stomach contents on the toilet. When I finally got back to the table, he noticed I had a little bit of leftover vomit in my hair. Needless to say, there was no second date.

Now, I’m luckily in a stable relationship with a wonderful man who supports me through and through. There’s been many a time where I’ve had to cancel plans because of a flare up or be brutally honest about how I’m feeling, but he is nothing but supportive. My doctor recently asked me to try low FODMAP for 6 weeks to find out triggers and he is fully on board with however he can help. Though going out to eat still gives me anxiety (because there’s always a chance I will have to run again), he is supportive and does his best to keep me calm.


Tip # 7 : If you do get anxious about dates, learn how to calm nerves in the moment. Breathing practices can be a helpful tool if you deal with nerves or anxiety during a date. The more you practice deep breathing, the easier it becomes. It may also be helpful to practice meditation or journal through your worries before the date. If you’re a planner, like myself, write out what you are afraid of and list your plan if it does. For example, if you feel like you’re about to rush to the bathroom with nervous diarrhea, calmly reply “excuse me, there’s something in my teeth that’s bugging me. I’m going to go to the bathroom to get it out.” Yes, it’s not truth, but statements like that can be helpful in the first stages of dating if discussing your IBS is not comfortable for you.

Things may not always be perfect, so it’s important to also practice grace for yourself. Yes, you may have a terrible experience like Erica had, but eventually you will move on. If your anxiety and fear become crippling and you can’t seem to get ahold of it all, take the courageous leap of seeing a therapist.

Tip # 8 : Boost your confidence by wearing clothes you are comfortable in. If you’re worried about being bloated from nerves or the food during your date, don’t wear a really tight outfit that will make you uncomfortable. Instad, find outfits that you love, are still flattering even if you do have some bloat going on, and will be comfortable for the full date. No, confidence isn’t just about how you look. But, clothes (and even makeup) can help boost confidence that’s already there.

How Peppermint Oil May Be Able to Improve Your IBS Symptoms

Peppermint oil is one of my favorite remedies for IBS symptoms, because it is a natural option compared to many medications, and shows promise in research to actually work. If you’ve followed me for a while, you’ve seen me recommend it at least a few times, but may still be wondering why. Here’s your answer!

Peppermint oil has been used for decades for IBS symptoms and shows promise for its role in IBS management. Peppermint oil is a naturally-occuring, gas-relieving herb that contains monoterpene compounds, including L-menthol, that target the source of IBS symptoms. L-menthol blocks calcium channels in the smooth muscle of the small intestine to produce an antispasmodic (relaxes the muscle) effect on the gastrointestinal (GI) tract. Because of this effect, peppermint oil shows a lot of promise for those with IBS-D. There are actually studies that show peppermint oil to be more effective than anti-spasmotics, tricyclic antidepressants, and fiber.

Peppermint oil also has antimicrobial, anti-inflammatory, antioxidant, immunomodulating, and anesthetic properties, which means it may be able to contribute to a stronger gut and immune system.

What does research say?

A current review of available studies shows that peppermint oil significantly improves abdominal pain and global symptoms of IBS. Most studies are done using enteric-coated peppermint oil capsules, and some some studies were unspecified as to how they used peppermint oil as a treatment. Peppermint tea has also been studied, but results are limited.

Every person with IBS is different, so everyone may respond to peppermint oil differently. However, based on the evidence, this treatment is worth trying (after consulting with your doctor, of course!). Side effects are mostly mild and rare, but peppermint can cause heartburn and anal or perianal burning or discomfort. If you experience a negative side effect, stop using and talk with your doctor.

What should you use?

IBgard peppermint oil capsules have the most research to back up their claims for improving IBS symptoms. In 2016, a study showed that their capsules significantly reduced symptoms in 72 patients with IBS-M or IBS-D. They are designed to be released in the small intestine, and can be released over 3-4 hours for continued relief. Studies show most efficacy when capsules are taken 30-90 minutes before meals, twice a day. IBgard also contains fiber, which is beneficial for healthy gut bacteria. However, the added fiber could cause discomfort, so discuss with your doctor to make sure this is appropriate for you.

My favorite option is Young Living Peppermint Vitality oil. While there’s not as much research to back it up, I enjoy adding one drop of this oil, which is shown to be safe for human consumption, to a cup of hot water to ease bloating and help improve digestion. This would be similar to the effect of strong peppermint tea. I also like this oil because I can rub it on my abdomen when I’m experienced bloating to ease the pain. While this works for me, it may not work as well for you. Talk with your doctor and dietitian, then try out a few different options to find what works best for your body and your symptoms.

Find IBgard here!

If you’d like to try Young Living Peppermint Vitality oil, email me and you can order through me!


Why Coffee May Make Your IBS Symptoms Better or Worse

When you see a picture of coffee, do you start thinking about the pleasant aroma and bold flavor? Or, does your mind immediately go to you rushing to the bathroom?

People with IBS can have very different relationships with coffee, depending on the effects they experience when they drink it. Coffee is low FODMAP, so it’s not completely off limits on a low FODMAP diet, but it can either make symptoms much better or much worse for those with IBS. Many people think that coffee is ultimately “bad” for IBS so they eliminate it without actually knowing if it can work for them.

About 26-40% of those with IBS claim coffee as a trigger for diarrhea and stomach pain. Why? The caffeine in coffee stimulates the gut to function more quickly, increasing gut motility. For those with IBS-D, this can be problematic because gut motility is already faster than it should be. This is also problematic for those with IBS who are experiencing anxiety or high levels of stress, because that tends to create a more spasmodic effect for the gut, and caffeine may make that worse. Caffeine can also increase heart rate, which may heighten the stress response, and then causing more symptoms.

For those with IBS-C, the stimulating effect of caffeine from coffee can be helpful to get the bowels moving each morning. There is a limit, though, as too much caffeine can still lead to abdominal cramps, even for those with IBS-C.

So, is coffee “good” or “bad” for IBS? Depends on your symptoms, how much you’re drinking, and when you’re drinking it!

How much should you have?

Before deciding whether or not to have or eliminate coffee for good, take it away for a week or two, then reintroduce it in a small portion. Slowly increase your portion to test your tolerance. If coffee doesn’t seem to trigger your symptoms, then you should be safe to incorporate it into your life.

If you do decide to include coffee, keep your caffeine intake to around 400 mg per day, or less. Most people complain of coffee first because it is highest in caffeine, but other caffeine sources can still become problematic in larger amounts.

Sources of caffeine:

  • 8 oz coffee 95-165 mg

  • 8 oz cold brew 100-150 mg

  • 8 oz decaf coffee 2-5 mg

  • 1 oz espresso 47-64 mg

  • 8 oz black tea 25-48 mg

  • 8 oz green tea 25-29 mg

  • 8 oz soda 24-46 mg

  • 50 g dark chocolate 21 mg

  • Energy drinks (varies by brand)

  • Pre-workout supplements (varies by brand)

What about the acidity of coffee?

A lot of people will say that drinking less acidic coffee, like cold brew, is more tolerable. While the caffeine may be the same, the acidity of the coffee can lead to stomach pain and indigestion. These aren’t necessarily IBS symptoms, but can still be frustrating and uncomfortable. Like you would with caffeine, test your tolerance for the acidity in coffee by taking it away for a while, then introducing a small amount of a less acidic coffee, like 6-8 oz cold brew, then increasing your portion and moving to a more acidic coffee, like a traditionally brewed hot coffee.

Low FODMAP Protein Powders

Protein is one of our macronutrients, meaning it plays a vital role in our overall nutrition. Protein is made up of amino acids that break down then form inside our bodies to build tissues, including muscle, protective layers of organs, and skin! Protein can come from animal sources, including meat and dairy, as well as plant sources, including legumes, nuts, seeds, and soy. Like all of our macronutrients, it’s important to eat a variety of protein sources to get all of the amino acids your body needs.

Some people have a hard time getting enough protein through whole food sources, due to inability to prepare meals, food allergies or intolerances, high protein needs, and more. This is where protein powders come in handy.

Protein powders are isolated protein from different whole food sources, and can come in three different forms: concentrate, isolate, and hydrolysate.

