Let’s break down what we know so far.

How Trauma Affects Digestion

1. The Gut and Brain Are Always Talking

Your gut and brain communicate constantly through nerves, hormones, and the gut microbiome. When trauma or chronic stress enters the picture, this communication can become disrupted.

For some people, this shows up as:

• IBS
• Functional dyspepsia
• GERD
• Chronic bloating or pain
• Unpredictable bowel habits

Trauma doesn’t cause these conditions outright, but it can make the gut more sensitive, reactive, or inflamed.

2. Stress Can Change the Gut Microbiome

Early life stress, including emotional neglect or difficult childhood experiences, can leave long‑lasting “fingerprints” on the gut microbiome.

This can influence:

• Immune function
• Inflammation
• How the nervous system develops
• How the body responds to stress later in life3,4

Even in adulthood, chronic stress can shift the microbiome toward more inflammatory patterns. Some studies show that adults with a history of childhood abuse have higher levels of inflammation‑related microbes.5

3. Trauma Can Make the Gut More Sensitive

Many people with trauma histories experience visceral hypersensitivity, meaning the gut feels pain from sensations that wouldn’t bother most people.6

Normal things like gas, pressure changes, or digestive movement can feel sharp, intense, or alarming.

This isn’t “in your head.” Trauma can increase stress hormones like CRH and reduce parasympathetic nervous system activity (that’s the “rest‑and‑digest,” calm state rather than the sympathetic “fight-flight-freeze” nervous system). Together, these hormone and nervous system imbalances can make the gut more reactive.7,8,9

4. Trauma Can Affect Eating Patterns—and Vice Versa

There’s a strong connection between digestive disorders and eating disorders. In one study, 90% of people with an eating disorder had at least one disorder of gut‑brain interaction, also known as a DGBI.10

Sometimes GI symptoms (like nausea, bloating, or pain) lead to food avoidance. Other times, disordered eating behaviors create or worsen GI symptoms. Trauma often sits underneath both.11

This can make recovering from disordered eating feel confusing and complicated. But understanding the gut‑brain connection can bring clarity and self-compassion.

Why This Matters for Healing

If you’ve lived through trauma and now struggle with chronic GI symptoms, you may feel frustrated, discouraged, or disconnected from your body. Many clients tell me they don't trust their bodies, and their gut symptoms feel unpredictable. They feel their bodies are failing them.

But here’s the truth:

Your body is not failing you—it’s responding to a flawed environment the best way it knows how.

Your symptoms are not failings. They’re communication.

A Trauma‑Informed Approach to Gut Healing

Healing the gut in the context of trauma requires gentleness, curiosity, and collaboration—not rigid food rules or harsh elimination diets.

A supportive approach may include:

• Exploring your symptoms and history with compassion
• Understanding how stress affects your gut
• Adding nourishing foods rather than restricting
• Keeping simple food + symptom logs
• Working alongside mental health providers
• Rebuilding trust in your body, slowly and safely

Research shows that people with GI conditions often experience more anxiety, depression, and food‑related stress when starting nutrition therapy.12 A trauma‑informed dietitian can help reduce that burden rather than adding to it.

You Deserve Care That Sees the Whole You

Your gut symptoms are real. Your history matters. And your healing doesn’t have to be overwhelming.

​

When we understand the gut‑brain axis through a trauma‑informed lens, we can finally see your symptoms not as random or “broken,” but as meaningful—and treatable.

If you’d like support navigating your gut symptoms with compassion and science, I’m here to help. You can send me a message here or schedule a free discovery call here.

If you’re interested in learning more but not ready for 1:1 nutrition therapy yet, I’ve also got a comprehensive IBS course where I walk you through diagnosis, treatment, and maintenance, using the same trauma-informed approach I use in session with my clients. We do cover intensive dietary interventions like the low-FODMAP diet, but alongside other gentler and more trauma-appropriate approaches like FODMAP-gentle, gut-directed hypnotherapy, lifestyle-supportive interventions, and more. 

Lastly, a note to other healthcare professionals: I’ve got a book on this! Chapters 2-3 of my book, Trauma-Informed Care: An Integrative Nutrition Approach to Empowered Healing, go much, much deeper on physiological impacts of trauma, including GI-specific impacts, than we can go here (plus 14 CEUs for RDs, DTRs, and CDCESs).   

