Worried about what you eat and if it will lead to digestive distress later on? Do you find yourself dreading social situations that involve food, or looking around to spot the nearest bathroom?
Have you ever thought you might have Irritable Bowel Syndrome (IBS), food sensitivities, or even something worse? Maybe you’ve had medical tests done to rule out “something worse”, but instead of feeling relieved you feel frustrated and bothered by your ongoing stomach symptoms.
If you’ve experienced any of the above situations, you’re not alone. I’m right there with you!
And it’s not just us. In one study of 71,000 adults, nearly 2 out of 3 people reported suffering from gastrointestinal (GI) symptoms (1). The most common complaints were heartburn or acid reflux, abdominal pain, bloating, constipation and diarrhea.
IBS, one of the most commonly diagnosed GI disorders, affects 10-15% of the population. (2) Less common disorders include a true food allergy (4% of adults), and autoimmune disease such as celiac disease (1-3%), and Inflammatory Bowel Disease or IBD (less than 1%).
Am I stuck with these annoying symptoms forever?
Even though GI disorders are very common, you might be wondering if your symptoms are here to stay?
No! While it IS important to see your healthcare provider to rule out autoimmune disease, infection or illness requiring medical treatment, there are diet and lifestyle steps you can take right now to feel better and improve your quality of life!
Following is a list of proven solutions shown to help manage a sensitive stomach- even if an exact cause for your symptoms is yet to be found. They have helped many of my clients (and myself) learn how to enjoy life without fear of eating or having anxiety over the potential consequences.
10 proven solutions to tame tummy troubles
1. Set yourself up for smooth digestion BEFORE you eat.
Scientists are learning more and more about how the brain and the gut work together. So if you are feeling stressed, rushed, even overly excited, guess what? Digestion suffers and you may suffer along with it.
Emerging research shows that we can shift our minds from a state of stress, anxiety or excitement to a state of relaxation for better digestion by doing a few minutes of DEEP BREATHING before taking our first bite of food.
One simple way to do this is to inhale slowly and deeply for a count of 4 seconds, then hold for 2-4 seconds before exhaling for a count of 4-8 seconds. (3). Need reminders or instructions on how to breathe deeply? There are many helpful phone apps such as these two: Breathe2Relax or Belly Bio.
2. Chew longer than you think you should!
Did you know that digestion begins in the mouth?
As we mechanically break down our food by chewing it into smaller pieces, enzymes in our saliva begin digestion so we can absorb nutrients further along in the digestive tract. If we wolf down large chunks of food, then our stomachs have to do more work.
How long should you chew an average bite of food? Until it’s the consistency of applesauce or a well-blended smoothie! Something with greater texture - like meat- might take more than the average 20-30 chews per bite.
In my experience, this takes some practice and focus, so try to pay closer attention the next time you eat something. You may find that this simple step of chewing longer makes all the difference in preventing digestive distress!
3. Practice portion control.
Smaller meals and snacks are easier to digest than larger ones. Eating Thanksgiving-sized meals should not be the norm! Large meals take a longer time to empty from the stomach, which may lead to discomfort, bloating and acid reflux.
Practice using smaller plates (9” diameter or less) and stick to one helping of an entree and any side dishes at meals. Recommended serving sizes vary, but ½ cup to 1 cup food portions are typical; for meat, poultry and fish, it’s about 3 ounces or the size of a deck of cards.
Want to learn more about portion size guidelines? Check out this article from the Academy of Nutrition and Dietetics.
4. Beware of belly-busting beverages.
For many of my clients with gut issues, it isn’t only what they are eating that contributes to symptoms, but what they are drinking as well. Review the list below of some potentially bothersome beverages and ingredients.
Be careful with:
*caffeine, a known bowel stimulant and a trigger for acid reflux symptoms
*sugary beverages, as sugar is a food source for undesirable bacteria in the gut microbiome, in turn leading to potential GI symptoms
*alcohol, another trigger for reflux and a stomach irritant causing inflammation of the stomach lining
*carbonation, a source of excess gas that may lead to bloating
*lactose, a sugar found largely in milk which is difficult to digest for many, leading to gas, bloating and diarrhea
Note that individual tolerance varies and is also based on portion size and frequency consumed.
On the other hand, drinking plenty of water is encouraged to help digestion run smoothly, prevent and treat constipation, and replace fluid lost through diarrhea. There are many formulas for determining daily needs; a good place to start is with the well-known guideline of 8 cups per day.
Do you struggle to get enough water? Track your intake, or if you’re like me and need reminding, try a phone app like this one: Water Reminder- Daily Tracker.
