Irritable Bowel Syndrome (IBS) is an umbrella term used to describe numerous digestive complaints that have no clear pathology[i]. IBS is very common, and the number of people experiencing it is increasing. The main symptoms are bloating, diarrhea, urgency, constipation, indigestion, abdominal pain and cramping, gas and mucus in stools. Usually, people will swing from constipation to diarrhea, but there will be one they experience more often. IBS-D is when diarrhea is the most common symptom and IBS-C is constipation[ii].
Recently, it has been suggested that a condition called SIBO is a cause of IBS in up to 78% of people with the condition[iii]. Other possible contributing factors are anxiety and stress (due to the gut-brain axis)[iv], post-bacterial infection, food intolerances[v], microbiome diversity[vi], pathogenic bacterial overgrowth, non-coeliac gluten sensitivity[vii] or a parasite infection[viii].
The low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is commonly suggested to those with IBS. This is because the foods suggested to avoid typically exacerbate the symptoms of IBS in a lot of people. This is a very restrictive and therefore can’t be followed for more than a couple of months. Patients often find that their symptoms return once they start eating normally again. If you follow this diet, I suggest doing some gut healing support alongside it to help minimize any symptoms that might return when you start eating normally again. The FODMAP diet typically excludes some fruit and vegetables, dairy, sweeteners, legumes, wheat, other grains such as barley and rye and drinks such as beer, wine, and fruit juices.
Alternatively, you could focus on removing or reducing inflammatory foods and drinks. As nutritional therapists, we address the person as a whole, and believe that if you provide the body with the nutrients and health factors it needs then you will see an improvement in symptoms, without being too restrictive of foods (that offer lots of health benefits such as fruit and vegetables). Concentrate on including whole foods with minimal processing involved and reduce agents such as gluten, cow’s dairy, alcohol, and sugar, as these are all involved in inflammation.
If you want to include legumes and pulses, do so but go for dried versions and soak them over-night as this will help with digestion and minimize symptoms. Additionally, start with a small portion (1 tbsp) and slowly make your way up to a cup sized portion over a few weeks so your gut bacteria can adjust to the increase in fibre.
For IBS-D, stay away from stimulants such as caffeine, sugar and alcohol as they will only increase your stool transit time even further.
As anxiety and stress are often drivers of IBS symptoms, try techniques to manage them. Breathing exercises, walks in nature, calming yoga and massage can all help to sooth our minds and manage feelings of stress and anxiety.
A specific strain called Lactobacillus Rhamnosus GG has shown promise in reducing constipation too.
If you have IBS-D, go for Saccharomyces Boulardii as this has been proven to help with loose stools and diarrhea.
Living Nutrition do a broad range of fermented products which are specific for different areas of gut health.
Digestive enzymes help us to breakdown food, which relieves pressure on the digestive tract and encourage proper absorption of nutrients from our food (a process which is often hindered in IBS). There are different options and different ways to take digestive enzymes so follow the instructions from a health provider based on the ones you choose.
For IBS-C (constipation), try adding in some extra fibre which will encourage your body to pass a stool:
For general gut health improvement, try some Lions mane mushroom. This medicinal mushroom supports a healthy gut mucosal lining and also helps with the gut-brain axis as it is very supportive of cognitive health:
Often, it’s a good idea to do some further investigation to identify the root cause, or leading offenders of our symptoms. Below are some testing options for IBS symptoms:
[i] Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
[ii] Schoenfeld PS. Advances in IBS 2016: A Review of Current and Emerging Data. Gastroenterol Hepatol (N Y). 2016 Aug;12(8 Suppl 3):1-11. PMID: 28070176; PMCID: PMC5210026.
[iii] Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017 Mar 15;11(2):196-208. doi: 10.5009/gnl16126. PMID: 28274108; PMCID: PMC5347643.
[iv] Popa SL, Dumitrascu DL. Anxiety and IBS revisited: ten years later. Clujul Med. 2015;88(3):253-7. doi: 10.15386/cjmed-495. Epub 2015 Jul 1. PMID: 26609253; PMCID: PMC4632879.
[v] Cuomo R, Andreozzi P, Zito FP, Passananti V, De Carlo G, Sarnelli G. Irritable bowel syndrome and food interaction. World J Gastroenterol. 2014 Jul 21;20(27):8837-45. doi: 10.3748/wjg.v20.i27.8837. PMID: 25083057; PMCID: PMC4112903.
[vi] Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, de Vos WM, Manichanh C, Golic N, Enck P, Philippou E, Iraqi FA, Clarke G, Spiller RC, Penders J. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol. 2015 Feb;110(2):278-87. doi: 10.1038/ajg.2014.427. Epub 2015 Jan 27. PMID: 25623659; PMCID: PMC4317767.
[vii] De Giorgio R, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut. 2016 Jan;65(1):169-78. doi: 10.1136/gutjnl-2015-309757. Epub 2015 Jun 15. PMID: 26078292.
[viii] Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A Review of Microbiota and Irritable Bowel Syndrome: Future in Therapies. Adv Ther. 2018 Mar;35(3):289-310. doi: 10.1007/s12325-018-0673-5. Epub 2018 Mar 1. PMID: 29498019; PMCID: PMC5859043.
Please note that the information contained within this website does not and should not replace medical advice, and is not intended to treat or diagnose. We always recommend you consult with your doctor. Our Nutritional Therapy team is highly trained and we offer one to one Nutritional Therapy Consultations, which are designed to be complementary to any medical treatment from a functional medicine approach, as well as offering a preventative & optimal health focus.