Could the answer to IBS lie in the ancient practice of meditation?

IBS is a world-wide problem and the most common gastrointestinal disorder.

For a long time, irritable bowel syndrome has just been thought of as a functional problem: there’s nothing measurably, or visibly wrong with the intestines, so labeling IBS as a functional problem is almost like a shrug from the experts. 

Now, IBS has earned a new classification: a disorder of gut-brain interaction. So, instead of IBS being a functional problem, there’s actually something physical that becomes disrupted – it’s just not visible to the naked eye. 

What is gut-brain interaction? It is the two-way communication highway between your brain and your gut. It’s also called “gut-brain axis”. When the connection is disrupted, there are misunderstandings and overreactions that lead to IBS symptoms. You can read more about the gut-brain axis in this blog post.

What disrupts the gut-brain interaction? Many things, but a big culprit looks to be stress (1). Stress causes stress hormones to surge in the body, which turn digestion off. With a lower digestive “fire”, food digests poorly, leading to abdominal pain, diarrhea/constipation and/or bloating. 

To make matters worse, the brains of people with IBS are wired in ways that make them more sensitive to stress, triggering a stress response more easily, which causes a difficult situation to turn into gut symptoms more easily as well. (2)

Solution? To mend the gut-brain interaction through stress release practices and mindset shifts. 

And what I’m really excited about, is meditation’s ability to change the brain to withstand stress better (4). This means that while stress is not going to go away, you cope better with stress, and a stressful situation less easily leads to IBS symptoms. Naturally, these effects come from a long-term practice. But, even a one-time practice of a few minutes of meditation can measurably reduce stress. (5)

Personally, after 15 years of practice, daily meditation has become my secret weapon. Not only do I feel great while meditating (though not always, sometimes my brain is just too restless), I’ve noticed in general feeling calmer, more empathetic, and having a better emotional control than I used to. It feels like my brain gets triggered less easily.

One of the meditation techniques I particularly love is Hong Sau (Sau pronounced “saw”). It’s a technique of attentive focus on the breath. Since the breath is always there, it becomes an excellent object for meditation (no, meditation is not about blanking the mind). A focused mind is a calm mind, and a calm breath leads to a calm mind and vice versa. Or how do you breathe when you are reading a book with deep focus? 

I’m teaching the Hong Sau meditation technique live online starting today on Wednesday January 8^th 2025. There’s still time to sign up! Even if you miss the first class, you can still participate live in the remaining four. All the sessions will be recorded, so you’ll get the recording of the first session, and they will be made available for purchase as a full course after the live course is finished. Go here for more info. Sign up by emailing me at [email protected]

Questions? You got my email address.

Let’s make the year 2025 the best one yet! Let’s start by taking up meditation, or some other stress release practice, and cultivating the belief that improvement is possible – I really do believe that. Even if you feel like you’ve tried everything, something will help you, if you keep working at it.

References

1. Cryan JF, O'Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, Codagnone MG, Cussotto S, Fulling C, Golubeva AV, Guzzetta KE, Jaggar M, Long-Smith CM, Lyte JM, Martin JA, Molinero-Perez A, Moloney G, Morelli E, Morillas E, O'Connor R, Cruz-Pereira JS, Peterson VL, Rea K, Ritz NL, Sherwin E, Spichak S, Teichman EM, van de Wouw M, Ventura-Silva AP, Wallace-Fitzsimons SE, Hyland N, Clarke G, Dinan TG. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019 Oct 1;99(4):1877-2013. doi: 10.1152/physrev.00018.2018. PMID: 31460832.
2. Mayer EA, Ryu HJ, Bhatt RR. The neurobiology of irritable bowel syndrome. Mol Psychiatry. 2023 Apr;28(4):1451-1465. doi: 10.1038/s41380-023-01972-w. Epub 2023 Feb 2. PMID: 36732586; PMCID: PMC10208985.
3. Baboș CI, Leucuța DC, Dumitrașcu DL. Meditation and Irritable Bowel Syndrome, a Systematic Review and Meta-Analysis. J Clin Med. 2022 Nov 2;11(21):6516. doi: 10.3390/jcm11216516. PMID: 36362745; PMCID: PMC9658118.
4. Taren AA, Gianaros PJ, Greco CM, Lindsay EK, Fairgrieve A, Brown KW, Rosen RK, Ferris JL, Julson E, Marsland AL, Bursley JK, Ramsburg J, Creswell JD. Mindfulness meditation training alters stress-related amygdala resting state functional connectivity: a randomized controlled trial. Soc Cogn Affect Neurosci. 2015 Dec;10(12):1758-68. doi: 10.1093/scan/nsv066. Epub 2015 Jun 5. PMID: 26048176; PMCID: PMC4666115.
5. Mandlik GV, Siopis G, Nguyen B, Ding D, Edwards KM. Effect of a single session of yoga and meditation on stress reactivity: A systematic review. Stress Health. 2024 Jun;40(3):e3324. doi: 10.1002/smi.3324. Epub 2023 Oct 11. PMID: 37822096.

I’ve recently noticed a diet that is trending – the carnivore diet – not just among people in general, but also among people with IBS. Being a dietitian makes me very interested in all diets, but I must say this takes the cake. This diet seems to be completely counterintuitive, as it goes against all dietary guidelines out there, so why do people try it anyway?

It's because some people who follow the carnivore diet report feeling much better after switching. They feel more energetic and lighter than before. They report that their IBS symptoms get better, even disappear in some cases. As a registered dietitian, this is hard hard for me to believe, so let’s dig in and see what is going on here.

