Managing IBS is so important for those who suffer from it. Many of the GI symptoms of IBS have a major impact on a person’s quality of life.
Currently, there aren’t many things a person with IBS can do to help manage their symptoms. The FODMAP diet is a useful way to find out specific foods that trigger your symptoms. We covered the FODMAP diet in our last blog, which you can check out here.
The cool thing about a FODMAP diet is that it develops a diet specifically tailored to you. In addition to reducing gas and bloating, it also also improves how gut hormones affect the small intestine in those with IBS.
But diet is simply one lever you can pull to help manage IBS. There are other tools at your disposal that help too. Furthermore, these tools might move the needle even further, allowing those with IBS to live a more normal life and potentially lock in the improvements you experience with a FODMAP diet.
Let’s take a look at 5 proven techniques for managing IBS.
Managing IBS with yoga
It should come as no surprise to anyone with IBS that stress plays an important role in managing symptoms. The autonomic nervous system, which plays an important role in our ability to switch into and out of the stress response, also regulates how our gut works.
A study back in 2017 compared the effects of yoga with a low FODMAP diet for improving the IBS symptoms severity scale (IBS-SSS). They found both 12 weeks of twice daily hatha yoga and the low FODMAP diet led to similar improvements in the IBS-SSS at 12 and 24 weeks.
Interestingly, there was no significant difference between yoga and the low FODMAP diet for the IBS-SSS at both timepoints. The best part is, they likely work via different mechanisms. The low FODMAP diet works by changing the microbiome, and yoga likely works by balancing the autonomic nervous system.
So incorporating yoga along with a FODMAP diet may provide better improvement than either approach alone.
Note: We use the term FODMAP diet instead of low FODMAP diet. The most up to date approach is only truly low FODMAP for the introductory phase. Since this study was done in 2017, and used low FODMAP, we use that term to discuss this study.
Managing IBS with meditation
Meditation is another useful approach for IBS symptom management that works through the autonomic nervous system. The cool part is there are a lot of different forms of meditation to choose from.
Mindfulness meditation is a commonly practiced form of meditation where you focus on the present. A recent paper found that 71% of people with IBS that took an 8 week mindfulness meditation saw improvement in symptoms.
Unfortunately, there was no control group for comparison in this study. They found that the ability to maintain focus on the present and act with awareness were the components of mindfulness meditation that led to improvements.
Vaishvanara Agni meditation (VAM) is another form of meditation focusing on the digestive system. A recent paper found that 50 days of VAM led to significant improvements in GI quality of life. Particular improvements were seen in core symptoms, psychological strength, and physical strength.
As with exercise, the form of meditation that works best for an individual likely varies. While all tend to focus around stress management and breathing techniques, the most important factor is sticking to it.
So if you go the meditation route, find one that you enjoy so that you stick to it.
Managing IBS with more activity
Let’s face it, the modern lifestyle is very sedentary. Estimates vary depending on the publication, but Americans generally get around 4800 steps per day.
This is quite low. There isn’t hard evidence that the magical 10,000 steps per day is ideal. However, the actual target is probably closer to that number than what the average American gets. It may even be more than 10000 steps/day.
A study published last year took a look at symptom severity in people with IBS based on daily step counts. Based on their findings, moving from 4000 steps per day to 9500 should reduce the severity of IBS symptoms by half in those with mild IBS.
It’s important to point out that this study was observational. As such, we don’t know the direction of the relationship. Does more activity decrease symptoms or do people with more severe symptoms walk less?
Be that as it may, moving from 4000 steps per day to 9500 is a very low risk, high reward way to manage IBS symptoms. One review paper found that increasing physical activity not only improved GI symptoms in IBS, it also improved symptoms throughout the body.
Participants remarked that exercise improved quality of life by creating achievements and “strengthening of self”.
Managing IBS with exercise
Exercise is another excellent technique for improving symptoms and quality of life in people with IBS. However, it’s one that you should approach pragmatically and with caution.
When your average Joe decides to exercise, they generally jump in head first with bootcamps, 5 mile runs, or HIIT. The problem with this approach is that most people aren’t ready for these things. As a result, they can jack your stress up sky high. This is obviously something people with IBS should avoid doing.
A smarter way to approach it for people with IBS is incorporating strength training along with increased walking. While there isn’t strong evidence that strength training will improve symptoms of IBS, it will prepare you for incorporating aerobic exercise, which does have some strong evidence for improving IBS symptoms.
One study found that low to moderate aerobic exercise decreased systemic inflammation and enhanced antioxidant properties in women with IBS. Another found significant improvements in quality of life and IBS symptom severity after a 6 week program compared to a control group.
When using aerobic exercise as an approach in IBS, it’s important to focus on low to moderate exercise in the early stages. Try to keep your heart rate in the 60-75% of maximum range, as that is the range most studies find benefit in.
As with meditation, the best form is the one you’ll stick with.
Managing IBS with sleep hygiene
Sleep is an important variable for both physical and mental health that shares a reciprocal relationship with IBS. On the one hand, IBS symptoms can disturb sleep. On the other, poor sleep can affect the microbiome, stress-related parameters, and many aspects of digestion.
A recent pilot study found that behavioral therapy directed at sleep hygiene improved sleep scores in people with IBS. The study was small and only meant to determine whether the approach was feasible, so the results on sleep scores were not significant.
However, more people undergoing sleep hygiene-based therapy saw at least slight improvements in IBS symptom severity than the control group (50% vs 16%). Interestingly, this was a really basic form of behavioral therapy that mostly focused on setting consistent sleep/wake times and sticking to them with phone-based consults.
Incorporating other important sleep hygiene factors centered around light exposure and other circadian factors may lead to greater improvements in sleep. Whether this translates into better outcomes in IBS-related symptoms is unknown, but this is another low risk-high reward intervention that most people have access to.
Stacking therapies to tackle IBS
To get the most bang for your buck, it’s probably a good idea to stack some or all of these therapies. Again, being pragmatic is important: What are your personal needs, strengths, and weaknesses? And as always, what will you stick to?
One of the best tools to get started is an activity tracker such as a Fitbit. In the first stages, we like to take a set it and forget it approach for the first week. Just wear it without changing your habits. See where you stand to get a handle on everything.
Are you closer to 4000 steps per day or 9500 steps per day? How is your heart rate throughout the day, is it elevated?
If your steps are low, start there. There’s no point in adding in exercise if you’re not meeting your daily low-level activity goals. heck out your resting heart rate and aerobic fitness. If your heart rate is high and fitness low, you may want o start exercising.
What about your sleep? If your sleep is bad, start implementing some simple sleep hygiene tactics to improve it.
Most people don’t even know sleep hygiene is a thing, but it is a very powerful tool for improving sleep and overall health. Once you get sleep working for you, move on to meditation or yoga to help improve your stress resilience. We’ve covered the importance of resilience in a blog you can check out here.
Once you get those strategies incorporated, you can look into increasing resilience with different forms of exercise.
Currently, there aren’t a lot of ways to help with managing IBS. The FODMAP diet is a great way to develop a personalized diet that improves symptoms, but for those looking for more, there are other useful strategies.
Increasing physical activity, exercise, yoga, meditation, and improving sleep quality are additional therapies people can stack with a FODMAP diet. And the best part about these therapies is that side effects are typically low to nil if you approach them pragmatically.
Develop your own personal program by stacking these approaches to improve your IBS symptoms and overall quality of life.