References:

1. Glynn, H., Möller, S. P., Wilding, H., Apputhurai, P., Moore, G., & Knowles, S. R. (2021). Prevalence and Impact of Post-traumatic Stress Disorder in Gastrointestinal Conditions: A Systematic Review. Digestive diseases and sciences, 66(12), 4109–4119. https://doi.org/10.1007/s10620-020-06798-y
2. Szkodny, L. E., Bardach, S. H., Hacker, K., Tormey, L. K., Gohres, K., Siegel, C. A., & Salwen-Deremer, J. K. (2025). Implementation of a Trauma-Informed Care Approach in a Gastroenterology Setting. Digestive diseases and sciences, 70(1), 119–127. https://doi.org/10.1007/s10620-024-08766-2
3. Leclercq, S., Forsythe, P., & Bienenstock, J. (2016). Posttraumatic Stress Disorder: Does the Gut Microbiome Hold the Key?. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(4), 204–213. https://doi.org/10.1177/0706743716635535
4. Winder, C., Lodhia, A., Basso, M., Kadosh, K. C. (2025). Gut microbiome differences in individuals with PTSD compared to trauma-exposed controls: a systematic review. Frontiers in Neuroscience, 19. https://doi.org/10.3389/fnins.2025.1540180  
5. Rohr, J. C., Bourassa, K. A., Thompson, D. S., Fowler, J. C., Frueh, B. C., Weinstein, B. L., Petrosino, J., & Madan, A. (2023). History of childhood physical abuse is associated with gut microbiota diversity among adult psychiatric inpatients. Journal of affective disorders, 331, 50–56. https://doi.org/10.1016/j.jad.2023.03.023
6. Farzaei, M. H., Bahramsoltani, R., Abdollahi, M., & Rahimi, R. (2016). The Role of Visceral Hypersensitivity in Irritable Bowel Syndrome: Pharmacological Targets and Novel Treatments. Journal of neurogastroenterology and motility, 22(4), 558–574. https://doi.org/10.5056/jnm16001
7. Fuentes, I. M., & Christianson, J. A. (2018). The Influence of Early Life Experience on Visceral Pain. Frontiers in systems neuroscience, 12, 2. https://doi.org/10.3389/fnsys.2018.00002
8. Dudzińska, E., Grabrucker, A. M., Kwiatkowski, P., Sitarz, R., & Sienkiewicz, M. (2023). The Importance of Visceral Hypersensitivity in Irritable Bowel Syndrome-Plant Metabolites in IBS Treatment. Pharmaceuticals (Basel, Switzerland), 16(10), 1405. https://doi.org/10.3390/ph16101405
9. Lawrence, S., & Scofield, R. H. (2024). Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and physical illness. Brain, behavior, & immunity - health, 41, 100849. https://doi.org/10.1016/j.bbih.2024.100849
10. Stanculete, M. F., Chiarioni, G., Dumitrascu, D. L., Dumitrascu, D. I., & Popa, S. L. (2021). Disorders of the brain-gut interaction and eating disorders. World journal of gastroenterology, 27(24), 3668–3681. https://doi.org/10.3748/wjg.v27.i24.3668
11. Werlang, M. E., Sim, L. A., Lebow, J. R., & Lacy, B. E. (2021). Assessing for Eating Disorders: A Primer for Gastroenterologists. The American journal of gastroenterology, 116(1), 68–76. https://doi.org/10.14309/ajg.0000000000001029
12. Fink, M., Simons, M., Tomasino, K., Pandi, A., Taft, T. (2022). When is patient behavior indicative of avoidant restrictive food intake disorder (ARFID) vs reasonable response to digestive disease? Clinical Gastroenterology and Hepatology, 20(6), P1241-1250. https://doi.org/10.1016/j.cgh.2021.07.045