  • Concentrate: protein is extracted from a whole food source using heat and acid or enzymes. 60-80% is protein and 20-40% is carbohydrate and fat.

  • Isolate: extracted like concentrate, then goes through another filtering step to remove carbohydrate and fat. 90-95% is protein.

  • Hydrolysate: goes through a final step to break down amino acids in simpler forms, using heat and acid or enzymes. This version is more easily absorbed.

For IBS, protein powders can be tricky. If the source of the protein is a high FODMAP food, like peas, you will want most of the carbohydrate removed, in its isolate form. Same for whey, to ensure it is lactose-free.

Because protein powders are already broken down from whole foods, many with IBS may not tolerate them well. Always try a small amount, before moving towards a full serving, to test your tolerance.

Also, be mindful of any added ingredients. Most protein powders will have added flavor, which comes with many ingredients that are high FODMAP, including honey, agave, artificial sweeteners, inulin, and chicory root. Gums may also be tricky for those with IBS, so it’s important to know your tolerance of these additives before investing in a protein powder.

If you do choose to add a protein powder to your diet for a morning smoothie, or post-workout snack, your low FODMAP options will include whey, pea, hemp, brown rice, and soy isolate.

Whey

Whey protein is isolated from the liquid part of cow’s milk that is separated in cheese making. It contains a variety of proteins from milk, and the isolate version is low lactose. One serving can range between 25-50 grams of protein, but it’s best to stick closer to 25 grams, to avoid digestive issues. If you’re allergic to milk, this would not be a great option.

Try this one!

Pea

Pea protein is isolated from ground yellow peas. It is naturally rich in quality protein, as well as iron. One serving will typically give you 15 grams of protein, which is closer to a recommended amount per meal, for most individuals. This one is naturally gluten and dairy-free. Many with IBS are concerned about pea protein because peas can be higher FODMAP. but Monash University shows one serving of pea protein to be low!

This is the one I recommend most often, because it is easy to find, and tends to have a more pleasant texture.

Try this one!

Hemp

Hemp protein powder is made by grinding hemp seeds into a powder. Instead of extracting the protein, you are eating the entire seed. This is a complete protein, but since the protein isn’t isolated, you will get a little less protein per serving that other options. One serving could provide 10-15 grams of protein, but will be much higher in calories than your pea protein option.

This is a great option for those on a plant-based diet, and for those who prefer less processed protein options.

Try this one!

Brown Rice

Brown rice protein powders are isolated from brown rice. This won’t be a complete protein, meaning it won’t have all essential amino acids, so many products also include quinoa and chia, which are both complete proteins and also low FODMAP! One serving will give you around 20 grams of protein, so this is a great vegan and gluten-free option for someone with higher protein needs.

Try this one!

Soy Isolate

Soy isolate is extracted from soybeans and one serving can give you 20 grams of protein, but it is one of the more controversial plant-based protein options. While soybeans can be a great source of protein for plant-based eaters, there could be ingredients in soy isolate powder that can be toxic or decrease mineral absorption. More studies need to be done.

This is a low FODMAP option, but I typically don’t recommend it to my clients. Instead, if you’re a plant-based eater, you can benefit from soy by eating edamame, tofu, and tempeh!

If you want to try a soy isolate option, go for this one!


The bottom line with protein powders is that they aren’t necessary, but can be helpful, in moderation. If you’re getting all of your protein from powders, I suggest working with a dietitian, like myself, to increase variety in your food choices and go for more whole foods sources. If you’re choosing a protein powder for convenience, or to increase overall protein intake, be mindful of the source of protein, added ingredients, and the amount you are taking in per serving. The body only processes around 15-25 grams of protein at a time, so large amounts of supplemental protein aren’t necessary.

PCOS and IBS: Diagnosis, Symptom, and Treatment Overlap

If you’ve been diagnosed with PCOS, your bowel habits should be a topic of discussion with your medical providers. Why? Women with PCOS are at a greater risk of also living with irritable bowel syndrome (IBS). IBS affects 10% of the worldwide population, and 20% of Americans. IBS is a functional bowel disorder that is characterized by changes in the function of the gut (gut motility) and chronic symptoms of abdominal pain, bloating, gas, diarrhea, and/or constipation. These digestive symptoms are also commonly seen in those with PCOS.


Like PCOS, IBS is a disorder that has many potential causes. We still have a lot to learn about IBS, but right now the causes are thought to be either changes to the gut bacterial makeup, or microbiota, or structural changes to the gut. These can be caused by chronic stress (physical and psychological), post traumatic stress disorder (PTSD), chronic antibiotic use, or gastroenteritis. IBS is diagnosed according to Rome criteria, based on changes in gut motility, presented as diarrhea and/or constipation, and chronic symptoms. Symptoms have to occur at least 3 days each month for 3 months or longer. It is common for IBS to present in adulthood, but many of the factors leading to IBS may occur during childhood, when the gut microbiota is developing. IBS is diagnosed according to this criteria once other conditions have been ruled out, including celiac disease and other allergies, Crohn’s disease, ulcerative colitis, and colon cancer. SIBO (small intestinal bowel overgrowth) may also be tested for, and could present alongside IBS. The more we learn about IBS, the more we see a relationship to the brain via the gut-brain axis, which is the communication pathway between the two. We know anxiety, depression, and psychological stress are linked to IBS symptoms, and vice versa. 

The connection to mental health is also seen in PCOS. There is an increased risk of depression and anxiety in those with PCOS, which could be connected to the presence of IBS. We also know that changes to the gut microbiota, referred to as gut dysbiosis, leads to gut permeability, which may be a cause of systemic inflammation in the body. Gut permeability means that the tight junctions in the gut lining that typically protect the body from foreign invaders has been compromised and is not as tight, so organisms, like bacterial endotoxins and luminal contents, are able to pass through the gut lining. The presence of bacterial endotoxins in the blood, called endotoxemia, triggers inflammation. Continued release of bacteria and luminal contents into the bloodstream favors systemic inflammation. Systemic inflammation is linked to insulin resistance, which is a major factor in the cause of PCOS. 

When it comes to treatment for IBS and PCOS, there are many similarities between the two. Both are managed through a holistic nutrition and lifestyle approach, including changes to diet and modifications in stress management, exercise, and sleep. For IBS, the top nutritional approach is the low FODMAP diet. FODMAPs are fermentable (gas-causing) components of carbohydrates that can be difficult to digest for those with IBS, resulting in symptoms. FODMAPs are broken down into the subgroups fructose, mannitol, sorbitol, galacto-oligosaccharides, fructan, and lactose. Not every individual with IBS will be triggered by all FODMAPs. Each person has their own tolerance, most likely due to the makeup of bacteria in their gut. The low FODMAP diet is designed in three phases to help individuals with IBS identify their specific FODMAP triggers. Phase one is elimination, where all FODMAPs are removed from the diet. Phase two is challenge, where FODMAPs are reintroduced by subgroup and symptoms are observed. Phase three is customization, where more FODMAP-containing foods are incorporated back into the diet based on subgroup triggers and tolerance. This is a nutritional approach, so it should be followed under the guidance of a dietitian. In addition to identifying and avoiding trigger foods, it’s also important to focus on a diet that will increase beneficial bacteria, and reduce negative bacteria, in the gut. This is done through a focus on plants, hydration, and adequate intake of fiber, while limiting excessive amounts of sugar, caffeine, and alcohol. Since stress plays a major role in the cause of IBS and symptoms, it’s vital to manage stress through creating boundaries around time, incorporating daily self-care practices, exercise, breath and meditation, and adequate sleep. Those with IBS benefit most from low-intensity exercise, like weight training, yoga, pilates, barre, and light cardio. High-intensity and long duration workouts can lead to IBS symptoms because they increase the release of the stress hormone cortisol, which then triggers symptoms.

There is an overlap in the management of PCOS. For PCOS, the major focus is on hormone balance and the balance of blood sugars to support insulin sensitivity. This can be done through reducing foods that are linked to inflammation in the body, balancing carbohydrates with fiber and healthy fat, and similar lifestyle modifications to those made with IBS that support hormone balance and reduce inflammation. Those with PCOS may already be avoiding foods like gluten, dairy, and sugar, which are also limited for IBS as wheat contains fructans and dairy contains lactose. Exercise, stress management, and sleep recommendations are also the same to balance stress and endocrine hormones. 