The Carnivore Diet: A Closer Look

Let’s first find out what this diet is. This diet is almost exactly as it sounds: it is all meat, fish and chicken. You are also allowed a little bit of cheese, heavy cream and eggs. Fat sources are lard and tallow, although some allow plant oils in the diet also. You can drink unsweetened coffee and tea and add spices that contain no carbs. 

Basically, this diet is an extremely low carbohydrate diet, very high in protein, and high in fat. It is not possible to get all the nutrients your body needs from this diet, especially vitamin C, B vitamins, vitamin K and calcium, unless you include a variety of organ meats in your diet every day, like liver, kidney, and brain. For omega-3 fatty acids, it’s important to eat fatty fish, like salmon. Unless you drink coffee or tea, this diet contains hardly any antioxidants - these are highly beneficial for your health as they fight free radicals that damage your tissues. Animal foods contain no fiber that are needed to support the health of the gut microbiota. 

To sum up, the carnivore diet is a highly restrictive eating plan that consists of 99% animal-based foods and carries with it a high risk of malnutrition. It’s not a diet that any dietitian or doctor can recommend to be followed. How is it possible then, to feel better with this diet?

Why you might feel better

There are no objective studies done, so I can’t say anything for sure, but I have a few theories why someone might feel better.

1. You eat hardly any processed food and no sugar. Processed food is a big problem in today’s world. These foods usually contain additives, sugar, and hardly any vital nutrients, and so they are harmful to health. People who follow the carnivore diet are likely to eat a lot less processed food, perhaps even none, unless they choose deli meats and sausages etc. on their plate.
2. Ketosis. The carnivore diet contains close to 0 grams of carbohydrate, which means the body must go into ketosis to survive. People on a ketogenic diet report feeling more alert (though not always!). Ketogenic diets also increase fat loss in the body, which helps lose weight and may help make you feel better (at least in the short term).
3. Placebo effect. It is a big dietary change, and if you are expecting to feel better, the placebo effect can help you achieve this. At least for a while. Placebo effect tends to lose power long term.
4. No carb fermentation. Gut symptoms may improve as there is no fiber for the gut microbes to process and make gas from – bloating and flatulence improve. However, a diet with no fiber, and without green/herbal tea no polyphenols either, cause negative changes to the composition of the gut microbiota (=dysbiosis).  The lack of fiber tends to lead to constipation, and some people might even experience diarrhea caused by the dysbiosis.

The risks involved

• Who knows what this does in the long term! There are no studies, and objective studies are not possible because of ethical reasons as mentioned above. Researchers would have to rely on a small group of volunteers, and so there would be many biases that come from a non-random study groups making results untrustworthy.
• In the long term, you will very likely get nutrition deficiencies without supplementation.
• No fiber in the diet leads to gut microbiota dysbiosis, which leads to health problems 
  • Gut microbes will need to process proteins and amino acids instead, leading to production of potentially harmful compounds.
• High meat consumption is linked to a host of health problems, like gout, osteoporosis, and kidney stones, and even colon cancer, whereas plant rich diets are linked to longevity and lower risk of chronic illnesses.
• No antioxidants at all, unless tea/coffee is added to the diet. Antioxidants fight free radicals and tissue damage.
• Humans are not actually carnivores, we are omnivores. Just compare the digestive systems of a wolf and a human. It’s not built to process only animal protein.
• Very high protein content. Excess protein will be turned into carbs and other molecules, and getting rid of protein waste products is very tough on the body. Kidneys will be taking a hit in the long term.
• The diet is not sustainable, you’ll get cravings eventually and it will be hard to maintain the diet. Resuming to your normal diet after being on a carnivore diet can cause you to regain all the weight you had lost, and sometimes gain even more.
• Following the diet increases the risk of disordered eating for people prone to them.
• Constipation from no fiber / diarrhea from changed microbiota.

Who absolutely should not try this diet

But what about the Inuit?

The carnivore diet (or any meat-heavy diet for that matter) is against the dietary recommendations of any given country in the world. But then we have Inuits who mostly eat fish and meat. They seem to do well on this diet. So why shouldn’t others do the same?

This is an excellent question! Here’s what I found.

However, it’s important to note that the traditional Inuit diet is not a carnivore diet, it also includes local plant foods, studies are estimating 8-50% carbohydrate. Also, the Inuit eat lots of marine mammals and fish, including their internal organs, which helps provide more of the nutrients the body needs. 

It has been thought that heart disease doesn’t exist among the Inuit population, but this might not be the case. Another problem with this diet is also that it doesn’t promote bone health - the Inuit have been found to have very poor bone health and early onset osteoporosis. 

What to do instead

If you have IBS, and are seeking a diet that minimizes symptoms, it shouldn't be the carnivore diet. It might not be the low FODMAP diet either. What you need is a balanced, highly individualized diet that takes into account much more than just your gut symptoms, such as your age, gender, background history, habits, skills and so on. This is what dietitians do – they look at your diet from all angles and recommend changes to support your gut health, your overall health and your wellbeing.  

If you are considering trying out an extreme diet like the carnivore diet, it is a sign to talk to an IBS dietitian and get real solutions that bring you real results, without risking your long term health. Book a free gut health review with me to kickstart your journey to finding your very own, best possible IBS diet.

PS. If you haven’t yet, download my free “5 Easy Ways to Beat the Bloat” guide packed with actionable tips that you can start applying in your day to day life right away.

