The Connection Between Foodborne Illness & IBS feat. IBS-Smart

Irritable bowel syndrome (IBS) has been one of the most mysterious gastrointestinal (GI) disorders. We still don’t fully understand the condition, but as we learn more, we have been able to draw out a few potential causes. One common cause of IBS we see is foodborne illness, which is often referred to as post-infectious IBS (PI-IBS).

PI-IBS occurs after acute gastroenteritis (inflammation of the gut) caused by a foodborne illness. IBS symptoms, specifically diarrhea, can occur immediately after the foodborne illness has passed, or can take up to a year or more to present themselves. Studies across the globe show a 5-32% prevalence of PI-IBS after a foodborne illness. The most recent meta-analysis of research from the Mayo Clinic shows that one out of every nine people with a foodborne illness will end up with IBS.

Why is the link so strong? Infection and acute gastroenteritis leads to an autoimmune response that can cause gut nerve damage and dysfunction of the cells and migrating motor complex that regulate gut contractions. This leads to changes in gut motility that is a major marker for IBS. Infection and inflammation are also thought to increase intestinal permeability by damaging enterocytes, and alter the gut microbiome. All factors we know contribute to IBS.

Diarrhea-predominant IBS, known as IBS-D, is the most common form of PI-IBS. The more common pathogens that can lead to this are Campylobacter jejuni, Salmonella enterica, Shigella sonnei, E. coli, C. diff, and Giardia lambia. Infection with one of these pathogens can happen from contaminated water or produce, undercooked meats, food left out for long periods of time, not washing hands, other contact with the pathogens in the environment (ex: hospitals), and more. We see these infections most when people are traveling to underdeveloped countries, but they can happen to anyone, anywhere. The risk of PI-IBS is shown to increase in females, with anxiety disorders, and with a history of antibiotic use. Risk is shown to decrease as age increases, so onset may be more common among children.

PI-IBS is treated in a similar way to IBS-D. The use of the low FODMAP diet may help identify specific food triggers and reduce symptoms. Gut-directed hypnotherapy or cognitive behavioral therapy could be helpful, and medications may be used to reduce gut spasms. Antibiotic and probiotic therapy may also be used to treat the infection and rebuild the microbiome.

Something unique to PI-IBS is that symptoms have been shown to slowly decrease with time. They may last 8-10 years, but they could significantly improve in the first 2 years, which is encouraging for those dealing with this type.

Why is it important to know if your IBS is post-infectious? Knowing the cause of IBS can increase confidence in choosing treatment options, and knowing that your symptoms may improve over time can increase hope in the present moment. Knowing that you have PI-IBS can also be helpful for those who have had foodborne illness and are wondering why their symptoms are not improving.


In the past, PI-IBS was diagnosed using the Rome IV criteria (like every IBS diagnosis) and noting that symptoms occurred after a foodborne illness. The problem with this is that some people have no idea that their sickness is actually a foodborne illness, so they don’t state that they had one when they present their symptoms to their doctor. Also, symptoms could take a year to present themselves, and even longer for someone to go to the doctor out of concern, so the foodborne illness may a distant memory at time of diagnosis.

Now, we have an option for accurately spotting PI-IBS : IBS-smart! IBS-smart was created by doctors at Cedars-Sinai Medical Center after they found two antibodies, anti-CdtB and anti-vinculin, that are elevated in PI-IBS patients. These antibodies are involved in the autoimmune response that leads to the physiologic changes of the gut to develop IBS. Read more about their findings here.

IBS-smart is shown to be 90% specific in distinguishing IBS from IBD, which would be helpful to identify if IBS is overlapping with an IBD diagnosis. It is also shown to be 98% effective in identifying IBS, so you can be confident in a positive result.

The test is currently being used by many doctors around the country, and recently became available in Canada. You can talk with your doctor about ordering the test, or find a doctor in your area that is using the test here.

Want to learn more? I interviewed Dr. Pimentel, the leading researcher and developer of IBS Smart, to dig deeper into how IBS Smart works and what the value could be for you!


Erin: What does the process of ordering the test, taking it, then getting the results look like? What could someone expect?

Dr. Pimentel: You can simply log on to our website www.ibssmart.com/getdiagnosed and follow a few easy steps to request the ibs-smart test. The ibs-smart kit includes phlebotomy supplies and prepaid shipping materials and will be shipped directly to your home. Once you receive your kit you can bring it with you to any blood draw lab, along with your signed test order form to collect and ship your sample. Test results are reported within seven days of receiving your sample and include both qualitative and quantitative results. 

