Wait, what is IBS again?
If you're unfamiliar (lucky, lucky you!), IBS is a chronic disorder affecting the large intestine. Typical symptoms include cramping, bloating, gas, and abdominal pain. Some people with IBS experience constipation, while others experience diarrhea, and others experience a vacillation between both. While it affects a significant portion of the population, there is a spectrum of severity when it comes to IBS; some people experience mild, occasional symptoms, and others deal with more severe cases. And unfortunately for those who have it, certain food choices can trigger these symptoms; coffee and IBS, for example, are often a match made in hell.
- Alex Naoumidis, Alex Naoumidis is the Co-Founder of Mindset Health, a company helping people manage chronic health issues with app-based hypnotherapy.
- Niket Sonpal, MD, New York-based internist and gastroenterologist
There is no cure for IBS, but the condition is manageable. Your doctor might prescribe medication to help you treat symptoms, but dietary interventions are the most common treatment. Often, sufferers will eliminate potential triggers such as dairy, alcohol, caffeine, and fried foods.
A specific diet known as the low-FODMAP diet is also often prescribed to those trying to manage IBS. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, and it refers to short-chain carbohydrates that cause gastric distress. Basically, these foods ferment in the gut, causing gas. This happens to everybody, explains Alex Naoumidis, co-founder of Mindset Health/Nerva, a company helping people manage chronic health issues with app-based hypnotherapy, but many people with IBS have hypersensitive nerves in their colon that signal to the brain that something's amiss. "Then the brain triggers, 'Hey, we've got to evacuate this. Let's cause pain, let's cause diarrhea, let's cause constipation,'" he says.
With this in mind, it makes sense that one method for managing symptoms is to eliminate FODMAP foods from your diet. But this includes difficult-to-avoid foods like garlic and onion as well as otherwise healthy (and yummy) foods such as apples, beans, Brussels sprouts, mushrooms, and yogurt. In other words, it's not an easy diet to follow, and it requires abstaining from many foods that are otherwise beneficial to your health.
Can hypnotherapy actually calm your colon
While some IBS patients do have visceral hypersensitivity—those aforementioned super sensitive nerves in their colon—there's likely not anything "wrong" with the large intestines of most IBS sufferers. "It's actually a behavioral issue of the colon," says Niket Sonpal, MD, an internist and gastroenterologist in New York City and faculty member at Touro College of Medicine.
Because of the gut-brain connection, he explains, mental health issues—including depression, anxiety, and stress—can wreak havoc on your digestive system. In other words, you can certainly feed your colon foods that are less irritating to it, but it might need a therapist, so to speak. This is why experts like Dr. Sonpal prescribe stress-reduction strategies for IBS, whether yoga, therapy, running, etc.—whatever works for the patient. "All stress busters are good stress busters," he says.
It's here that hypnotherapy enters the picture. Multiple studies—including a 2016 randomized clinical trial conducted by the Monash University Department of Gastroenterology, where the low FODMAP diet was born—have demonstrated the efficacy of hypnotherapy for the alleviation of IBS symptoms, including pain, constipation, diarrhea, and more. The Monash study suggests that hypnotherapy intervention was as effective as a low FODMAP diet, and that the two treatments together were no more effective than hypnotherapy alone. This is huge for IBS sufferers like myself, who might be looking for alternatives to FODMAP.
But what, exactly, is IBS-specific hypnotherapy, and how can it be incorporated into an individual's lifestyle to manage symptoms?
There's an app that uses hypnotherapy to manage IBS
Naoumidis and his co-founder (and brother) Chris Naoumidis decided to launch IBS-specific programming in their Mindset app, a hypnotherapy app designed to address a broad range of health concerns. It was so successful that they've since spun it off into its own app, Nerva, in collaboration with Simone Peters, PhD, a gut-directed hypnotherapist who led the Monash clinical trial. The app currently has 11,000 users, and in a retrospective study, the company says that 89 percent of them showed some improvement in symptoms.
Before you sign up for the Nerva app, it leads you through an assessment to ensure you're a fit for the program. If you are and you decide to participate, you'll begin with a six-week intensive program. "A day of the program might include a psychoeducation article about, for example, the gut-brain connection, and then you'll listen to a session of hypnosis-based guided imagery," says Naoumidis.
If you've never tried hypnotherapy before, Naoumidis explains that it's a similar experience to guided meditation. "You'll be asked to sit somewhere comfortable and close your eyes, and then the hypnotherapist brings you into a state of focused attention and relaxation through their words," he says.
Because this particular hypnotherapy is designed to address IBS, the visualizations are sort of bowel specific (but not in a gross way!). "You might be guided through an eighteenth-century pharmacy, where you're drinking medicine that can coat your insides and help numb them," Naoumidis says.
After the six-week intensive, Nerva can be used as needed to manage symptoms. Naoumidis says some people use it once a week thereafter, while others may only lean on the program during flare-ups.
Nerva's founder wants to clarify that Nerva is not a treatment for IBS; rather, it's a self-management program that individuals can use to alleviate their symptoms and improve their quality of life. He says a significant percentage of the app's users come from doctor and nutritionist referrals.
The company is now looking to conduct a randomized clinical trial comparing Nerva to a sham program (aka an inactive treatment designed to mimic a therapy) in the hopes of further validating their product.
You can try other stress-reduction techniques
If you can't access Nerva due to budgetary restrictions (it costs $69.99 for three months worth of access, which sounds pricey for an app but is, in fairness, less expensive than a single in-person hypnotherapy session), Dr. Sonpal reiterates that any stress-reduction technique can help alleviate IBS symptoms.
"We know that irritable bowel syndrome is, for the most part, a mind-gut access disconnect," he says. "So anything that's going to help with centering a person's mind and alleviating stress and emotional distress—whether that be exercise, therapy, hypnotherapy, acupuncture—is worth a try."
He also notes that this approach can benefit, not just IBS sufferers, anyone with a colon because everyone experiences gastric discomfort at one point or another due to stress or emotional turmoil. If your "stomach" is upset, in other words, it might make sense to treat it exactly as you do an upset mind—e.g., take it for a run or to see a shrink. (Just maybe skip stress eating because that particular coping strategy is unlikely to tame the tummy!)
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