PPS. Let’s chat! There is a right IBS diet for you out there. Book your free gut health review now!

References:

1. LeWine, H. E., What is the carnivore diet? Harvard Health Publishing. 2024. Accessed 11/20/2024 
2. Eagle, R, medically reviewed by Seitz, A. Carnivore diet: What it is and how to do it. 2020.  https://www.medicalnewstoday.com/articles/carnivore-diet accessed 11/20/2024
3. Campbell, T. Masai and Inuit High-Protein Diets: A Closer Look. NutritionStudies.org. Accessed 11/20/2024
4. Fumagalli M, Moltke I, Grarup N, Racimo F, Bjerregaard P, Jørgensen ME, Korneliussen TS, Gerbault P, Skotte L, Linneberg A, Christensen C, Brandslund I, Jørgensen T, Huerta-Sánchez E, Schmidt EB, Pedersen O, Hansen T, Albrechtsen A, Nielsen R. Greenlandic Inuit show genetic signatures of diet and climate adaptation. Science. 2015 Sep 18;349(6254):1343-7. doi: 10.1126/science.aab2319. PMID: 26383953.
5. Oliphant K, Allen-Vercoe E. Macronutrient metabolism by the human gut microbiome: major fermentation by-products and their impact on host health. Microbiome. 2019 Jun 13;7(1):91. doi: 10.1186/s40168-019-0704-8. PMID: 31196177; PMCID: PMC6567490.

To truly manage IBS, you need to fix the way your brain and your gut talk to each other.

When talking about irritable bowel syndrome and IBS symptoms (abdominal pain, bloating, diarrhea, constipation), the discussion is not complete without considering the gut-brain axis. Especially since IBS experts are now calling the syndrome a disorder of gut-brain interaction. It’s a fascinating subject that reminds you how everything in the body affects everything - in good and in bad. This applies also to managing IBS symptoms: it’s not enough to focus on one aspect of gut health, like your diet, but also sleep, circadian rhythms, exercise, stress, and even thoughts have to be assessed as all of these affect the gut-brain axis.

What is the gut-brain axis 

Often called the gut-brain-microbiota axis, the gut-brain axis is the communication channel between the gut and the brain, the two-directional phone line between the two.

Your gut and your brain are talking to each other all the time! The main office (the brain) wants to know what the branch office is doing (the gut) and give orders if need be. They relay information back and forth about gut processes, hunger, satiety, stress, and feelings, just to name a few. 

Problems in this information exchange are linked to irritable bowel syndrome and other “functional” gut problems, immune function, sleep problems, mood disorders, neurodegenerative diseases, and even obesity.

How are your gut and your brain connected?

It’s not simple. Many processes are involved:

• Central nervous system (brain and spinal cord): both the sympathetic (stress response) and the parasympathetic (rest response) branches of the autonomic nervous system are involved, especially the vagus nerve
• Enteric nervous system (gut’s own nervous system)
• Endocrine pathways (hormones): such as HPA-axis with cortisol (stress hormone), gut hormones like ghrelin (hunger hormone) and leptin (regulates appetite)
• Immune system of the gut: cytokines (inflammation controlling molecules)
• Microbiota (gut microbes) and the molecules they produce, like short chain fatty acids and neurotransmitters

To simplify, what you need to know is that 

• The enteric nervous system takes care of digestion, but the brain can override its functioning in stressful situations. 
• The vagus nerve is the main information pathway between the brain and the gut, and there is evidence to show that it’s not working well in people with IBS. 
• Gut microbes are highly important, and how you take care of them makes an impact on the gut-brain axis level also. 

What disrupts the gut-brain axis

It’s not completely clear how this happens, but it seems stress plays a big role, as does the health of the gut microbiota. Your gut microbes are affected by your lifestyle and your diet, both in helpful and harmful ways. It is thought that dysbiosis of the gut microbiota (negative changes in your gut microbes) can cause problems in the gut-brain axis, but it is not clear whether dysbiosis happens first, or whether the disruption of the gut-brain axis causes the dysbiosis. 

IBS can become triggered by a gut infection, which could support the idea that your gut microbe balance becomes disrupted first, but an infection also causes inflammation which the immune system controls. Gut infection is also a source of stress, and a sensitive brain may overreact to infection signals coming from the gut, starting a feedback loop that causes IBS. So, it’s not clear.

The brain then is responsible for assessing whether we are in danger or not, but your lifestyle and your diet can also affect your stress sensitivity, or how readily a stress response is triggered in the body. A typical Western diet and an irregular lifestyle with sleep deprivation could make you more sensitive to stress.

Stress sensitivity

People who have had lots of stress in their lives, whether in childhood or in adulthood, become more sensitive to stress, and are at a higher risk for developing IBS. Studies show that over time their brains have adapted to stress in an unhelpful way, which explains this increased sensitivity, and probably also why not everyone with stress has IBS.

Additionally, people with IBS tend to have these similar structural brain changes and increased stress sensitivity also, and a history of highly stressful life periods. For example, I had a client whose gut symptoms began after a serious natural disaster hit her country. This all suggests that chronic stress wreaks havoc on the gut-brain axis and promotes chronic gut issues, like IBS.

What’s more, it’s relatively common that anxiety and depression happen together with IBS, both probably feeding the other. What came first, however, is not clear. 

Looking after the gut-brain axis

Everyone can benefit from taking good care of the gut-brain axis, but this is especially important for people with IBS and other functional digestive disorders. It seems that gut symptoms are like the tip of an iceberg – your gut-brain axis may have been disrupted for a while before gut symptoms surface!

