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The 4 Pillar Approach – Get A Healthy Gut for IBS

Feature, Gut Health & IBS | May 27, 2019

A young girl feeding her father a nutritious homemade sandwich.
The 4 Pillar Approach – Get A Healthy Gut for IBS Featured Image

What does it mean to have a healthy gut in irritable bowel syndrome?

So many of our patients have struggled for years to feel healthy and come to us to get a healthier gut and end those digestive woes.

At Ignite Nutrition, we have developed a system called the 4 Pillar Approach for Gut Health™ so patients with IBS can get a healthy gut!

When research is done properly, there is always only 1 intervention. However, we KNOW real life isn’t a research project. At Ignite, we have combined the most up-to-date evidence, with our expertise on digestive disorders and developed a plan that can be specifically tailored to your digestive issues, so you get feeling better FAST.

Our 4 Pillar Approach for Gut Health™ refers to:

  1. The Nutrition Pillar
  2. The Lifestyle Pillar
  3. The Medication Pillar
  4. The Gut-Brain Connection Pillar

Today we’ll review these 4 pillars and give you some actionable steps to improve each one. Let’s get started!

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The Nutrition Pillar

As dietitians, we definitely believe in the power of food! At Ignite Nutrition, we see that the majority of our IBS patients prefer to manage their symptoms through lifestyle changes first and then add medications if necessary. While there is nothing wrong with pharmacological therapy, our goal is to take a food first approach to see if we can reduce the need for medications – especially since they can be costly and are not without side effects.

People with IBS often have a difficult time digesting certain types of carbohydrates that we refer to as FODMAPs. When we can’t effectively digest these carbohydrates, they either pull water into the gut, or the bacteria in the gut ferment them. This leads to increased gassiness, bloating, abdominal pain, and/or changes in bowel habits. Plus, people with IBS often have a sensation called visceral hypersensitivity – which is essentially perceiving normal digestion as abnormal and painful. No, that doesn’t mean IBS is “all in your head”, but rather that gut-to-brain communication getting misinterpreted!

The low FODMAP diet is a 2-6 week elimination style diet (though we prefer to think of it as a ‘swap this for that’). Following elimination, we strategically reintroduce to see which and how much FODMAPs you tolerate. This allows us to develop a long-term plan which we call a ‘modified low FODMAP diet’ – where you can consume FODMAPs, but we watch the overall amounts. This should be done under the supervision of a doctor or dietitian who specializes in digestive health to ensure the process is done correctly. This allows us to tailor the recommendations to you! Based on your symptoms we may tweak the diet so it’s the least restrictive version possible to get YOU symptom control.

This is only ONE dietary strategy we use in IBS management – however it is the MOST common. Working with one of our dietitians will help to develop tailored dietary strategies for you in the long term.

The Lifestyle Pillar

The term ‘lifestyle’ is broad and can encompass many different aspects of life, so what exactly does this pillar mean? This is the pillar where things that are not dietary and also not pharmacological would fit – but that doesn’t mean they aren’t important! In particular, adequate exercise, getting enough sleep, and maintaining a healthy gut microbiome are BIG contributors to a healthy gut. These are the main aspects of the lifestyle pillar.

Our intestines are the home of billions of bacteria that play a role not only in our digestion, but in our immune function, and chronic disease development. To promote good gut health, we want to do everything we can to foster a healthy microbiota – we want to build the community of “good” gut bacteria!

Our good gut bugs are called probiotics. To improve our microbiota’s function, we can take additional probiotics in supplement form that can help improve IBS symptoms and foster a healthy gut microbiota. When it comes to choosing a probiotic supplement, we want to choose the right types of bacteria, for the right person, for the right reason. Not all brands and bacterial strains work for everyone! However, certain strains have been shown to improve IBS symptoms like bloating, abdominal pain, and gut motility. Talk to your doctor or dietitian about the best options for your symptoms specifically.

Probiotic supplements may be helpful in symptom management, but most importantly, we want to take care of the bacteria already living in our gut. Our gut bacteria feed on fibre from the foods we eat, so eating the right high fibre foods can keep them alive and thriving!

