Irritable Bowel Syndrome (IBS) impacts millions of Americans every year with symptoms including intestinal cramping, bloating, gas, constipation, and/or diarrhea. It affects women twice as often as men. The symptoms can be so urgent that many who suffer from IBS find it restricts their social and work lives.
IBS symptoms
Around 50% of all women experience regular digestive issues. IBS has become so common that it accounts for around 30% of all referrals to a gastroenterologist. Prior to being recognized as a legitimate condition, women were frequently told the cause was psychological. Now we know that people with IBS have greater sensitivity in the muscle and nerve fibers in their intestines than people who don’t suffer from IBS. They are more reactive to stimuli from certain foods, stress hormones, and environmental toxins. It may have a genetic factor involved.
Some people with IBS may suffer symptoms due to situations that cause stress. Others have symptoms regardless of any major emotional triggers. Most IBS sufferers report that their symptoms occur or are worse after a meal. Many women report that symptoms are worse just before the start of their periods. And IBS is associated with endometriosis.
Conventional treatments include medications like antispasmodics to relieve cramping, laxatives, antidepressants, and anti-anxiety medications. These provide symptomatic relief but do address the root causes and underlying factors that result in gut hypersensitivity or irritability.
The four underlying factors of irritable bowel syndrome (IBS)
IBS has four main root causes: diet, food intolerances, stress, and dysbiosis (a disrupted gut microbiome). Knowing this leads to solutions. In many cases, a combination of the root causes is happening. One issue might trigger another. An intolerance to dairy could lead to gas and bloating, but it can also cause inflammation that triggers dysbiosis.
Identifying IBS triggers
To identify your specific IBS triggers, you must pay attention to when symptoms occur. Keeping track will help you find clues to the causes. There are some common threads, although each individual is unique. An effective method is to keep a 5-day food diary. Record everything you eat and drink and at what time you consume them. In conjunction, record how you feel between 15 minutes and an hour after consumption.
This will help you see the connections between your triggers and your symptoms. And, you will be better able to avoid triggers, which will allow your gut to heal over time.
Dietary factors
IBS with constipation:
- Increasing your intake of fruits and veggies, especially high fiber veggies -like cooked leafy greens including kale, collard greens, and broccoli – and high fiber fruits like apples
- Increase your fiber intake (30-50 grams/day) by eating a variety of veggies, ideally 2 servings per meal.
- 1-2 TBSP ground flaxseed daily
- A probiotic
- Ginger which can help with intestinal motility, gas, and bloating
- Avoid caffeine, fatty foods, and alcohol
IBS with loose stools:
- Limit raw fruit and veggies
- Eliminate fructose and lactose for 4 weeks. Reintroduce one at a time afterward and pay attention to whether symptoms reappear
- Treat gut dysbiosis
- Ginger, which can help with gas and bloating
Food intolerances
People with IBS have hypersensitivity in the intestinal lining, which can be aggravated by inflammation of the lining. Food sensitivities are one of the most common reasons for intestinal inflammation. Identifying food triggers is important to relieve symptoms.
The most common foods that lead to intestinal irritation are gluten-containing foods (anything with wheat, barley, or rye) and gluten cross-reacting grains, especially corn and dairy products including milk, yogurt, cheese, and other milk-based products. If you see a significant improvement in symptoms after eliminating gluten, you may also have celiac disease. Check with your doctor.
An elimination diet can help heal your intestinal lining and relieve your sensitivity to certain foods. However, some people will remain sensitive to gluten or dairy. The reintroduction phase of the elimination diet will help illuminate whether this is an issue for you.
A “Low FODMAP Gentle” Approach for Irritable Bowel Syndrome (IBS)
FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short-chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon.”
This diet is commonly suggested for the relief of IBS symptoms. It’s accepted by conventional, integrative, and functional medicine. The diet helps you avoid foods that are high in specific short-chain carbohydrates which are found in many gut-healthy fruits, vegetables, and legumes. Studies have shown that it may provide symptom relief for IBS, including when it’s associated with endometriosis.
While this diet may be helpful for symptoms, the overall goal is to be able to tolerate them by healing your gut. Eliminating these foods permanently is difficult and not optimal because it removes many healthy foods like greens, legumes, and beans.
A standard IBS-friendly diet can be effective at relieving IBS symptoms as effectively as stricter elimination plans. This includes eating regular meals, avoiding coffee, spicy foods, and unhealthy fats, and eating quality fiber, fresh fruits and veggies, and good quality fats.
When a more advanced approach is needed, what is called a “low FODMAP Gentle” approach can help. It removes a few foods that are the worst offenders when it comes to high FODMAP foods, including:
- Gluten-containing grains (wheat, barley, rye)
- Dairy
- Legumes
- Onions
- Cauliflower
- Mushrooms
- Apples
- Pears
- Dried fruit
- Stone fruit
- Watermelon
Keep in mind that this is not a long-term diet solution. Use a reintroduction protocol and keep track of any symptoms that return.
Stress
It’s well-established science that stress had a direct relationship with your brain and gut. Chemicals that affect your nervous system, mood, and emotions affect your gut. For someone with IBS, this connection is even more sensitive. It also works the other way around – symptoms in your gut can affect your mood. If you have IBS, you want to have ways to calm yourself during stressful situations.
Mindfulness and meditation help keep moods more even and help to relieve IBS symptoms. You can find quick ways to encourage a tranquil mindset through directed thoughts or deep breathing. Calming your emotions will help calm your gut.
In addition, address the causes of ongoing stress in your life.
Dysbiois
Conventional medicine has overlooked the role of the microbiome, which is the collection of microorganisms living in our intestines. This is part of why an effective cure for IBS hasn’t been discovered by conventional medicine. However, the awareness of the impact of diet, lifestyle, and emotional stress on the microbiome has grown. As a result, insight into how dysbiosis can contribute to IBS has also grown.
If you experience gas, bloating, and particularly if it’s worse after meals, you likely have dysbiosis. What is dysbiosis? It’s an imbalance of microorganisms. You have too many harmful bugs in relation to the beneficial bugs. This can happen from changes in the diet, overuse of antibiotics and other medications like ibuprofen and PPIs (i.e., Prilosec) that impact the gut and gut flora health, and prolonged stress.
Ways to improve gut flora include:
- Eliminating medications that interfere with gut flora and gut health (check with your doctor)
- Adding fermented foods into your diet on a regular basis (sauerkraut, kimchi, miso, and yogurt or kefir),
- Taking a daily probiotic that contains the helpful species mentioned above.
- You can address the harmful bacteria with herbal medicines such as Oregon grape root, oregano or thyme essential oil, or others.
Is medical testing necessary?
If there is blood in your stool, talk to your doctor. It can be indicative of ulcerative colitis, Crohn’s disease, or colon cancer. IBS typically will not result in blood in the stool.
Many integrative and functional medicine doctors use quite a bit of extensive testing to diagnose what’s going on in your gut. This includes looking for food sensitivities with IgG and other tests, gut microbiome analysis, tests for parasites, digestive enzymes, and intestinal antibodies. However, you may want to wait for medical testing. First try an elimination diet 6-12 weeks, following the 4R program for this same amount of time. If you still have symptoms, testing may be appropriate. Keep in mind that it can be expensive and doesn’t always result in answers.
Final thoughts
IBS can be successfully managed through diet and lifestyle changes. Keep track of your diet and symptoms. Look for connections and respond appropriately. Relief can be as easy as avoiding certain foods or learning relaxation techniques. If these don’t provide relief, check with a functional medicine doctor for ways to completely heal your gut.