How to nurture your gut-brain axis:

• Feed your good gut bacteria with a balanced diet rich in fiber
• Support digestive processes by eating regularly, avoiding overeating, drinking enough fluids, limiting alcohol consumption
• Stimulate vagus nerve and calm the nervous system with stress releasing activities 
• Activate brain areas that lower stress sensitivity: breathing exercises, meditation
• Work on your mindset to reduce catastrophizing, expecting problems etc.
• Pay less attention to your gut symptoms
• Nurture body’s processes: keep regular daily rhythms with sleep, meal patterns and exercise, do your best to sleep well
• Perhaps specific supplements, like probiotics can help

It’s a lot! But not impossible to do. 

Strong gut-brain axis plan

The first step is to map out honestly how you are doing in these different areas listed above. 

The second step is to make a plan: what needs to change and in what order. Consider what might be easier to start with, or what might make the biggest impact. 

But you don’t have to figure this out on your own. Nurturing a sturdy gut-brain axis and relieving IBS symptoms in the process is what I do. If you are not sure, let’s chat. You will have the opportunity to tell an expert about your situation, and I will go over your best next steps without you having to commit to a program. I want to make sure you and I are a good match before you invest anything in working together. Book you free consultation here.

I hope you enjoyed learning about the all-important gut-brain axis! If you are feeling overwhelmed by this, just remember that even small adjustments to diet, lifestyle, thought patterns and stress sensitivity can make a big difference. Check out all of my free resources (scroll down my home page) - they provide lots of tips to get going with.

Thank you for reading!

PS: Book your free 30-minute consultation here!

PPS: Feeling bloated? Get your copy of the free “5 Easy Ways to Beat the Bloat” guide here!

References

1. Chen M, Ruan G, Chen L, Ying S, Li G, Xu F, Xiao Z, Tian Y, Lv L, Ping Y, Cheng Y, Wei Y. Neurotransmitter and Intestinal Interactions: Focus on the Microbiota-Gut-Brain Axis in Irritable Bowel Syndrome. Front Endocrinol (Lausanne). 2022 Feb 16;13:817100. doi: 10.3389/fendo.2022.817100. PMID: 35250873; PMCID: PMC8888441.
2. Mayer EA, Nance K, Chen S. The Gut-Brain Axis. Annu Rev Med. 2022 Jan 27;73:439-453. doi: 10.1146/annurev-med-042320-014032. Epub 2021 Oct 20. PMID: 34669431.
3. Mayer EA, Labus JS, Tillisch K, Cole SW, Baldi P. Towards a systems view of IBS. Nat Rev Gastroenterol Hepatol. 2015 Oct;12(10):592-605. doi: 10.1038/nrgastro.2015.121. Epub 2015 Aug 25. PMID: 26303675; PMCID: PMC5001844.
4. Karakan T, Ozkul C, Küpeli Akkol E, Bilici S, Sobarzo-Sánchez E, Capasso R. Gut-Brain-Microbiota Axis: Antibiotics and Functional Gastrointestinal Disorders. Nutrients. 2021 Jan 27;13(2):389. doi: 10.3390/nu13020389. PMID: 33513791; PMCID: PMC7910879.
5. Sun LJ, Li JN, Nie YZ. Gut hormones in microbiota-gut-brain cross-talk. Chin Med J (Engl). 2020 Apr 5;133(7):826-833. doi: 10.1097/CM9.0000000000000706. PMID: 32132364; PMCID: PMC7147657.

If you are wondering the answer to this question, you are not alone. There are millions of people out there experiencing gut symptoms and wondering if they should be worried about them.

The most common IBS symptoms are:

• Abdominal pain
• Bloating and/or distention of the belly
• Constipation
• Diarrhea

The way IBS is diagnosed, in order for your symptoms to “qualify” as IBS, abdominal pain must be present. It can be crampy, aching, and even quite severe. Often it is triggered or made worse by food, bowel movements and stress.

This abdominal pain is also often associated with a change in stool frequency or consistency. It typically gets better after having a bowel movement, and it would actually be concerning if it didn’t. Since abdominal pain in IBS is considered visceral pain, you’ll often feel pain in the midline of the body.

Bloating is a feeling of tightness and fullness of the abdomen, and your belly feels like it is visibly bigger, even though it may or may not be so. Distention is the term for your belly protruding more than usual with measurable increase in the abdominal circumference. People feel like they have a balloon in their belly, or that they are pregnant when they are not pregnant. Bloating and distention can cause discomfort and it may feel embarrassing.

Constipation is an infrequent bowel movement pattern, in which you have a bowel movement less than three times a week. Though it seems to me you can feel constipated even if you move your bowels daily. Constipation usually goes hand in hand with small, hard, pebble-like stools and they are hard to pass. You might feel like your bowels are not emptying fully.

Diarrhea is the opposite of constipation. It refers to loose, watery stools, more than three times per day. Diarrhea could also cause urgency - you can’t wait a minute longer to go to the bathroom or else an accident might happen.

These symptoms can be very debilitating. They might also change from day to day, one day having constipation and the next diarrhea. People experiencing IBS symptoms may feel like they need to watch closely what they eat, not stray too far from the toilet, and avoid going out to see friends, travel or eat out.

If you’ve been experiencing IBS symptoms for longer than a few weeks, or less if the symptoms are very difficult, I encourage you to go get them checked out. Then, even if your symptoms didn’t fulfill the IBS diagnostic criteria, you’d find out whether there’s something more serious going on, or whether there’s nothing to worry about. Either way, it’s better to be in the know than to be guessing!

