Managing irritable bowel syndrome (IBS) is complex—there are many moving parts to consider, and formulating a plan for your clients may even feel overwhelming at times.
Here’s how you can introduce the proper management tools and therapies to your clients and when to consider referring them to gut-directed hypnotherapy.
Three ways to manage IBS
There are three main therapies that can be implemented for IBS management: diet, pharmacological, and psychological.
Dietary options include:
- the low FODMAP diet, which limits rapidly fermentable carbohydrates found in onions, apples, cashews, and watermelon. The low FODMAP diet is effective in 75% of people with IBS
- reducing intake of non-FODMAP gut irritants, such as caffeine, spicy foods, fried foods, and alcohol
- manipulating fiber intake.
Pharmacological options include:
- osmotic and stimulant laxatives to help relieve constipation
- loperamide (Gastrostop or Imodium) to increase transit time to reduce the frequency of diarrhea
- antidepressants or selective serotonin reuptake inhibitors (SSRIs)—research has shown these are beneficial to 55% of people with IBS
- antispasmodics to ease muscle spasms.
Psychological options include:
- gut-directed hypnotherapy. It can improve IBS symptoms by sending positive information from a person’s brain to their gut nerves to reduce their response to certain foods and matter as it passes through their digestive tract.
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Questions to guide your clients
With so many effective treatment routes available, it can be challenging to discern the right path for your patients to take.
Here are three questions that guide my treatment plans.
1. Who cooks and prepares the food at home?
Implementing the low FODMAP diet process can be difficult if a patient has little to no control over their diet. However, if they are responsible for their own shopping and cooking, it may not be a problem.
2. Have you got any social plans, holidays, or significant life events (e.g. moving house) planned in the next three months?
The FODMAP process takes a minimum of 12 weeks to complete. While this can be executed well, and your clients can continue enjoying their life during this period, I suggest pumping the breaks until there is some stability and routine before going ahead.
3. Are you ready to make short-term, significant changes to your diet if it meant achieving relief from your symptoms?
Many people with IBS will have already tried cutting out dairy or gluten, but they may not have tried the low FODMAP diet before. It’s essential to inform them of the rigid, three-phase nature of the process and ensure they’re ready to commit.
After asking these three questions, you should have a better understanding of your patients and what is going to work for them. If you continue down the path of implementing the low FODMAP diet, regularly check in with your clients, especially during the elimination phase.
Personally, I check up on my clients every week to ensure they’re experiencing symptom relief. Many will experience relief in as little as 24 hours. For others, it will take one to three weeks. I rarely keep a client in the elimination phase for longer than this. The elimination phase of the FODMAP diet should range from two to six weeks.
For clients who don’t experience relief after six weeks, it’s important to know that with every therapy, there will be non-responders, and the plan won’t always work for everyone. However, before dismissing the low FODMAP diet approach, ensure your client is adhering to the plan by checking their food and symptom diary. Draw correlations between their symptoms, diet, and lifestyle to understand the bigger picture.
Introducing gut-directed hypnotherapy
You can introduce your clients to gut-directed hypnotherapy via an app like Nerva in conjunction with the low FODMAP diet. Alternatively, they can begin a hypnotherapy program on its own before any kind of dietary intervention—research has shown the outcomes are similar.
Researchers haven’t identified which particular patient groups would best benefit from gut-directed hypnotherapy, suggesting that all patients with IBS could see improvements in symptoms (just know, it’s not suitable for those that have been diagnosed with or experience psychosis). And the good news is the science has shown that 9 out of 10 Nerva users report improved IBS management after completing the six-week program.
Your clients can access gut-directed hypnotherapy by seeing a psychologist privately or starting the Nerva app’s six-week program. The advantages to Nerva are it’s accessible (the program can be completed anywhere, anytime), it’s affordable, and it’s all backed by research from Monash University. As a healthcare practitioner, you can also monitor and support your clients as they progress through the program.
The Wrap Up
Managing IBS interventions for your clients can be complex, and you may even feel overwhelmed trying to decide on the right treatment plan for them. The three best practice therapies are dietary changes, pharmacological options, and psychological interventions. It’s best to tailor treatment plans that suit your individual clients’ lifestyles, particularly if you’re recommending the low FODMAP diet, which can be restrictive and requires a long-term commitment. Referring clients to gut-directed hypnotherapy can be recommended as a standalone intervention before they attempt any dietary or pharmocological treatments. However, a hypnotherapy program like Nerva can also be completed at the same time as a low FODMAP diet, with researchers reporting the outcomes will be similar.
About Chelsea McCallum
Chelsea McCallum is an Accredited Practising Dietitian, nutritionist, and recipe developer. She has years of clinical experience as a dietitian and is highly skilled in working with adolescents and adults. Since finishing a Bachelor of Nutrition and Dietetics, she further developed her knowledge in Irritable Bowel Syndrome (IBS), the gut microbiome, and gut health, attending several workshops and courses within Australia and internationally in the UK. She is an an expert in IBS and the low FODMAP diet.
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