To boost fibre intake in your diet, be gradual and intentional; adding too much or the wrong kinds may be equally as uncomfortable as not having enough. Foods with fibre include plant-based foods – vegetables, fruit, nuts, seeds, legumes, and whole grains. Start by adding 1-2 more fibre-rich foods in your diet every few days. Your dietitian can tailor your fibre plan to you. In IBS, many high fibre foods may be triggers for your symptoms. In this case, we often use specialized fibre supplements to hit those fibre targets to begin with – and then focus on getting fibre from food after reintroduction of FODMAPs.

Evidence also suggests that specific types of exercise, particularly aerobic activity (think walking, running, swimming, or cycling) can benefit our gut health. Although we still have lots to learn about the influence of fitness on our gut bacteria, it looks very promising and getting moving is also a great way to relieve stress and get out in nature!

Lastly, sleep is also an influential factor when it comes to symptom outcomes for IBS. Although there are limited studies on the influence of sleep on the GI tract, without adequate length and quality of sleep, it is difficult to prioritize other lifestyle and nutrition goals for a healthy gut as well. Not only do we feel lethargic without proper rest, but it can significantly impact our motivation to exercise, cook, socialize, and more!

The Medication Pillar

Medication often gets a bad reputation. And yes, there are drugs that can actually worsen IBS symptoms depending on each individual. If you take medications that may be causing side effects that worsen IBS, it is best to discuss them with your family doctor or gastroenterologist.

There are also many medications that can be a great companion to lifestyle and diet changes. As mentioned earlier, some people simply need extra help from medications, which is totally valid! At the end of the day, the goal is to improve your quality of life. However, medication is not a cure to IBS, but rather a band-aid solution. Therefore, it is also important to determine the underlying cause and subsequently treat that cause! This is one of the main reasons we take a “food first” approach at Ignite Nutrition. There are times where food first may not be appropriate, or we may need additional medication on top of dietary interventions. At Ignite, our dietitians will advocate for the right medications for you – we work alongside your physician or gastroenterologist to get the right treatments for you!

What makes our team unique is, over 75% of our patient cases are IBS. We have literally seen it ALL. This makes us the perfect dietitians to advocate for your care. We have plenty of experience with patients on a wide variety of medications – so we can help determine & advocate for which is best for you.

The Gut-Brain Connection Pillar

Above we talked about gut-to-brain communication. Just like the gut talks to the brain, the brain also talks to the gut – the two are constantly communicating. Some people even call our gut the second brain because it has so many neurons! Therefore, if the message being sent from the brain to the gut is negative – ie. stress, anxiety, negative self-talk, etc. – we can have worse digestive symptoms as a result.

Sure, almost everyone experiences stress in their lives and it’s nearly impossible to just be stress-free all the time. However, consistent and chronic high levels of stress can lead to negative physiological reactions in the body, especially the gut. Even ‘good stress’ can be a trigger. There’s a reason we call it a “gut feeling!” This can manifest itself in the form of altered gut motility as well as increased gut sensations and pain.

We see that many of our IBS patients have some element of psychological or emotional distress – sometimes small, but still significant! For example, even the fear of eating a “trigger food” could be enough to worsen symptoms! Or the ever-present worry of knowing where the nearest bathroom is just in case. Sometimes this can lead to a bit of a self-fulfilling prophecy – we worry it will happen, and then it does. But is it the food, or the fear itself?

It is important to find stress management and mindfulness techniques that are practical and easy to implement. These strategies can improve the interaction between the brain and the gut and ultimately improve symptom response.

Some of our favourite strategies to help the gut-brain connection are:

  • Slowing down before meals – Try taking 5 deep belly breaths before digging in!
  • Guided Meditation
  • Reading
  • Journaling – Writing down thoughts and feelings helps us to reflect on them
  • Eliminating distractions at meal times – turn off televisions, phones, and computers

Keep in mind, everyone’s mindfulness journey will look a bit different. While not every strategy will be your cup of tea, it is more important to regularly include something to reduce stress in your routine. This list of suggestions is not exhaustive – there are many different options! Additionally, if you have unresolved trauma or grief (or simply want more support) it is best to work with a psychologist or counsellor. Talk to your dietitian about your options.

Key Messages

To conclude, IBS is a complicated condition. There are many factors to consider to improve your gut health. All the information out there on gut health and IBS can certainly feel overwhelming, so taking a team approach is highly recommended.

You can also work with one of our RDs to better understand dietary management of IBS and how to build and maintain a healthy microbiome! We will help to tailor a plan for you, incorporating in the 4 pillars of IBS management to get you feeling better fast.

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