IBS symptoms generally occur in response to some kind of trigger, which is often dietary or stress related. While emotional conflict and stress do not cause IBS, they are common triggers for IBS symptoms. In a person with IBS, the colon is more sensitive than usual and responds strongly to stimuli that would not bother most people. Eating causes contractions of the colon. Normally, this induces the urge to have a bowel movement within 30 – 60 minutes. For a person with IBS, this urge can come earlier and food intake is associated with gas, abdominal pain and sometimes alternating constipation & diarrhoea. The intensity of symptoms are often associated with the number of calories ingested and the amount of fat in each meal.
Nutritional Recommendations
IBS with Predominant Constipation: A diet high in protein and low in fiber from fruits, vegetables, and whole grains can be very constipating, so if you are predominantly constipated, increasing your intake of fruits and veggies, especially high fiber veggies -like cooked leafy greens including kale, collard greens, and broccoli – and high fiber fruits like apples, can really get your bowels going.
- Increase your fiber intake (a good goal is 30-50 grams/day) by eating a wide variety of vegetables, ideally 2 servings per meal, and include vegetables as part of your snacks. You can substitute fruit for one or two of your vegetable choices.
- Additionally, consider adding in 1-2 TBSP fresh ground flax seed into a daily shake, or onto your salads to increase your fiber intake.
- Consider taking 300-600 mg of magnesium citrate before bed each evening to get your bowels going regularly (start with the lower dose and adjust up or down until you have an easy regular daily BM)
- Add in a daily probiotic which can help with intestinal motility, which can also be slow if you have IBS with constipation.
IBS with Predominant Loose Stools: If you are more prone to loose stools, fruit and veggies, especially those high in fructose, can be a major trigger for you. If a high fiber diet gets you on the run, then:
- Try a Fructose Elimination diet for 3 weeks and see if this helps, along with improving your gut flora by treating dysbiosis. Lots of surprising foods contain fructose and can be causing your symptoms, so follow the fructose elimination diet completely, and keep a food journal as you go to be able to track improvements or symptoms.
- Take a digestive enzyme and a probiotic daily to help your body tolerate more foods by giving you the enzymes and bacteria you need to break down sugars and fats.
Visceral Hypersensitivity and IBS
One of the facts known about IBS is that “visceral hypersensitivity,” an extra-sensitive state of the intestinal lining in people with IBS, can be caused or aggravated by inflammation in the intestinal lining. Food sensitivities are one of the most common reasons for intestinal inflammation. Therefore, identifying your food triggers is key.
The most common foods that lead to intestinal irritation are: gluten-containing foods (anything with wheat, barley, or rye) and gluten cross-reacting grains, especially corn and dairy products including milk, yogurt, cheese, and other milk-based products (with the exception of butter which is usually easy to tolerate).
Of note, many people who are diagnosed with IBS might actually have celiac disease that has not been diagnosed. If taking gluten out of your diet significantly improves symptoms, and adding it back in aggravates them again, then also consider whether you could have celiac disease.
An Elimination Diet, done for at least 4 weeks, along with a 4R program to heal your intestinal lining, can help relieve sensitivity to many foods, however, you may be more permanently sensitive to either gluten or dairy, and might need to keep those out of your diet indefinitely. The reintroduction phase of the elimination diet can help you sort this out.
Food Sensitivity Testing
Alternatively, a simple blood test called the IgG food sensitivity test can identify which foods you are sensitive to – this is the preferred method of identifying sensitivities as it covers 220+ foods that may not be identified through the use of the elimination diet.
The Stress Connection
If you’ve ever had “butterflies” in your stomach, felt like “you just couldn’t stomach something,” or if you just “knew something in your gut,” you’re probably not surprised that science has established, beyond any doubt, that there is a direct relationship between the brain and the gut. In fact, the nerves in the intestine come from the same origins as the nerves in the brain and spinal cord in the fetus, and are closely connected in adults. As a result, chemicals that affect our nervous system, mood, and emotions affect our gut, and in someone with IBS, this connection is even more sensitive. It also works the other way around – symptoms in your gut can affect your emotions! Therefore, if you have IBS, you’ll want to have a set of tools you can use to keep your inner peace as much as possible.
