How Your Thoughts May Affect Your IBS
I was off last week, celebrating my older sister's graduation from law school with the rest of my family in Arizona. It's always good to get away into the sunshine, especially if you live in the dreary Pacific Northwest like I do. Well, having food sensitivities and digestive issues always comes with its challenges when traveling, maybe especially so when traveling with a lot of family. I had some negative emotions come up about my IBS and food sensitivities while I was away and so I thought I'd share about it because I don't think we talk about these things enough!
I think it's very hard for people who don't struggle themselves with food intolerances or digestive issues to grasp what it actually means to live this way--luckily for them, but not so much for us. I often feel and worry that people think I'm just being difficult, or dramatic or picky when I say that I can't eat certain foods or when I need to place a special order at a restaurant. Most of my family members are those lucky people who don't have digestive disorders, so going out to eat and going to the grocery store are not emotional triggers or areas of extra stress for them. I felt a certain level of background stress while I was away, and it had partly to do with knowing that I was alone in my food issues, that I couldn't share groceries with my siblings with whom I was sharing a rental house like they wanted to, that the whole family would be going out for some meals together and I wouldn't have a lot of say in restaurants that were chosen.
My sister and brother-in-law rented an Asian food truck to come to their house for her graduation party. How cool is that! My sister assured me when I asked if there were gluten free options (I need to be on a totally gluten free diet), and that you could order all ingredients separately. I know they spent a lot of money on this truck and they were very excited about it. So I was pretty bummed when I went to order and the server told me that their sauce is not gluten free, that there are onions mixed into the vegetables which she could try to pick out. Onions are one of my bigger food triggers, and being that it was cooked with the rest of the vegetables, I knew some FODMAPs would leach into the rest of my food if I ate it. I was already overwhelmed by some other stressful family dynamics, and so I kind of wanted to run away and cry at that moment. But I needed to eat and I didn't want my sister and brother-in-law to waste money on a meal for me, so I asked the server to make me steamed vegetables with no sauce and fried tofu and rice. Fortunately the truck also served some fresh rolls in rice paper as an appetizer beforehand, and they were all low FODMAP so I snacked on those and wasn't starving when my dinner was ready. This saved me from over eating, which in and of itself can trigger GI symptoms. I did accidentally eat a piece of onion and actually found myself for a moment getting panicky as I realized what I was chewing. There were definitely times early in my FODMAP journey where I totally stressed out and assumed the worst if I ate something high FODMAP, but this was not one of those times. I told myself that it is unlikely that one bite of onion was going to make me sick and it certainly wasn't going to kill me, and so I tried instead to enjoy the flavor and texture of it (though I realized I actually don't even like onions anymore!).
Besides the food truck, there was another situation in which everyone was going out to eat, and I had no say in which restaurant since a reservation had already been made to accommodate our large group. I can't expect anyone else to keep track of my food intolerances, but it's always nice when someone acknowledges it or just asks if a certain restaurant will work for me. I also wanted to be included and part of the festivities like everyone else and not be stuck home, or sit in a restaurant not eating while the rest of them eat. I can feel bad for myself if I do that and throw myself a pity party, but this was not the head space I wanted to be in during this celebratory time so I made a choice not to dwell there. I'm not in the strict elimination phase of the low FODMAP diet, and I'm more daring than I once was because, if I get a little garlic or onion powder on my meat, I know from past experience that I will be ok and will not die and I can reassure myself of this. I have to really go crazy off-track for my symptoms to get to life-ruining status.
If you have read my health story, you may understand why I often wrestle with a sense of being different from everyone else, even in my own family. I struggle with these thoughts fairly often in social settings, and have to work hard to stay in a positive mind set--and hard work it is. Our internal dialogue, the things we say to ourselves, is important in so many ways. If you were to look at it from a "woo woo" perspective, one might say that our thoughts create our reality, as in the Law of Attraction. In the scientific world, there's something called the "nocebo effect", in which, if you feel convinced you are going to have a reaction to something, like a certain food or medication, you probably will have a worse reaction. Do not misunderstand, this does not mean that IBS is all in your head or that you created it yourself! But we can worsen our symptoms by expecting the worst.
These concepts may relate to the reason why a particular type of psychotherapy (Cognitive Behavioral Therapy or CBT), has been found to be especially helpful in managing IBS symptoms. CBT helps you realize your thoughts and learn a more productive, balanced way of thinking. Because our brain and gut are so connected, and in fact have a bi-directional communication system between them, the words we feed to our guts may be as important as the foods we feed it! If you were to work with a therapist trained in CBT, you might do some exercises like learning to identify the automatic and catastrophic thoughts in your head, find evidence for and against the thoughts, and then learn to create new, more helpful thoughts. Before I learned about identifying thoughts, I never even realized how many negative, automatic thoughts were playing continuously in the background of my brain!
Let me give you an example of CBT. Saying something like "I'm never going to be able to fly again because I would die if I got diarrhea on an airplane" could be considered a catastrophizing thought. A way you might turn this thought around using CBT could be to say instead "Before I get on the plane, I will be prepared and eat right, I will take an antidiarrheal or an antispasmodic, and if I get diarrhea I will deal with it." Because you can actually handle it, you will deal with it and you will move on. You're not actually going to curl up in a ball and die. This doesn't minimize how uncomfortable and embarrassing it could be, but stewing in the negative may further contribute to a poor mood and ultimately worsen your digestive issues.
I am not a psychotherapist, but I may refer my patients to one when I feel that stress and anxiety are playing a large role in their symptoms, or when IBS is interfering greatly with mood and quality of life. There's a new, emerging field of GI specific psychology called Psychogastroenterology. Last I heard they were working on making a database of GI psychologists but it doesn't appear to be published yet so I'll report back when I hear more about it!
In conclusion, diet may only be a part of your IBS management puzzle. If you're struggling with anxiety or depression, please consider looking for a therapist trained or specializing in GI disorders, or a coach to help you improve your mindset.
Have you had any positive results using CBT, visualization, or affirmations for your IBS? Please share your experience in the comments if you're comfortable doing so! I'd love to hear from you.
"Whatever the mind of man can conceive and believe, it can achieve"- Napoleon Hill