What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome (IBS) is a commonly diagnosed chronic gastrointestinal disease defined by irritation in bowel habits and abdominal pain in the absence of known organic pathology (Weaver et al., 2017).
Individuals who suffer from IBS not only have to deal with the physiological symptoms of gastrointestinal distress, but approximately 40–60% experience psychological disorders that play a role in the cause of the disease, highlighting the cross-talk between the gut-brain axis leading to disorders such as depression or anxiety (Dekel et al., 2013).
Symptom-based approaches best recognize the IBS subtype of functional bloating, constipation, and diarrhea. Subtypes of IBS are controversial and should be based on stool form (Longstreth et al., 2006). For example, specific diagnoses include IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), IBS with mixed bowel patterns (IBS-M) and IBS undefined subtype (IBS-U) — symptoms vary. (Guilera et al., 2005).
Signs and Symptoms
IBS is a symptom-based disorder, and thus, treatment goals are aimed at resolving symptoms such as pain, bloating, cramping, and diarrhea or constipation. For constipation, fibre supplements and laxatives can be helpful. In those with diarrhea, medications such as loperamide or probiotics can be beneficial (Chey et al., 2015).
The main symptoms of IBS include, but are not limited to:
Stomach pain and cramping.
We are experiencing significant bowel changes – such as diarrhea, constipation or both.
Bloating of the stomach.
Excessive flatulence.
Less common symptoms include:
Lack of energy (feeling lethargy)
Feeling sick
Constant heartburn
IBS symptoms can also have a notable day-to-day impact on sufferers' lives, which can lead to some individuals experiencing symptoms of depressed mood and stress.
Individuals can often associate specific food intake with IBS symptoms. Foods with a wheat base, gluten, onions, certain fruits, vegetables, and some dairy can include short-chain, poorly absorbed, highly fermentable carbohydrates, which have also been associated with GI tract symptoms. These carbohydrates are known as FODMAPs (Chey et al., 2015).
What does an IBS-friendly diet look like?
Understanding the role of food in someone who suffers from IBS can be an essential tool in your toolbox, and seeking advice from a professional like a registered dietitian or clinical nutritionist can help you create a long-term diet plan to fit your lifestyle. An IBS-friendly diet should include foods that are low in specific carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) that have been known to cause gas, bloating, and abdominal pain by slowly fermenting in the intestines (Halmos et al., 2014). Low-saturated fat foods, such as lean meats that contain protein, have also been shown to help ease IBS symptoms (Chen et al., 2022).
Lean Meats
A study done by (Bellini et al., 2020) suggests the following protein sources are ideal for those who have been diagnosed with IBS:
White meat chicken
White meat turkey
Lean pork, and
Lean cuts of beef (such as sirloin, filet, top round, eye round, and bottom round). You should also be aware that even dark poultry (chicken or turkey) meat can be problematic for some people with IBS (Bellini et al., 2020).
Eggs, pasteurized
Although eggs are easily digestible and are considered a safe choice for people who suffer from IBS, not every person who has been diagnosed with IBS responds to eggs the same. Some are sensitive to the proteins found in the egg whites, while others react to the higher fat content of egg yolks (Melchior et al., 2022). Consuming eggs will have to be evaluated on an individual basis.
Fermented Foods
Probiotics are living nonpathogenic microorganisms known to produce several beneficial effects, such as gastrointestinal tract health. A natural source of probiotics is found in many fermented foods containing many natural strains of probiotics. (Satish Kumar et al., 2022) the study concluded that probiotics had shown tremendous benefits to IBS sufferers by slowing down the transit time of the colon, which will translate into the reduction of the total number of bowel movements daily, leading to a better quality of life for IBS individuals.
Some excellent probiotic-rich fermented foods include, but are not limited to:
Kefir
Kombucha
Kimchi
Pickles
Sauerkraut
Yogurt (unsweetened)
*(Satish Kumar et al., 2022)
Fatty cold-water fish
High levels of Polyunsaturated fats (PUFAs), also called omega-3 fatty acids, are found in fatty cold-water fish, which are powerhouse fish that contain nutrients linked to improving blood lipids and reducing inflammation. The reduction in gut inflammation from consuming more omega-3-rich cold-water fish is linked to lowering IBS symptoms (Ng et al., 2018).
The best Fatty Cold-Water Fish to help reduce IBS Symptoms include:
Mackerel
Salmon
Sardines
Low-FODMAP fruits and vegetables
Studies have shown that restricting FODMAPs in the diet reduces gastrointestinal symptoms in individuals with IBS. As a result, a low-FODMAP diet represents an opportunity for treatment in IBS sufferers (Magge & Lembo, 2012).
If you find some vegetables hard to digest, in that case, I recommend that you slightly cook or steam your vegetables before consuming them; introducing raw vegetables gradually to help reduce gas and bloating is also recommended. The best low-FODMAP fruits and vegetables include:
Broccoli
Carrots
Eggplant
Green beans
Sweet potato
Cabbage
Avocado,
Blueberries
Pineapple
Evidence-based Supplements for IBS
Depending on the type of IBS you are dealing with (IBS-C, IBS-D, IBS-M, or IBS-U), some supplements may be better than others, and that is why you should work with a healthcare professional who has a working knowledge of all the IBS types to determine the correct supplement protocol for you.
