From Survival Mode to Safety: Rethinking Restrictive Diets for IBS

Our nervous system state becomes our story. When we’re stuck in survival, everything looks risky—including food, hunger and the body.

When I first met Riley, she was in her early twenties, juggling her first real job and trying to get her gut symptoms under control. She had recently been diagnosed with IBS-D and was doing everything she could to feel better.

A former straight-A student and total go-getter, Riley approached her health the same way she had approached school: follow the rules, do everything right, fix the problem.

Her provider had suggested the low FODMAP diet, and Riley dove in headfirst. But when it didn’t bring the relief she was hoping for, she doubled down. Without checking back in with her provider, she started layering on more restrictions—first adding the Autoimmune Protocol (AIP) on top of low FODMAP, then cutting out anything flagged on a SIBO diet list she found online.

By the time she landed in my office, she was down to fewer than ten foods and completely terrified of adding anything new.

If this sounds familiar, the rest of this article will shed light into why previous protocols haven’t worked for you or your clients—and what you may need to consider instead.

The Fear-Driven Loop of Restriction

I remember one session when Riley mentioned that grapes still felt relatively safe. I asked if she’d be willing to try a single raisin. That’s when she froze. It was like all the alarm bells in her body went off at once. Logically, she knew it was just a dried grape. But her nervous system told her it wasn’t safe.

And she’s not alone. I see this all the time—clients who start out just trying to feel better and end up in a fear-driven loop of restriction. Sometimes it starts with physical symptoms. Sometimes with a desire for control. But either way, restriction becomes the only way they know how to feel safe.

What Polyvagal Theory Tells Us

And it’s no wonder people end up this way. Polyvagal theory helps us understand that when we’re in a survival state—whether that’s fight, flight, or freeze—our nervous system is wired to perceive the world as dangerous.

Even something as small as a raisin can feel threatening when your body is bracing for harm. In these states, logic doesn’t lead; neuroception—the nervous system’s automatic threat detection—does.

In this way, our nervous system state becomes our story. When we’re stuck in survival, everything looks risky. Food choices become moral decisions. Hunger feels untrustworthy. The body itself feels like the problem.

This pattern isn’t just theoretical—it’s backed by research. A recent review in Neurogastroenterology & Motility, which looked at over 60 studies, highlighted that even when restrictive diets like FODMAP improve physical symptoms, they can also contribute to anxiety and an unhealthy preoccupation with eating only the “right” foods.

Symptom relief shouldn’t come at the cost of your mental health. So how do we know when a specialized diet might do more harm than good? One major clue is the presence of trauma.

The Connection Between Trauma and IBS

We now have research showing that IBS and trauma are closely connected. Many people with IBS report early life stress—things like neglect, bullying, or growing up in an unpredictable home. But the impact of trauma doesn’t start or stop with one generation.

Even the stress your mother experienced before you were born—like her own childhood trauma or anxiety during pregnancy—can shape your gut health.

In a large study of over 450 mothers and their children, researchers found that adversity across two generations changed the gut microbiomes of the children by age 2.

It didn’t matter if the adversity happened to the mother as a child, during pregnancy, or to the child directly—each kind of stress was linked to different changes in gut bacteria. Even more striking, some of the same bacterial patterns linked to early life stress were also tied to the child’s emotional and behavioral health at ages 2 and 4.

Why does that matter?

Gut Health, Trauma, and Digestion

Because trauma doesn’t just affect the mind—it reaches into the gut. It can change how fast or slow food moves through the digestive tract. It can make normal sensations feel painful or too intense.

It can disrupt the two-way communication between your gut and brain. And it can shape the gut microbiome in ways that influence digestion, inflammation, and mental health for years to come.

So if trauma can lead to gut symptoms—and restricting food to manage those symptoms can add even more stress—what’s the path forward?

Safety Matters for Healing Gut Issues

It starts by recognizing that food restriction isn’t always needed—and it isn’t always neutral. Before we even consider a therapeutic diet, we have to ask: Can this person’s nervous system handle it? Will this change feel like a stretch or a stress?

That framing comes from polyvagal therapist Deb Dana, who teaches that we can safely build capacity by choosing experiences that gently challenge us—stretch us—without overwhelming our system.

The difference matters. When dietary shifts are made from a regulated state, they can be empowering. But when they’re made from fear, they often backfire.

Why IBS and Restriction Don’t Pair Well

That’s why clinicians are beginning to raise concerns about the use of restrictive diets in patients with disorders of gut-brain interaction, like IBS. According to a recent study in Neurogastroenterology & Motility, disordered eating behaviors are common in this group—and restrictive diets may actually increase psychological distress. The researchers recommend screening for disordered eating before initiating dietary changes and referring to a psychologist if concerns arise.

In my practice, I’ve found it helpful to consider any dietary change through the lens of the nervous system. I ask my clients: Will this adjustment feel like a stretch or a stress? Stretch helps build capacity. Stress can cause collapse. For people with a trauma history or a sensitive gut-brain connection, that distinction matters more than we think.

Here’s what a “stretch-to-stress” continuum might look like when using the low FODMAP diet:

A Gentler Approach to Healing the Gut

On the gentler, more stretch-oriented end of the continuum, we might begin with something simple—like adding a FODMAP-targeted digestive enzyme or trying pre-made low FODMAP meals (if that’s financially doable). The next step could be identifying and reducing just the foods that already seem to trigger symptoms—like garlic, onion, or milk.

If the client feels steady and open to a bit more change, we might explore a modified low FODMAP diet, where only one or two FODMAP categories are restricted. Then—and only if their nervous system stays regulated and the changes still feel like a stretch rather than a stress—we might consider a full low FODMAP elimination diet, ideally with the support of a Certified Nutrition Specialist (CNS) or registered dietitian (RD) and a clear plan for reintroducing foods.

Here’s a list of ideas my interns and I put together to guide this process:

Low FODMAP Strategies (from gentle to more intensive):

• Start with support tools:

  • Use FODMAP-targeted digestive enzymes like FODZYME or FODMATE

  • Try low FODMAP meal delivery services like Modify Health or Epicured to reduce decision fatigue

• Make gentle adjustments:

  • Focus on crowding in safe, low FODMAP foods rather than obsessing over eliminations.

  • Add variety to ensure no single, triggering food makes up the majority of the diet

  • Shift macronutrient ratios (e.g., moderate carbs and increased protein and fats) to reduce overall FODMAP load.

• Target known triggers:

  • Cut back on specific problem foods like garlic, onion, or apples

  • Use low FODMAP swaps like garlic-infused oils (e.g., FODY or Garlic Gold)

  • Eliminate just one FODMAP category (e.g., fructose) if that seems to be the main culprit

• More structured approaches:

  • Try a “light” low FODMAP plan—removing only the two most reactive groups

  • Follow the full low FODMAP elimination diet, ideally short-term and supervised, with a plan for reintroduction

Healing IS Possible—But You May Need Another Solution

No matter where you fall on that continuum, the most important question isn’t “What diet is best for IBS?”—it’s “What feels safe enough to try right now?”

Because gut healing isn’t just about what you take out of your diet—it’s about what you build: trust in your body, safety with food, and flexibility over time.

For Riley, that began not with another list of foods to avoid, but with learning how to slow down notice when her system felt overwhelmed, and how to pause before reacting. One raisin at a time, she began to rebuild not just her diet, but her relationship with food, her body, and herself.

If you’re navigating IBS and a history of stress or trauma, know this: relief is possible—and it doesn’t have to come through restriction alone.