Season 4 Episode 8: How Do I Manage IBS Holistically?
As a medical professional in the IBS space, something I'm really passionate about is the idea of Holistic Management of IBS and all digestive disorders. A lot of times, I think people don't fully understand what Holistic Management really means, and this can cause a lot of confusion, mistrust, and misinformation. During this episode, I talk about what a holistic approach to health actually means, how you can apply holistic approaches to your IBS, what your body needs for proper digestion and what the next steps are after symptom management.
In this episode, we cover:
What is holistic health management?
Managing digestion for IBS symptoms holistically
What you need for proper digestion
Get your sleep, health, and other routines on track
Understanding your triggers
The next steps after symptom management
Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.
What if you could develop vital skills to help manage intrusive IBS symptoms in only 10 minutes a day? How would your life change? Today’s episode is sponsored by Mahana, an app that teaches you skills to manage your IBS and decrease symptom severity. Through the app, you’ll get short daily lessons and experiment with new skills, unlock tools to support your symptom management, and learn to make small changes to improve everyday patterns. Get started now and download the app at mahanatx.com/TheGutShow.
As a medical professional in the IBS space, something I'm really passionate about is the idea of Holistic Management of IBS and all digestive disorders. A lot of times, I think people don't fully understand what Holistic Management really means. I think sometimes because of marketing and the culture that we live in, holistic has kind of come to equate these almost alternative practices, versus being what Holistic Management truly is, and holistic health truly is.
So that means that we're looking at you as a whole person, and we're addressing your health from every single angle. We're not just looking at the surface, we're not just looking at the symptoms themselves, and we're also not just looking at one form of management, but instead we're looking at the whole being, your health as a whole, and even your entire life.
With IBS, one of the best parts of this, and this is the short answer to the question of how do you manage IBS holistically, it's to use every tool available for your whole life. With IBS, this could not be more true, because IBS is impacted by so many different things in your life. I often talk about IBS management like putting together a puzzle, how you know, each piece is so valuable, like you know, the low FODMAP diet, which is evidence based or maybe even certain supplements or stress management or whatever it may be, each piece matters. But for some people, one single piece is not going to make the whole puzzle come together. What also isn't going to work is putting one piece down and throwing it out when it doesn't work and then looking at the next piece. Instead, what we need to do is we need to put each piece together, and we need to look at that full picture until it all comes together.
For some people, this puzzle may only be a few pieces. Others this puzzle may be many, many, many, many pieces. The positive to that really is that you get to individualize your approach this way and there are plenty of puzzle pieces that you can choose from, that can work for you if one puzzle piece maybe doesn't fit in your life, like stress management for the new mom who just brought her baby home and isn't able to, you know, do anything outside of take care of a child like that's a special circumstance or diet interventions when you have a history of an eating disorder or present eating disorder and that's not the right fit for you. There are so many different puzzle pieces.
What I want to go over today is a bit more about what I look for as a practitioner and how I kind of address IBS more holistically, what you can be thinking about and hopefully spark some ideas in your mind of things that maybe you haven't tried before, you haven't really considered before, and then we will also talk about how to actually kind of work in steps as well, because with IBS management, it's not just about symptom control. That is number one, symptom control is the first thing we want to work on because we want to give you margin, we want your symptoms to go down, we want you to feel better.
But outside of symptom control, we really need to make sure that your gut microbiome is supported, your gut brain connection is supported, your immune system is supported, because those are going to be the main drivers, which we've talked about a lot in this season, those drivers of symptoms. So that's something that we have to make sure we hit on so that we can improve the tolerance in your gut, we can improve the resiliency in your gut, we can improve kind of how how you handle things in the future versus only symptom management, which can kind of wax and wane each day and also be impacted by changes in routines, travel, you know all of those different things.
We have to think about in stepwise pieces, and that is something that I think, you know, this traditional healthcare setting is often missed, which is why we've kind of changed the way that we do that here at Gutivate, and I'll talk a little bit more about what that looks like so that you can see, you know, what could be possible and how you could put that together for yourself.