If you have both IBS and PCOS, there are a few things to consider. If you’re eating a lower carbohydrate diet to manage PCOS, be mindful to eat an adequate amount of fiber through non-starchy vegetables. Examples of these include greens, bell pepper, broccoli florets, bok choy, and cucumber (these are all low FODMAP options!). If you’re eating a low FODMAP diet for IBS, be aware of how you are balancing out carbohydrates for PCOS. If you are eating meals heavy in starches, like grains and potatoes, it may be helpful to reduce portion sizes to ¼-½ cup, depending on the level of your insulin sensitivity. 

If you are struggling with both PCOS and IBS, it may be confusing where you should begin with your treatment. Since IBS can directly affect PCOS through gut permeability, it may be helpful to work with an IBS-specialist dietitian to identify trigger foods and develop lifestyle habits to reduce IBS symptoms and improve beneficial gut bacteria. Once that has been established, work with a PCOS-specialist dietitian to modify the diet and plan to support your specific type of PCOS. You could also do this in reverse if you have already begun working with a dietitian for PCOS. 


The Effect of the Keto Diet on IBS and Digestion

The ketogenic (keto) diet is one of the most popular diets in our world these days. Before we get into the role keto may play in IBS and digestion, I want to lay the foundation about what keto actually is and what research says about it. The keto diet isn’t actually new, but has been around for while, used a medical nutrition approach for epilepsy and seizures. It was designed to be applied in a clinical setting with both a dietitian and a doctor. It was never intended to be long term, but did show success in the treatment of these conditions.

Keto hit the wellness world with the growth of low carbohydrate diets, including South Beach, Atkins, and Dukan. It is marketed as a quick way to lose weight, and has left the clinical setting to be recommended by influencers, personal trainers, and nutrition gurus. The difference of keto versus many other low carb diets is that the focus is on an increase of fats, a decrease of carbs, and a moderate amount of protein.

The keto diet is coupled with intermittent fasting, and low carb fasting (less than 50 g/day). This causes the liver to produce ketones from fat to be used for energy. Normally, our body’s ideal energy source is glucose, which comes from carbs. Utilizing ketones, instead of glucose, is referred to as ketosis.

What are the pros?

The keto diet isn’t completely useless or a total fad. It does show some positive effects in research. Studies show that the keto diet can aid in weight loss, stabilize blood sugars in the short term, and have a positive effect on mood, memory, and cognitive ability. These studies all shown a short term benefit. There is currently no studies showing a long term benefit.

What are the cons?

The major con to the keto diet is how restrictive it is. Consuming very low amounts of carbohydrates can limit adequate intake of vitamins, minerals, and fiber which all play a role in the health of the body and gut microbiome. Another con to the diet is that many people either lead themselves through it, or follow their favorite influencer’s advice. Without the supervision of a dietitian and doctor, the concern is that an individual may be putting themselves at risk for heart disease or other health conditions due to food choices and balance of nutrients. Every individual has a unique metabolism and nutrition needs, so the diet may not be appropriate or effective for everyone.

We also don’t know much about the long term effects of the diet. We know there are some benefits for specific populations in the short term, but the diet may not be a sustainable or appropriate lifestyle.

Even in the short term, the keto diet is not recommended for those who are pregnant, breastfeeding, have a history of eating disorders, those with Type 1 diabetes, or those diagnosed with kidney, pancreatic, or liver disease.

What about IBS?

There is an increased interest in using a low carb diet, like a keto diet, for IBS and digestive health. One small study shows a positive effect from using a very low carbohydrate diet (VLCD) in those with IBS-D. Symptoms improved, but the study was small and done over a short duration of time. Other studies actually show a decrease in microbial (the makeup of bacteria in the gut) diversity with the keto diet. This is problematic because dysbiosis of the microbiome (poor diversity) is thought to be a major factor in the onset and progression of IBS. We also know that a diverse microbiome is an indicator of long term health, including reduced inflammation and a reduced risk for many metabolic and autoimmune conditions.

We also know that high fat meals and prolonged periods of fasting can actually lead to IBS symptoms due to slowing gut motility and increasing risk for FODMAP stacking and large meals outside of the fasting period.

What to do instead

Many of the benefits seen from a keto diet (when done correctly) come from a consistent intake of healthy fats. While high fat meals can be problematic for those with IBS, a moderate intake of healthy fat throughout the day is possible and beneficial. Healthy fats improve the health of our brains, help stabilize blood sugars, and contribute to the feeling of satisfaction after a meal, which helps increase relationship with food and pleasure from meals. Healthy fats come from plants and fish, and some of those sources are high FODMAP, including avocado and large portions of nuts and seeds. Low FODMAP healthy fat sources include peanuts/peanut butter, sunflower seeds/sunbutter, olives and olive oil, and fatty fish. Small portions of some nuts and seeds can be tolerated, as well as 1/8 avocado. Refer to the Monash University FODMAP Diet app for specific portion sizes.

Instead of restricting carbohydrates with a keto diet, it may be more beneficial to modify intake of resistant starches, fiber, and FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), per your tolerance. This would be more sustainable and decrease the risk for poor microbial diversity long term. There are actually more studies to support the use of the low FODMAP diet approach for those with IBS versus a very low carbohydrate diet. However, this approach can still be very restrictive, so it’s best to work through it with a dietitian to ensure you’re meeting your nutrition needs, not over restricting foods, and increasing your beneficial gut bacteria.

If you want to learn more about the low FODMAP diet, my Low FODMAP Diet E-Course will give you the information you need to walk through the diet, appropriately. I also offer 1-on-1 services for a more personalized approach through the diet and other interventions for IBS.


Holiday BBQ Tips for Those With IBS

One of my favorite parts of summer is going to BBQ hangouts with my friends and family. July 4th is usually celebrated with one, but they also pop up throughout the season on lake days and sunny Saturday afternoons. Like many food-centered parties, a BBQ can be hard to navigate with IBS, so I wanted to share a few tips you can use to get all of the joy out of these hangouts without the dreaded symptoms.

Talk to the host

The first tip is simple, but can be one of the most challenging. Before the BBQ, have a conversation with the host. You don’t have to share the details of your symptoms, but you can mention your main food triggers and simply ask what the plan for food is. If they’re planning to grill burgers, hot dogs, or chicken, you can ask that yours not be pre-marinated or spiced with high FODMAP ingredients, like garlic and onion. If they’re unable to accomodate, you will know you to bring your own. You can also ask that a small portion of salads or other vegetable dishes be set aside without dressings or spices, so you can add your own. I know many of us struggle with these conversations because we don’t want to seem needy or high maintenance, but it truly never hurts to ask. Be respectful and kind, and ask about accomodations without demanding or expecting them. If they happen, amazing. If they don’t, you now know how to prepare.

Another thing you can do here is be the host yourself! Feel isolated by IBS and your food restrictions? Host your own party and create a full low FODMAP menu!

Come prepared

Don’t show up to a BBQ empty-handed and expect to have plenty of food choices. Bring a low FODMAP dish that you enjoy and that will be satisfying to you. If you know there won’t be a protein without added high FODMAP ingredients, bring your portion and ask that it be cooked separate from the others or ask to cook it yourself! I like to bring a few dishes so I know I have plenty of options, and it gives me the chance to share some of my favorite recipes with my friends and family.

You can also bring portions of your own low FODMAP ketchup, bbq sauce, and salad dressing to avoid having small amounts of garlic and onion add up throughout the day. Seems kind of embarrassing to do, but I promise you will feel so empowered and confident having them with you! And guess what, you don’t have to over-explain why you have them. If you don’t bring much attention to it, others probably won’t even notice.

Some of my favorite recipes to make for a BBQ include tabbouleh, bruschetta, loaded potatoes, homemade ice cream, and brownies!

