Irritable bowel syndrome (IBS) is a common gastrointestinal disorder of the gut-brain interaction. Before going on any extreme diets or cutting out major food groups, we spoke to dieticians about how to implement healthy eating and lifestyle changes to curb those IBS symptoms.
Meet the experts: Emily Innes is a registered dietician. Sandi van Zyl is a registered dietician. Dr. Maré Du Plessis is a specialist surgeon in private practice at Mediclinic Milnerton in Cape Town
What Causes IBS?
First off, IBS is complex and challenging, not just for patients, but for healthcare providers, too. “The exact cause of IBS is multifactorial and not fully understood, though we do find it predominantly affects women,” says Dr Du Plessis. “Abnormal interaction between the brain and the gastrointestinal system plays a role, and untreated anxiety and depression can exacerbate symptoms.”
What Are The Symptoms Of IBS?
The symptoms that make up IBS are defined by abdominal pain, bloating, and intermittent constipation or diarrhoea. It’s no surprise that IBS can significantly impact your quality of life.
READ MORE: Everything You Really Need To Know About Irritable Bowel Syndrome
What Should I Do If I Think I Have IBS?
IBS is a lifelong chronic condition that can be managed via a range of methods, most of which are lifestyle interventions. If your suspect you might have IBS, you should definitely seeking medical help.
One of the key reasons IBS patients should consult a gastrointestinal specialist is to rule out other conditions that present with similar symptoms but are treated with medication or surgery.
An ultrasound of the abdomen can exclude gallstones, for instance. Endoscopy (gastroscopy/colonoscopy or both) can exclude polyps or colorectal cancer, or inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.
What Foods Trigger IBS?
Some of the known trigger foods include dairy products high in lactose (such as regular cow’s milk), foods containing gluten, onion, garlic, high-sugar foods, some artificial sweeteners, fried foods and those containing a relatively high ratio of fructose to glucose (think apples, pears, mango, watermelon, honey and raisins).
But… weirdly, some of these foods might not trigger any symptoms in some people and can be included in their diets without any problems.
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What Can Make IBS Symptoms Worse?
Gut Sensitivity
People with IBS may have a heightened gastrointestinal tract sensitivity, reacting to certain stimuli. “An elimination diet to pinpoint certain foods that your system reacts badly to may be indicated, but it is best to seek medical advice,” says Dr Du Plessis.
Abnormal Gut Motility
Disruptions in the rhythmic contractions of the intestines can result in alternating diarrhoea and constipation. “Over-the-counter medication is available to treat the symptoms of diarrhoea and constipation, but in severe or ongoing cases, it is best to seek medical advice,” advises Dr Du Plessis.
Inflammation
Although IBS is not characterised by inflammation, low-grade inflammation within the intestines might make symptoms worse. “Diet can be key here and it is worth experimenting with eliminating certain foods to pinpoint those that cause inflammation,” says Dr Du Plessis.
Hormonal Changes
Fluctuations in hormones, particularly in women during menstruation or perimenopause, may influence IBS symptoms. “If symptoms are severe, a gynaecologist or GP may order blood tests to check for hormone issues, and treat accordingly,” says Dr Du Plessis.
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Infections
Gastrointestinal infections, such as bacterial or viral infections, may trigger the onset of IBS symptoms in some individuals. “In severe or prolonged experience of IBS symptoms, medical advice should be ought to identify the possible cause, to rule out infection or other more serious conditions,” notes Dr Du Plessis.
The Gut-Brain Axis
The intricate connection between the gut and the brain plays a significant role in IBS. This is where untreated psychosocial issues like stress, life events, anxiety and depression come into play.
Dr Du Plessis advises that “talk therapy with a psychologist may help alleviate symptoms, and medication to treat the anxiety and depression can sometimes be indicated.”
Microbiota Imbalance
Alterations in the composition and function of gut bacteria are often associated with IBS. If this is your problem, probiotics can help restore the balance in your gut.