One thing to think about, because if you look at research and we are thinking about symptom management strategies, we have some evidence based management strategies for IBS. That's where the low FODMAP diet fits in got directed hypnotherapy, cognitive behavioral therapy, and even certain medications. There's also some evidence for things like kiwi for constipation, things that aren't necessarily in those initial categories.
But outside of that we don't really have a lot of evidence and research on some of these more are holistic strategies that we talked about, so the way that I like to explain it is looking at digestion and how digestion actually works and that's how I pull a lot of the strategies that I may use with a client into our plan.
So taking into account IBS and the drivers of IBS, and evidence based techniques and strategies and therapies for IBS, which I've covered a lot in this season, but also taking into account how your digestive digestive system is meant to function. Since IBS is a functional disorder, and does impact the function of the gut and the function of digestion, your gut is going to need more support than someone without IBS.
Now, ideally, right, digestion is something that you know, we come out pooping, and then we can poop easily, and digestion just happens without much of unconscious effort. And that is a great scenario. But digestion actually needs a lot to actually work. It's not something that just happened. It's not like a heartbeat, where your heart is going to beat no matter what, it's going to be the priority and it's going to be happening in the background unless something is like seriously wrong with the heart.
Digestion is something that can be impacted by conscious thought. It can be impacted by hormones, hormones are communicators in your body and there are a lot of hormones that are directly involved in the digestive process, including even breaking down food and hunger and those signs but also elimination, stool, signaling for elimination, we know that circadian rhythms and the body's internal clocks can impact that, sort of linked with hormones. But even from a clock standpoint, and how the body is meant to work in those kinds of cycles, that impacts digestion, and muscle activity, your digestive tract is all made up of smooth muscle tissue. And these are not just in involuntary muscles, these are also voluntary, you have to kind of think about it and they have to work that way and they're stimulated by things being inside of them, for the most part, but also impacted by some of these other things.
Now, muscle activity is something that is altered a bit with IBS, and it's something that can become even more altered as we're dealing with poor function. So like those who are dealing with constipation, you know, if those muscles are being stretched, and if they're not working, they're going to get weak, sluggish and lazy and they're not going to work, which can lead you down the spiral of constipation.
If your muscles are spasming, if they're working too much with diarrhea, then what you may see are more cramps, more spasms, and even a weakness and a tension that is not healthy for the muscle. And so it's important to make sure that we take into account muscle activity. Now, we can't necessarily work the muscles like we do in the gym with, you know, bicep curls, and squats and things like that, but there are ways that we can support healthy muscle function and coordination as part of our strategy.
Now, I bring all of that up, because these things may not be IBS treatments, but if your digestive system is not supported at a baseline, and then you bring in this barrier of IBS, that's impacting your function and then you know, we try to implement a strategy to kind of deal with those symptoms, we are missing a huge chunk of the puzzle if we are ignoring digestive system function. And that's something I am very passionate about as a dietitian in this space, because I've seen way too many people just get prescribed a low FODMAP diet or just get prescribed a medication that comes with side effects and costs and no one has talked to them about the basics of digestion. It's not something we learn, it should be, it should be something we learned in health classes, and even in elementary school of how to poop well, how to digest our food well, how to support this process, but it's something that so many people are missing and it can be one reason why symptoms are volatile, and all over the place, and getting control can be such a roller coaster, because these are things that are going to actually improve your digestive function, if they're not supported, they're going to work against you.
And so what those things actually are, what your gut needs and what your body needs for proper digestion, the first thing is actually nourishment and enough calories. This is a huge because not only do we see this in the link between eating disorders and dieting culture to IBS, where restricting calories and even weight loss and even severe restriction like we see with actual eating disorders, that does not provide the energy that your body needs to function.
I mentioned your heart is gonna function, your brain is going to function, your lungs are going to function, those organs are going to take priority over everything else in your body for survival. So if you are not eating enough, even if it is that high level of restriction, or maybe it's just some dieting, where you're not quite meeting all of your needs, that you've put something into a calorie calculator and it's really low or let's say you're on the other camp or you're not really trying to lose weight, you're really not trying to diet, but because of your symptoms, you've restricted your intake. You're not eating any food. Fear is getting in the way, that is actually going to impact your gut and again, work against you. So you're doing what feels safe but now it's working against you, because your body doesn't have the energy it needs to actually support the function of your GI tract.