If you’re going to be gone most of the day, like a day on the lake, come prepared with plenty of snacks to satisfy your hunger if there aren’t many food options available for you. Click here for snack ideas!

Be mindful of drinks

You’re prepared on the food side, but drinks are another big part of the BBQ. If choosing to drink alcohol, opt for low FODMAP options, like whiskey, wine, vodka, and gin. Beer may be tolerated, but be aware of the carbonation and wheat content (if diagnosed with celiac disease). Be careful with drink mixers, too, as many can contain high FODMAP ingredients, and keep portion sizes small. Even if the drink is low FODMAP, large portions of alcohol can lead to digestive issues and IBS symptoms.

Stay hydrated throughout the day with plenty of water. Avoid carbonated drinks, like seltzer waters and sodas, as those could lead to bloating, and beware of excessive caffeine from coffee, teas, and sodas. My favorite drinks include water infused with lemon/lime or berries and decaffeinated iced teas!

As always, remember that you’re there to enjoy community and relationship with your friends and family. If you feel stressed about your food options, use the tips above and practice mindfulness throughout the day to take care of your mind. If you need a few minutes of breath and meditation, slip away to do what you need to do, then come back!

I’d love to hear your tips and tricks for navigating holiday parties and hangouts. Comment below to share!

Low FODMAP Guide to Burger Stops

To continue our low FODMAP guide series for fast-food restaurants, I decided to put all of the burger stops together! The benefit to grabbing a burger on the go is that many beef patties do not have garlic or onion, so they can be a solid choice for protein when you’re in a hurry. For the fries, sides, and toppings… that’s where things get tricky. For all of these, it may be helpful to bring your own low FODMAP dressings and ketchup.

Burger King

For breakfast, your low FODMAP options will be the croissan’wich sans bun with egg, bacon or ham, and cheese (per your tolerance). You can also have the oatmeal! Hashbrowns do contain wheat, so they’re off limits unless you can tolerate smaller portions of wheat/fructan. Pancakes will be high FODMAP.

For lunch and dinner, all beef patties are low FODMAP! Remove the bun, top with fresh vegetables like lettuce and tomato, and avoid sauces. You may be able to tolerate a slice of cheese. French fries are safe as a side, or you can choose a garden salad without dressing or croutons. Bring your own dressing to add flavor.

The seasoned chicken breast may contain garlic or onion. The veggie burger will also contain high FODMAP ingredients, so beef burgers are the safest choice.

Wendy’s

For breakfast, the steel cut oats are safe, but be mindful about any toppings. Egg sandwiches will also be safe without bread or sauces.

For lunch or dinner, Beef patties are low FODMAP, so choose a burger with fresh veggies and cheese (per your tolerance). Ditch the bun and sauce. French fries and a garden salad without dressing are safe sides. The broccoli cheese potato may be safe too. You can remove the cheese sauce if you’re sensitive to lactose.

Grilled and fried chicken options contain either wheat, garlic, or onion, so those will be high FODMAP. The berry burst salad will be safe if you remove the chicken and dressing.

McDonald’s

For breakfast, egg sandwiches without the bread or pork are low FODMAP. Enjoy cheese per your tolerance.

For lunch and dinner, beef patties are safe. Enjoy a burger with fresh vegetables, pickles, no bun, and no sauce. Side salad is safe without dressing, but fries do contain wheat so they are high. All chicken breasts also contain wheat and garlic, so burgers are your safer option.

In-N-Out Burger

Choices here are simple: beef patties in lettuce with fresh veggies and a slice of cheese are safe! Avoid buns or sauce. Fries are also safe!

Low FODMAP Guide to Taco Bell

One of the top questions I get from clients and social media followers is “what do I eat on the go?” The low FODMAP diet is tricky enough at home, but it can be even more challenging eating out. To help relieve some of that confusion, I have put together a low FODMAP guide series to common fast-food restaurants. We have already visited Panera and Chipotle, so now it’s time for a personal favorite: Taco Bell.

Taco Bell is pretty tricky for the elimination phase of the low FODMAP diet, but there are a couple of options if you’re in a bind. If you have walked through reintroductions and have more tolerance of some high FODMAP ingredients, you will have more options to enjoy!

Protein

Most proteins are seasoned with high FODMAP ingredients, like garlic, onion, and wheat. Unfortunately, that means fire grilled chicken, grilled steak and chicken, seasoned beef, and sausage are all high FODMAP. Beans are another protein, but they are high FODMAP by themselves, and also contain garlic and onion.

Your safest proteins will be bacon, egg, and cheese. So your Taco Bell run may be best for breakfast. Sounds like the best nutrition advice, right? (ha, not really, but do what you gotta do).

If you know you can tolerate small amounts of onion and garlic, you may be able to enjoy a small serving of one of these proteins, but be mindful about how you pair higher FODMAP options together.

Carbs

All flatbreads and flour tortilla will be made with wheat, so they’ll naturally be high FODMAP. However, if you know you can tolerate small amounts of wheat, 1-2 tortillas may be tolerated. The rice is seasoned with garlic and onion (shocker), as well as the potato bites, so those items may be off limits too.

Corn tortillas and tortilla chips are low FODMAP and your safest options. Hash brown potatoes will also be low, so that may be a nice side to a breakfast option.

Toppings

For toppings, choose fresh ingredients like lettuce, cilantro, jalapenos, and tomatoes. Choose cheese per your tolerance.

All sauces are high FODMAP, but Tabasco hot sauce is safe. You can bring your own low FODMAP salsa if you want a little more flavor.

Why IBS Symptoms May Be Worse During Your Period

Have you noticed that you’re IBS symptoms seem to ramp up in the days leading up to your period? You’re not alone! This is a concern I hear from many of my clients, and have actually experienced myself. There’s actually a clear reason why this happens. Let me start by saying that I am not a hormone expert, but I will share what I do know on the hormone level and how that correlates with IBS.

There are 2 major hormones involved in menstruation: estrogen and progesterone. These hormones are not only at work in our sex organs, but also have receptors in the gastrointestinal tract, so fluctuations in both hormones can influence gut function and IBS symptoms. Before ovulation, estrogen levels reach their peak, then rapidly drops at the end of ovulation. This can increase symptoms of bloating and constipation for those with IBS. During the luteal phase (before your period), progesterone levels reach their peak, then drop at the start of menstruation (your period). This can increase symptoms of abdominal pain, bloating, diarrhea, and nausea for those with IBS.

* Check out the chart below from the Monash University blog to see a visual of how this works. *

On the opposite side of the table, studies show that having IBS can also increase your risk or severity of period symptoms, including painful cramps, backache, fatigue, insomnia, food sensitivity, and water retention. Mood-related changes during menstruation (PMS) is not shown to increase for those with IBS. However, anxiety related to the increase in digestive symptoms during this time may increase.

Why in the world is all of this connected? We don’t fully understand the cause. There’s a lot of research to be done, so hopefully we have more answers in the coming years.

PCOS and Endometriosis

PCOS and endometriosis are two common gynecological disorders, that are both related to the balance of female sex hormones and the function of sex organs. Studies are also showing a connection between IBS and these disorders, but again there’s a lot we don’t fully understand. Symptoms can overlap between either of these and IBS, and many women will carry diagnoses for both. We aren’t sure which disorder causes or worsens the other, or if there’s an issue with misdiagnosing one for the other, but we do know that it’s important to develop a plan to address the common issues in both to manage symptoms fully.

So, what do I do?

If you’re dealing with an increase in IBS symptoms after ovulation or in the days leading up to your period, there are a few things you can do to support your body and improve your symptoms.

  1. Know your cycle. Tracking your cycle will allow you to know when you are ovulating, in the luteal phase, and approaching menstruation. Being proactive is key to preventing symptoms, so that starts with knowing your body. You can use apps, basal temperature thermometers, and more to do this. Chat with your gynecologist if you need guidance.

  2. Support your gut with gentle exercise, adequate hydration and fiber, reduction in trigger foods, and plenty of sleep leading up to the days when you experience symptoms the most. Avoid large amounts (doesn’t mean exclude completely!) of caffeine, sugar, or alcohol during these days as those can also worsen symptoms. Giving your body a little extra care will help prevent the symptoms from coming on in the first place.