If you have been diagnosed with IBS, but are not sure whether this is the right diagnosis, I would again encourage you to speak with your doctor. Ask how they diagnosed the disorder and voice your concerns. The end result (should be) that your doctor will either order more tests, or explain to you more thoroughly their thinking process, so that you can rest assured the right call has been made and that you can begin to apply the right therapies.

If you end up being diagnosed with IBS, or even if you’re not, I have what you need to improve your symptoms. Sign up to my IBSwise program, or if you’d like a more individualized approach, book a free 30-minute chat to discuss your next move.

Whatever you do, don’t be left alone with your symptoms! There is so much you can do to ease them.

I had the pleasure of being hosted in an educational webinar to my fellow dietitians in Finland this past week. The topic was the connection between stress and irritable bowel syndrome. I had the opportunity to speak to over 50 of my peers about this subject that important and yet, significantly overlooked. 

Many studies show the intimate connection between stress and our digestive system through the gut-brain axis. Many factors affect digestion, including the food we eat, but when stress levels are high, what we eat makes no difference – we will have gut trouble until we address the stress. Eating or not eating results in pain, bloating and either diarrhea or constipation. So yes, I can tell you that stress causes gut problems, likely also IBS, and it can certainly make it worse!

In this presentation that I gave to my fellow dietitians, I talked about the science behind stress and IBS. I went over the mechanisms through which stress affects the gut. For example, stress can cause inflammation in the gut, disrupt your gut microbiota and make the gut more sensitive to what’s happening within it, even to normal things, like a small amount of gas from bacterial fermentation of whole grains (which is good for us!). 

All my clients have experienced significant improvements in their gut issues when they have not only paid attention to their diet, but also started a daily stress release routine. For example, taking time to eat in peace instead of hurrying through each meal has made a big difference! Breathing exercises have also been a very central part of their stress release routines and my clients say they have been “life saving”.

If you are thinking “I don't have any stress”, I would suggest to question this, because everyone has some stress, and stress is not always felt on a mental level. Physical symptoms can be the only telltale signs of stress in your life. So, even if you don't feel like you're stressed out but are suffering from a lot of ailments, including gut issues, try stress release anyway because more than likely it will help you. 

Furthermore, it will not only help your gut health, but your well-being overall. 

Everything affects everything, so only adjusting your diet is not enough for true health. We need to look at every aspect of life to truly find the causes for our symptoms and the best solutions.

You can start by signing up to IBSwise and exploring the different stress release techniques I offer there, or visit my Instagram page to try the box breathing exercise that I have pinned to the top of the posts.

Any questions? Just comment below, or email me at [email protected].

Thank you for reading!

PS: I host free 15-minute stress release sessions on Thursdays, every other week. The next session is September 5. You can register here for the next session, and email me if you’d like a link to watch the recording from the last session.

PPS: I have lots of free stuff you can download! For example, you can get the free guide “5 Easy Ways to Beat the Bloat” here!

Earlier this month National Geographic published an article headlined “Why women are more likely to have IBS”. I love that big publications such as National Geographic are paying attention to irritable bowel syndrome, as it is so common, and as there is so much misleading information out there. Big publications could help bust some of that misinformation. 

The article aimed to explore why more women than men have IBS, and to discuss some of the treatment options. Since the comments below the original Instagram post, where I first spotted the article, seemed to point out some discrepancies, I thought I’d chime in and expand on some of the unclear points. Here are some of my thoughts:

• According to Dr. Raj, a gastroenterologist, IBS is a diagnosis of exclusion – more severe illnesses with overlapping symptoms need to be ruled out before an IBS diagnosis can be made. My experience: not all doctors test for everything, like cancer and IBD. This is probably to save resources, especially in a public healthcare setting, where money is tight. However, this leads to patients feeling unsure of their diagnosis. It's one of the reasons why it's so important to be able to advocate for yourself when talking to doctors. When you know a bit about what to expect, you will feel more empowered to ask the right questions and get the help you need (one of the reasons I created IBSwise). Here’s my wish to doctors seeing patients with IBS and these kinds of gut issues: spend time explaining your decisions on testing and recommendations so that people feel heard, and can understand and accept their diagnosis and thus go for correct treatments, instead of wasting time and money looking in the wrong places.
• The reason why women are more likely to have IBS is hormones. This I can agree with. I wrote a blogpost about it.
• Another reason for women being more susceptible to IBS: sensitivity to stress. Yes, seems true. I was also glad to see stress mentioned early in the article, as this is also what I have found in my IBS research. Stress is a real culprit in IBS, for both women and men. Even so, it seems that both doctors and patients resist this fact. Maybe blaming stress feels like it belittles the problem, which is not true. The effect of stress on gut function is a real physical response triggered by our thoughts, beliefs and feelings. So, IBS is not just in our head, but the brain has a lot to do with it in a real, physical way.