Erin: Who is the test best used for? Who would the test not be effective for? 

Dr. Pimentel: If you have chronic diarrhea and bloating with occasional pain or cramping, you may have IBS. It is the most common disorder in gastroenterology and one of the most common cause of visits to the doctor. However, recently a new test for the first time allows a patient or doctor to get to a diagnosis faster. This test is ibssmart which measures two antibodies. We now know that a large proportion of IBS sufferers have IBS starting from food poisoning which lead to autoimmunity and gut dysfunction. This new blood test assesses for this and hence can diagnose IBS within days (where it used to take years of unnecessary testing. 

There are people who should be cautious when taking this test. If a person has blood in their stool, unexpected weight loss or are over the age of 45 and have never had a colonoscopy, they should see a doctor to be sure there is not some other diagnosis. However, if testing here is negative, ibssmart may still be helpful. 

 Erin: What happens with a positive test? What about a negative test?

 Dr. Pimentel:

IF: CdtB: Elevated; Vinculin: Not Elevated

Levels of anti-CdtB, a biomarker for post-infectious IBS, were elevated in your blood. While levels of anti-vinculin were not elevated, this still means that there is nearly a 90% likelihood that you have post-infectious irritable bowel syndrome (IBS). The cause is likely a long past infection from food poisoning that has developed into an autoimmunity driving your IBS symptoms.  

IF: CdtB: Not Elevated; Vinculin: Elevated

Levels of anti-vinculin, a biomarker for post-infectious IBS, were elevated in your blood. While levels of anti-CdtB were not elevated, this still means that there is nearly a 90% likelihood that you have post-infectious irritable bowel syndrome (IBS). The cause is likely a recent infection from food poisoning. 

 IF: CdtB: Elevated; Vinculin: Elevated

Levels of both anti-CdtB and anti-vinculin, biomarkers for post-infectious IBS, were elevated in your blood. While levels of anti-CdtB were not elevated, this still means that there is a 98% likelihood that you have post-infectious IBS. The cause is likely a recent infection from food poisoning that has developed into an autoimmunity driving your IBS symptoms.

 IF: CdtB: Not Elevated; Vinculin: Not Elevated

Levels of anti-vinculin or anti-CdtB, biomarkers for post-infectious irritable bowel syndrome (IBS), were not elevated in your blood. This means there is a very low probability that you have post-infectious IBS. You could still have IBS from a source other than gastroenteritis, or your symptoms may indicate a condition other than IBS.

Erin: What is the overall value of taking this test versus the traditional method of diagnosis? 

Dr. Pimentel: What we know is that the sooner a patient gets a diagnosis for a disease, the sooner they get the right treatment. Some patients pay up to $20,000 in copays before they are told it’s IBS. These included so many negative investigations such as colonoscopy, ultrasounds, CT scans, stool testing and other blood work. Getting an answer in 48 hours would save that cost.  

Besides the cost, this test tells the patient why they have IBS. This is important because if food poisoning did cause your IBS, you need to avoid further food poisoning which make your illness more severe, potentially. 

Erin: How does this test change the treatment plan for a patient? How has the test revolutionized your work with IBS?

Dr. Pimentel: The test, when positive, points in the direction that IBS is a microbiome disease. In animal studies, when these antibodies are elevated, it leads to bacterial overgrowth. We know that antibiotics work in IBS but only found out why recently and bacterial overgrowth appears to be the reason. 

The test has put the power back in the hands of patients. Patients get an answer that they have IBS. Now if the test if positive, IBS becomes a real disease, not a psychological condition. This is empowering for patients and doctors. I believe this second generation test, ibssmart is a gamechanger. 


FOOD : The Main Course Conference Overview

If you follow along on Instagram, you may have noticed I was in Michigan for a digestive health conference at the end of September. I was able to connect with other dietitians across the country that work with gastrointestinal disorders, and learned a ton from the speakers.

I had a few requests to share what I learned and share about low FODMAP products that were featured during the conference, so here we go! This may seem a bit scattered, as I am literally sharing my top takeaways, so comment at the bottom of the post if you have any follow up questions or want to dig deeper in a specific area.

