For the millions of people suffering with Irritable Bowel Syndrome, IBS is a dreaded acronym. In the world of gastrointestinal disorders, IBS, may be one of the most…annoying. Characterized by chronic abdominal pain or discomfort in conjunction with altered bowel habits, it’s estimated that IBS affects 10-15% of Americans, and disproportionately affects women. The signs and symptoms of IBS are not the most pleasant to talk about. They can include a mixture of constipation, bloating, gas, diarrhea, and abdominal pain. The exact cause of the disorder is still not completely understood, but multiple factors could be involved, including genetics, abnormal gut motility, and impairments in the gut-brain interaction.
Having a finicky gut is not fun, and there are a few reasons why IBS can be a particularly frustrating condition. First, unlike some other GI disorders like Crohn’s and Ulcerative Colitis, IBS lacks structural causes or biological markers that can be tested to make a diagnosis. So, there is no specific test for IBS, per se, rather a diagnosis is made after examining signs and symptoms and ruling out other possible causes. Second, symptoms of IBS may vary and change over time, which may mean having to explore several different treatment options. Finally, symptoms can range from mildly uncomfortable to severe. Severe symptoms, though not life threatening, can significantly disrupt a person’s life. And those individuals whose symptoms are mild might not seek treatment right away, if at all. In fact, according to the International Foundation for Gastrointestinal Disorders, fewer than half of people with IBS seek healthcare.
So how exactly can nutrition play a role in mitigating IBS? Well, the majority of people with IBS associate their symptoms with reactions to eating certain types of foods, known as triggers. One approach to ameliorating symptoms is removing all possible food triggers from the diet, then slowly re-introducing them over time to further identify specific triggers. This approach, called an “elimination diet,” can be effective when done under the supervision of a Registered Dietitian. Another standard approach to reducing IBS symptoms is to follow more broad dietary guidelines, i.e. have regularly scheduled meals and avoid lactose-rich, high-fat and/or gas-producing foods. This last group includes beans, cabbage, and onions, to name a few.
Finally, there’s the low FODMAP diet. If you have IBS or know anything about it, you’ve probably heard the acronym. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. In layman’s terms: certain types of carbohydrates and sugar alcohols that are not well digested and that may contribute to IBS symptoms. This approach gets a lot of attention in the discussion about managing IBS, and for good reason – research shows that it can work. The downside? FODMAPs are found almost everywhere in our food, and the foods that are high in FODMAPs also happen to be pretty nutritious. These include:
- Vegetables: Asparagus, cauliflower, garlic, mushrooms, onions
- Fruits: Apples, cherries, dried fruit, peaches, pears, plums, watermelon
- Dairy & alternatives: Cow’s milk, ice cream, yogurt, soy milk
- Protein: Most legumes, some processed meats
- Breads & cereals: Wheat, rye and barley; breakfast cereals
- Sweeteners: High-fructose corn syrup, honey
- Nuts: Cashews and pistachios
Personally, I would have a hard time giving up most of these foods (I can’t cook without garlic), even if it meant having a happier tummy. And it’s important to note that eliminating some or all of these foods means potentially cutting out essential mirco- nutrients, so it’s best not to try this on your own. Studies have shown that this approach works – although it may not work for everyone. Since people’s triggers and symptoms are so individualized, it’s crucial that treatment be individualized as well. A Registered Dietitian can help you identify personal food triggers and come up with a meal plan that’s best suited for you.
The bottom line? If you think you may have IBS—no matter how mild you believe your symptoms to be–consult with your doctor. If you’ve already been diagnosed, and are still struggling to effectively manage your symptoms, enlist the help of a dietitian who can help you explore nutrition therapy. Don’t let that dreaded acronym control your life.
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