5. Be cautious with known triggers!
A common trigger is fried or high-fat foods. Fat is the slowest nutrient in our foods to be digested and absorbed, and so it contributes to a feeling of fullness after eating. For some people, this can feel very uncomfortable and last for several hours.
People with gallbladder issues, fat malabsorption, or slow stomach emptying may also have trouble handling higher fat meals.
Highly spiced foods may be irritating to people with reflux or frequent stomach pain. In particular, the pepper family of spices is often a culprit, like cayenne, black and chili peppers. These spices trigger reflux symptoms, and can lead to diarrhea. (4)
High FODMAP foods. The acronym FODMAP stands for Fermentable, Oligo-, Di- and Mono-unsaccharides And Polyols. FODMAPs are certain types of carbohydrates found in foods that can be hard to digest for some people. Their fermentation during the digestion process may lead to gas, bloating and diarrhea. Several research studies have shown that a diet low in FODMAPs improved symptoms in 50-86% of IBS patients! (5) This has truly been a game-changer in IBS treatment over the past decade.
Which carbohydrate foods are high in FODMAPs? Apples, pears, onion, garlic, wheat, legumes, cow’s milk and sugar-free gum to name a few. Low FODMAP foods include grapes, oranges, green beans, quinoa, almond milk, and chia seeds.
To learn more about FODMAPs and a low FODMAP diet, check out this educational site from the researchers who first identified them, Monash University in Australia, or consult with a Registered Dietitian with expertise in this area.
6. Review medication and supplement labels for potential side effects.
Do you read the information given with your prescription medication? Many people don’t!
Medications may have GI side effects, with two common examples being some pain medications (associated with constipation) and antibiotics (linked to diarrhea).
In my clinical experience, there have been dozens of times when I assessed patients for a diarrhea problem thought to be diet-related only to discover it was a side effect from their medication. Switching to an extended-release formula often solved the problem!
Medications are often prescribed to be taken with food to help decrease potential side effects. You can review possible GI side effects for your prescription medications here.
What about vitamin and mineral supplements? Some may contribute to stomach symptoms- especially when taking larger doses or certain formulations. For example, the most common iron supplement, iron sulfate, is known to be tough on sensitive stomachs and may lead to constipation.
Calcium carbonate is also linked to constipation. On the flip side, high doses of Vitamin C or Magnesium supplements may lead to diarrhea, and magnesium is even used as part of constipation treatment. Dose is key!
More tolerable supplement formulations include slow-release iron, calcium citrate, magnesium citrate or magnesium glycinate, to name a few.
For safety guidelines and possible side effects, check out these supplement fact sheets from the Office of Dietary Supplements.
7. Try a probiotic... or not!
You’ve heard the recommendations. "Take a probiotic to help keep the gut healthy and immune system strong!" But, some people may find that probiotics make their stomach symptoms worse, especially for those dealing with excess gas and bloating.
The truth is, we need more research on probiotics before making specific recommendations. Probiotics are technically “live microorganisms that confer a health benefit on the host” (6) also known as the good bacteria that live in our gut microbiome. However, we all have a unique gut microbiome, so the supplement that benefits one person may not help another.
Consider trying a probiotic supplement for a month or so to see if it makes a difference for you. Use this guide to help you with your selection.
You can also consume more foods and beverages that naturally contain probiotics: yogurt with active cultures, kefir, raw sauerkraut, tempeh, kimchi, miso and kombucha.
8. Adjust your fiber intake to find what works for you.
Fiber is crucial for good health (not just GI health), and most of us don’t get enough. The dietary guidelines for fiber are 25-38 grams per day for most adults, yet only 7% of us meet the goal. (7). Fiber is a PREBIOTIC, which is food for PROBIOTICs- our healthy gut bacteria you just learned about!
Check food labels for “Dietary Fiber”, which is listed in the number of grams per serving. A good source of fiber provides at least 3 grams per serving.
If you have a sensitive stomach, you may need to carefully and gradually adjust your fiber intake. Why? Because many high-fiber foods are also high in FODMAPs, which are a major cause of GI symptoms!
Choose foods high in fiber but low in FODMAPs such as quinoa, oats, chia seeds, raspberries, mandarins, carrots, green beans and chickpeas. For more suggestions on low FODMAP fiber sources, check out this blog by FODY foods, a low FODMAP food company.
If you are working on increasing your fiber intake, be sure to include plenty of water because fiber absorbs water and this helps minimize GI symptoms. Increasing tolerable fiber sources, plus water intake, may be the best way to prevent and/or treat constipation!
9. Try an elimination diet protocol for 2-4 weeks... but not forever!
What’s an elimination diet? An eating plan that removes potentially bothersome or suspected foods, beverages, and food additives for a set period of time.
