Irritable Bowel Syndrome (IBS) is frustratingly common. Symptoms such as bloating, pain, diarrhoea and constipation can flare up when life gets stressful. We see the same pattern – stress doesn’t just make you feel anxious, it changes how your gut behaves. Here we explore the gut-brain connection, highlighting evidence based management including dietitian support, to provide practical strategies to support your gut and mental health.
What is the Gut-Brain Axis – and Why Does it Matter for IBS?
The “gut-brain axis” is the bidirectional conversation between our central nervous system (the brain) and our enteric nervous system (the gut’s own nervous system), as well as the immune system and the gut microbes.
Signals travel via nerves, hormones and microbes. IBS is a disorder of the gut-brain axis, where symptoms impact interactions between the gut and brain. The communication here is dysregulated, and the gut may amplify certain gut sensations (which can cause visceral hypersensitivity) as well as the gut sending abnormal signals back (such as altered motility and inflammation. This explains why psychological stress and GI symptoms are very closely linked.
How Does Stress Affect Our Gut?
When we are stressed, the body activates certain pathways, including the hypothalamic-pituitary-adrenal (HPA) axis, and the autonomic nervous system. This leads to:
- Increased gut sensitivity and pain signalling; the gut becomes more reactive
- Changes in motility; stress can speed transit, leading to diarrhoea, or slow it down, increasing constipation risk.
- Altered gut barrier; this can increased permeability, and make the gut more reactive
- Immune activation; mast cells can be released, which worsens symptoms
- Microbiome shifts; chronic stress can shift the gut microbiome, which influences gut signalling and immune function.
Understanding these mechanisms will explain why management techniques help, such as breathing exercises, dietary changes and therapy. These all act on the same system!
Evidence-based Treatments That Target the Gut-Brain Axis
The Low FODMAP approach and personalised nutrition
The low FODMAP diet is a structured elimination, reintroduction and personalisation process, that has the strongest evidence to support with reducing IBS symptoms for many people. It is not a long term diet, it should be a short term restriction, following by reintroducing and tailoring, to avoid unnecessary long-term restriction, and to support diversity and the microbiome. Working with a FODMAP experienced registered dietitian is important to implement this diet safely and improve outcomes.
Psychological or gut-brain behavioural therapies
Cognitive Behavioural Therapy (CBT) and gut-directed hypnotherapy have robust evidence for reducing IBS symptoms long term. These therapies work by changing the pain perception, stress response and provide coping strategies. This can effectively re-tune the brain’s response to the gut signals. Relaxation, mindfulness and other therapies can help.
Lifestyle; sleep, exercise and stress-management
Ensuring you take part in regular physical activity, have a good sleep hygiene and have targeted stress reduction (such as mindfulness and breathing techniques), can reduce the hyperactivity and improve GI symptoms for many people. These are low risk and high benefit practices that should be part of any IBS management pathway.
Practical plan you can start today (dietitian-approved!)
We have put together a step by step plan to support your gut health and IBS. It’s important to highlight that we only recommend the below for those diagnosed with IBS, and also strongly suggest working alongside a dietitian, for supervised and personalised dietary changes.
Step 1 – Track (2 weeks)
Keep a food, stress and symptom diary. Not down:
– Meals & snacks, and timings
– Bowel habits, using the Bristol Stool Chart
– Stress levels, and major stressors
This will help identify patterns e.g. if symptoms spike during high stress at work.
Step 2- Stabilise basic routines (for 2-4 weeks)
– Regular meals: Build in consistency with eating at regular times in the day, to avoid overeating
– Hydration: Aim for regular fluid intake across the day
– Movement: Incorporate regular exercise throughout the week
– Stress: Aim for a consistent schedule, of 7-9 hours sleep per night
Step 3 – Targeted dietary intervention (if required)
– If your symptoms such as bloating, gas or pain are major complaints, and steps 1 & 2 above have not helped, reach out to a registered dietitian for 1:1 support with a structured low FODMAP trial.
If you are already following a low FODMAP diet, check out our 7 day dietitian approved low FODMAP menu for meal inspiration.
Step 4 – Stress management toolbox
Work on finding a way to manage your stress. This could be a number of techniques, including:
– Diaphragmatic breathing, 5 minutes, twice a day
– Meditation and mindfulness
– CBT – based techniques; reach out for specialist support when needed
– Consider gut-directed hypnotherapy if symptoms persist and impact quality of life
When to see a registered dietitian for gut-brain support:
We would recommend reaching out to our team if you are:
- Considering the low FODMAP diet to support with IBS symptoms. This is a diet that should never be done without the right supervision.
- You have experienced unintentional weight loss to due removing foods from your diet
- Symptoms are persistent despite initial changes, or IBS is limiting your daily life.
A dietitian will be able to support you with the right dietary strategy with psychological approaches for best outcomes.
FAQ:
Q – Can stress cause IBS?
A – Stress does not directly cause IBS but it can worsen symptoms such as impacting gut motility, sensitivity and immunity.
Q- Will therapy cure my IBS?
A – Therapies such as CBA and gut-based hypnotherapy can significantly improve symptoms and quality of life. Although we can’t promise a cure, many people see long lasting improvements.
Q- Should I just try probiotics?
A – We do not recommend starting a probiotic without individualised feedback and guidance. There are so many types of probiotics available, and it’s important to work with a professional who can find you the right probiotic with specific strains, if recommended, based on your specific symptoms.
A disorder of the “gut-brain axis” can make IBS symptoms worse. The good news, is that many areas can tackle symptoms from different directions – diet, stress and behavioural management therapies. Get in touch with our experienced team of registered dietitians to make the right step into managing your IBS symptoms and improving your quality of life.