  3. Easy symptoms you are not able to fully prevent with gentle movement (like yoga!), peppermint oil or capsules, ginger tea, heating pads, warm baths, and warm non-trigger foods!



Best Fiber Supplements for IBS

Fiber is important, and the general recommendation is to increase dietary fiber wherever you can. But, per usual, this recommendation can be tricky for those with IBS. Fibers are components of plants that we eat, but they aren’t digested. They play a role in feeding our beneficial gut bacteria, help stabilize blood sugars, and help lower cholesterol levels.

While most fibers have similar roles in the body, they aren’t all equal. There are two major factors that can differentiate fibers and determine whether or not the fiber source is helpful for IBS: solubility and fermentability.

Solubility refers to the fiber’s ability to dissolve in water or not, giving it the label soluble or insoluble. Read here to dig deeper into the difference between the two, as well as examples of both. Fermentability refers to the fiber’s gas-causing properties in the gut. FODMAPs are highly fermentable, so for IBS highly fermentable fibers are best avoided.

Highly fermentable fiber supplement sources include inulin, wheat bran, chicory root, fructo-oligosaccharides (FOS), and galacto-oligosaccharides (GOS). These are most likely to worsen IBS symptoms. Less fermentable fiber supplement sources include psyllium, linseeds, oats/oat bran, sterculia, and methylcellulose. These are less likely to worsen IBS symptoms, and may actually improve symptoms. There is also small evidence to support the use of partially hydrolysed guar gum (PHGG), which is used to make Sunfiber, to reduce symptoms.

Are fiber supplements necessary for IBS management?

This is the question I’m guessing you wanted to know when you opened this post. I wish the answer was a black or white, yes or no, but it’s more like a sometimes and not always. Daily fiber intake is definitely necessary, but the amount of fiber you eat may vary from another person with IBS, based on how much you currently eat, your symptoms, and other digestive health concerns (like ulcerative colitis).

Ideally, you will get your fiber intake from food, by eating a variety of grains, fruits, vegetables, nuts, and seeds. However, if you’re unable to eat a fiber-rich diet due to allergies, the restrictive nature of the low FODMAP diet, your trigger foods, low caloric needs, or your access to plant foods, a supplement could be helpful. Taking a fiber supplement “just in case,” like you may do with a multivitamin, is not wise. Too much fiber, especially for those with IBS, can actually lead to gas, abdominal pain, bloating, constipation, and/or diarrhea. As with any medication or supplement, it’s important to consult with your doctor or dietitian before starting a fiber supplement to make sure it’s appropriate and safe for you.

Got it. If I decide to try a supplement, which do I choose?

I’ll say this again - it’s best to consult with your doctor or dietitian to find the absolute best fit for your needs. But, if you want some ideas of different fiber sources that have shown to be effective for reducing IBS symptoms, here ya go:

  • Psyllium, which is found in Metamucil, has shown to reduce universal symptoms in IBS. Metamucil does contain other added ingredients, so it may be best to take psyllium in a more natural form, like this one.

  • Oats/oat bran may be effective for those with IBS-C. You can create your own oat powder by blending oats until they are a fine texture.

  • PHGG, or SunFiber, may be helpful both both IBS-C and IBS-D. Regular Girl is a certified low FODMAP brand for this fiber.

  • Methylcellulose, which is found in Citrucel, may be helpful for IBS-C.

If you choose to use supplemental fiber to increase your total fiber intake, it’s important to start with a small dosage. The body has to adapt to more fiber, so start small for a week or so, then increase slowly to your tolerance. If you increase the amount too quickly, you’re likely to experience negative side effects like bloating and gas. Like you would with an increase in fiber-rich foods, always increase water intake as you increase fiber. This will help you avoid constipation. You may also find that supplementing fiber is not a daily need, but most helpful on days when you’re unable to get enough fiber from foods. Work with your dietitian to find a dose and plan that works best for your diet and lifestyle.


My Favorite Essential Oils for IBS Management

Essential oils are all the rage in our culture right now, because we are shifting our mindset from using over the counter remedies for everyday issues, and instead turning to more natural solutions. Essential oils may be able to meet that need.

I’ll start by saying the research supporting essential oil use is limited, and essential oil companies are not regulated. This means, as a consumer, it’s important to educate yourself about which oils may be better supported, and what companies may be more trustworthy. My general recommendation is to always buy from a well-known, reputable company, versus looking for the cheapest option in a google search.

When it comes to IBS, essential oils can definitely play a role. There’s research to support the use of peppermint oil as a remedy for bloating and constipation. For other oils, there may not be as much research to back up their use. However, you can try them for yourself and if they work for you, whether it be a placebo effect or not, great! That’s how I found my top oils for my IBS management.


Peppermint & Peppermint Vitality

Peppermint oil is an oil I talk about the most and recommend to my clients. You can use it topically to help relieve cramping, stomach pain from bloating, as well as headaches and nausea. I use Peppermint Vitality from Young Living for internal use because it is a high-quality oil that has been tested to be safe for consumption. This helps me relieve bloating or constipation. Warm water with 1-2 drops of this oil is my go-to remedy for that annoying morning bloat.

Digize Vitality

Digize Vitality from Young Living is another oil I use for internal use to help with digestion. It’s made from a mixture of different herbs and spices that have been shown to aid in digestion. I will add this to an evening cup of tea to help digest my dinner before settling into bed.

Lavender and Cedarwood

These are my top stress relief oils. I will add these to a warm bath with epsom salts, or diffuse them at night or during a more tense day.

Deep Relief Roll-On and PanAway

These don’t have as much of a direct effect on my IBS, but are my top oils for muscle soreness and recovery. As a Barre3 instructor, I stay active and my muscles stay sore. I keep the Deep Relief Roll-On with me to apply directly to the areas that are more tense or sore. Since I do carry most of my stress in my neck and back, I will use this when I’m stressed to avoid a tension headache or an injury due to tight muscles. I use PanAway in my epsom salt bath for ultimate muscle recovery. You can also create a muscle rub with coconut oil and a few drops of oil.


As I mentioned before, essential oils still lack the research to put all of your hope into their role in the management of your IBS. However, they could still work for you. If you’ve been interested in trying them out, go for it! Then check in to see how your body is responding. If you have a favorite essential oil you use, comment and share!

Low FODMAP Guide to Panera

Panera is one of my favorite fast casual spots to go, because their menu is full of colorful veggies and fresh meals. From a low FODMAP perspective, options do become limited, but thankfully Panera makes it easy to customize your order. If you get overwhelmed doing this with a store associate, you can simple order ahead on your phone, or order from a kiosk in store. You can truly make the meal your own, which is a huge bonus. Here are a few things to look out for, and a few safe options for you to choose!

Skip the pastries and bread

I know it’s hard to go to a bread-focused restaurant and not enjoy the bread, but your best low FODMAP option is to do without. All breads contain wheat, and the sourdough bread is not slow fermented so it still contains a larger amount of fructan (read more about choosing sourdough here). If you have reintroduced wheat and can tolerate small amounts, you can try one of the breads, made without any added onion or garlic, and do the pick 2 option with a half sandwich.

Remove high FODMAP ingredients

When customizing your meals, remove added ingredients like onion, avocado, and apples. Get salads without dressing since all contain onion and/or garlic, or put the dressing on the side if you know you can tolerate small amounts. For oatmeal, remove honey and granola, as it’s made with honey and wheat.

What not to choose

Soups, broth bowls, and pastas will not be possible on the low FODMAP diet. All have either onion, garlic, wheat, or lactose.

What to choose

For breakfast, you can get a breakfast sandwich without the bread, choosing either whole eggs or egg whites, proteins, and low FODMAP veggies. The summer fruit cup, or the greek yogurt without granola is a great side option! You can also get any of the oatmeals, just remove honey, granola, and apples. When I need an extra protein boost, I will add a side of peanut butter.