Not only that, but it's going to impact your nervous system. And I'm going to talk a lot about nervous system because this is really big, but you have, in your autonomic nervous system, a branch of your nervous system, you have two states that work like a light switch, where one is on, the other one is off, you can use switch it, they can't be on together. But that is going to be your sympathetic nervous system state or your parasympathetic nervous system state.
Your sympathetic nervous system state, this is what we call the stress state. What happens in stress state is your body is prioritizing survival and it's prioritizing, releasing energy for kind of your brain, your heart and like your these muscles to like, move, fight, do whatever they need to do, You’re in kind of that fight or flight response. Your digestive system actually shuts down. So in high states of stress, if someone is kind of in an acute like high state of stress, like you are about to be in a car wreck, or you're about to be attacked, or something where your body's in alert, what can happen is your colon, which is you know, right at the base of your colon, your rectum is holding your stool, sometimes this will try to clear out. So some people might have an accident in those states.
But what's happening above that is that your gastric juices and your stomach that are actually helping the digestive process, and stomach acid that is shut down. So that gets turned off. Peristalsis, that movement of the smooth muscle to move food and then poop through your digestive tract, it shuts down. And so what your body is saying is, we need to support everything else, we don't need to be digesting, because we don't need to be pooping, and peeing and dealing with all of these things, we need to be fighting or flighting, right? Running. And so that's what happens in the sympathetic nervous system state, if you are there chronically, even a lower level where you might not be at that heightened amount of stress, but you're chronically in this nervous system state, your digestive system is impacted.
Now, the opposite of that is parasympathetic nervous system state. And this is our rest and digest state, where the digestive system is fully supported. So it's where your body is able to actually function well, and in a controlled environment without being in that fight or flight place. And so it's really important to know how to regulate the nervous system and that is something that needs to be in place for the digestive system to function.
So that brings in stress management, which is key for proper digestion. Not only that, but stress is going to impact the way that you feel overall, and can impact the food that you eat. So it has a direct and indirect effect. Something else that your body needs related to that circadian rhythm that I talked about earlier or your body's clocks, is good sleep and routines. Sleep is one of the best ways to help regulate your circadian rhythm and your circadian clock. And that means adequate amount of sleep for the body to recover, and that kind of goes back into nervous system regulation and hormones, but also good consistency with sleep schedules. So the same kind of wake and sleep time and then having routines around those that mimic the sunrise and sunset and kind of get your body on that rhythm.
Routines overall outside of sleep also can impact this. So your routines of movement, your routine of even toileting behaviors and time, your routines of eating, all of that can impact the way that your gut functions, because your body really is meant to work like a bunch of clocks and it's meant to work with ease and that's where that's going to really fit in inconsistent routines will make this a bit harder. So it might not shut down digestion necessarily, but it's going to give you another hurdle to go over in order to function. With IBS, you already have that one big one, so you really don't want others in place.
Other things that can matter would be movement and muscle coordination. So your movement overall is actually going to impact your digestion. And that kind of again, goes into a direct and indirect place. So directly, movement might help stimulate muscle function and that smooth muscle activity which is going to help with healthy motility. Movement is going to help with blood flow, which is going to be really important. And then indirectly movement is going to help a circadian rhythms, it's going to help the nervous system regulation and stress management and all of those different pieces. So movement is key!
Muscle coordination is kind of the deeper level of that. So for some people, their IBS either is going to lead to this or this is what's gonna cause their IBS, but there can be a dysregulation of muscle activity, whether that's the abdominal muscles in the diaphragm, which is that muscle right at the base of your lungs, those can impact digestive system function and if there's some poor regulation and coordination of those muscles in terms of digestion, that could impact If the way that you are pooping and digesting your meals, and then there's pelvic floor dysfunction, which is the base of your core, your pelvic floor is involved in the release and the holding of your stool in your poop and so that can be impacted by things like the spasms and the cramping and the diarrhea or the constipation and that weakness. It can also be caused by some other things and lead to the digestive issues.