Science

Before we talk food, let’s talk science. There is a lot of research coming out for IBS and other digestive disorders. It’s fascinating and will hopefully lead to breakthroughs in medical care. I had a lot of takeaways, so I’m going to break down the ones that are related to IBS:

  • The pathophysiology (cause) of IBS has evolved over time. We originally thought it was a psychological disorder (the all in your head idea), then it moved to impaired gut motility (movement) and hypersensitivity. Today, we know these all play a role, but we also include causes of genetics, changes in the microbiome, gut-brain axis, immune activation, and increased gut permeability.

  • Research shows that environment influences the gut microbiome more than genetics. Environmental factors include birthing method, infant feeding, antibiotic use, exposure to microbes, and stress.

  • IBS versus controls in research shows a significant difference in microbiome makeup, and continued to show differences between each individual. In general, those with IBS has elevated amounts of lactobacillaceae, bacteroides, and enterobacteriaceae; and had reduced amounts of bifidobacterium and faecalibacterium. This could be beneficial for identifying IBS and developing a treatment for dysbiosis of the microbiome.

  • While evidence is still lacking for probiotic use for IBS, we generally see an improvement in symptoms and won’t do much hard recommended probiotics. There is conflicting data on which strains to recommend, so this is an area we can learn more.

  • There is some evidence to support probiotics for anxiety and depression, which could also be beneficial for those with IBS. B. longum is the strain that was studied.

  • There is a study showing a potential benefit to prebiotic therapy (basically adding in FODMAPs) versus low FODMAP for IBS. The study showed the same effectiveness, which is promising for improving the gut microbiome. Not used in practice yet.

  • We may start seeing breath testing for IBS and possible Rifaximin use for IBS. Won’t work for everyone, so we need to develop a way to test first and treat those that will be more successful with this treatment.

  • The number one nutrition approach for IBS is still the low FODMAP diet. We also see a benefit with the Mediterranean diet, which may be a valuable transition after the low FODMAP diet.

  • Mast Cell disease can cause similar symptoms to IBS. Rare, but could overlap. Histamine is the most common mediator here, and symptoms of diarrhea and pain are more commonly seen. Can also present with allergy-like symptoms, including hives. This is all new information and we are still studying it to find clear biomarkers for this disease.

LOW FODMAP PRODUCTS

There were many low FODMAP brands present to share their products and how that may benefit those with IBS and other digestive disorders. Before giving specifics, I was also introduced to the FODMAP Friendly Food Program. They test and certify food as low FODMAP, giving products a label that you can trust. They have an app, so grab it and have a list of products on hand at all times. Here are the brands that stood out the most to me:

  • Schar gluten free products - most are low FODMAP! Their ciabatta bread and pizza crusts are so so good. Excited to try more.

  • Fody Foods - we love them, we know them, but they’re still a fave.

  • Epicured - they sell premade low FODMAP meals and deliver them to your door! Only available in select areas of the United States now, but may be expanding soon!

  • Enjoy life - they had chocolate chips, chocolate bites, and breakfast bars to try. I don’t love their chocolate bars (I prefer simple dark chocolate) but it’s still a great option for a protein-rich snack.

  • Freshcap Mushrooms - low FODMAP mushroom powders are here! If you’re into that, these are certified and a great option.

  • Fodmapped For You - premade soups! Hello easier meal prep. I can’t believe it took me so long to experience these!

  • Casa de Sante - they have bars, dry soup mixes, protein powders, spice mixes, and more! A great place to try different flavors.

  • Rachel Pauls Food - their Happy Bars are unique and completely low FODMAP!

  • Eat Bobos - oat bites are low FODMAP and easy to find in most health food stores.

  • 88 Acres - they were highlighting a chocolate bar that was incredible! They also have seed butters and other bar flavors.

  • Wow - they shared a packaged gluten free cookie that’s also low FODMAP. Would be a great option for a kiddo.

  • Blue Diamond Nut Thins - my favorite low FODMAP crackers! Perfect plain or with cheeses!

Natural Remedies for Gas

Gas (flatulence for the proper faces out there) is one of the most annoying symptoms of IBS. Yes, gas isn’t as traumatizing as a diarrhea flare in public, but gas can be more common and can be an embarassing symptoms to deal with on the daily. Because, let’s be honest, it’s hard to hide a smelly fart. Pardon my french.

