The Comprehensive Guide to IBS

IBS: The current definition

The current medical definition is based on symptoms alone. It is also a diagnosis of exclusion, meaning there is no other cause for your symptoms. The ​National Institute of Diabetes and Digestive & Kidney Diseases​(NIDDK) ​defines IBS​as “A group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both.” When you are diagnosed with irritable bowel syndrome, you will likely be given a subtype: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with mixed bowel habits (IBS-M). These are as they sound. IBS-C means that constipation is the primary stool type. On days where you have an abnormal bowel movement, 25% or more of your stools are hard. Less than 25% are loose. IBS-D means that diarrhea is your main complaint. On days where you have an abnormal bowel movement, 25% or more of your stools are loose or watery. Under 25% are hard. IBS-M means that constipation and diarrhea both occur frequently. On days where you have an abnormal bowel movement, more than a quarter of your stools are hard and more than a quarter are loose or watery. But being labelled with IBS or one of its subtypes only describes your symptoms. You are well aware of these already! While a diagnosis can guide the medications prescribed, it really offers nothing by way of understanding the cause or any triggers. And if you don’t know the cause, you can’t adequately address this condition and it becomes nigh on impossible to achieve remission. With this in mind, let’s look at what we really know about IBS.

Irritable bowel syndrome: Why does this common condition occur?

When we understand why IBS happens, we can look at eliminating its causes. Thorough investigation and evidence-based advice is how our patients achieve remarkable results. We must begin with the truth. A study published in ​World Journal Gastroenterology ​noted that: “Altered gastrointestinal motility, visceral hypersensitivity, post infectious reactivity, brain-gut interactions, alteration in fecal micro flora, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, and intestinal inflammation all have been implicated in the pathogenesis of IBS.” As you can see, it’s a complex problem. One or several sources can underlie IBS. Understanding the triggers leads to relief but finding them can be difficult. Wonderfully, there are simple approaches and advice that help to solve the riddle and provide relief. But first…

What are the common and less common symptoms of IBS?

IBS can cause: Abdominal pain and cramping Bloating Brain fog Constipation Diarrhea Excessive wind Feelings of incomplete evacuation (when it feel like you haven’t completely emptied your bowel) Food sensitivities Insomnia Joint pain Mental illness, including anxiety and depression Tiredness

The basics: What happens in the gut?

When most people think about the gut, their mind flicks to the inside of the body. But, in reality, the digestive track is like the hole through a donut. It passes through us but its contents are not part of us. This is a good thing. When we eat, we place food into the mouth, chew and shallow. This propels partially digested food into the stomach. Here it is dissolved further to release its life sustaining nutrients. When ready, the sphincter at the bottom of the stomach opens allowing the “food” to move into the small intestine. Here, most of the nutrients are absorbed. The indigestible material is then pushed into the large intestine. Remaining water and nutrients are extracted. Feces are formed and shunted toward the exit point: the anus. It’s here, within the large intestine, that irritable bowel syndrome flares.

What food are limited on a low FODMAP diet?

Fruits: apples, blackberries, cherries, Nashi pears, peaches, plums, figs, mangoes, and dried fruit. Vegetables: artichoke, cauliflower, garlic, leek, onion, and spring onion. Legumes: baked beans, falafel, red kidney beans. Plus, wheat, cow’s milk, processed meats and honey. What foods do I personally encourage for patients with IBS? Phytonutrient rich foods: These are foods that have high amounts of polyphenols, flavonoids, terpenes, and chlorophyll. As a whole, these phyto-compounds will help boost gut health. They are found in many vegetables, but if you are having trouble intaking a substantial amount, you may consider caffeine-free herbal teas, such as Rooibos and Peppermint. One of my personal favorites is the “Three Mint” tea by Pukka. Some of my patients have reported drinking two cups a day of each tea (4 cups total) and seeing a noticeable difference in their digestion in 3 days. Plant-Based Digestive Enzymes: These complex proteins elicit a bloating and immune response in the gut. I encourage the use of digestive proteases with large meals to help with this issue. Some of my favorite enzymes in this category can be found here. Prebiotics​: The food that feeds the good gut bugs are called prebiotics. These can be wonderfully therapeutic. Celery, chicory root, flax seeds, and seaweed are suitable options. Probiotics​: The term probiotic refers to microorganisms that are introduced to raise the good microbiome count. These can be taken in supplement form. They can also be consumed in foods like water kefir and almond yogurt. Even something as simple as a spoonful of fat-free greek yogurt four times a day is generally well tolerated (even in people with IBS and lactose intolerance). Anti-inflammatory foods:​ Foods that ease inflammation calm the digestive tract, too. Find out more in my article, ​A Crash-course on Inflammation and Nutrition​. Keep a food diary (date and time) of all problem foods, and when you experience symptoms. This is helpful for determining whether food preparation methods or certain combinations/timing of food is problematic. I once worked with a patient that had severe issues with pineapple, and raw spinach. Once she steamed lightly steamed the spinach, the problem went away. Cara is a low-cost app you can download to start tracking your symptoms today!

Stress management: Calming your body, mind and gut

Are you stressed? Does worry permeate your life and often? Stress is known to ​trigger IBS symptoms​. But you likely know this already. This happens because psychological strain increases visceral hypersensitivity, reduces motility, changes the gut microbiota, alters gut-brain interactions and leads to leaky gut. This means managing stress well is crucial. Simple enjoyable strategies to create calm include: Mindfulness Meditation Focused breathing Regular exercise Sufficient sleep Healing foods: Foods rich in B vitamins, zinc, and omega 3 fats are recommended. Wild-caught salmon, free-range eggs, and sunflower seeds are ideal.