Guidance for Irritable Bowel Syndrome

Irritable bowel syndrome, or IBS, is a class of disorders involving gut-brain interaction that affects up to 1 in 10 Americans. Diagnostic criteria includes abdominal pain at least once per week on average over the past three months associated with changes in stool frequency or form. Symptoms affect the large and small intestines and typically include periodic or chronic bloating, diarrhea, constipation, gassiness, and cramping.The cause of IBS is unknown, however genetics, allergies, infection, lifestyle, and gut microbiota may contribute to IBS and stress and certain foods may trigger symptoms. The large intestine has nerves that communicate with the brain, so stress can stimulate intestinal spasms resulting in pain and discomfort. Specific foods can initiate episodes of IBS, and many people with IBS notice that symptoms worsen after consuming high-fat foods or large meals.

Until recently, the medical advice provided to patients with IBS was to reduce stress and eat more fiber. Research has indicated that IBS can be managed with a focus on diet composition and eating habits, possibly with the assistance of medications, probiotics, and stress management. Consider the following modifications to your diet to provide relief from IBS and prevent future flare-ups.

• Consume small, frequent meals to ease the volume of food in the intestinal tract.
• Eat on a regular schedule to help regulate bowel movement. 
• Consume adequate fluid to help move foods through the intestine.
• Eat high-fiber foods, such as whole vegetables and fruits, beans, and whole grains (e.g., brown rice, rolled oats, whole-grain bread and pasta).
• Limit alcohol and caffeine, as both can stimulate the intestines and cause diarrhea. Note that beverages containing sugar alcohols can also stimulate diarrhea and carbonated drinks produce gas.
• A diet low in fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP) guided by a registered dietitian may help alleviate symptoms of IBS. FODMAPs are short-chain carbohydrates found in a variety of foods that are sometimes poorly absorbed in the gut. FODMAPs are fermented by gut bacteria and pull additional water into the intestine.

If you suspect you have IBS, be aware that additional testing may be needed if you observe blood in stool, unintended weight loss, or anemia. It is generally not necessary to test for food allergies/sensitivities unless reproducible symptoms exist. Blood tests to evaluate C-reactive protein levels and fecal lactoferrin are helpful to rule out inflammatory bowel diseases and celiac disease. Don’t allow IBS symptoms to interfere with your quality of life - a registered dietitian can help you identify triggers and learn how to manage symptoms.