Irritable bowel syndrome (IBS) is a long-term condition characterized by abdominal pain, bloating and changes in the bowel movements. It is a disorder which is known for its ability to go into remission for months, only to flare up again all of a sudden.
This very unpredictability can cause depression and a lower quality of life, especially because all the triggers are not usually identified. As there is no cure for this condition, a lot of improvement can be seen by introducing changes to everyday diet and lifestyle in general.
The first step in facing IBS is to modify your eating habits. Some useful tips may be:
- If you have diarrhea, eat smaller meals more regularly, and eat more frequently. Reduce your portion size. This will leave less undigested food lying around in your bowel to be fermented, causing less gas and therefore less symptoms.
- Eat at regular times, but eat more at each time, and especially more fiber, if you have constipation.
- Eat foods which are low in fats and contain more carbohydrates - especially fruits, vegetables, and whole grains. The fiber in these foods may help soften the stool so that constipation is relieved. However, all fiber is not the same.
- Soluble fiber is found in foods like oats, rye, barley, fruits such as bananas and apples, and some root vegetables like carrots. Increasing the soluble fiber in the diet, with plenty of water or herbal teas, may relieve constipation. Insoluble fiber is found in whole grains like wheat, most nuts, and seeds. Patients with diarrhea may find it helps to reduce the amount of insoluble fiber, including the above foods as well as seeds, skin, and pith, in fruits and vegetables.
- Fiber should be added in small quantities (2-3 grams a day) to allow the body time to adapt to it. Some forms of fiber may be fermented by the gut bacteria, adding to the discomfort of patients with IBS, who may develop abdominal cramps and bloating. Three apples a day should be more than adequate to supply your need for fiber without overloading the gut with fermentable substrate.
- If you do not feel that increasing the fiber through food is working, substitute fiber supplements. Always make sure to drink plenty of water before and after taking them. Continue to take them long-term if they help.
- Avoid drinking through straws or chewing gum, because it can increase the amount of air you swallow, worsening your gas.
- Have plenty of water every day, rather than other beverages.
Keeping a food diary can also aid in managing IBS. It should contain all the foods you eat, and the times at which you eat them. Also note the symptoms you feel, and when you feel them. This will help you find out if any foods trigger your symptoms, and if so, under what conditions. Such foods should be avoided. Some likely suspects include:
- Fatty food
- Dairy and dairy products - try substituting yogurt for milk, take lactase supplements, or combine milk in small amounts with other foods to test how far you can tolerate lactose
- Alcohol and caffeine-containing beverages and medications which can worsen diarrhea, and sodas which can worsen the bloating
- Artificial sweeteners such as xylitol or sorbitol
- Beans and other legumes should be tested one by one
- Cabbage and other cruciferous vegetables should be tested one by one
- Resistant starch, which is often found in processed or recooked foods, can cause gassy symptoms because it is not easily digested and provides a substrate for bacterial fermentation
Make sure that when you have to delete one vegetable or fruit from your diet, you add in another that you like and which doesn’t create problems, so that you continue to have a healthy balanced diet.
Ask your doctor about the low FODMAP diet which focuses on avoiding or eating very little of the following specific foods, which have carbohydrates that are hard to digest:
- Fruits or fruit juice made from apples, apricots, blackberries, cherries, plums, pears, mangos, watermelon; in addition, dried or canned fruit with natural fruit juice should be cut back
- Vegetables such as asparagus, artichokes, beans, cabbage, cauliflower, garlic, garlic-containing seasonings, lentils, snow peas, snap peas, mushrooms and onions
- Dairy products such as milk, soft cheese, ice-cream, yogurt and custard
- Grains - wheat and rye, or products made from them
- Sweeteners such as honey, high-fructose corn syrup and artificial sweeteners ending in “–ol,” (such as sorbitol, mannitol and xylitol)
Exercise and medication
Exercise regularly and in moderation. It not only helps move your bowels, and relieve constipation, but mitigates depression and relieves stress. Start slowly and build up, and discuss it with your doctor first if you haven’t been exercising regularly.
Medications that are available over the counter include anti-diarrheals and laxatives. Use the smallest dose that helps, and use them infrequently. You may get so used to them that your bowel refuses to move without them, so use them only if you need to, as when your meal includes some food that could cause diarrhea.
Learn and practice techniques to help you relax and stop worrying because these emotions perpetuate the vicious cycle that operates between the brain and the enteric nervous system, the nerve supply to the gut. Stress relief may involve:
- Breathing exercises
- Relaxation techniques such as taking a retreat, slow deep breathing exercises
- Exercise which relaxes and tones the body, and also strengthens the mind-body connection, such as yoga postures, Pilates, or tai chi
- Walking, running, or swimming can help a lot, by distracting the mind from the internal sensations and providing new and better stimuli as well as a sense of well-being and achievement(with the additional physical benefit of exercise)
Reviewed by: Dr Tomislav Meštrović, MD, PhD