Salads are easy to customize and make low FODMAP, for lunch and dinner options. Bring your own low FODMAP dressing to add more flavor, or talk to the associate about getting only olive oil, vinegar, and lemon juice. The seasoned grilled chicken options are marinated in onion/garlic, so avoid these and ask for plain chicken, quinoa, or eggs as your protein options. These salads are easiest to customize:

  • Strawberry Poppyseed Salad with Chicken

  • Spinach, Bacon & Poppyseed Salad with Chicken (no pickled onion)

  • Modern Greek Salad with Quinoa (no tomato sofrito)

  • Seasonal Greens Salad with protein of choice (no onion)

  • Greek Salad with protein of choice (no onion)

For sides, potato chips are low FODMAP, or you can go for the summer fruit cup.

Drinks

Drinks can be tricky. Coffee and low FODMAP teas will be fine, as long as you don’t add honey, artificial sweeteners, or lactose. You can also ask for lattes made with soymilk. You can get a unsweetened iced black tea or the iced passion papaya green tea, but avoid other flavored teas. For lemonade, your safe option is the blood orange lemonade. Avoid the agave lemonade, as agave is high FODMAP.

The smoothies may seem tempting, but each smoothie is made with a high FODMAP fruit base, so it’s best to stay away from these. Sodas and seltzer waters may be low FODMAP, but the carbonation can still lead to bloating, so ti may be best to avoid these, as well.

Low FODMAP Diet Guide to Chipotle

The low FODMAP diet is hard enough to manage at home, so eating out can be an added challenge that many people find overwhelming and frustrating. I always tell my clients that eating out is a chance to try something new, do your best, then give yourself grace when it’s not “perfect.” To help you do your best, I’ve decided to start a low FODMAP diet guide series to some of the more popular food chains. First up : Chipotle.

Skip the tortilla, beans, & salsas

The first thing you’ll want to do when ordering at Chipotle is ditch the flour tortilla and opt for a burrito bowl with rice, or a salad. The seasoned rice is low FODMAP, and you can get the crispy corn tortillas if you prefer tacos!

Beans can quickly become high FODMAP, and are resistant starches, so they will be more difficult to digest. Both black and pinto beans at Chipotle are cooked with garlic, so even a small amount may not be tolerated.

All of the salsas are made with high FODMAP ingredients, like garlic and onion. Instead, add flavor with fresh tomatoes (ask the staff nicely for diced tomatoes, due to intolerance) and hot sauce, or bring your own low FODMAP salsa (like this one!).

Choose your protein

Unfortunately, Chipotle uses garlic to marinate their steak, chicken, barbecoa, and sofritas. Carnitas will be the only low FODMAP protein option. If you’re a vegetarian or vegan, you could choose to have a small amount of black beans or sofritas, but you will not be fully eliminating garlic so you could feel some symptoms from the meal.

Add toppings

Many toppings will contain either garlic, onion, or lactose, including guacamole, salsas, sour cream, and queso. Instead, choose lettuce, ask for fresh vegetables like tomatoes and corn, and use a small amount of cheese. You can also ask for fresh cilantro and lime to add more flavor!

I know it’s not fun having to make a ton of changes to every meal you eat, but avoiding symptoms can be worth it. If you have done a proper reintroduction of FODMAPs, you may be able to incorporate more ingredients. If you haven’t worked through the low FODMAP to determine your triggers, my program may be a good fit for you.

20 Low FODMAP Snack Ideas

Every single client asks me the same question when we start working together, “what snacks can I eat?”. On the low FODMAP diet, limiting common snack foods like almonds, apples, wheat, and honey can lead to a feeling of being stuck on snack ideas. Instead of finding replacements for these snacks, many people tend to omit them, which leads to under-eating and feeling hangry.

To help out, I’ve compiled a list of low FODMAP snacks to avoid feeling overwhelmed and help you on your IBS journey. Here are a few portion sizes and options for fruits, nuts, and nut butters that are referenced in the snacks. All information is sourced from Monash University.

If you want to buy low FODMAP snacks, use these discount codes to save some $$:

FODY Foods : get 15% off your first order with code ibs.nutrition15

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Low FODMAP Nuts/Seeds/Butters

  • 2 Tbsp peanut butter

  • 1 Tbsp almond butter

  • 10 almonds

  • 10 brazil nuts

  • 20 chestnuts

  • 10 hazelnuts

  • 20 macadamia nuts

  • 10 pecan halves

  • 1 Tbsp pine nuts

  • 2 Tbsp pumpkin seeds

  • 2 tsp sunflower seeds

  • 10 walnut halves

Low FODMAP Fruit

  • Medium firm banana

  • 1/4 cup blueberries

  • 1/2 cup cantaloupe

  • Medium clementine

  • 1 cup grapes

  • 1 small kiwis

  • 2 small mandarins

  • Medium orange

  • 2 passion fruits

  • 1 cup pineapple

  • 1 Tbsp raisins

  • 1 cup strawberries

  • Medium starfruit


Low FODMAP Snack Ideas

1 serving nuts/seeds + 1 serving fruit

Lactose-free yogurt + 1 serving fruit + 1 serving nuts/seeds

Lactose-free yogurt + low FODMAP granola (try this one)

Peanut butter + carrot sticks

Peanut butter or sunflower butter + 1 serving fruit

Peanut butter or sunflower butter + rice cake (can flavor with maple syrup, cinnamon, berries)

1 string cheese + 1 serving fruit or 2 slices deli meat (no garlic/onion/celery added)

2 hard-boiled eggs + carrot sticks + 2 oz sharp cheddar

2 cups popcorn

Popcorn Quinoa Chips

Low FODMAP bars: FODY foods, Go Macro peanut butter or sunflower butter chocolate, or Rachel Pauls Happy Bars

Tuna + rice crackers

Trail mix: 1/8 cup walnuts or pecans + 1 Tbsp pumpkin seeds + 1 Tbsp shredded coconut + 2 Tbsp dark chocolate chips (or try this premade one)

Corn chips + red bell pepper slices + low FODMAP salsa (try this one!)

Low FODMAP hummus (recipe here) + corn chips + carrot sticks + cucumber

Gluten free pretzels + 2 oz sharp cheddar

2 oz mozzarella + cherry tomatoes + sliced ham (no onion/garlic/celery added)

Rice crackers + 2 oz swiss or cheddar + 2 slices deli meat (no onion/garlic/celery added) + grapes

Simple smoothie : 6 oz almond milk + 1/2 frozen banana or 1/2 c frozen strawberries + 1 scoop bone broth, soy, or pea protein powder + 1 Tbsp peanut butter + 1 Tbsp hemp seeds + 1 cup spinach + 1/2 cup ice

Chia seed pudding (2 Tbsp chia seeds + 1/2 cup almond milk) + 1 serving fruit + maple syrup + cinnamon

Why is Sourdough Better Tolerated for IBS & the Low FODMAP Diet?

When you embark on a low FODMAP diet, wheat is one of the hardest parts to give up, because there aren’t as many low FODMAP alternatives for bread. But what you may not realize is that small amounts of wheat are actually low FODMAP. Wheat breads are made with wheat flour and quickly become high FODMAP, but traditional sourdough bread is actually lower in FODMAPs and may be better tolerated. I should clarify that low FODMAP is not the same thing as gluten free. If you’re on a strict gluten-free diet due to celiac disease, then this post is not applicable to you.

Why are regular breads high FODMAP?

There is a carbohydrate component of both wheat and rye called fructan that is one of the FODMAP subgroups. It’s also found in garlic and onion.

Why is sourdough bread better tolerated?

Sourdough bread is still made with wheat, but is actually lower in fructan. Traditional sourdough bread goes through a different process than other breads. Most breads are made using baker’s yeast, which shortens the fermentation process. Fermentation is Sourdough is made using a “starter,” instead of baker’s yeast. This is a culture of flour and water, that is made over many days, which produces yeast and lactobacilli. The starter is mixed with the bread dough and ferments over many days. The bacteria and yeast remove many of the fructans from the wheat. The longer fermentation and leavening steps in the bread making process, the lower the fructan content of the wheat.