In those scenarios, your body needs healthy movement with those muscles and so that's where exercise can fit in and really healthy exercise as well as toileting posture, toileting habits, different things like that, but there may also be more specific therapies and treatments involved with like a pelvic floor physical therapist or utilizing things like biofeedback therapy, that can be really beneficial for that coordination of those muscles.
All right, so once we know that we have supported the dysfunction of the digestive system, then we want to think about the triggers of symptoms themselves. So again, we have to start there with we know that we're supporting digestion, I refer to these a lot in my practice as foundational habits, these are things that are so important, and then we want to work on then identifying the things that are going to trigger your symptoms and modifying those triggers. So we identify them, then we modify them.
This is kind of like a band aid for some, but it will be less of a band aid and more of a solution and more of a real help, once you've supported digestive system function. Trust me, I've done this for many, many years, worked with many, many people with IBS and that has rang true time and time again.
So thinking about the triggers of symptoms, these are not just the drivers of symptoms that I've talked about in previous episodes. And if you're not familiar with that, that wording or that statement, go listen to more episodes throughout this season, because I've covered that in a lot of detail. But the triggers of symptoms are going to be the next layer of that. So the drivers are deeper and now we're kind of getting closer to the surface of what's happening with symptoms and cells.
When we're looking at triggers, that includes stress, kind of like that stress state in the nervous system state that I mentioned, nervous system dysregulation, so not the inability to regulate and that's where it kind of anxiety is gonna fit in, poor boundaries and habits kind of work works in distress management a lot. Certain foods can be triggers, and even gut irritants, so thinking about things, not just trigger foods like FODMAPs, or maybe high amounts of fruits or something like that, that you may notice in yourself, but gut irritants including drugs, alcohol, spicy foods, things that we know can irritate the gut, caffeine, coffee, things like that.
And then there's also going to be intensity of exercise. So for some people, and this again goes to stress and cortisol, and that stress response in the body, for some people, certain types of exercise is going to trigger more symptoms and so that's something that we may look at based on the research based on what we know, based on even anecdotal research and surveys and things that have shown us what people have experienced, we're going to identify what those are. The goal is to modify them. It's not possible to live in a world 100% stress free, it might be but not many people can attain that, so just taking away every stressor in your life is probably not possible, but teaching good habits around stress management boundaries, how to approach stressors, how to cope with stress, that can be really beneficial.
With the nervous system, we can't always perfectly regulate the nervous system. For some people, especially those who live with autoimmune conditions or other things going on in your body, that's going to give you a stress state. So we have to understand kind of the stress bucket, and how to start turning that light switch off. There's a really great graphic, in a book called Big Feelings, I really highly recommend it. It's a really good book about coping with certain emotions. But they talked about nervous system regulation, as you know, we think it needs to be like, you know, 100% of the time we're in this rest and digest state. That's not possible. What it should be is a little bit like a staircase, where stress, regulate, stress, regulate stress, regulate, you're meant to go through that cycle day, after day and then moment after moment, you might be in a state of stress and you regulate stress and you regulate, having those skills can be really beneficial for modifying this trigger and then reducing how it impacts your body.
When it comes to certain foods, this is where we might utilize something like a low FODMAP elimination diet, an allergen elimination diet, even just looking for certain correlations. If you'd kept a food log or journal, you may have noticed certain correlations to certain foods or drinks that definitely trigger for you. The modification there is going to be to reduce, not eliminate as much as possible, or eliminate, reintroduce, and then build it back in.
So whether that's a true elimination diet or a backwards approach where you just kind of reduce, reduce, reduce until you get to that sweet spot, that's going to help you make sure you're not overly restricting things but then you're also personalizing it to your body, which is what is key because that's how you're gonna have more confidence in using what you know about your triggers to prevent symptoms in different situations.
