When *Sarah began emailing dietitian Miriam Mullard photos of her gut twice a day to illustrate her bloating, it was evident that anxiety played a significant role in her IBS symptoms. By guiding her through a dietary intervention alongside gut-directed hypnotherapy, Miriam was able to help Sarah reclaim her life.
A growing problem
Sarah experienced severe food poisoning back in 2016 and had been struggling with her gut health ever since. Desperate for help, she met with a gastroenterologist for endoscopic investigations in late 2022.
“It came back all clear,” Miriam said. “No inflammatory causes or celiac disease were detected. They also did H-Pylori testing, and it was all negative. This is when she was referred to me for dietary manipulation.
“Her presenting complaints were constipation, bloating, brain fog, and fatigue, which she had been experiencing since her initial food poisoning episode, so we thought it was post-infectious.”
When Sarah first presented to Miriam, it became clear that anxiety was a clear component. As a busy working mother, Sarah led a frantic life, and her IBS symptoms were deeply intertwined with her stress.
“I saw straight away that anxiety was an exacerbating factor. She was just in so much distress,” Miriam said. “She started sending me emails morning and night of photos illustrating her bloating symptoms. I could just feel her anxiety. It was constant.”
Implementing a plan
Sarah began with a dietary intervention to manage her symptoms.
“I started Sarah on a full low FODMAP diet. As an added complexity, she had been taking medicinal mushrooms and CBD gummies, which we agreed she would discontinue.
“As she was willing to try anything, we went ahead with the diet, starting in January 2023. However, she started sending me emails telling me she was confused, that the diet was too difficult to follow, and she was losing weight.”
After this initial setback, Miriam quickly refined her plan and developed a new approach for Sarah.
“When she came back to see me a month later, I switched the plan and got her going on a simplified low FODMAP diet. And that’s when I introduced her to Nerva to help regulate her gut-brain axis”
Miriam took the time to focus on education and explained in detail how Nerva would reduce her stress and anxiety. Armed with a new understanding of her condition, Sarah was receptive to her new management plan and was interested in giving the six-week program a go.
“She was very open to trying gut-directed hypnotherapy as I think it complimented her own holistic approach to health. I spent a considerable amount of time educating her, sharing information about the gut-brain axis and how it connects to her symptoms.
“I think Nerva is a conservative option, which was part of the appeal for Sarah. She felt like she had more control with an intervention like Nerva compared to the low FODMAP diet as she had children and had to consider preparing meals for everyone in the family.”
A fast turnaround
Sarah responded quickly to Miriam’s new plan, and the simplified low FODMAP diet was much more conducive to her lifestyle.
“Sarah was happy to tell me that she liked listening to Nerva right away. She thought it was just wonderful, and in her first session, she felt so relaxed she fell asleep.
“She made it all the way through the six weeks, listening every day, and she was very compliant. She is still using the maintenance plan today.
“When I saw her recently, she shared that her symptoms had almost entirely disappeared. She said she was no longer so fatigued and felt much more energetic, particularly in the morning, and she was fitting into her clothes again.
“I’ve currently got her working through some FODMAP challenges and will be following up with her soon to see how this is all going.”
Looking back, Miriam said she would rethink her initial management plan for Sarah.
“If I had my time over, I’d have started her on a simplified low FODMAP diet and encouraged her to try Nerva from the very beginning because of her anxiety. I usually ask patients whether they feel like their symptoms are food related or if anxiety is playing a role. Often it’s a bit of both; it’s not always clear cut.
“It still surprised me that Nerva worked almost immediately for Sarah, even though I know that it can be a placebo effect when changes happen so quickly. Being more mindful and the process of slowing down with eating could benefit all of us really; it doesn’t have to involve gut-directed hypnotherapy.
“After working with Sarah and seeing the impact of combining Nerva with a simplified dietary intervention, it gave me a better idea of how to target my patients with anxiety more effectively.”
- Miriam secured buy-in from her patient by focusing strongly on education about the gut-brain axis.
- Patients with anxiety are often particularly well suited to a hypnotherapy intervention.
- Miriam was flexible and successfully intervened and adapted her plan when the full low FODMAP diet proved unsuitable for her patient, which still led to a positive outcome.
Miriam Mullard has over 15 years of experience in public and private healthcare, postgraduate teaching, and dietetic service management. She is the Lead Dietitian at the MacMurray Centre in Auckland, New Zealand.
*Name changed. As we share real stories from real people, stock images have been used to ensure we protect the privacy of our users.