Don’t get too excited, though, because all sourdough breads aren’t made this way. If the bread you’re eying at the store has yeast or other additives on the ingredients list, chances are it wasn’t made the traditional way. What you want to look for are simple ingredients: flour, water, salt, and starter (sometimes listed, sometimes not). If you’re purchasing from a local bakery or market, you can ask if it was made using traditional techniques, like slow fermentation and with a starter. You may also want to check that no high FODMAP flavor additives are in the bread, including high-fructose corn syrup, honey, onion, and garlic.

If you want to incorporate sourdough bread into your low FODMAP lifestyle, stick to 1-2 slices per day. You can avoid during the elimination phase and bring back as part of your fructan reintroductions if you want to to make sure you tolerate it. You may also be able to find sourdough made from lower FODMAP flours, like oat or spelt, which may allow a larger portion size.

My recommendation is to start with sourdough from a local bakery. You’ll most likely find traditionally made sourdough bread, plus you’ll be supporting your local economy! If you want to be creative, you could also start making your own sourdough bread. This book may be able to help you get started!

How Sleep Affects Gut Health & IBS Symptoms

Sleep and digestion are major parts of our day that may seem unrelated, but they are actually very connected. Studies have found a strong association between sleep and gastrointestinal disease, including IBS, and we think this is due to the gut-brain connection. The gut and brain are in constant communication through a bidirectional (goes both ways) pathway. Along this pathway, there is communication about hormone release and regulation, gene expression, and more! The gut-brain connection is also the connection between the gut and anxiety, stress, and depression. We know these can negatively affect digestion, especially for those with IBS, and we know that issues with digestion can lead to anxiety, stress, and depression. Sleep is also negatively affected by these, and we see the same bidirectional effect between the gut and our sleep as we do between the gut and the brain.

What does that mean? We are learning that poor sleep can negatively affect our digestion and our microbiome (makeup of bacteria in the gut), and poor gut health can negatively affect our ability to sleep and our quality of sleep. There are actually studies that have shown that a lack of sleep can reduce the number and variety of beneficial bacteria in the gut. This is huge, because with IBS we are concerned about the lack of beneficial bacteria in the gut. Even without IBS, this is a big deal because beneficial gut bacteria improve immunity, decrease inflammation, and play a major role in our overall health, including the communication to the brain that we discussed in the last paragraph.

So, what do you do? Our circadian rhythm regulates both our sleep-wake cycle, as well as our microbiome. If we want to improve our gut health, while also improving our sleep, we have to support our circadian rhythm. Here’s how:

  • Avoid excessive intakes of sugar and alcohol.

  • Avoid caffeine late in the day - it can stay in the system for 12 hours!

  • Get regular exercise & avoid high intensity exercise late at night.

  • Eat balanced meals throughout the day & avoid heavy meals or snacks close to bedtime.

  • Aim to go to bed & wake up around the same time each day - yes, even on the weekend!

  • Keep your stress in check with meditation, breath practices, exercise, journaling, yoga, and more!

  • Use essential oils like lavender to help your body fall asleep.

  • Reduce blue lights from screens later at night - turn off the TV and put your phone away at least 30 minutes before bedtime!

  • Create a bedtime routine to help the body settle and the mind release from your day so you can fall asleep more easily - some ideas: warm bath, light yoga, reading a book, and journaling.

The current recommendation for sleep is 7-9 hours each night, so hopefully these tips will help you hit within that range to support your gut health and reduce your IBS symptoms! As always, tracking your sleep can help you notice any patterns between the quantity and/or quality of your sleep and any IBS symptoms that occur. This is a major focus I have with my clients in my IBS Management Program. If you’d like personalized guidance through your IBS journey, apply for a free consultation here!


The Difference Between Soluble and Insoluble Fibers and Their Roles In IBS

Fiber is vital for IBS management and gut health, but not all fiber is actually the same. Fibers can either be labeled as soluble and insoluble. Let’s break each type down, then talk about which one may be best for your IBS symptoms.

Soluble Fiber

Soluble fiber dissolves in water. As it moves through the digestive tract, it dissolves water and forms gel. This helps to speed up digestion by softening the stool, and can help boost beneficial gut bacteria!

Source: oats, beans, lentils, many fruits and vegetables, chia seeds, flax seed, psyllium husk, avocado, and oat bran.

Insoluble Fiber

Insoluble water doesn’t dissolve in water. As it moves through the digestive tract, it doesn’t break down or change. Instead, it adds bulk to the stool and helps stool move more quickly through the digestive tract.

Sources: the skin and stalks of many fruits and vegetables, cauliflower, potatoes, wheat bran, nuts, beans, peas, and lentils.

Fiber and IBS

Fiber supports overall digestion, and helps boost good bacteria in the gut. For those with IBS, fiber can help regulate bowel movements, which could help alleviate symptoms. Studies have shown more success in IBS symptom relief with soluble fiber, especially supplemental psyllium. Too much fiber could also trigger symptoms, especially if increased too quickly. Recommended daily fiber intake is 20-30 grams for women and 30-40 grams for men. If you’re going above that, it may be helpful to reduce insoluble fiber, until symptoms improve.

It’s best to work with your dietitian to determine which sources of fiber may be best for you, especially if you are working through a low FODMAP diet. A simple way to start incorporating more fiber into your diet is to start with small portions of soluble fiber at a time from whole foods sources. Your dietitian can help you go from there, or consider whether or not supplemental fiber would be beneficial.

8 Types of Movement for IBS and Gut Health

Co-authored by intern Aubrey Baker.

Irritable Bowel Syndrome (IBS) can decrease quality of life because of how symptoms can deter you from enjoying daily activities and routine, which can lead to frustration and anxiety, and thus more symptoms. The majority of IBS symptoms (bloating, flatulence, constipation, diarrhea, etc.) are caused by stress or consumption of trigger foods. One way to relieve mental, physical, and emotional stress is by exercising. To learn more about stress and IBS, click here. Unfortunately, some forms of exercise can create distress on the digestive system. In general, high intensity exercises may aggravate symptoms and lead to unwanted flare-ups, but low intensity or shorter duration workouts can be beneficial. Learn more here!

Here is a list of exercises to avoid until symptoms are controlled:

  • HIIT and bootcamp-style workouts (especially longer duration ones like CrossFit)

  • Running or competitive cycling/spinning (long duration or high intensity)

To improve IBS and symptoms, focus on gentle movements that will increase your heart rate and allow you to create a positive experience for your body and digestive system. For an added bonus, take your movement outside!

Yoga

Yoga can be a very versatile workout. Yoga sequences can be altered to whatever level or comfort state you are experiencing. With yoga sequences and classes, you are given the power to be in complete control of how long you hold poses or how far and deep you lean into positions.  The stretches and controlled breathing relax your body and mind, letting go of both mental and physical stress.

Ways to incorporate yoga:

  • Local yoga studio 

  • Online yoga videos 

  • Goat yoga

  • Yoga in the park

  • Sunrise yoga class

  • Acro yoga with a partner

Barre and Pilates

Like yoga, barre and pilates practices are alignment-based, low intensity, and focus on breath. These can all help build muscle tone, improve flexibility, and reduce stress hormone levels. My personal favorite practice is Barre3 because it incorporates low intensity movement that also lifts the heart rate like crazy, all while focusing on body-positive language to empower you to feel amazing in your body. I’m a little biased as an instructor, but I truly do believe in this company for IBS management.

Ways to incorporate barre and pilates:

  • Try out a local studio or class at your gym

  • Stream workouts online or through a DVD

Tai Chi

Tai Chi is a prime example of gentle movement that is designed to relieve stress. Although, in the past this was used for self-defense practice, it has evolved into a graceful form of exercise that is mindful and gentle on the body. Tai Chi consists of slow and concentrated movements partnered with deep and intentional breathing. This practice, like yoga, is very versatile. You are in control of how deep you move, how long you hold a pose and how much you want your heart rate to increase.

Ways to incorporate Tai Chi:

  • Join a class in the park or at a studio

  • Follow a youtube video in the comfort of your own home

  • Connect to nature by practicing at the beach or in the forest

 Walking and Jogging

Running can lead to stress in the body and can cause a release of epinephrine, which is part of the stress response. When this hormone is released it internally causes the body to work/react faster. This is problematic for people with IBS because when your body attempts to compensate this rush, it “skips” a couple of steps. The main step skipped, is the complete breakdown of nutrients, which causes bloating, flatulence, or constipation. This can also exacerbate spasms in the gut, which is problematic with IBS-D. Instead of running, try power walking or light jogging. Start off taking leisure walks and slowly work your way up to a power walk, where you heart rate is elevated and the muscles in your legs are firing.