Food Sensitivities
Certain foods, including dairy, gluten, and FODMAPs, may trigger symptoms. FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides and polyols or carbohydrates (sugars) that are poorly absorbed by the small intestine. Per Dr Du Plessis, “an elimination diet is the most effective way to pinpoint foods that trigger IBS symptoms.”
Can The FODMAPS Diet Ease IBS Symptoms?
The FODMAPS diet is a dietary approach that helps limit symptoms of IBS through avoidance of some of the known trigger foods. “The idea behind it is that once your symptoms subside and your gut has had time to restore itself (which can take up to eight weeks), you slowly reintroduce the foods again to see what amount is tolerated.
In the interim, it might be necessary to supplement with B vitamins and calcium if you’re unable to meet your daily requirements for these nutrients,” says Sandi.
READ MORE: What Exactly Is The Low-FODMAP Diet And How Do You Do It?
Should I Take Supplements To Help My IBS?
Research shows that a healthy gut microbiome is essential when it comes to maintaining a healthy, well-functioning gut and overall health.
Dietician Sandi van Zyl says a diet rich in fibre and antioxidants and low in protein and saturated (animal) fat appears to be optimal when it comes to promoting a healthy gut microbiome. “Ironically, during active flare-ups of IBS, one often has to reduce the overall fibre content of one’s diet in order to best manage symptoms,” she says.
Some people have found relief from IBS symptoms by taking a mixture of digestive enzymes and probiotics. “This is a strategy that might work to relieve symptoms during active bouts of IBS. The strain and dose of bacteria in the probiotics is important. The general consensus is that strains from the Bifidobacterium and Lactobacillus bacteria are the most favourable and most likely to bring about an improvement,” says van Zyl.
Also, any supplementation with probiotics should be supported with good nutrition to ensure that the gut environment is suitable for optimal growth of healthy bacteria.
What Lifestyle Changes Can I Implement To Help IBS Symptoms?
Dietician Emily Innes says many people want to go on ‘elimination diets’ and cut out many foods to manage their symptoms, but it’s not great to jump straight into a restrictive diet. “One should first implement some healthy lifestyle changes. IBS may be affected by certain foods, but it can also be impacted by stress, depression and anxiety,” she says.
Dr Du Plessis strongly suggests establishing a daily toilet routine, saying it is crucial for symptom management. Consistency is key, and creating a fixed time every day to visit the toilet is beneficial. “It is important that patients make the time to form a daily habit, which typically takes 7-10 days to establish, as holding on to stools exacerbates the condition,” she says.
10 Lifestyle Changes You Can Make
- Eat regular meals. Don’t skip meals or leave long gaps between eating. Take time to eat your food and chew it properly.
- Drink at least eight cups of water per day.
- Restrict caffeine intake to three cups of tea or coffee per day and limit alcohol and gassy cool drink intake.
- Reduce your intake of processed foods.
- If you have diarrhoea you should avoid sorbitol. It’s an artificial sweetener in sugar-free sweets (including chewing gum) and drinks and in some diabetic and slimming products.
- People with wind and bloating may find it helpful to eat oats and linseeds (up to one tablespoon per day).
- Don’t eat insoluble fibre (for example, bran); rather get your fibre from soluble fibre, like oats.
- Exercise regularly.
- Make sure you’re getting enough good quality sleep.
- Put stress management strategies in place. Seek the help of a mental healthcare professional if you’re struggling with anxiety and/or depression. Set aside some downtime for yourself every day, whether it’s walking the dogs, meditating or reading a book.
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Prevention is better than cure
As with most things in life, it’s all about finding the right balance. “Often IBS sufferers can manage their symptoms effectively by managing their portion sizes and the combinations of food they eat. For example, having a bowl of watermelon, apple, raisins and honey all together might not be the best combination for someone prone to IBS. Having just one apple on its own might be perfectly okay,” says Sandi.