The theory is that by removing these items, symptoms will improve or disappear altogether. Once you are symptom free or close to it, the removed items are reintroduced into the diet one at a time to test tolerance. Many times, smaller portions of a bothersome food may be tolerated without leading to symptoms.
Popular examples of elimination diets include low FODMAPs, dairy-free, gluten-free, wheat-free and anti-inflammation diets.
In general, health symptoms in the GI tract improve quickly when the offending foods or beverages are removed. Therefore, following a strict elimination diet indefinitely is not necessary, unless in the case of an autoimmune issue like celiac disease or a true food allergy.
Elimination diets can be confusing, challenging, and nutritionally deficient if followed for a long period of time. It is highly recommended that you work with a dietitian or nutritionist with expertise in this area.
10. Consider non-dietary factors that contribute to stomach symptoms
While our eating habits are a major player affecting stomach issues, there are other lifestyle factors. Exercise for one. Regular physical activity promotes better digestion, and can prevent or treat constipation.
Many health experts recommend a goal of 150 minutes of exercise per week, or about 30 minutes, 5 days a week to maintain good health. Start slowly, and increase your time gradually.
Walking is one of the best digestion-friendly and budget-friendly activities. A good place to start is to walk for 10 minutes after a meal, then add more time or another post-meal walk.
Stress and anxiety levels have a significant effect on stomach symptoms too and can interfere with proper digestion. Remember the brain-gut connection? Chronic stress and anxiety oppose smooth digestion as our body remains in the “fight or flight” stress mode, the opposite of “relax and digest” mode! Plus, in a stress state we are more likely to make impulsive and less healthy food and beverage choices.
There is very exciting research looking at gut hypnotherapy as a new way to help manage GI symptoms. At home, you can try the self-guided hypnotherapy phone app NERVA, which was designed specifically for calming a sensitive stomach and has research to back it up. Take advantage of the free trial to see if it might help you. There are clinically-trained gut hypnotherapists throughout the US that you can find here.
And finally, sleep quality affects GI symptoms. During sleep, the body is working hard to repair, recharge and refresh. Self-reported sleep trouble is a significant indicator of next-day stomach pain, anxiety and tiredness.(8) If you think you have sleep issues, see your doctor or sleep clinic for a personal assessment.
Keep a food and symptom diary. Especially if you plan to try out one or more of the solution tips in this blog, or plan to see your doctor or dietitian. Having 1 or 2 weeks' worth of information will be invaluable at your visit. Patterns and clues to symptoms may emerge that you hadn’t noticed before.
Your food and symptom diary should include the following information:
What you eat or drink, approximate serving size, and the Time of consumption
The Time symptoms occur, the Type of symptoms, and the Severity (mild, moderate, severe)
Other- record your stress level, sleep quality, exercise, medications and supplements taken
The diary format is your preference. Pen and paper, Excel spreadsheet, website or phone app- they all work! Here is an example:
Food and Symptom Diary: Symptoms
12:30 pm severe
9:00 am mild
3:00 moderate bloating, belching
12:30 pm moderate
9:00 am mild
7:30 pm moderate heartburn
1:15 pm urgent diarrhea
10:00 loose BM
Food and Symptom Diary: Food and Beverage Intake
7:30 am 1 egg, 1 slice toast, 1 cup coffee
8:30 am 1 cup bran cereal, 1 cup skim milk, 1/2 banana
8:00 1 cup oatmeal, 1/2 cup blueberries, 1 cup coffee
12:00 pm grilled cheese sandwich, apple, 1 cup milk
12:00 1 bowl chicken vegetable soup, 6 crackers, water, cookie
12:30 pm taco salad with meat, beans, shell; tangerine, coffee
3:00 carrots and hummus, water
2:30 small chocolate bar and carbonated water
6:00 1 pork chop, 1 sweet potato, butter, 1/2 cup green beans, water
6:30pm 4 ounce salmon filet, 1/2 cup risotto, 1/2 cup broccoli, dinner roll, 1 glass wine
6:30 1 cup spaghetti with 1 cup tomato sauce, 2 meatballs, 1 breadstick, small side salad with dressing
High stress; took multivitamin
Walked 45 minutes after lunch
For a personalized review and assessment of your food and symptom diary, an action plan to help manage your most bothersome stomach symptoms, and individual support, schedule an appointment with me. Unsure of your needs? I offer a free discovery phone call to see if I’m a good fit for you. To schedule with me, click here! As a registered dietitian nutritionist, my personal health journey and family GI problems have led to my professional passion of helping others find solutions to their food-related stomach problems.