Ways to incorporate power walking or jogging:

  • Join a walking group

  • Walk on a treadmill at your gym

  • Glow in the dark night walking in your community

  • Walk or jog with your dog

  • Take a walk around a nature trail

  • To increase resistant on your walk, go for a hike or create an incline on your treadmill

Dancing

Dancing is a great way to release endorphins for a good mood, and increase your heart rate. Dancing activates muscles while relaxing the mind. The movement (when performed according to your body’s comfort level) can relieve stiff and achy joints, reduce muscle tension, and control anxiety by lifting the mood. Swaying along with the music and allowing yourself to express what you are feeling has been known to release pent up energy and stress.

Ways to incorporate dancing:

  • Join a dance class at a gym or local dance studio

  • Invite friends over for a dance party

  • Join a flash mob

  • Have a solo dance party with your favorite playlist blaring, Meredith Grey style

Swimming

Swimming is a great workout that increases your heart rate without exerting a lot of stress on your body. According to the UCSB Science Line, when an object is placed in a fluid, the fluid presses on the object in all directions. The force that presses upwards is known as buoyancy. Buoyancy is what keeps you floating and “weightless” in the water. For a lot of people when they feel weightless, their bodies relax. This sensation allows for a greater amount of movement and a decrease amount of restriction and resistance. Swimming elongates your muscles, by stretching and activating them. Stretching while strengthening your muscles can reduce the amount of inflammation and stiffness of your bones and instead, increases the protection which then releases stress on your body.

Ways to incorporate swimming:

  • Have a pool party

  • Take swim breaks while you’re on the lake with friends

  • Join water aerobics class

  • Teach your kids how to swim

  • Join a nauditorium’s swim membership

  • Swim laps at your local YMCA

Light Cycling

The words bicycling and IBS together can cause panic. The constant up, down motion and swaying motion can cause digestive agitation and potentially lead to an unfortunate accident. Fortunately for you, there are ways to decrease the chances of this unfortunate accident from happening. Instead of working on increasing resistance, focus solely on your form and (cautiously) contracting your muscles. Before going on a ride, it might be beneficial to scope out trails that have a lower amount of hills and bumpy areas. If desired, purchasing a softer seat cushion could be beneficial to you.

Ways to incorporate cycling:     

  • Nature trails or parks

  • Bicycle around your neighborhood

  • Start a bicycle club with your friends or neighbors

Weight Lifting

Resistance training with weights is a great way to build muscle and support stronger bone density. This is important to prevent injuries, as well as osteoporosis and osteoarthritis as we age. Very heavy weight lifting and weight lifting with extreme bursts of movement may increase cortisol in the body and make symptoms worse. However, moderate weight training that is controlled and focused may be able to lower cortisol and increase blood flow, improving symptoms.

Ways to incorporate weight lifting:

  • Work with a personal trainer that understands the need to support the gut

  • Try a low-intensity resistance training group exercise class

  • Work with resistance machines and moderate weights in your local gym

  • Buy moderate handheld weights to work out at home

 It is important to stay optimistic when finding exercise that best suits your body and your symptoms. These gentle movement ideas are not definite cures and should be altered to fit your comfort level. As always, consult with your doctor before participating in exercise. Nutrition is not the cause of IBS, but is an inflammatory factor and should included when adjusting your lifestyle to decrease symptoms. It’s important to know your specific food triggers so you are not restricting foods that your body can tolerate. The best way to determine your triggers is through the low FODMAP diet. You can work with me 1-on-1 in my 12 week structured IBS Management Program. This will guide you through the FODMAP diet to identify your specific triggers, as well as lifestyle modifications that impact IBS, to establish a life free of restriction caused by IBS. You can apply for a free consultation here. If you live outside of the U.S., my Low FODMAP Diet E-Course may be a better fit for you! Enroll here! I hope this post has shed some light on the importance of gentle movement and listening to your body when working with IBS digestive stress. Let us know other ways you incorporate gentle moving into your routine in the comments below!

The Effect of Stress on IBS

Stress, whether psychological or physical, plays a major role in the development of IBS and symptoms. When the body is stressed, the body goes into its “fight or flight” response. Heart rate and blood pressure are elevated, airways are opened, epinephrine (adrenaline) is released, senses are sharpened, and glucose is released into the blood. This response starts in the brain, but after the initial response is complete the body begins to respond via the HPA axis. Hormones are shifted, and cortisol (stress hormone) is released. The HPA axis is also the bidirectional communication pathway between the community of gut bacteria (microbiota) and the brain.

So what does this mean?

Activation of the HPA axis during chronic psychological or physical stress has been shown to alter the composition gut microbiota and increase gut permeability. These are both key factors in IBS. Changes in the gut microbiota and gut permeability has been linked to the development of depression and anxiety, due to altered communication along the HPA axis, as well as chronic inflammation. This is the gut-brain cycle that can be tricky for those living with IBS. Research has also shown that exposure to stress early in life can actually increase susceptibility to stress because the HPA axis is abnormal, which also puts that individual at risk of gut dysbiosis (changes in microbiota) and IBS. In reverse, gut bacteria can produce brain chemicals along the HPA axis called neurotransmitters, including dopamine, norepinephrine, GABA (gamma-aminobutyric acid) and the precursors to serotonin. Alterations in these neurotransmitters can impact how we feel. For those with IBS, this means that gut dysbiosis may be leading to feelings of anxiety or depression. There is also a small amount of research that shows a possible connection between a healthy gut microbiota and reduced risk for neural conditions, like alzheimer’s and dementia.

What can we do?

The role of stress in the development of IBS and symptoms highlights the need for a stress management approach to manage IBS. You can reduce stress by eliminating unnecessary stressors in your life, by increasing dopamine and lowering cortisol levels with exercise, and reducing cortisol and lowering heart rate through breath and meditation. There is also research to support gut directed hypnotherapy to help with psychological symptoms.

It’s also important to support the gut microbiota to prevent poor signaling from the gut to the brain that could lead to anxiety and depression. Our gut bacteria are so complex and unique, and there’s still so much we have to learn about them. The goal is to have a diverse, and large number of beneficial bacteria populating the gut. This can help reduce negative bacteria, and will contribute to improved digestion and a stronger immune system.

Here are a few ways you can support a healthy gut microbiota:

  • Plants! Eat a plant-heavy diet from whole grains, fruits, vegetables, and plant-proteins (legumes, nuts/seeds, tofu/tempeh). These provide fiber that the beneficial bacteria feed on and thrive on!

  • Less sugar, caffeine & alcohol. These are all fine in moderation, but excessive amounts can promote negative bacteria, which would lower beneficial bacteria.

  • Exercise! Low intensity exercise has been shown to support beneficial bacteria.

  • Get outside. Being in the outdoors not only increases your feel good hormones, but the microbes in the area and on the ground can help increase beneficial bacteria inside the gut.

  • Probiotics. There is limited research here, but there is a small amount of evidence to support using supplemental probiotics to support a beneficial gut microbiota. Work with a dietitian to pick a probiotic that is best for your needs. It’s also helpful to eat probiotic-rich foods from yogurt, kimchi, kefir, sauerkraut, and kombucha.

  • Reduce the stress! This is a bit repetitive, but we already know the stress response can alter the gut microbiota, so if you want to increase your beneficial bacteria you have to reduce stress levels. If you have a hard time getting control of this, a mental health professional could be helpful.

  • Avoid excessive antibiotic use. Antibiotics are incredible for getting rid of bacterial infections in the body, but they also clear out some of the beneficial microbes. Antibiotics should not be the first line of therapy for every single infection, so talk with your doctor about all options before starting an antibiotic round.

That’s a lot of information, so take a second and set one action item today that you can start implementing into your life to support your gut microbiota and reduce your stress!