• IBS treatments: proper sleep and stress reduction. Yes, 100% agreement. Poor sleep affects everything, including gut health and stress sensitivity. The article also mentions that “finding your stress management technique, whether it’s meditation, cognitive behavioral therapy or exercise is key for keeping symptoms at bay.” This is correct, but I’d add that you don’t have to choose just one stress management or release method, you can utilize multiple of them. Combining meditation with exercise for example is more effective than doing one or the other. Not to mention there are many other methods to try, too.
• Antidepressants in low doses can help. Yes, true. However, science is showing that dietary changes can be as effective as medication. For this reason experts consider diet to be a first line therapy as compared to meds.
• Low FODMAP diet is considered to be an effective approach. Yes, studies show that the low FODMAP diet helps reduce symptoms in 2/3 of cases or so. However, the article is not mentioning any risks involved with the diet. Like reduced enjoyment of eating, increased cost, food relationship changes (like food fears) and that the diet can cause stress, which is not helpful when stress is a major IBS trigger. To me, deciding on whether or not to follow the low FODMAP diet should be given thorough consideration. It shouldn’t be something automatic for every IBS patient. This even though it is one of the more natural approaches to managing IBS. Other, more simple, diet changes may be all that is needed.
• Proper hydration is key. Someone commented below the article on Instagram that they drink a lot of water, and increasing water intake doesn’t help them (this person even seemed frustrated by this advice). Both the article and the commenter are correct: drinking enough fluids is important, but if you already are drinking a lot, at least 2 liters (8 cups) a day, then drinking more is not going to help. The point is that dehydration dries out stool in the gut, predisposing us to constipation.

• Fiber is needed. It’s true that most people in the Western world don’t get enough of it, not even close. However, the article doesn’t go into any detail here, they only mention that many brands are adding fiber into their products. Fiber is critically important for gut function, and it’s important to note that there are different types of fiber that are handled differently in the gut. This is where speaking with a dietitian is helpful for making sure increasing fiber intake is done right – something the article could’ve mentioned.
• If you have persistent digestive issues, get tested. Yes, absolutely. It’s important to know your gut symptoms are not a sign of something more serious. IBS isn’t serious in the eyes of health care practitioners in that it doesn’t shorten life span, but it’s serious in a different way - it dramatically reduces quality of life. I know it can feel embarrassing to talk to a doctor about your gut function, but taking that step also brings you closer to symptom management and improving your quality of life. Remember that 10% of the global population have IBS, so it’s very common and nothing to be embarrassed about. What’s important is your health and wellbeing.

Thanks for reading! I’m glad we are talking more about IBS publicly, but much more is needed! More publications should write about IBS in an easy-to-understand way. In the meantime you can ask me. I’m here to help!

Love,

PS: If you have questions about this, or any other gut health or stress topic, get in touch!

PPS: Did you download my free guide “Beat Stress and Boost Your Mood” yet? 

Link to the original NatGeo article here.

Have you noticed that your gut functions differently depending on where you are in your cycle? That every time you are about to have your period, your gut gets messed up, or your already loose stools become worse?

You are not imagining it – female hormones do affect the gut, especially through pain sensitivity, how fast the gut contents move (motility), and indirectly through greater stress sensitivity (1-4). Female hormones could explain why women tend to have more IBS than men in general, and more IBS-C than men (1,2). In this article, I briefly go over what this means in terms of gut symptoms. 

Menstrual cycle

First, let’s briefly discuss the menstrual cycle. There are three phases: 

Phase	Days	Estrogen and progesterone	Gut impact
Menstruation phase	1-7	Both are low	Faster motility, higher risk of diarrhea, urgency Increased pain sensitivity
Follicular phase	8-14 (until ovulation)	Estrogen: Increases until peaks at ovulation Progesterone: low	Slower motility
Luteal phase	15-28	Estrogen: high, drops quickly Progesterone: high	Slower motility

Female hormones and the gut

Now, let’s dive into how female hormones can change how the gut functions.

Motility

Very simply put (I discuss this subject in more detail in my IBSwise course), estrogen affects the gut by lengthening gut transit time, which means that gut contents move slower through the intestines. When estrogen levels are high, gut moves slower, and when estrogen levels drop, gut motility increases. This is probably why women tend to be more prone to IBS-C, and have constipation especially during follicular and early luteal phases, and higher chance of diarrhea around menstruation. During pregnancy, estrogen levels are high, which could at least partially explain why constipation is so common in pregnant women, especially during the third trimester. (1,2)

On the other hand, progesterone’s effect on gut motility is not as clear, as it affects serotonin mechanisms also, but the overall effect seems to be similar to estrogen: higher levels are associated with slower gut movements (1). 

Pain sensitivity

It’s unclear how estrogen affects pain sensitivity, but it looks like changes in estrogen predispose to pain, such as a few days after ovulation when estrogen levels drop quickly (6). Pain sensitivity has also been found to be higher around menstruation when there is an increased number of serotonin receptors due to low estrogen, which leads to detecting pain and sensations more easily. Estrogen affects inflammatory pathways as well, which can lead to higher sensitivity – in IBS it has been noted that the number of a certain estrogen receptor is often high, which increases inflammation and therefore pain sensitivity (1,3,4).

Stress

Another mechanism that can increase gut symptoms in women is that women are naturally more reactive to stress than men. Female sex hormones have been connected to HPA-axis activity, and to a higher limbic system activity (1-3). This all lowers the threshold for a stress response to be triggered in the body, which leads to gut issues, especially in IBS.

Birth control?

What about women on birth control? According to Dr. Liao (5), birth control that allows for menstruation doesn’t protect from hormonal gut changes, but ones that skip menstruation could. Discuss with your doctor if you feel that at different phases of your cycle you experience difficult symptoms, whether it’s constipation during follicular and early luteal phase, or diarrhea and pain around menstruation phase. Still, even though female hormones seem to affect gut symptoms, data doesn’t support utilizing hormone therapies for women with IBS (3).

What can you do about it?