Gas is the result of our gut microbes fermenting and breaking down certain carbohydrates, which produces hydrogen and methane (what we refer to as simply gas). Lactose/dairy and beans are the most common gas-causing carbohydrates, but there are many plants that can also lead to more gas production, including cruciferous vegetables and fermentable fibers.

As I grew up with IBS and didn’t understand why these symptoms were occuring, I remember being terrified of having gas in public. I didn’t want to be the girl that stank up a room, and I came from a family that was very reserved about passing gas, so I felt a lot of shame about the possibility of letting it out around others. I also remember the pain that came with trapped gas. There were many moments where I found myself (and still do on occasion) laying on a dirty public bathroom floor, or stepping away from an event to go lie down in my car on my belly to get the gas out. It almost always works for me, but it’s disgusting when you’re on the floor where others let their pee travel all over, or when you have to leave your friends/family to go lie down until things moved along. I never talked about this because I thought I was weird and abnormal, but now as I lead a community of others living with IBS, I realize that we all have these stories and none of us are alone in these symptoms.

Long story short, gas sucks. So what do we do about it? There are plenty of medications out there that target gas, but I want to focus on a few natural remedies for preventing and releasing gas. Before diving in, I will start by saying that if you have IBS, it’s vital that you figure out what your major triggers are. If you’re not managing those triggers, it will be harder to prevent gas. If you haven’t taken that step yet, I have two options for you. If you live in the United States and need more individualized care (personalized process, lots of feedback, ongoing assessment, etc.), my IBS Management Program would be a great fit! If you don’t need an individualized approach, or if you live outside of the United States, my Low FODMAP Diet E-Course could be a great start! As a bonus, use code BLOG for $40 off!

Back to the gas, there are many reasons why you may be experiencing gas, beyond simply having IBS and being more sensitive to foods, like FODMAPs. Potential causes, include:

  • Eating too fast and not chewing your food

  • Cruciferous vegetables

  • Spicy and fatty foods

  • Beans and legumes

  • Garlic and onion

  • Apples and dried fruits

  • Alternative sweeteners (sugar-free)

  • Dairy

  • Fiber supplements

  • Drinking a lot of water with meals

  • Wearing tight-fitting clothes

  • Carbonated drinks

  • Large meals

  • Swallowing excess air from chewing gum, drinking from a straw, and talking while eating

After you determine your IBS triggers, you can then prevent gas by adjusting some of the behaviors and foods listed above. After that, use these simple remedies to get the gas out and move on with your day.

Peppermint

Peppermint is a naturally-occuring, gas-relieving herb that contains monoterpene compounds, including L-menthol, that target the source of IBS symptoms. Dig deeper into the “why” behind peppermint here! You can take peppermint in capsule form, from IBgard, which has the most studies to back up its claims. You can also try a high quality, ingestible peppermint essential oil, or try peppermint tea.

Ginger

Ginger has been shown to affect the enzymes trypsin and pancreatic lipase during digestion to speed up motility and emptying of the stomach. This can help prevent against constipation, gas, bloating, and indigestion. Read more about ginger and digestion here. You can add ginger to your meals in its fresh or dried forms, or you can make ginger tea when you’re feeling bloated to get things moving along.

Digestive Enzymes

Gas isn’t always caused by your enzymes not working properly, but gas can be a result of slow fermentation due to either a lack of enzymes or poor function of enzymes. You can try lactase for dairy and alpha-galactosidase for oligosaccharides found in wheat, garlic onion, beans, and other pulses. Alpha-galactosidase may also help with cruciferous vegetables. Common brands of these are Lactaid and Beano. Read more about enzymes and IBS here.

Activated Charcoal

I included this one because I knew I would get questions about it. There is very limited (almost none) evidence that this is safe and effective for those with IBS. However, this has been used in alternative medicine for a while as a remedy for gas, and many people claim relief from it. Since research is limited, you’ll want to discuss this with your doctor to make sure it is safe for you. Aka don’t just trust the influencers on the internet about it.

Movement

This one is my favorite, because it takes the focus off of food for a bit. When you move your body, you increase blood flow to the gut, which helps increase motility to move things along, including gas. Go for a walk or do a little yoga after a meal to help aid digestion, or try moving in an enjoyable way when you feel gassy to help relieve it.


