Navigating IBS With Diet and Lifestyle
- Brainz Magazine
- 5 days ago
- 11 min read
Katarina Lijovic is a Functional Nutrition and Holistic Wellness expert who successfully applies her konwledge and skills to help individuals and communities to optimize their health and quality of life.
If you are diagnosed with irritable bowel syndrome (IBS), you are not alone. IBS is one of the most common gastrointestinal disorders and health concerns in modern society, with prevalence estimated at 5% to 10% worldwide. Approximately every 1 in 7 adults is affected by IBS, which can significantly reduce quality of life due to uncomfortable symptoms such as cramping, abdominal pain, gas, diarrhea, constipation, or even both. Yet, many people remain undiagnosed and unaware that their symptoms indicate a medically recognized disorder.
Researchers continue to explore the exact cause of IBS but believe that a complex combination of factors, such as an altered gut microbiome and disturbances in the gut-brain axis, are the main contributing factors for the onset of IBS. Gut microbiome dysbiosis and changes in the gut bacteria and its metabolites can trigger immune responses, alter gut-brain communication, and influence motility overall. One of the reasons for the altered gut microbiome lies in the worldwide spread “Western diet” or “Standard American diet” (SAD) which is characterized by frequent consumption of fried foods, trans fats, highly processed foods with endless list of food additives, colorings and flavors, sugars, sweets, sugary drinks, and simple, refined carbohydrate, and, at the same time, low consumptions of fiber, healthy fats, fruits, and vegetables. Overall, people have less diverse diets that are packed with processed foods, which negatively affects the gut microbiome, and these changes can lead to different GI issues, such as IBS. In addition, a fast-paced life, chronically elevated stress levels, and the stress hormone cortisol have a major influence on the onset of IBS. Key risk factors for IBS include lifetime stress, depression and/or anxiety, and poor diet and sleep quality. Other risk factors include obesity, smoking, and increased use of certain medications.
The incidence of IBS has increased drastically over the last few decades, which can be attributed to the “Western diet” and consequent alterations in the gut microbiome. Interestingly, IBS is more prevalent in women. The consequences of IBS are intestinal irregularity, pain, nutritional status disruption, poor quality of life, and considerable cost for both the patient and the healthcare system, which is why it is crucial to address these conditions with effective dietary and lifestyle interventions. IBS International Awareness Month falls in April each year and this year the focus is on educating the public about the symptoms, treatment options, and challenges faced by individuals living with IBS.
What is IBS?
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, and it is defined as “abdominal discomfort associated with altered bowel habits”. IBS is considered as a “functional” disorder because tests don’t show histologic abnormalities, and that is why diagnosis is determined based on the symptoms. Rome IV criteria (recurrent abdominal pain is present at least one day in a week for the past three months and is related to defecation, change in stool frequency, and appearance of stool) is used to determine the IBS subtype and to determine a diagnosis based on the presence of GI symptoms. Patients can be classified into four major subtypes based on the stool pattern - IBS with constipation (IBS-C); IBS with diarrhea (IBS-D); IBS with mixed bowels (IBS-M), and unclassified IBS. Oftentimes, there are no clinical signs of IBS, and test results may come back normal. IBS is characterized by unexplained abdominal discomfort or pain that is associated with changes in bowel habits. Other symptoms are gas, bloating, diarrhea, and constipation, and they can be vague and transient, which makes it difficult to make a final diagnosis. Patients with IBS typically also experience food intolerances, mood disorders, and bacterial overgrowth in the small intestine, all of which can also potentially cause IBS. Symptoms occur without any visible signs of damage or disease in the gastrointestinal tract. Symptoms are often exacerbated by stressful events, and individuals usually link their symptoms with stress. The symptoms of IBS are common in other gastrointestinal diseases; thus, it is important to exclude those diseases by conducting different tests and by taking a thorough history. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, infections, stress, altered gut microbiome, anxiety, and food sensitivities.
In addition, it is important to distinguish IBS from IBD (irritable bowel disease such as Chron’s disease or Ulcerative Colitis) because these two can be confused oftentimes due to similar names and acronyms, and sometimes people might think it is the same health condition, so let’s clarify this confusion. The main difference between the two is that IBD is a disease and IBS is a syndrome, a collection of signs and symptoms. IBS is different from IBD because there are no histological (tissue) changes or damage in the GI tract in IBS, and diagnosis is determined based on the patient’s GI symptoms according to the Rome IV criteria. On the other hand, IBD is accompanied by histological changes (tissue damage) in the GI tract, which can lead to permanent harm to the intestines. For example, there are ulcers in Ulcerative Colitis. Furthermore, during an imaging scan test, IBD can be seen as there are changes in the lining of the intestines in the GI tract, while there is no sign of abnormality during diagnostic imaging in IBS. In IBS, radiology/endoscopy tests do not show signs of inflammation. Also, in IBD, blood can be detected in the stool, which is not the case in IBS.