If your gut behaves differently during different phases of the menstrual cycle, it’s nice to know it is caused by your hormones. While I don’t recommend observing gut symptoms too closely, knowing when you are more likely to have diarrhea vs constipation could help you anticipate these changes. 

Perhaps you can prepare a bit, also – if you are often constipated outside of menstruation, you could increase the amount of fiber you eat at that time of the month, whereas if you experience diarrhea during and close to menstruation, you could utilize soluble fiber from chia seeds, flaxseed and oatmeal. Additionally, focusing on anti-inflammatory foods during menstruation may be useful, like eating lots of colorful fruits and vegetables, and omega-3 rich foods, like walnuts, hempseed, and salmon, although these are important foods to eat every day. 

So, female hormones and gut function are connected. Knowing how is useful, as you won’t be surprised by the changes, nor will there be a need to be worried. And you can make better food choices according to your cycle too.

PS: Check out all the free giveaways on my home page!

References

1. Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones. World J Gastroenterol. 2014 Jun 14;20(22):6725-43. doi: 10.3748/wjg.v20.i22.6725. PMID: 24944465; PMCID: PMC4051914. 3
2. Mulak A, Taché Y, Larauche M. Sex hormones in the modulation of irritable bowel syndrome. World J Gastroenterol. 2014 Mar 14;20(10):2433-48. doi: 10.3748/wjg.v20.i10.2433. PMID: 24627581; PMCID: PMC3949254. 4
3. Pati GK, Kar C, Narayan J, Uthansingh K, Behera M, Sahu MK, Mishra D, Singh A. Irritable Bowel Syndrome and the Menstrual Cycle. Cureus. 2021 Jan 14;13(1):e12692. doi: 10.7759/cureus.12692. PMID: 33614302; PMCID: PMC7883586. 5
4. Chen C, Gong X, Yang X, Shang X, Du Q, Liao Q, Xie R, Chen Y, Xu J. The roles of estrogen and estrogen receptors in gastrointestinal disease. Oncol Lett. 2019 Dec;18(6):5673-5680. doi: 10.3892/ol.2019.10983. Epub 2019 Oct 11. PMID: 31788039; PMCID: PMC6865762.
5. Liao, S. Do Your Hormones Affect IBS? WebMD. https://www.webmd.com/ibs/hormones-ibs. Accessed 6/16/2024
6. Athnaiel O, Cantillo S, Paredes S, Knezevic NN. The Role of Sex Hormones in Pain-Related Conditions. Int J Mol Sci. 2023 Jan 18;24(3):1866. doi: 10.3390/ijms24031866. PMID: 36768188; PMCID: PMC9915903.

Most people don’t feel great after eating a large amount of sugar in one form or the other, I know I’ve been there many times! On top of feeling off or crashing from blood sugar swings, some may even get a stomachache, diarrhea or become bloated - your typical IBS symptoms. We know that carbohydrates, including sugars, affect the gut, and in this post I will briefly discuss what is known specifically about the effect of sugar (excluding lactose in dairy) on gut function. Is it something we should avoid eating altogether?

To lay the foundation, sugar is simple carbohydrate, and there are actually many types of sugar. What is important to know is that all carbohydrate (starch) must be turned into sugar before it can be absorbed, and more specifically, into single sugar units called monosaccharides. Even two sugar molecules together, like sucrose in table sugar is too large to be absorbed. So, despite what we may have heard, this also means that sugar is not in and of itself bad for us AND all the cells in our body prefer to be fueled by the monosaccharide glucose. It’s more that high sugar foods tend to be highly processed and poor in other nutrients, like vitamins and minerals that doesn’t promote general health.

Another way in which fructose can trigger gut problems is that when there is enough of fructose particles together in the gut, they attract water to themselves (happens with any particles, not just fructose). This can lead to a fluid buildup in the intestine quickening it’s movement and volume, which can then lead to a fast exit, and discomfort. However, if fructose is together with glucose, it absorbs better and is likely to not cause any gut issues. (1)

You might then wonder if adding some glucose to foods that have a lot of fructose would help the fructose absorb better and thus prevent gut symptoms? Scientists have been wondering the same and while theoretically this would make sense, scientific studies haven’t been able to show this to be helpful in reducing gut symptoms (2).

But what about high sugar foods that don’t have more fructose than glucose in it? Could this kind of sugar also cause gut trouble?

The short answer is yes, it could.

In theory, sucrose and especially glucose are sugars that absorb quickly and quite completely in the small intestine so that they shouldn’t really end up in the large intestine to be fermented by our gut microbes and cause problems. 

But one reason sucrose, or table sugar, could lead to gut symptoms is a genetic disorder called sucrase-isomaltase deficiency, in which the enzyme that breaks down sucrose is missing or not working well which lets this sugar stay in the gut to attract water and travel into the large intestine to be fermented. This is very rare, however. But, if you always have gut symptoms after eating sugary food, and the low FODMAP diet hasn’t helped, and especially if you have had issues since childhood, experts suggest checking for sucrase-isomaltase deficiency. (3)

A study investigating a diet low in starch and sucrose found that this diet helped reduce gut symptoms – as for the mechanism, they suggested sugar overload also, and also that the gut microbiota become improved on a lower sugar and starch diet (4). This could also be due to the fact that when we eat less sugar, we might eat more foods that positively nourish the microbiota. However, what is important, is that the authors of the study remind us that gut health is a sum of all the dietary and lifestyle choices we make, rather than depending on one or even a few foods or nutrients in our diet.

In the end, it all comes down to moderation – large amounts of anything can cause gut symptoms.

