A Self-Care Routine for Irritable Bowel Syndrome

A Holistic Approach to Reducing Symptoms of IBS Through the Mind-Body Connection

• Components of an Irritable Bowel Syndrome Self-care Plan|
• Lifestyle Changes to Support the Mind-Body Connection|
• Improving Sleep Hygiene|
• Adjusting Your Diet|
• Gut-Supportive Supplements and Medications|
• An IBS-Friendly Daily Routine|
• Thriving with IBS Through Self-Care|

Living with untreated irritable bowel syndrome (IBS) can feel pretty limiting sometimes. Maybe you’re nervous to wander anywhere too far from a restroom. Maybe eating at a new restaurant or trying a cuisine you’ve never had before feels scary and risky because of the potential for a flare-up. Perhaps you’re curtailing your life experiences to try to accommodate or avoid the abdominal pain, cramping, constipation, and diarrhea that come with IBS.

The truth is that these worries and concerns, while valid when you’re experiencing persistent IBS symptoms, can sometimes contribute to a vicious cycle of physical and psychological symptoms that feed on each other and make your digestive experience worse than it needs to be. There are important psychological components to managing gut health, and managing IBS is no exception. That’s because of a phenomenon called the gut-brain axis, which, when incorporated into a treatment plan, could vastly improve your quality of life.

A holistic approach to irritable bowel syndrome self-care is within your reach and may include a few recommendations you haven’t heard before. By taking steps to create a daily routine that supports your gut health, mental health, and overall well-being, you could free yourself of the burdens and limitations associated with IBS. Let’s go over the details of what some of these lifestyle changes might look like.

Components of an Irritable Bowel Syndrome Self-Care Plan

The main components of a gut-focused self-care plan will be:

• Developing restorative activities that support mental health and stress management (including exercise)

• Improving sleep hygiene
• Adjusting your diet and drinking more water

Adding in probiotics and possibly other supplements or medications that support gut health

 Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, which essentially means that, for an unknown reason, your digestive tract is malfunctioning. As both a practitioner and a patient, I know how frustrating it can be to hear a diagnosis of a condition with an unknown cause. It can lead to feelings of powerlessness and resignation that you’re just going to feel bad forever. But we do actually have more information than we used to about IBS, so relief could very well be available to you, and possibly from unexpected places.

The Gut-Brain Connection

It’s thought that IBS symptoms can arise from the gut-brain connection—the “conversations” traveling up and down the vagus nerve between the brain and the gut [1]. This connection is a two-way street, meaning that both systems can communicate with each other [2, 3, 4]. I always like to use a relatable example to illustrate this connection: butterflies in the stomach when you’re nervous signal that your brain is communicating with your gut.

Stress can trigger the fight or flight response, which releases hormones that can negatively impact the gut microbiome and increase inflammation [5]. It’s also true that the neurotransmitters you associate with a healthy mood and brain function (serotonin, dopamine, norepinephrine) are actually made in the gut and transmit signals to the brain via the vagus nerve [6, 7]. 

This connection is really important because it means that the solution may lie outside your diet. This isn’t to say that you won’t need to change anything about your diet, but it is to say that if you’ve tried diet changes and haven’t found much relief from your symptoms of IBS, there’s still hope for you. In other words, by improving lifestyle factors that impact mental health as well as improving diet and daily habits, you could find reasonable solutions to reducing your symptoms over time. Let’s start with some of these changes as we build a plan that includes some shifts in your diet, sleep, exercise, and supplements.

Lifestyle Changes to Support the Mind-Body Connection

If you’ve been living with IBS for a while, it’s possible (and maybe even likely) that you also experience mood disruptions, such as depression and anxiety [8]. Even without these diagnoses, people with IBS often experience flare-ups during acutely stressful or upsetting moments in life, and even during moments of positive stress, like planning a party that you’re really looking forward to.

Developing habits and skills around supporting your mental health is a key and often missing factor when it comes to addressing IBS.

Admittedly, the term “stress management” can sometimes induce more stress— ”Great, one more thing I have to do every day,” or “If I fail at stress management, then I’ll just be more stressed,” or “I hate meditation and the thought of having to do that stresses me out.”

Plenty of people have those kinds of reactions, and that’s because our tendency as humans and as Westerners is to focus on a goal and treat achieving it as success and not achieving it as failure. Instead, try viewing this endeavor as a process of discovery and learning, trial and error, getting to know yourself better, and developing a toolkit to empower you to respond better during stressful situations.

The stress part of the equation is a function of being a human being—that part isn’t going away—but how you choose to process it is as individual as you are. That might look like starting a daily meditation practice. It might also look like a brisk walk outside at the same time every day, calling a friend who will make you laugh, or writing in a journal for 20 minutes first thing every morning.

Daily Practices and Relaxation Techniques

Beginning some sort of self-care daily practice is akin to playing the long game. By starting now (even if there’s nothing immediately stressing you out), you will begin developing the muscles of stress management that you will eventually need to flex during those inevitable moments in the future.