Gut microbiome, gut-brain axis, stress, and IBS
Alterations in the gut microbiota play a crucial role in the pathogenesis of IBS. Research has shown that the gut microbiome in IBS patients differs from healthy controls. Patients with IBS have lower fecal Lactobacillus and Bifidobacterium (the beneficial bacteria) and higher Escherichia coli and Enterobacter (harmful bacteria), which means that IBS is associated with dysbiosis in the gut microbiome. Also, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. The imbalance of the beneficial and harmful bacteria causes the intestinal microbiome barrier to be compromised, allowing other pathogens to enter and causing more harm to the gut. Gut dysbiosis (loss of microbial diversity and richness and increased number of pathogens in the gut) and alterations in gut microbiota are involved in the pathogenesis of IBS due to altered immunity and integrity of the gut barrier, neuromuscular junctions, and gut-brain axis. Also, small intestinal bacterial overgrowth or SIBO is oftentimes seen in patients with IBS, and it is considered to be as one of the root causes a swell. Furthermore, IBS is linked to low-grade mucosal inflammation, and that inflammation, coupled with an altered gut microbiome, are possible underlying factors for IBS pathogenesis. Also, stress is a contributing factor and stress worseness the symptoms of IBS. Patients usually have changes in their gut motility or bowel movements when faced with a stressful event, and that is linked to the gut-brain axis, a bidirectional communication between the gut and the brain. In fact, IBS patients commonly suffer from comorbid disorders such as depression and anxiety.
Diet and nutrition for IBS
Diet is both an important therapy in IBS and the most powerful modulator of the gut microbiota, which must be restored in the patients with IBS. Also, diet plays a critical role in the symptom management and IBS activity. The influence of diet is unique to each person and there is no one-size-fits-all dietary protocol that will work for every person with IBS. A traditional dietary advice for individuals with IBS was to avoid caffeine, alcohol, spicy and fatty foods. However, in the past years, the growing evidence showed that there is more than just avoidance of these types of foods and drinks. Dietary recommendations must be individualized as every patient has different symptoms, triggers, and GI issues. Also, some foods can be bothersome at certain times but not at other times. It is helpful to keep a food journal to know which food triggers the symptoms. The general dietary recommendation for IBS is a healthy, well-balanced diet that is rich in nutrient-dense foods and anti-inflammatory foods. Individuals with IBS should have regular meals, eating and chewing slowly, avoiding foods that trigger their symptoms, avoiding high-fat foods, spicy foods, processed foods, refined grains, sweets, trans fats, sugary drinks, avoiding overeating and eating smaller portions, reducing alcohol intake, and limiting coffee consumption. Increased intake of dietary fiber, especially soluble fiber (i.e., psyllium) to 20-30 g/day is recommended for individuals with IBS with constipation (IBS-C) because fiber increases stool bulk and facilitates passage. It is also important to pay attention to fluid intake, especially in IBS-D type, as diarrhea can lead to dehydration. Furthermore, a common treatment approach is to avoid the foods that trigger symptoms. An elimination diet is the most effective way to find out which foods are triggering IBS symptoms, and one such diet is the low-FODMAP diet. The FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) elimination diet, or low-FODMAP diet, is primarily prescribed to patients with IBS to manage their symptoms and to improve their quality of life. These foods contain lactose, fructose, fructo-oligosaccharides (fructans), galacto-oligosaccharides (galactans), and polyols or sugar alcohols (sorbitol, xylitol, mannitol, iso-maltase, and maltitol). FODMPs are made up of these fermentable carbohydrate portions of plant-based foods, and these plant foods are rapidly metabolized and fermented by bacteria which increases gas production and causes intestinal dysmotility. Also, FODMAPs are poorly absorbed in the small intestine and are highly osmotic. All these can cause discomfort, pain, and diarrhea in individuals who are sensitive.
When FODMAPs are eliminated/reduced, the symptoms are also eliminated. The elimination diet usually lasts for several weeks (4-6 weeks), and symptoms can be improved after already two weeks. The reintroduction phase is the challenging part because it is a long-lasting period of reintroducing each food item individually for a period of a few days to eliminate or confirm the sensitivity to that food. The goal is to introduce FODMAP foods at the most tolerable level or to avoid certain foods that patients cannot tolerate even in small amounts. Foods are gradually reintroduced, which helps patients to identify which foods are causing digestive issues, and this helps in improving the patient's quality of life and general well-being. After identifying troublesome foods, foods that are well-tolerated are reintroduced back into diet. Additionally, some foods can be tolerated but in lower quantities than before. Most individuals with IBS can alleviate and manage their symptoms with a low-FODMAP diet and, most importantly, identify the foods that are triggering IBS. Other than that, some individuals can consider a gluten-free diet and lactose or dairy-free diet. It is important to note that low-FODMAP is a short-term dietary regimen (6-8 weeks) or protocol that should not be used for a prolonged period of time because low-FODMAP diet is associated with nutritional deficiencies and a reduction in the quality and diversity of the diet which may disturb the gut microbiota and potentially reduce total bacteria abundance. Nutritional deficiencies that can occur if person follows a low-FODMAP diet for prolonged period of time are deficiencies in vitamins B1, B2, B9, D, and calcium, iron, and magnesium deficiency.