1. Plan Ahead
2. Planning ahead can be a great first step to ease your mind and prepare for the eating experience. Consider reading over an online menu at a restaurant in advance to find more IBS-friendly options. This will give you ample time to choose what you’re going to eat without rushing to make your selection when the waiter arrives at the table.
3. For home gatherings, you might want to ask the host ahead of time what they will be serving. You can then offer to bring an IBS-friendly dish that you know agrees with you, especially if their menu isn’t ideal.
4. It’s important to note that planning ahead may not always be feasible, and that’s totally okay. Our daily plans can’t always be structured. This might mean you unexpectedly go out to eat, or have to switch restaurants, or they’re out of the item you picked ahead of time. Don’t panic! The following tips can help improve your experience.
5. Politely Ask Questions
6. Sometimes, you may worry that you’re inconveniencing waiters, restaurant managers, or host friends by asking about ingredients or how the food was prepared. However, most hosts and restaurant staff are happy to answer questions and accommodate your needs to give you the best possible experience.
7. If there’s a certain ingredient in a menu item that bothers you, consider asking if the item can be prepared without it. Restaurants that prepare most foods from scratch can usually accommodate substitutions and customizations. At friends’ homes, you can clarify certain ingredients if you’re unsure. Most hosts are happy to accommodate dietary needs of their guests. For example, they may be able to set aside minimally-seasoned portions for you prior to adding ingredients like garlic and onion powder.
8. Eat Mindfully
9. Start with calm. If you’ve struggled with communal or restaurant meals in the past, start by taking some deep breaths and reminding yourself that body, and your digestive system, is your ally. Eat slowly and enjoy the textures, flavors, and sensations of eating an enjoyable meal. Listen to your body’s cues to tell you when to stop and when to go back for more. Gratitude and mindful eating are linked to better digestion and less IBS symptoms—besides being great for you in a hundred other ways, as well.
10. Choose IBS-Friendly Foods
11. When possible, simpler meals made from IBS-friendly ingredients can make a difference in IBS symptoms for some people. This is obviously much easier if you know your triggers, which you may have learned by working with a dietitian to follow the low-FODMAP diet or by keeping a food and symptom log.
12. For example, you might choose simple protein options such as grilled chicken or fish, and opt for sides with safe ingredients when possible. You might even skip the complimentary chips and salsa or bread basket, since spicy foods, greasy foods, and breads can be a common IBS trigger. Avoid heavy sauces, cream-based dishes, or fried foods if they trigger symptoms. (And don’t forget that you can usually request a sauce to be served on the side; this allows you to add only the amount you want.) Additionally, you can request ingredient substitutions or customizations.
13. See the end of this post for some specific ideas on low-FODMAP restaurant options.
14. When you can't get low-FODMAP options, IBS-specific digestive enzymes can sometimes be helpful, as well.
15. Consider Your Drinks
16. Water is your best friend, especially in scenarios where the food environment is already stressful and potentially a trigger for your IBS symptoms. Skip or limit the soda and alcohol if they are known triggers for your symptoms. Caffeinated coffee and certain types of tea can be triggers for some individuals, as well. If you do choose to drink other beverages, consistently reassess how your body is reacting to avoid consuming too much and triggering a flare-up.
17. Bring Backup
18. While the goal is to enjoy yourself and participate fully in the eating experience, it can still be a good idea to bring a small snack with you in case the available options don’t align with your needs. Additionally, you may consider eating something before going out to prevent being overly hungry, which can sometimes trigger uncomfortable symptoms, as well.
19. Manage Your Stress
20. It’s so important to remember that it’s not all about the food. Social meals can be stressful, which can unfortunately trigger IBS symptoms, resulting in further stress. On the other hand, stress management techniques like mindfulness and deep breathing are known to reduce IBS symptoms. And while they can be stressful at times, social meals and eating in community can be incredibly healing. Take some deep breaths, go with supportive friends, and remember that you’re there to enjoy the company, not just the food.

• Need some examples of low-FODMAP alternatives at your favorite restaurants? Here are a few ideas to get you started.Burgers: Try a hamburger in a lettuce wrap, and ask to hold the onions. French fries are low-FODMAP, but oily and greasy foods are common triggers. If that’s the case for you or you’re not sure, try a side salad or baked potato instead.  Most people can tolerate condiments in small amounts, but if you’re able to plan ahead, you might consider bringing your own Low-FODMAP condiments like ketchup made with sugar (instead of high-fructose corn syrup) in a small to-go container.
• Mexican: Try corn tortilla tacos with chicken or beef, lettuce, tomato, cheese, and a little avocado and sour cream, and rice on the side. BYO salsa, if you like.
• Thai: Opt for a stir-fry with steamed rice or rice noodles and ask for it to be prepared without onion and garlic, if possible. Tofu or meat-based stir-fries including steamed vegetables like broccoli florets, green beans, carrots, green bell peppers, bamboo shoots, and water chestnuts are great options.
• Italian: Try gluten-free pizza with olive oil, tomatoes, olives, green bell pepper, and cheese. (Opt for harder cheeses like parmesan if you have difficulty tolerating lactose.) If you want pasta, opt for gluten-free pasta, and see if any of the sauces might be free from garlic and onion. Try a house or Greek salad dressed with olive oil and vinegar on the side.