Daily Practices May Include:

• Starting every morning with 10 to 20 minutes of journaling [9]. Can’t think of anything to write about? That’s ok, there are tons of places online to find journal prompts for a morning routine. Here’s a good one.
• Schedule a brisk walk [10]. Even a walk as short as 10 minutes can improve your mood, including reducing anxiety, anger, and depression levels. Try to walk quickly enough to break a light sweat. As you build endurance, try adding time in  5-minute increments until you get to 30 minutes of physical activity at least five days a week.
• Try a guided mindfulness meditation* [10]. Mindfulness meditation helps you experience breathing and being in the present moment without judgment. Doing this for 10 minutes daily was shown to have the same beneficial effects on mood as a brisk walk. And you can even just start with 2 minutes if 10 feels daunting.
• Spend 10 to 20 minutes in the sun without sunscreen [11]. The length of time you spend outside without sunscreen will heavily depend on your complexion, but when done safely, sun exposure promotes vitamin D production and has been shown to alleviate depressive symptoms. 
• Spend time in nature, which has been shown to reduce anxiety and depression, boost overall mood, and calm the autonomic nervous system. Having a relaxing walk in nature without sunscreen would meet three of these daily methods in one go! 

*There are many types of meditations and therapies geared specifically toward relieving IBS symptoms and inflammatory bowel disease (IBD). These include mindfulness meditation, gut-directed hypnotherapy, cognitive behavioral therapy, and mindfulness-based stress reduction.

Improving Sleep Hygiene

Sleep is a challenge for so many in the modern world. And much like the term “stress management,” hearing generic advice to start sleeping better can feel stressful and annoying. That being said, we know that proper sleep helps keep inflammation at bay,  improves learning outcomes, restores the synapses (junctions) between neurons, solidifies memories, and removes brain waste [12, 13]. Poor sleep is also correlated with gastrointestinal disorders, possibly because of the important relationship between your body’s circadian rhythm and gastrointestinal tract [14]. 

There are small changes you can make to begin improving your sleep quality and efficiency. There are also some big changes. But let’s start with the small ones. You’ll be happy to see that some of these recommendations overlap with those above. Here are a few:

• Ensure that your room is cool, dark, and quiet.
• Start your bedtime routine (dim the lights, brush your teeth, wash your face, etc.) at the same time every night, about an hour before you want your head to hit the pillow.
• Exercise daily, ideally before the dinner hour.
• Practice stress reduction techniques.
• Seek cognitive behavioral therapy to aid in sleep retraining.

A bigger, more expensive change may be getting a new mattress if yours is old and you wake up with back pain or are not well-rested. Or if you like your mattress and run hot at night, you may consider investing in a cooling pad for your bed. I’m not affiliated with SleepMe, but this is an example of what I’m referring to.

Adjusting Your Diet

Because there doesn’t seem to be a physical mechanism in the gut itself causing IBS, it can be a challenge to determine what dietary interventions will work to start reducing symptoms. For example, some gastroenterologists recommend slowly adding more fiber into your diet, while, in some cases, completely eliminating fiber for a few days may actually provide relief while your gut recovers from a flare-up.

I’m going to offer a few different suggestions for diet changes in order from least restrictive to most restrictive.

The method of removing foods over time and observing how your body adjusts is essentially an elimination diet. However, in some particularly stubborn or painful cases of IBS, you might want to skip the gradual approach and go straight to an Elemental Diet (a very simple fiber-free meal replacement) for a few days to give your bowels a break.

The options below are geared specifically toward eliminating foods with the intention of relieving IBS symptoms.

Some of these build upon the ones before, but it will be your job to find what works for you.

5 Foods to Remove

Johns Hopkins recommends that people with IBS remove the following foods from their diet [15]. These foods may make IBS symptoms worse, although you will need to experiment to figure out your personal tolerance level.

• Dairy Products– most people do not produce enough of the digestive enzyme lactase to adequately process the lactose in dairy. This can lead to bloating, gas, and discomfort. 
• Foods high in fructose – foods high in fructose can aggravate symptoms of IBS. This includes high-fructose corn syrup and some fruits such as apples. 
• Carbonated Beverages – bubbly drinks can stay bubbly through your digestive tract and create gas and discomfort.
• Caffeine – caffeine is a stimulant and can increase diarrhea in people with IBS.
• Sugar-free chewing gum – the sweeteners xylitol and sorbitol may cause diarrhea.

Remove Highly Inflammatory Foods

If eliminating the five foods above doesn’t bring you significant relief, you may need to graduate to an anti-inflammatory diet. Some of the foods below overlap with those in the top five. The most common inflammatory foods in the Standard American Diet are [16]:

• Sugar and sugar-sweetened beverages
• Refined carbohydrates (bread, pasta, crackers, cookies made from white flour and highly processed grains)
• Processed meat
• Deep fried foods
• Trans fats and very fatty foods

Gluten-Free Diet

Gluten-free foods often fall into some of the categories already listed above, so going gluten-free doesn’t mean swapping regular Oreos for gluten-free ones and hoping for the best. Use the lists above as your guidelines in addition to removing glutinous grains from your diet. If you’re already following the programs above, removing gluten shouldn’t be that much of a stretch. You will have already removed processed foods made from white flour, which is a big source of gluten in most standard diets [17]. Being gluten-free has become a trendy diet, and you may be surprised to know that I don’t recommend a gluten-free diet for just anyone. That said, multiple studies show that a gluten-free diet can improve IBS symptoms like stool frequency and bloating, which is why I recommend giving it a try if the less restrictive options above aren’t helping [17]. 