SIBO Overview & Its Relation to IBS

SIBO, or small intestinal bowel overgrowth, is a condition that often overlaps with irritable bowel syndrome (IBS). Both conditions share similar symptoms, including abdominal pain and distension, and changes in bowel motility (constipation or diarrhea). Many times SIBO can be misdiagnosed as IBS, and SIBO can also increase risk for IBS. Because of these overlaps, these conditions are further misunderstood and leave those living with them confused.

SIBO is a condition where there is an overgrowth of both aerobic and anaerobic bacteria in the small intestine. Usually, the small intestine has very low levels of microbes, while the large intestine is home to the majority of our important microbes. The overgrowth of bacteria are not all “bad” bacteria. We still have a lot to learn about SIBO, but it seems that the microbes are just in the wrong place, finding their home in the small intestine instead of the large intestine. Dysbiosis, on the other hand, is the imbalance of microbes, where the “bad” outweigh the “good.” This can be present in both the small and large intestine, and will have its own effect on the body. For dysbiosis, the goal is to increase the “good” bacteria through different lifestyle and nutrition interventions. For SIBO, the goal is to clear the small intestine of the bacterial overgrowth, then prevent reoccurence.

SIBO and IBS can be present together or separately. Since symptoms overlap, it’s hard to know for sure whether both are actually present. It’s important to ask for a SIBO breath test when you are getting an IBS diagnosis. Once you treat SIBO, you can monitor symptoms. If IBS-like symptoms still occur after SIBO is treated, then you may also receive a clear IBS diagnosis.

IBS is diagnosed according to Rome criteria, based on symptoms and duration, in the absence of other conditions, including celiac, allergies, and irritable bowel disease (Crohn’s or colitis). SIBO is diagnosed using a glucose or lactulose breath test. Many studies support the glucose test, which may be more ideal for those with severe symptoms. The lactulose test may be able to detect distal SIBO, but it can lead to diarrhea, which may not be ideal. The results of the tests can either be negative, or will be positive for two potential types of SIBO: hydrogen dominant or methane dominant. Breath tests may not 100% accurate, but they are the most non-invasive option we currently have.

The good news is that there are treatments for SIBO that have shown to be fairly effective. The conventional treatment method is to use non-absorbable antibiotics that target the overgrowth, without having a broad spectrum effect. Rifaximin is used for hydrogen dominant, and a combination of rifaximin and neomycin is used for methane dominant. The alternative treatment option is to use herbal therapy, which has still shown a lot of great success. This method uses a combination berberine herbs, allicin (for methane dominant), oregano, and neem to have an antibiotic effect. It’s important to work with a knowledgeable practitioner if you are considering this option.

After treating with antibiotics or herbal therapy, following a low FODMAP diet or other low fermentable carbohydrate diet can help control symptoms and prevent reoccurence. There is very little research to recommend a clear nutritional approach, but practitioners agree that modifying fermentable carbohydrates is effective. Options include low FODMAP, low fermentable diet, GAPS, or paleo. Some practitioners may also recommend a reduction of sugar and resistant starches. The low FODMAP diet is what I use in my practice because it can allow for more variety and less restriction after the reintroduction phase. After treatment, a prokinetic, like erythromycin, may also be used to to enhance intestinal motility. Alternatives include prucalopride or cisapride.

During antibiotic or herbal therapy, the consensus is to avoid complete restriction low fermentable carbohydrates, to allow bacteria to flourish in order to be removed. There are mixed reviews on the use of probiotics during treatment. A 2017 study shows a benefic to probiotic therapy. Align or Culturelle would be good options to consider with your doctor during treatment.

With SIBO, it’s important to find and treat the underlying cause of the bacterial overgrowth to prevent reoccurance. The problem is that the cause can be tricky to identify. Potential causes, include:

  • Foodborne illness - prokinetic therapy or herbal supplement Iberogast can help with this

  • Long-term PPi (proton pump inhibitor) use - can alter the pH of the small intestine and reduce motility - work with a doctor to reduce or discontinue use

  • Chronic constipation - work with a dietitian to alter diet, lifestyle habits, and body positioning to improve

  • Decrease in bile acids - work with doctor

  • Chronic stress - work with therapist to implement habits and practices to reduce stress

  • Migrating motor complex (MMC) deficiency - can be stimulated with a prokinetic

Other conditions can increase your risk of SIBO. If these are present, it’s important to work with your doctor to treat or manage them. Conditions include scleroderma, small intestinal pseudo-obstruction, intestinal adhesions, pancreatic insufficiency, small intestinal diverticulosis, low stomach acid (achlorhydria), diabetes, radiation enteritis, immunodeficiency, and ileocecal valve resection. SIBO, or its underlying cause, could also lead to malabsorption, so it’s important to check nutrient levels in your blood so you can supplement, if necessary.