Mindfulness and meditation have been shown to keep moods more even and helps to relieve IBS symptoms. These don’t require sitting in one place and breathing deeply for an hour – think of it more as learning to get into a tranquil mindset by using specific thoughts, images, or deep breathing to calm yourself and bring your emotions to center, while calming your gut. Use mindfulness before and during your meals to eat slowly and in a relaxed, enjoyable way, rather than anxiously eating because you’re anticipating symptoms after. Keep calm and don’t panic is a great way to think of it!
Dysbiosis
Western medicine has, until recently, pretty much overlooked the important role of the microbiome – the vast collection of bacteria and other organisms that live in our intestines (and outnumber us by factors of 100s!) in health. This is part of why an effective cure for IBS hasn’t been “discovered” by conventional medicine. However, as our awareness of the impact of diet, lifestyle, and emotional stress on the microbiome has grown, so too have our insights into how dysbiosis, or imbalance in the microbiome, can contribute to IBS.
If you experience gas, bloating, and particularly if it’s worse after meals, you likely have dysbiosis. What is dysbiosis? It’s too many of the harmful gut bugs, and not enough of the good ones. This can arise because of lack of variety in the diet, especially of high fiber vegetables, overuse of antibiotics and other medications like ibuprofen and PPIs (i.e., Prilosec) that impact the gut and gut flora health, as can prolonged stress. Most commonly, in functional medicine practice, we see conditions like SIBO, overgrowth of candida species in the intestines, and too little of the good guys like Lactobacillus and Bifidobacterium species.
Key ways to improve gut flora include:
- Eliminating medications that interfere with gut flora and gut health,
- Adding fermented foods into your diet on a regular basis (sauerkraut, kimchi, miso, and if you tolerate it, yogurt or kefir), and
- Taking a daily probiotic that contains the helpful species I mentioned above.
Sometimes it is also necessary to reduce the number of the not-so-great gut bugs using herbal medicines such as Oregon grape root, oregano or thyme essential oil, or others. In some functional medicine practices, severe dysbiosis is also treated with antifungal medications or a non-absorbing antibiotic.
4R Program
- Remove : Take out what ails you. Start with an Elimination Dietfor 2 weeks. Remove all of the triggers that irritate your gut including foods, medications (of course check with your doctor on this), and ideally, stress, too! If you have been diagnosed with Candida (yeast) in the past, or have a lot of gas, bloating, and either loose stools or constipation, you might want to do this phase in conjunction with a functional medicine doctor who can provide comprehensive stool testing to see if this is still a problem and who can work with you on supplements (or sometimes medications), to eliminate the yeast overgrowth.
- Replace:Add in digestive support. This includes digestive enzymes, and if you have a lot of nausea with meals or when you take supplements, you might also need something to improve your stomach acid with meals.
- Reinoculate:Add in a good quality probiotic to restore your gut flora. You want it to have a minimum of 5 billion CFUs in each dose, and a good range of Lactobacillus and Bifidobacter species. Fermented foods such as miso, sauerkraut, kombucha, and kimchee can also be helpful.
- Repair:There are a variety of following supplements that can be taken to help to heal the intestinal lining – always check with your healthcare practitioner to find the best for you!
- Turmeric, aloe vera, marshmallow root, and DGL licorice (aloe and licorice are not for internal use during pregnancy; these are fine for children) are some of the most effective herbs for healing the gut lining. They are best taken in capsule or extract form, though tumeric can also be added to foods. DGL licorice is available as chewable lozenges and thus may be the simplest one to give to kids. L Glutamine powder has fantastic research for repairing the gut lining as well!
As you can see, IBS requires an individualized and thorough approach that is best treated with your favourite healthcare practitioner!
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