Chronic stomachaches. Constipation and/or diarrhea (and sometimes both, alternating). Bloating and gas. These are all symptoms of irritable bowel syndrome (IBS).
This is the most common abdominal complaint I see, after reflux symptoms. Generally patients have been told to decrease their stress level and eat more fiber. These are helpful, as low fiber intake and high stress levels are associated with IBS. However, often these measures aren’t successful in completely resolving symptoms.
I wanted to review 3 very effective strategies for helping patients get their irritable bowel syndrome symptoms under control. Note I don’t say “treating irritable bowel syndrome.” That’s because the focus in managing irritable bowel syndrome is on patient self-management. There’s no magic pill to fix it, it’s an ongoing process of self-care that leads to the best results.
1. Probiotic therapy
One of the simplest and, in my experience, most effective strategies for improving IBS symptoms is a high-quality probiotic supplement. Probiotic supplements have been proven effective at improving the pain and other symptoms of IBS.
A probiotic supplement contains large amounts of bacterial organisms which are beneficial to the GI system. Since you have 10 bacteria on and in your body for every cell that is actually “you,” disruptions in those bacteria can cause illness. Your intestinal bacteria help digest your food and provide vitamins and other beneficial substances as well as affecting your mood, your immune system, your skin and inflammation in your body. This area of research is very active right now, so if I wrote this article next year the list would probably be much longer! Stay tuned!
The first thing I recommend patients with irritable bowel syndrome symptoms do is add a probiotic supplement. Often this by itself is enough to make patients feel better. In choosing a probiotic supplement, you want one that’s enteric coated to protect the bacteria from stomach acid. My family and I take Shaklee’s OptiFlora, of course 🙂
A word about prebiotic fiber. The bacteria in your intestine depend on YOUR diet for their own food. Your diet hugely influences what bacteria are dominant inside your intestine. Healthy bacteria thrive on what is called prebiotic fiber. This is found in plant foods like fruit, vegetables, beans and whole grain bread products. If you eat predominantly processed foods, gradually changing your diet to include more plants and whole grains will benefit your little passengers which will improve your digestive health.
2. Food allergen elimination diet
A food allergen elimination diet is useful for people with unexplained symptoms of all sorts. A trial of a food allergy elimination diet is a reasonable thing to do if irritable bowel syndrome symptoms do not respond to probiotic supplements and improving the diet.
Food allergies are much more common in children and are severe hypersensitivity reactions that may cause hives, trouble breathing, swelling of the throat, shock, and even death. Common allergens are cow’s milk, egg, soy, peanuts and tree nuts.
On the other hand, food intolerances may be linked to a whole range of symptoms from irritable bowel syndrome to migraine headaches to eczema to menstrual disorders. Unfortunately blood and skin testing are not accurate when it comes to identifying food allergies and intolerances.
The most effective way to identify foods to which you may be allergic or intolerant is to do a comprehensive allergy elimination diet. In general this should be done under a doctor’s supervision. The one I recommend for my patients can be found at this link. I have had a number of patients identify important food intolerances that they would never have identified otherwise.
Before you say you can’t be allergic to something because you haven’t changed your diet recently, you can develop a food allergy at any time in your life. There’s only one way to know for sure. If you have irritable bowel syndrome and your symptoms don’t respond to simple measures, an allergen elimination diet may be your next step.
3. Eliminate FODMAPs from the diet
I can hear you now. “What the heck is a FODMAP?!”
FODMAPs are “Fermentable Oligo-Di-Monosaccharides and Polyols.” They are sugars found in food that seem to be involved in some cases of IBS. If someone did not improve with probiotics and increasing prebiotic fiber, and did an elimination diet without improvement, the next step would be to try eliminating FODMAPs from the diet.
A low-FODMAP diet is very effective for IBS symptoms. However, it’s not easy to stick to. Here is a great handout from Stanford University with information about a low-FODMAPs diet plan:
So, if you have been told you have irritable bowel syndrome, the first thing to do is to tidy up your diet. Make sure you’re eating plenty of healthy plant fiber (fruits, veggies, beans and whole grain bread products). Add a high-quality probiotic supplement.
If that is not successful, consider a comprehensive food allergen elimination diet. Figuring out if you’re intolerant to gluten, dairy, egg, soy, peanut, or other foods goes a long way towards settling IBS symptoms.
If all else fails, eliminating short-chain sugars from the diet with a low-FODMAPs diet is very effective but difficult to maintain.