IBS - Now What?
If you've struggled with embarrassment and frustration of excess gas, abdominal bloating and pain, urgency to use the bathroom, and either constipation or diarrhea (or both!), you're not alone. The Canadian Digestive Health Foundation estimates that about 5 million Canadians suffer from Irritable Bowel Syndrome (IBS), however, many individuals suffer in silence. Let's be real, bowel issues don't make great table talk and there can be a lot of embarrassment around it.
IBS is a complex functional gut disorder where there are no structural issues, but something is wrong with how the bowel functions. This can relate to the brain and gut connection, type and amount of bacteria in your gut, and visceral hypersensitivity (ie. how a person senses digestion).
It’s important to speak with your doctor to get a formal diagnosis. This includes ruling out structural gut disorders such as colorectal cancer, celiac disease, crohn’s disease or colitis. Your doctor will complete a physical assessment and series of questions related to functional gut disorders. Once you have a formal diagnosis, a dietitian trained in this area, can then help you to figure out what your triggers are, and create a strategic plan to help manage your symptoms and discomfort.
In clinic, it's not uncommon for me to see people trialing various elimination diets on their own, cutting out a lot of foods that are unlikely to be an issue but then have lingering trigger foods causing them symptoms. And sometimes, food has little to do with their IBS! Naturally, people get frustrated about food restrictions, not understanding what their triggers are, and not seeing improvements in symptoms.
Food First Treatment Options
The most popular, evidence based way to manage IBS is with the Low FODMAP diet developed by researchers at Monash University in Australia. It’s not a diet in the way we think of weight loss dieting, rather it’s referred to as medical nutrition therapy and studies show that, when explored properly and with the help of a dietitian, symptoms can improve in ~75% of patients with IBS. The low FODMAP diet is complex because it's not based on eliminating specific food groups, rather, foods that contain FODMAPs.
It's important to note that the Low FODMAP diet is not appropriate for everyone, such as people who experience anxiety around food and eating, or for those with disordered eating habits (including eating disorders). A trained dietitian conducts a careful and thorough assessment to decide on the appropriate course of actions. This may or may not include the Low FODMAP diet.
FODMAPs is an acronym for certain types of carbohydrates that go undigested in someone with IBS and they either pull water to the bowels or ferment in the gut. This causes the symptoms experienced - pain, excess gas and bloating, diarrhea or constipation. Foods that are high in FODMAPs can include (to name a few):
- Blackberries, apples, pears, cherries, peaches, and apricots;
- Wheat-based grain products;
- Regular cows milk;
- Onion and garlic;
- Cauliflower, beets, celery, and green peas;
- Dried black beans.
It can be overwhelming and complex. The best chance at improving your symptoms and better understanding your food and non-food triggers is to work with a trained dietitian who can help to create a careful strategy, using the 3 phase approach:
- Phase 1: reduce high FODMAP foods (ie low FODMAP eating pattern) for about 3-6 weeks.
- Phase 2: challenge high FODMAP foods to assess tolerance level based on various portion sizes.
- Phase 3: long term management of the condition, which may include non-pharmacological agents such as prebiotic or probiotic supplements and other over the counter medications.
IBS is highly individual and requires a detailed assessment of the individual, careful planning, and follow up support as you navigate.
Brooke has been supporting individuals with IBS since 2015 and continues to keep up with current evidence and trends related to functional gut disorders. To inquire further, contact us.