Probiotic Supplement
As previously mentioned, probiotics in food and dietary probiotic supplements with specific strains, including Lactobacillus, Bifidobacterium, and even Saccharomyces, have yielded some benefits for individuals with IBS. However, the exact number of species that bring specific therapeutic gains is unknown (Williams, 2010).
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One of the main ingredients that make up Healthology GUT-FX is the amino acid L-glutamine, found in a 2019 study to improve symptoms in people with IBS-D who developed diarrhea-predominant IBS following an intestinal infection (Zhou et al., 2018). GUT-FX is the ultimate formula to repair your intestinal tract lining, heal inflammation, support healthy gut flora, and restore your gut health. Another essential ingredient that plays a role in IBS is Marshmallow Root, which soothes the digestive lining to improve symptoms of gastritis, digestive upset, and IBS (Wright et al., 2021) (Deters et al., 2010).
Enteric-coated Peppermint Oil
A systematic review and meta-analysis by (Khanna et al., 2014) aimed to evaluate the effectiveness of enteric-coated peppermint oil supplements for treating IBS found that peppermint oil was notably better than a placebo for improving IBS symptoms. Although peppermint oil subjects were much more likely to experience an unfavourable reaction such as heartburn, researchers concluded that peppermint oil was a safe and effective short-term fix to treat IBS (Khanna et al., 2014).
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Two Types of Fibres Depending on IBS-Symptoms
When we observe the correct diet-based treatment available to IBS sufferers, there are two different approaches to consider based on which type of IBS you have. The focus is on two distinct categories of carbohydrates that are not digestible in the human gastrointestinal tract. One targets dietary fibre (DF), while the other highlights the symptom affliction by fermentable oligo-, di-monosaccharides and polyols (FODMAPs) (Chouinard, 2011).
Dietary fibre (DF) types are best for improving IBS symptoms by enhancing stool hardening, frequency of defecation, stool bulking, and abdominal pain (Cameron-Smith et al., 1994). A variety of different DFs have been tested concerning their potential for treatment of IBS. Certain DFs, such as partially hydrolyzed guar gum and psyllium husk fibre, have been identified to improve IBS patients' overall quality of life (Campbell et al., 2017).
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The second type is FODMAPs. This fibre describes carbohydrates that are neither digested nor absorbed in the gut and helps people with IBS-D or small intestinal bacterial overgrowth (SIBO). These individuals react best to low-FODMAP soluble fibre (Varney et al., 2017).
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Food and Drink Triggers to Avoid
There are certain foods that IBS patients associate with their symptoms and perceive as food intolerance. For example, when we look at individuals with IBS-D, there may be a higher prevalence of food-triggered reactions. The most widespread foods that have been reported as symptom triggers are fruits (citrus, banana), grains (wheat, barley, rye, oats, corn), vegetables (onions, peas, potatoes), dairy products (yogurt, milk, cheese, eggs, butter), legumes (beans, lentils), and fried foods (Böhn et al., 2013) (Eswaran et al., 2011). These foods should be eliminated or tested for sensitivities before regular consumption.
Alcoholic beverages
Several studies have been inconclusive or conflicting regarding alcohol and alcohol intake (Heizer et al., 2009). However, studies indicate that for individuals with IBS-D, the consumption of alcoholic beverages may exert a more substantial influence on symptom severity than those individuals with IBS-Cs or IBS-Ms (Reding et al., 2013).
Caffeine
High sources of caffeine, including tea, soda drinks, and chocolate, can stimulate gastric acid secretion and colonic motor activity, particularly coffee, which can increase diarrhea and other symptoms of IBS (Eswaran et al., 2011). In a research study of 330 IBS patients, coffee was in the top ten most frequently reported foods producing symptoms, and the three most common symptoms reported were indigestion, pain, and loose stools (Böhn et al., 2013).
Final Takeaway
(IBS), whether you are dealing with IBS-D (diarrhea and abdominal discomfort), IBS-C (mainly constipation and abdominal pain), IBS-M (mix or alternating loose stools and constipation with abdominal discomfort), or IBS-U (undefined subtype — symptoms vary), it can present daily challenges regarding meal planning at home or eating out with friends and family members. There are a lot of variables to consider with IBS symptoms, and that's why I highly recommend that you work with a dietitian or clinical nutritionist to determine food choices, supplement protocol and mindfulness practice to calm your mind.
References
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Böhn, L., Störsrud, S., Törnblom, H., Bengtsson, U., & Simrén, M. (2013). Self-reported food-related gastrointestinal symptoms in ibs are common and associated with more severe symptoms and reduced quality of life. American Journal of Gastroenterology, 108(5), 634–641. https://doi.org/10.1038/ajg.2013.105
Cameron-Smith, D., Collier, G. R., & O'dea, K. (1994). Effect of soluble dietary fibre on the viscosity of gastrointestinal contents and the acute glycaemic response in the rat. British Journal of Nutrition, 71(4), 563–571. https://doi.org/10.1079/bjn19940163
Campbell, G. M., Ross, M., & Motoi, L. (2017). Bran in bread: Effects of particle size and level of wheat and oat bran on mixing, proving and baking. In Bubbles in food 2 (pp. 337–354). Elsevier. https://doi.org/10.1016/b978-1-891127-59-5.50037-7
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