And then gut irritants, this is something that we might pause on for a little bit and again, modify kind of in a different way. So with irritates some people can handle them occasionally, alcohol is a great example of this. Some people also just cannot, and it depends on the state of your gut and your healing process, but if you are in a state of high vulnerability, irritability, then it might be a good idea to pause on a lot of gut irritants to give your gut extra support, allow it to heal, allow it to function, and then start building those things in in a way that works for you if it actually does work for you. And so that's going to be addressed slightly different than what I would call food or drink triggers.
Now, once symptom management is in place, we've utilized some of these tools, and we've been able to get symptoms down, we’re supporting gut function, then we want to start thinking about what are the next steps to kind of go deeper. So we went a little bit deeper for gut function, kind of came to the surface for symptom management, now we want to go even deeper at how do we actually build up the right environment in your gut.
We have to make sure we're supporting your gut microbiome. This is where we may utilize prebiotics, fiber diversity, we may think about resistant starches, probiotics might fit into here for some, we may also think about things like fermented foods, stress management is still going to fit into this piece. And what's really great is that once we have supported digestive function, we've reduced symptoms there and we've also increased tolerance to some of these triggers, we've modified triggers, so we know where you stand, so it's a lot easier to implement those tools once we have done those things first.
We also want to make sure we're supporting gut brain communication. So we've done that a lot through stress management, nervous system regulation, and all of those pieces, this is where we might go even deeper on coping tools, which is where cognitive behavioral therapy is really beneficial. And this is also where we might start addressing fears and the body's responses, almost like the trauma responses from the past and expectations.
Something that I see often and again, this is myths, this isn't really highly researched, but when people have dealt with symptoms, it's very hard to start not expecting those symptoms to happen, even if you haven't had them for a long time. And on a level of trauma, if you've had very severe symptoms, or an episode that was so significant that now every time you even have a small sensation in your gut, you immediately think that worst case scenario is going to happen. This can be something that your body is responding to and it's impacting your gut brain communication pathway. And so that is something that we need to start addressing with either a therapist, a psychologist or through different resources that are available.
For some we have to address how we even think about foods and the fear of food and introducing those foods. So this is going to be highly personalized, because that's where we can start going deeper once we know, we know we're supporting your gut, we know what your triggers are, we know we've worked around that we know the symptoms have been managed well and so now we can go deeper into addressing those fears without addressing them when you're in that state of uncertainty, because that's going to develop more distrust in your body and our goal really is to develop more trust and security in your body here.
And then we also need to support the immune system. So not everyone with IBS is going to have this immune component, but most people are and so it is something we want to be aware of. For some people, this is going to be really key. The gut microbiome support is part of that but we may also look at overall immune system support to make sure that we are supporting that side of it as much as possible.
So hopefully, this was a good conversation. You know, this isn't every puzzle piece that's available, there is more to it. There's a lot of overlapping factors like other conditions, we didn't get into nutrient deficiencies and replenishment or even addressing overgrowth, so bacterial balance, or blood sugar stabilization, all of that is also really important, but this is kind of a base framework that you can look at and think about.
So I hope that this brought up some ideas or maybe some gaps or holes that you may have noticed in your journey that could be potentially kind of holding you back. And like I mentioned at the start, at Gutivate, which is the private practice I started many years ago, the reason why we work the way we do with our clients, we work very hands on, we work over a longer period of time, we're not in that traditional clinical setting where you just see us once and then you move on and, you know, we spend a few minutes together and that's it. Like, we really do spend a lot of time with our clients and this is the reason why we want to make sure that we're not just giving a handout, we're not just implementing one thing, that we're looking at the person as a whole, we're looking at your whole life, we're evaluating what's really happening, we're adjusting, we're modifying, and we really are putting that puzzle together.
And so if that is something that you're looking for, and we'd love to talk, there's more information here if you're interested in that, but even outside of that, like that is what you want to look for with your healthcare team. Those are the things you want to ask for and the things you want to be thinking about. Not just the band aid, it's not just the quick fixes, not just one piece of the puzzle at a time, but shifting that kind of mindset and that approach to okay, how can I actually put these pieces together for me and really build a plan that works and a holistic plan that works for me that is the shift that can make all the difference.