Supplements for IBS
Nutritional and botanical interventions have been associated with a potential to impact dysbiosis and rebalance and heal the gastrointestinal tract and microbiome. When it comes to herbal remedies, research has shown that peppermint oil (in the form of an enteric-coated supplement) and peppermint tea are effective in the management of the symptoms of IBS such as abdominal pain and/or cramping and constipation because peppermint oil (PO)contains L-menthol that exerts antispasmodic effects on the gastrointestinal tract. Also, PO exerts antimicrobial, anti-inflammatory, antioxidant, immunomodulating, and anesthetic activities, which can all help in alleviating symptoms of IBS. PO has a relaxing effect on the intestinal smooth muscles. Omega-3 fatty acids and vitamin D can support the restoration of gut microbiota and reduction of symptoms and inflammation, which is common in patients with IBS. These supplements will help and support immune system too and build a strong foundation that will support healing. Probiotics, prebiotics, and synbiotics are helpful for IBS because they can restore gut microbiota and gut lining and modify the altered gut microbiome, which is all involved in the pathogenesis of IBS. Many studies utilizing specific probiotic strains (Lactobacillus plantarum, Lactobacillus bulgaricus, Bifdobacterium infantis) to mitigate symptoms associated with IBS have shown a reduction in abdominal pain, bloating, gas, average number of daily bowel movements, reduction in urgency, and improved stool consistency.
Lifestyle modifications for IBS
There are several lifestyle interventions that can help in reducing the symptoms of IBS, such as mindful eating, limiting over-the-counter medications, regular exercise, yoga, relaxing techniques such as deep breathing exercises and meditation, and regular sleep. Stress management is critical as well because stress can exacerbate IBS. Regular exercise, movement, and yoga practice have been effective in the management of IBS symptoms. Quitting smoking can help improve symptoms because smoking can irritate the gastrointestinal system and lead to increased gut motility, which can trigger IBS symptoms, especially for those with IBS-D. Stress and anxiety are known to trigger or exacerbate IBS symptoms. Managing stress is a key component of controlling IBS. Meditation and deep breathing exercises can calm the mind, activate the parasympathetic nervous system (the “rest and digest” system), promote relaxation, lower the stress, and lower the GI discomfort. Relaxation exercises can help relieve not only stress but also help the patient cope with her anxiety related to her symptoms. Physically active individuals have more frequent bowel movements and more rapid colon transit than sedentary individuals. Research have shown that there is a significant reduction in IBS symptoms in patients who performed 20 to 60 minutes of moderate to vigorous physical activity three times a week for 12 weeks. Patients performing yoga experienced significantly decreased bowel symptoms, IBS severity, and anxiety compared with conventional treatment. The patients who performed yoga also showed significant improvements in quality of life, global improvement, and physical functioning, compared with no treatment. However, avoid overexercising, as too much physical activity can sometimes exacerbate IBS symptoms in some individuals.
Key takeaways
Everyone with IBS is different, with different triggers and different symptoms. Diagnosing IBS can sometimes be a process of elimination, meaning other conditions must be ruled out before a final diagnosis can be made. For example, if you have bloody stools or unexplained weight loss, it could be a sign of something other than IBS, and more tests would be needed. A highly personalized approach in the management of IBS is the key. It is important to identify foods (with the elimination diet) and other lifestyle factors that trigger the symptoms of IBS. At the same time, focus should be on the building and restoring the strong foundation and the “terrain” with proper diet and lifestyle modifications. In this process, it is critical to address gut microbiome as altered gut microbiome (i.e., gut dysbiosis) is the underlying cause for IBS. A healthy gut microbiota is resilient; on the other hand, compromised gut microbiota (dysbiosis) can lead to immune system dysregulation and changes in intestinal permeability, which can lead to intestinal inflammation and alterations in the gut-brain axis, all of which can be found in patients with IBS. By experimenting with these dietary adjustments and lifestyle modifications, many people with IBS find relief and can manage their symptoms more effectively. It’s important to work with a healthcare provider and/or nutritionist to find the right approach for your unique needs. If you need professional guidance and support in the management of IBS, reach out to me. Living with IBS can be exhausting; let’s work together to help you identify the triggers and create a plan for symptom management and healing.
Read more from Katarina Lijovic
Katarina Lijovic, Functional Nutrition Counselor/Nutritionist
Katarina Lijovic is a Nutritionist and Functional Nutrition Counselor who focuses on addressing the root causes of nutritional imbalances and health concerns, rather than merely managing symptoms. By using a holistic, personalized approach, Katarina works to optimize an individual’s health through tailored nutrition plans, lifestyle modifications, and evidence-based practices. Her mission is to guide individuals toward long-term, sustainable solutions. With her focus on prevention and balance, Katarina empowers individuals to make informed choices that support their overall health and well-being.
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