Whether going out to a restaurant with family or friends, or meeting at a friend’s house, IBS does not have to keep you from enjoying social meals. Making strategic choices and eating mindfully can help you can feel confident and comfortable, even when you're not fully in control.

Want more tools to help you manage IBS without overcomplicating your life? Our Living Well with IBS Course is designed just for you. You can access the IBS Mini-Course for free, and check out the full online course Living Well with IBS for a deep dive. 

Need more personalized guidance? Send Erica a message or schedule a free discovery call.

Renee Chmiel

with Erica Golden, RDN, IFNCP

Renee is a dietetics student at Texas A&M University.

Erica is an IBS & Mental Health Dietitian.

So I'll give you a heads-up at the outset: that headline above isn't really quite the right question. The right diet for IBS depends on you. Your symptoms, your history, your ability to control your diet in the first place, your food preferences, etc. etc. The right diet for you might actually be no diet at all. (That is, no change in your current dietary pattern. We all eat, so we're all technically on "a diet.")

With that being said, let me walk you through the range of dietary patterns that work for some individuals. There are certainly more approaches than what we'll cover here, but the below list gives an idea of some of the most popular approaches, with varying degrees of effectiveness, ease, accessibility, and practicality.

1. The Mediterranean Diet. If you've been listening to what's been going on in the health and nutrition space for the past several years, it'll be no surprise to you that this one makes the list. The Mediterranean Diet (or MedDiet, as it's popularly called) is an anti-inflammatory eating pattern that has been studied for, and has been shown to be useful for, a broad range of health conditions. It's not always the most effective for every given disease or condition or syndrome, but it almost always makes the list--clearly, it's far better than the Standard American Diet for just about everything.

• Now, it's worth mentioning that what we might call the Mediterranean Diet in nutrition research doesn't necessarily line up with what people are actually eating in the Mediterranean region. That's a very large and incredibly diverse area of the world. But in general, what nutrition researchers mean when they talk about the MedDiet is:Lots of fruits and vegetables--likely 8-10 servings per day at least.
• Choosing whole grains, when grains are consumed.
• Several servings of legumes and pulses per week.
• Nuts and seeds daily.
• Several servings of fish per week.
• Extra-virgin olive oil, and lots of it--often 3-4+ Tablespoons per day.
• Lots of herbs and spices for flavor and nutrients.
• Limiting red and processed meats, ultra-processed snack foods, and added sugar.

The Mediterranean Diet does have some effectiveness in IBS. While it's likely not the most effective approach for those with severe symptoms, it can certainly improve IBS symptoms in some individuals, while at the same time improving overall health. Plus, it's practical and doesn't require memorizing lists or eliminating anything--just diversifying a bit and limiting the ultra-processed stuff that we're all trying to reduce, anyway.

2. The High-Fiber Diet. High-fiber diets for IBS focus especially on soluble fiber sources, things like psyllium, oats, and the flesh of fruits and vegetables. Fiber is incredibly important for gut health, whether we're dealing with diarrhea or constipation or a mixture of the two. It can help nourish the gut microbiome, keep things moving at just the right speed, and reduce symptoms of bloating and abdominal pain. In fact, the fiber in plant foods is probably one of the reasons why the MedDiet is helpful for some with IBS.

Fiber supplements like Sunfiber (PHGG) and psyllium can be really helpful, as well, and can be quite gentle options for those who have a hard time making big dietary changes.

3. The Lactose-Free Diet. Lactose is an incredibly common dietary trigger for individuals worldwide. Lactose is commonly found in milk and dairy products, such as yogurt, ice cream, and soft cheeses. Many individuals are deficient in the enzyme needed to digest lactose (called lactase). Reducing the amount of lactose we consume, or taking supplemental enzymes to replace the lactase enzyme, can dramatically reduce symptoms in those who have that enzyme deficiency. 

