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 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 to create a strategic plan to help manage the 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. People get frustrated about the restriction especially when symptoms don't seem to improve.
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.
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:
- 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 which is why working with a dietitian is important. The best chance at improving your symptoms and better understanding what foods trigger those symptoms, a trained dietitian can help to create a careful strategy, using a 3 phase approach:
- Phase 1: reduce high FODMAP foods (ie low FODMAP eating pattern) for about 4-6 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.
It's important to note that the Low FODMAP diet may not be appropriate for everyone. 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.