If you’re looking for personalized care through your SIBO journey, my IBS Management Program can be adapted for you! We will use a low FODMAP approach to decrease symptoms, then talk about how to take care of the underlying cause of your SIBO so you can move forward with more food freedom and less risk for recurrence. If you’re interested, apply for a free consult here.


Ginger's Effect on Digestion and Irritable Bowel Syndrome

Ginger, also referred to as ginger root, has been used in alternative medicine to improve digestion, reduce nausea, and help fight the flu or common cold. It has also been used in the culinary world to add a unique flavor to many dishes, including curries, soups, sauces, and more! Why does it seem to be such a staple in health and food?

Ginger root is full of bioactive compounds, including gingerol, that have anti-inflammatory and antioxidant properties. This means, these components of ginger can help reduce inflammation in the body and protect the body against free radical damage, which both prevents disease and the negative effects of aging. Many of our plants have similar effects, but ginger also has unique effects on digestion, that may be of interest to those living with IBS.

Ginger has been shown to affect the enzymes trypsin and pancreatic lipase during digestion to speed up motility and emptying of the stomach. This can help prevent against constipation, gas, bloating, and indigestion. One study showed that 1.2 grams of ginger powder before a meal increased stomach emptying by 50%! Ginger has also shown to relieve gastrointestinal (GI) irritation, stimulate saliva and bile production, and suppress gastric contractions as food and fluids move through the GI tract. This may be able to help reduce pain caused by hypersensitivity for those with IBS. The most evidence for ginger’s role in health is in its ability to reduce nausea. One study found that ginger may be as effective as prescription medications for nausea.

Studies on the role of ginger in IBS treatment are limited and conflicting, so we still need to do more research to know exactly how ginger works with IBS. But, if you struggle with slow motility and constipation, then adding ginger to your diet could be helpful.

One thing I love most about ginger is the flavor it adds to meals. Ginger is low FODMAP, so it’s a great alternative to garlic for a somewhat spicy and bold flavor profile that also packs an antioxidant punch. Simply peel fresh ginger root, then chop it up or grate it into dishes like curries, soups, stir fries, salads, and more! My absolute favorite way to use ginger? Tea! Check out my go-to ginger lemon tea recipe below!

If you’re working through the low FODMAP diet and aren’t really sure how to begin, what meals to cook, or how to test food groups to identify your personal triggers, my Low FODMAP Diet E-Course is for you! Bonus: get $40 off by entering code BLOG at checkout!

NO BLOAT LEMON GINGER TEA

This is one of my favorite recipes for after dinner, to ease any bloating from my day and aid in my digestion before going to bed!

Peel and slice a 1/2-1 inch ginger root. Slice 1/2 lemon. In a mug, add ginger, lemon slices, and squeeze of lemon juice. Pour in hot water, then steep for 5ish minutes. Enjoy!


Gut-Directed Hypnotherapy and its Role in IBS Management

Gut-directed hypnotherapy is a form of hypnosis that aims to calm the digestive tract and take the focus away from the body (and symptoms) to relax the mind. This practice targets the miscommunication between the gut and brain that we see with IBS, and is used by trained therapists for IBS treatment.

Gut-directed hypnotherapy is relatively new, in terms of a go-to recommendation for IBS treatment, but research is promising. Studies show that this therapy is effective for IBS and can be effective for children. That’s huge, because a low FODMAP diet and other dietary interventions can be much more difficult for children living with IBS.

So, how does this work? Gut-directed hypnotherapy starts with relaxation, then uses guided visualization exercises designed to calm the gastrointestinal (GI) tract. This practice is different than meditation, because it has been standardized and tested to specifically target the gut. It is most effective for the symptom of pain and may be beneficial for anxiety-induced spasms. Studies show that the benefits could last a year and is thought to be as effective as the low FODMAP diet, with 53-94% of patients responding to treatment.