So no, you don’t have to stop eating sugar to keep your gut healthy. In addition to moderation, something also to consider is how you eat your sweets - do you eat them into an empty stomach or as a dessert? This changes how you digest the sugars in the food (I suggest you eat your sweets as a dessert).

And what else are you eating? Is your diet in balance? Is your lifestyle in balance? What can you do to bring more balance into your life so that you can enjoy a moderate amount of sugar without gut or health issues? If you are not sure, here’s a lifestyle checklist you can download to spot more easily what those changes could be. 

Thank you for reading! I’d love to hear your thoughts and also your requests for future blog posts.

Love,

Anna-Kaisa

PS: I created an IBS course called IBSwise to help people with gut issues to achieve IBS freedom! But if you’d like a more individualized approach, book a call with me to see how I can help you improve your digestive health without restrictive diets and giving up foods or nutrients.

References

1. Fernández-Bañares F. Carbohydrate Maldigestion and Intolerance. Nutrients. 2022 May 4;14(9):1923. doi: 10.3390/nu14091923. PMID: 35565890; PMCID: PMC9099680.
2. Tuck, C.J., et al., Adding glucose to food and solutions to enhance fructose absorption is not effective in preventing fructose-induced functional gastrointestinal symptoms: randomized controlled trials in patients with fructose malabsorption. Journal of Human Nutrition and Dietetics, 2017. 30(1): p. 73-82.
3. Foley A, Halmos EP, Husein DM, et al Adult sucrase-isomaltase deficiency masquerading as IBS Gut 2022;71:1237-1238.
4. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019 Jul 20;11(7):1662. doi: 10.3390/nu11071662. PMID: 31330810; PMCID: PMC6682926. 

Did you know that irritable bowel syndrome is now being classified as a disorder of gut-brain interaction? This is a big deal, because this classification also suggests a way to reverse IBS – by fixing this disordered gut-brain interaction! 

But let’s back up a little – what is gut-brain interaction anyway? Well, simply put, our gut and our brain communicate with each other constantly: the gut is sending signals about what is going in the gut and its contents and the brain is talking to the gut about our environment, such as of safety or danger. 

In a disordered gut-brain communication, the gut is telling the brain there are problems when there aren’t necessarily any, and the brain might be telling the gut that we are in danger when we are not. All of this might even become a vicious cycle, in which the gut and the brain feed off of each other and make everything worse.

What causes the gut-brain connection to go haywire? Sometimes a gut infection or antibiotics may trigger persistent gut symptoms probably because of inflammation and gut microbiota changes (1,2), but more importantly, all other signs point to stress. Having extensively studied and researched the mechanisms of IBS (such as visceral hypersensitivity, gut immune function changes, increased gut permeability and gut microbiota dysbiosis), all of them can be caused by stress (3). And stress is what causes the brain to send distress signals to the gut. 

For example, most of us have experienced a time when we were really nervous about something, like giving a presentation or having a sports competition, that lead to abdominal pain and maybe diarrhea. I certainly can remember many instances! What happens, is that the brain prepares the body for a dangerous situation, which triggers a stress response in the body (an important survival mechanism!), to which the gut responds by becoming hypersensitive (pain) and removing its contents (diarrhea), or not moving its contents (constipation) so that the body could be better prepared to fight or flee (4).

Usually when the event is over, the body returns to rest-and-digest mode and digestion goes back to normal. However, in IBS, a stress response has gotten stuck or triggers more easily leading to more persistent gut symptoms (3,5).

And there are many ways to do this! My IBSwise course discusses most of them and provides opportunities to try them, too – I heartily recommend checking it out.

One thing you can do right away: take deep diaphragmatic (belly) breaths before each meal and any time you are feeling stressed out – this is a very simple way to calm and relax the body and boost digestion. Also try yoga and meditation practices, other breathing exercises and spending more time in nature etc. I also talk about all of these and many others on IBSwise. 

Thanks for reading! There is so much you can do for your gut health that is free and doesn’t require medication or supplements! Get in touch if you have any questions.

Love,

References

1. Lupu VV, Ghiciuc CM, Stefanescu G, Mihai CM, Popp A, Sasaran MO, Bozomitu L, Starcea IM, Adam Raileanu A, Lupu A. Emerging role of the gut microbiome in post-infectious irritable bowel syndrome: A literature review. World J Gastroenterol. 2023 Jun 7;29(21):3241-3256. doi: 10.3748/wjg.v29.i21.3241. PMID: 37377581; PMCID: PMC10292139.
2. Mamieva Z, Poluektova E, Svistushkin V, Sobolev V, Shifrin O, Guarner F, Ivashkin V. Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations? World J Gastroenterol. 2022 Mar 28;28(12):1204-1219. doi: 10.3748/wjg.v28.i12.1204. PMID: 35431513; PMCID: PMC8968486.
3. Qin HY, Cheng CW, Tang XD, Bian ZX. Impact of psychological stress on irritable bowel syndrome. World J Gastroenterol. 2014 Oct 21;20(39):14126-31. doi: 10.3748/wjg.v20.i39.14126. PMID: 25339801; PMCID: PMC4202343.
4. Stress Effects. The American Institute of Stress. https://www.stress.org/stress-effects. Accessed 24/2/2024.
5. Punkkinen et al. Suoli-aivoakseli vai aivo-suoliakseli – hoitokeinoja toiminnallisiin vatsavaivoihin. Review. Lääketieteellinen aikakauskirja Duodecim. 2023;139(22):1831-9