If you're wondering whether this is you, try switching to lactose-free dairy products and limiting most cheeses to about an ounce or so at a time. You can also try the lactase enzyme caplets when you're consuming lactose-containing dairy. If this helps your symptoms, great! If lactase doesn't help but you still feel that your symptoms are connected with dairy consumption, remember that lactose is not the only potential trigger in dairy. The form of casein in most milks in the US is also a potential trigger, so you might try milk products containing only the A2 beta casein protein as well, before concluding that milk isn't the trigger.

4. The Gluten-Free Diet. This is a popular approach with some mixed findings in the actual nutrition research. Randomized controlled trials, the gold standard in clinical research, have yielded mixed results. Many individuals do improve on GF diets, but it's hard to tell in some cases whether it's the gluten that is the real variable here, or some of the other components of these grains (things like fructans, ATIs, or lectins--particularly fructans, as we'll talk about in a few minutes).

It's difficult to say at this time, but there do seem to be some individuals with a sensitivity to gluten itself. While it may be a smaller portion than what social media might make it seem, I believe that research does confirm that this group does exist. 

For those who have noticed issues with consuming grains and wheat products wondering if going GF is right for them, I strongly encourage discussing with a dietitian or gastroenterologist first, as we really should test for Celiac disease before completely eliminating gluten. Alternate approaches may include trying replacing regular bread with long-fermented sourdough to reduce some of the problematic components, and seeing if symptoms improve.

5. The Low-Fat Diet. Some individuals notice a big link between fat intake (especially greasy foods, fried foods, foods with lots of sauces or cheese, high-fat meats like steak, etc.) and symptoms. Keeping a food journal can help to determine whether reducing fat intake might be helpful for you, or you can just try avoiding or limiting portions of the foods I just mentioned. I would especially recommend this if your stools are often greasy or floating, since this indicates possible fat malabsorption. It's also possible that fat malabsorption can result from other issues above and beyond IBS, like exocrine pancreatic insufficiency (EPI) or bile acid malabsorption (BAM) to name a few. If you're not eating large amounts of fat but struggling to tolerate even small portions, consider talking to a gastroenterologist about getting tested for these conditions.

6. The Low-FODMAP Diet. Low-FODMAP is the most evidence-based diet for IBS, but also the most complicated and the most difficult to follow. It reduces portions of some difficult-to-digest and difficult-to-absorb dietary compounds, including lactose, sugar alcohols (polyols), excess fructose, fructans (fructooligosaccharides), and GOS (galactooligosaccharides). These are some of the most common intolerances for individuals with IBS, and reducing the total load of these FODMAP foods can have a dramatic impact on symptoms. Studies suggest that approximately 70% of those with IBS experience symptom improvement on the low-FODMAP diet. 

• The diet itself can be quite challenging to follow, because it's not a typical elimination approach. Foods are not generally completely off-limits; there are just specific portions that must be adhered to during the restriction phase. The types of foods that are restricted include:Certain grains, such as wheat
• Lactose-containing dairy products
• Certain fruits and vegetables that contain FODMAPs, such as apples, stone fruits, asparagus, garlic, and onion
• Certain nuts and legumes, such as pistachios, cashews, and pulses
• Certain food additives and sweeteners, such as sugar alcohols (sorbitol, for example), honey, high-fructose corn syrup, and inulin

However, this is far from an exhaustive list. Many nutritious foods contain FODMAPs, and support is often needed to properly follow this plan without creating nutrient deficiencies, issues for the gut microbiome, and anxiety around food. 

Following the restriction phase, if it's effective, individuals will gradually bring back the restricted food types, one at a time, to test which might produce symptoms for them. This is often the most challenging phase of the diet, as the background diet must remain low-FODMAP while the testing is going on. 

Finally, the last phase of the diet is the personalization phase, where individuals bring back all foods, in appropriate portions that they are able to tolerate. This phase of the diet is meant to be nutritionally adequate, diverse, and sustainable for the long-term.

Hungry for More?

If you want to learn more about low-FODMAP and these other dietary patterns for IBS, plus lifestyle and supplement recommendations and guidance on making sure you've got the right diagnosis in the first place, check out my online course. You can access my IBS Mini-Course for free for a limited time, and check out my full online course Living Well with IBS for a deep dive. 

Need more personalized guidance? I'm here for you. Reach out to me via email or schedule an appointment with me.

Erica Golden, RDN, LD, IFNCP

IBS & Mental Health Dietitian