Low-FODMAP Diet

A low-FODMAP diet removes certain carbohydrates, known as FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). These foods, including healthy foods like asparagus, broccoli, beans, and onions, can be somewhat challenging to digest for quite a few people, even those without IBS.

However, for those with IBS, it can be particularly uncomfortable to process these foods, leading to symptoms like abdominal pain, cramping, excessive gas, bloating, and belching, and changes in bowel movements like diarrhea or constipation [18].

So removing these foods temporarily (for about 4–6 weeks) could help give your system the break it needs to calm down and begin to heal. Here’s a chart to help you replace high-FODMAP foods with low-FODMAP foods.

You can download a more complete FODMAP food list here.

Gut-Supportive Supplements and Medications

Far and away the best supplement to start with for improving gut health is a probiotic supplement. Probiotics have also been shown in numerous clinical trials to be associated with significant mood improvements for those with depression and depressive symptoms [19]. Those with anxiety may also experience improvements with the use of probiotics [20]. 

Prebiotics, the fibers often included in probiotic supplements to help feed the good bacteria, may also be helpful to IBS patients—in small amounts. Many prebiotic foods fall into the FODMAP category, so look for a probiotic that has 3-5mg of prebiotics per serving.

I mentioned fiber earlier—whether or not to add a fiber supplement and how much to take is highly individual. If your IBS manifests as diarrhea, soluble fiber may help. If you tend toward constipation, look for one with more insoluble fiber, but more importantly, drink lots of water throughout the day.

Over-the-counter medications like Imodium AD (also called loperamide, an antidiarrheal) and laxatives may be ok to use very sparsely, but these medications are not meant to be used long-term or as a consistent treatment for IBS. Laxatives, in particular, can become habit-forming, which would cause a whole separate problem when trying to stop taking them.

An IBS-Friendly Daily Routine

Let’s put all this advice into something practical you can implement this week. Even if you haven’t determined exactly which direction you want to take your diet plan, you can still get started. Here’s a sample day for you to build from.

Daily Routine:

The way you start your day can have a big influence not only on your mood, productivity, and cognition but also on your blood sugar, energy levels, and digestive health.

• Select a high-protein breakfast that excludes the top five foods**. This could be something like two eggs, chicken sausage, spinach, and mild salsa. Make sure you drink plenty of water with your breakfast. Take a few slow, deep breaths before your first bite of food, and chew your meal thoroughly.
• Take a probiotic supplement.

• Spend 20 minutes journaling with the prompt: “Where have I recently experienced generosity?”
• At lunchtime, take a few slow, deep breaths before your first bite of food and chew your meal thoroughly. Lunch might be a large salad topped with roasted sweet potatoes, pumpkin seeds, and grilled chicken with oil and vinegar dressing. 
• Take 10 to 15 minutes to walk outside either before or after lunch for some sunshine and physical activity. If this doesn’t work for your schedule, move this to morning or evening. Mid-day sunshine is best if you’re not fair-skinned.
• Refer to this list of low-FODMAP snack suggestions for an afternoon snack.
• Make sure to drink plenty of water throughout the day. 
• A sample dinner may include pan-fried salmon with veggies like zucchini and bok choy over white rice or quinoa.
• One hour before bedtime, dim the lights in your home, either turn off the TV or make sure whatever is on is not stressful or evocative, and begin your evening routine.
• Ensure your room is dark and cool and that your clothing is loose and comfortable. Try to give yourself at least seven hours of sleep.

**If you’re a coffee or caffeine drinker, experiment with drinking a full glass of water and eating a few bites of food before sipping your morning brew. By drinking coffee after you’ve had a good amount of water and put some food in your stomach, you’re essentially diluting its stimulant effects on your bowels. You may find that this change allows you to keep coffee in your life. You may also find that no matter what you try, caffeine causes a flare-up, and you’ll benefit from removing it for a while so your gut can heal.

Thriving with IBS through Self-Care

Understanding your triggers, whether food, emotional, or both, is a big first step in mitigating symptoms of IBS. Because we know so little about the physical mechanisms involved in the intestines specifically, it’s difficult to come up with a single solution for all people with IBS.

That being said, we know that the gut-brain connection plays a role in the severity of IBS symptoms. Finding ways to take care of mental health, manage stress, sleep better, and get regular exercise can all go a long way to addressing the discomfort of the syndrome and improving both mental and physical symptoms. Interventions like cognitive behavioral therapy and introducing a daily probiotic may also be helpful.

Talk to your healthcare provider before starting a new exercise, diet, or supplement plan to find out if the changes you have in mind are safe for you. We’d be happy to help you get started. Reach out to our clinic for a consultation.

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