Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal disorder in the world, affecting about 14% of the global population as of 2019.
People with irritable bowel syndrome, also referred to as spastic or nervous colon, suffer from chronic abdominal pain, cramping, bloating, food intolerances, and altered bowel habits. IBS patients report having constant diarrhea, constipation, or both, especially when consuming certain foods that trigger their IBS sensitivities. This greatly reduces a person’s quality of life.
The precise cause of irritable bowel syndrome remains unknown however alterations in the gut microbiome constipation or diarrhea for any reason, along with stress, and gut hypersensitivity are all likely play a role[1-5]
Treating IBS can be challenging. With no specific medication developed to cure the disorder entirely, many patients focus on treating or minimizing the symptoms instead. However, there has been much research on treating IBS naturally by change in diet, supplementation, and modification of lifestyle.
The first stage is to examine whether you really have IBS, since its symptoms are not unique. There are other diseases that can mimic IBS symptoms including inflammatory bowel disease which I made another article about, celiac disease, fructose or lactose intolerance, colitis etc. These must first be excluded by a doctor taking a careful history, physical examination and some diagnostic testing to evaluate if there is another cause for concern. Symptoms such as unexplained weight loss, unexplained iron deficiency anemia, fever, parasites, a family history of colorectal cancer, celiac disease or inflammatory bowel disease, and onset of symptoms after age 50 may show other causes for concern. There are diagnostic tests to rule these out.
Once IBS is established, therapy begins with education, lifestyle interventions, especially diet-based, interventions and medications.
Here I will cover diet-based therapy.
Remove Food Intolerances
Approximately 84% of people suffering from IBS report that their symptoms are triggered by at least one food item [6]. These foods are suspected to cause or aggravate IBS symptoms. These intolerances may be caused by food chemicals in such foods, increased gut wall permeability, or that certain foods may increase water and gas volume, causing bloating, pain and sensitivity due to a mismatch between the microbiome and the foods consumed.
The most common food intolerances include gluten, dairy products, coffee, fructose rich foods, and fried foods.
Shift to a high fiber diet
Fiber is considered a main treatment approach for IBS. Fiber helps with production of short-chain fatty acids that are a food source for the healthy bacteria in the gut microbiome.
Fiber also acts as a bulking improving intestinal transit and decreasing constipation as well as diarrhea.
Soluble fiber is especially helpful and is found in oats, peas, beans and lentils, apples, citrus fruits, cooked root vegetables, strawberries, barley, whole rice and psyllium.
Aim for no less than 20–30 grams of total diet and supplementary fiber per day.
Eliminate dairy products from your diet
Many people with IBS describe symptoms similar to those with lactose intolerance. Therefore, many IBS patients try to avoid dairy products. In a study led by Joost Algera from the Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, dairy products were investigated and recognized as a food that provoked symptoms in patients with irritable bowel syndrome. [7]
Because of the complexity of treating IBS, eliminating your intake of milk, cheese, yogurt, ice cream, whipped cream, and sour cream and all dairy products in general is definitely worthwhile. Also excessive fermentation of malabsorbed lactose by the gut bacteria may trigger or exacerbate IBS symptoms.
A deficiency in lactase, the enzyme required to breakdown lactose, is commonly found among the general population and in even higher proportions among people with IBS.
Other foods that may contain lactose and should be avoided are butter, buttermilk, and whey. If you decide to follow a milk-free diet, make sure that you meet your daily protein requirements with lentils and seeds especially linseeds are good for IBS. Especially go for milk alternatives such as nut, or hemp milks which are fortified with vitamin D, calcium and B12, and at times also iodine, as well as cheese alternatives made naturally from nuts and not other fats.
Avoid Gas Producing Foods
Foods that increase intestinal gas and flatulence include alcohol, coffee, all foods from refined grains, beans, Brussels sprouts, raw carrots, raw onions, garlic, wheat germ, cabbage, and high fat foods.
Gradually eliminate caffeine intake to avoid withdrawal symptoms.
Also foods containing sorbitol, xylitol and mannitol found in sugar free chewing gum, some processed foods and drinks as well as in sweets should be avoided.
Eliminate Fructose Rich Foods
Similar to lactose intolerance, a fructose intolerance also exists. It happens when cells of the intestines aren’t able to break down fructose efficiently.
Studies show that one-third of patients with IBS have fructose intolerance, and their symptoms improved on a fructose-restricted diet. By contrast, noncompliance with a a fructose-restricted diet was associated with persistent IBS symptoms.
Foods that contain high levels of fructose to eliminate from your diet include:
Sodas, some energy cereal bars, watermelon, apple juice and pear juice and apple cider and all foods containing high fructose corn syrup or other fructose sweeteners namely: sugar alcohols, fructooligosaccharides (FOS), corn syrup, sorbitol, agave nectar and of course fructose.
Eliminate Gluten
Although the role of gluten restriction for people with IBS who are non-celiac is controversial, dietary restriction of gluten might be effective for decreasing IBS symptoms in some people because of existing gut dysfunction, and an impaired gut barrier.[8]. Gluten rich foods include: Beer, Breads, Bulgur wheat, Cakes and pies, Candies, most Cereals, Cookies and crackers and wafers.
Take probiotic supplements
By balancing out gut bacteria, probiotics are believed to improve IBS symptoms. Clinical studies have found that probiotics (like saccharomyces boulardii, Bifidobacterium lactis BB-12, and lactobacillus acidophilus NCFM) are some of the best live microorganism cultures for treating IBS-related symptoms. [9] These probiotic strains have been observed to minimize poor gut motility, loose stools, and abdominal discomfort. Probiotics may also promote bowel regularity.
I recommend taking probiotics as a supplement on an empty stomach because there is less residual stomach acid. In the case of IBS I recommend avoiding probiotic-rich foods such as kombucha, kimchi, miso, kefir, and sauerkraut because of their gas producing potential. Probiotics should have no less than 100 billion CFU’s and 10 different bacterial strains to be most effective.
Smaller Food Portions
Consume food in smaller portions more times a day. By following a regular meal pattern and avoidance of large meals you will find improvement of IBS.
Curcumin
Curcumin is a member of the ginger family that is derived from turmeric. Curcumin has anti-inflammatory activity and has been shown to decrease abdominal pain and improve quality of life in people with IBS. The recommended dose is 70-100?mg daily for two months.
Fennel Seeds
Fennel seeds have a relaxant effect on intestinal smooth muscle, so they reduce abdominal cramping and pain. You can take fennel seeds as an essential oil by adding the oil to a small amount of water and driving regularly or by adding crushed raw or toasted fennel seeds to your foods. Avoid this when pregnant or lactating.
Takeaway
By avoiding triggering foods mentioned here, and transitioning to a more nutritious diet, and taking the supplements recommended, people with IBS may avoid taking medication while drastically improving symptoms and managing the disease. Ultimately, diet and lifestyle modifications not only lessen IBS symptoms but may lead to better health and well-being in the long run.
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References:
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- 6. Simren M, Mansson A, Langkilde AM. et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion 2001;63:108–15.
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- [9] Vazquez-Roque MI, Camilleri M, Smyrk T. et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013;144:903–11.e3.
- [10] Werlang ME, Palmer WC, Lacy BE. Irritable Bowel Syndrome and Dietary Interventions. Gastroenterol Hepatol (N Y). 2019;15(1):16-26.
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