IBS: Decoding the Gut Puzzle
Irritable Bowel Syndrome (IBS) is a prevalent gastrointestinal disorder that affects people worldwide. Characterized by a range of symptoms, including abdominal pain, bloating, and changes in bowel habits, IBS can have a considerable impact on a person's quality of life. It involves a combination of factors making IBS somewhat of a blanket diagnosis and it’s important to get to the root cause of your symptoms. Studies indicate that Small Intestinal Bacteria Overgrowth (SIBO) is an underlying factor in up to 70% of IBS cases. IBS affects approximately 9-23% of the total population, making it one of the most common digestive disorders encountered today.1
The pathophysiology of irritable bowel syndrome (IBS) is multifaceted, involving various factors that contribute to its development and persistence. Classified under the ROME III criteria, there are three predominant subtypes: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and mixed IBS with both (IBS-M or IBS-A for alternating).1
Brain-gut interactions, bacterial overgrowth, carbohydrate malabsorption, food sensitivities, intestinal inflammation, nutritional deficiencies, and biochemical imbalances all have shown to play a role in this condition.1 For example, excessive consumption of certain fermentable carbohydrates (FODMAPs) can trigger symptoms like bloating and diarrhea while insufficient fiber intake may contribute to bowel irregularities.2 Alterations in gut microbiota composition, and gut motility disrupt normal digestive processes, leading to symptoms such as abdominal pain and altered bowel habits. Dysregulation of neurotransmitters and hormones involved in gut-brain communication, such as serotonin, can contribute to the development and persistence of IBS symptoms.2 Understanding the interplay of these factors is vital in exploring potential strategies for managing and alleviating its symptoms.
Dietary Interventions:
One of the most recommended dietary plans for managing irritable bowel syndrome (IBS) is the Low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet.3 FODMAPs are a group of carbohydrates that are poorly absorbed in the small intestine, leading to increased water content and gas production in the colon, which can trigger symptoms in individuals with IBS. The Low FODMAP diet involves restricting high-FODMAP foods for a specific period, followed by systematic reintroduction to identify trigger foods. This diet aims to reduce symptom severity and improve gut function. Some key foods included in the Low FODMAP diet are fruits such as berries, oranges, grapes, and pineapples; vegetables such as spinach, carrots, zucchini, and bell peppers; gluten-free gains such as quinoa, rice, oats, and corn; protein such as lean meats, poultry, fish, and tofu; lactose-free dairy alternatives such as almond milk, lactose-free yogurt, and hard cheeses; fats and oils such as olive oil, coconut oil, and avocado.3
A randomized controlled trial published in the Journal of Gastroenterology and Hepatology found that following a Low FODMAP diet for 4-8 weeks significantly reduced overall IBS symptoms, including abdominal pain, bloating, and flatulence, compared to a typical Western diet.4
However, it is critical that you only follow a low FODMAP diet for a short period of time, following the diet long-term has been shown to lead to more gut imbalances due to lack of food variety in the diet. Additionally, the low FODMAP diet has some potential drawbacks to consider. One is the restriction and limited choices it entails, which can make meal planning and social situations challenging. To address this, work with a professional that can help you navigate the diet and enjoy a diverse eating plan.
When implementing a low FODMAP diet, you may want to consider ginger as a therapeutic food. Ginger has long been recognized for its medicinal properties and is commonly used to aid digestion and relieve gastrointestinal symptoms.5 It contains active compounds, such as gingerols and shogaols, which have anti-inflammatory and anti-spasmodic effects on the digestive system.5 Nausea is a common symptom associated with IBS so it may be worth adding into your diet if this is a symptom you experience.
Dietary Supplements for Managing Irritable Bowel Syndrome (IBS)
While supplementation depends on underlying causes, there are a few general dietary supplements that have been shown to be helpful in IBS.