Gut directed hypnotherapy may be a great option for some, but may also not be ideal for all. While it sounds like a “quick fix,” the therapy sessions happen over many weeks, depending on the provider of choice. Most I have seen work over 7 sessions. I would recommend this approach for those with an eating disorder history and those who are not able to fully work through the low FODMAP diet. This could also be a great option for those that know their symptoms are more triggered by stress and anxiety.

Like every approach to IBS management and treatment, there’s no guarantee that one specific approach is going to work for your mind and body. If this is something you are interested in learning more about or trying, click here for a list of providers near you!


The Connection Between the Pelvic Floor and IBS

Featuring an interview by pelvic floor specialist, and Nashville-based physical therapist, Jen Le Coguic, PT, DPT, OCS.

Jen Le Coguic, PT, DPT, OCS is a pelvic floor physical therapist practicing at Susan Underwood Physical Therapy in Nashville, TN. She completed her Doctorate of Physical Therapy at Belmont University in 2011
and received her Board Certification as an Orthopedic Specialist in 2013. She completed her training as a pelvic floor specialist through the Herman and Wallace Institute.


I find it absolutely beautiful how our bodies are created to work together. As someone who lives with and works with IBS, I get to discover connections like this all the time. While every connection can add another layer to an already complicated IBS puzzle, they present opportunities for us all to grow and understand our bodies a little better.

One connection I have been diving into for the last few months is the pelvic floor. It’s not surprising that the pelvic floor is connected to our digestive process, but understanding how is fascinating. The pelvic floor refers to the layer of muscles that stretch along the bottom of the pelvis, extending from the tailbone to the pubic bone (front to back). These muscles work like a hammock to support the pelvic organs, including the bladder, bowels, and uterus (for women). The pelvic floor has openings for the urethra, anus, and vagina (for women), and the pelvic floor muscles work with the anal and urethral sphincters to keep these passages shut. This allows us to have control over the bladder and bowels to determine when we release urine, feces, and faltus (wind). The pelvic floor also plays a major role in sexual function for both men and women, and they work with the abdominals and back muscles to support and protect the spine.

That’s a lot of important stuff, right? So why don’t we hear more about the pelvic floor? Generally, the pelvic floor muscles do what they need to do. But, when they become weak or damaged, which can happen from a variety of causes including childbirth, this can lead to urinary incontinence, fecal incontinence, and/or pelvic organ prolapse (where the pelvic organs “drop” through the vaginal canal). When the pelvic floor muscles are too tight (a healthy muscle is able to both contract AND relax), this can cause constipation, straining during bowel movements, and incomplete defecation/emptying.

Many people with both IBS-D and IBS-C could be experiencing an issue with their pelvic floor that may not get recognized due to the symptoms being a “result of their IBS.” While pelvic floor dysfunction may not be the sole cause of your digestive issues, it could play a major role. And if you’ve been living with IBS for a long time, you may have more damage to your pelvic floor as a result of your symptoms.

To learn more about the pelvic floor, I had the honor of interviewing a local physical therapist, Jen Le Coguic, that specializes in this area.

Erin : In the most simple way, can you explain what pelvic floor physical therapy is?

Jen: Pelvic floor physical therapy is a specialized form of physical therapy with emphasis on the muscles, nerves, and connective tissues within the pelvis. These muscles encircle the openings and form a muscular support layer that runs from your pubic bone, out towards your sits bones, and back to your tailbone. These muscles help control your bladder, bowel, and sexual function, and they are an integral part of the body’s core stability system by supporting the spine, pelvis, and hips. Dysfunction can arise if these muscles are too weak or too tight. For example, if the muscles are too weak, a woman may leak urine with coughing or sneezing. On the other hand, if the muscles are too tight or uncoordinated, a woman may have problems with constipation, urinary frequency and urgency, pelvic pain, and/or pain with intercourse.

Erin: What is the function of the pelvic floor?

Jen: The pelvic floor has a wide range of functions but can be summarized by the 5 “S”’s:

  1. Sphincters: Keep things in/ let things pass!

  2. Stability: Stabilize the spine, hips, and pelvis.

  3. Support: Support the pelvic organs in their proper position within the pelvis.

  4. Sexual: Aid in sexual appreciation and orgasm.

  5. Sump pump: Help clear fluid out of the pelvis.

Erin: How would pelvic floor be beneficial for those with IBS?

Full article and interview with Jen, including what you can do for your pelvic floor today based on your symptoms, is found in the IBS Society. Click here to start your free 2 week trial today and keep reading!


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.