1. Peppermint Oil: Peppermint oil is a botanical supplement commonly used to alleviate symptoms of IBS, particularly abdominal pain, bloating, and flatulence. It is important to use enteric-coated capsules, which help allow the oil to get to the intestines for targeted action. The recommended dose is typically 0.2-0.4 mL taken three times daily.6 Some individuals may experience heartburn or allergic reactions to peppermint oil. It’s important not to use this if you struggle with GERD or indigestion (especially if it’s not enteric-coated as the oil can relax the lower esophageal sphincter and contribute to indigestion symptoms) or if you have a known allergy. It may also interact with certain medications, such as antacids, cyclosporine, and certain blood pressure medications.6 Consult a healthcare professional before starting peppermint oil supplements, especially if you have underlying medical conditions or take prescription medications.
2. Probiotics: Probiotics are dietary supplements containing beneficial bacteria that support gut health. They can help rebalance the gut microbiota and improve symptoms associated with IBS, such as bloating, gas, and bowel irregularities.7 Various strains and formulations of probiotics are available, including lactobacilli, bifidobacteria, and combination products. When considering probiotics, the specific strains, dosage, and duration of use can vary. It is best to choose a probiotic product that contains strains with evidence supporting their efficacy in IBS, such as Bifidobacterium breve, Lactobacillus plantarum, or a combination of strains.7 Dosages typically range from 1 to 10 billion colony-forming units (CFUs) per day, depending on the specific strain and product.7 While generally considered safe, individuals with compromised immune systems, critically ill patients, and those with indwelling medical devices should use probiotics with caution. Additionally, some individuals may experience mild digestive symptoms, such as bloating or gas, when starting probiotics. Consult with a healthcare professional if you have any concerns or are taking medications that may interact with probiotics.
Self-Management:
Take control of your irritable bowel syndrome (IBS) management through self-management techniques. Education is key to empowering yourself and improving your health outcomes. Start by understanding IBS, including its symptoms and triggers. Stress management techniques, like deep breathing and mindfulness, can help reduce IBS symptoms.8 Engaging in regular physical activity promotes better digestion and overall well-being.
In conclusion, managing irritable bowel syndrome (IBS) requires a comprehensive approach that encompasses dietary interventions, targeted supplements, and self-management strategies. The Low FODMAP diet has proven effective in reducing symptoms and improving quality of life for individuals with IBS. Incorporating therapeutic foods like ginger can further support symptom relief. Additionally, dietary supplements such as peppermint oil and probiotics have shown promise in alleviating IBS symptoms. However, it is crucial to consult with a healthcare professional before starting any new supplement. Embracing self-management techniques, including education, stress management, physical activity, and effective communication with healthcare providers, empowers individuals to take control of their IBS and enhance their overall well-being.
References:
1. Saha L. (2014). Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World journal of gastroenterology, 20(22), 6759–6773. https://doi.org/10.3748/wjg.v20.i22.6759
2. Ross, Kim. Lower GI. Recorded Lecture. Sonoran University of Health Sciences Instructure. Accessed 5/14/23. https://sonoran.instructure.com/courses/5721/assignments/62901?module_item_id=274056
3. Black, C. J., Staudacher, H. M., & Ford, A. C. (2022). Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut, 71(6), 1117–1126. https://doi.org/10.1136/gutjnl-2021-325214
4. Nanayakkara, W. S., Skidmore, P. M., O'Brien, L., Wilkinson, T. J., & Gearry, R. B. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and experimental gastroenterology, 9, 131–142. https://doi.org/10.2147/CEG.S86798
5. Giacosa, A., Morazzoni, P., Bombardelli, E., Riva, A., Bianchi Porro, G., & Rondanelli, M. (2015). Can nausea and vomiting be treated with ginger extract?. European review for medical and pharmacological sciences, 19(7), 1291–1296.
6. Kligler, B., & Chaudhary, S. (2007). Peppermint oil. American family physician, 75(7), 1027–1030.
7. Dimidi, E., & Whelan, K. (2020). Food supplements and diet as treatment options in irritable bowel syndrome. Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society, 32(8), e13951. https://doi.org/10.1111/nmo.13951
8. Moloney, R. D., Johnson, A. C., O'Mahony, S. M., Dinan, T. G., Greenwood-Van Meerveld, B., & Cryan, J. F. (2016). Stress and the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome. CNS neuroscience & therapeutics, 22(2), 102–117. https://doi.org/10.1111/cns.12490