The root cause of gastrointestinal troubles can be difficult to figure out but, with time and perseverance, it can be managed
If your digestive system is not running smoothly, it may be due to a common condition called Irritable Bowel Syndrome (IBS). IBS is the most prominent of gastrointestinal (GI) conditions affecting 10 to 15 per cent of the population, and women more than men. It’s characterized by symptoms of constipation, diarrhea, bloating and abdominal pain or discomfort, as well as nausea and vomiting for some.
Everyone experiences occasional episodes of GI upset or irregular bowels but IBS is characterized by ongoing symptoms at least three times a month over a three-month period, although the severity and frequency of symptoms can vary significantly. Fortunately, unlike inflammatory bowel disease (IBD) (i.e. Crohn’s and ulcerative colitis), there’s no structural issue or damage to the GI system and it doesn’t impact nutrient absorption.
IBS is a long-term manageable condition but only a small number of suffers seek out medical care, either out of embarrassment or feeling it’s a lost cause with no relief. No one treatment fits all; it can require both trial and error and a holistic approach, as well as checking for possible causes beyond the digestive system—the body is, after all, one big functioning system.
Here are some recommendations.
Put the ‘pro’ back into the gut with probiotics. These are the healthy bacteria that live in the gut and help balance out the bad bacteria. Studies show they may be linked to weight management, mood, chronic disease, immune function and gut function. For IBS in particular, these microbes may help normalize bowel movements and especially help reduce bloating and flatulence. They are found in various cultured and fermented foods such as kefir, cheese, yogurts, tempeh, sauerkraut and kimchi. Different strains are also available in pill form. To date, the strains that have shown the most benefit in IBS include bifidobacterium and lactobacillus. These are also the strains most frequently found in foods.
Aim to eat probiotic-rich foods daily. Avoid products fortified with probiotics yet full of sugar and/or fat. If diet is unrealistic, consider taking a supplement. To get the best coverage, choose one with over a billion cultures and with a variety of different strains. Always speak to your healthcare professional (MD, pharmacist, dietitian) about safety (adverse side effects, interactions), correct strains, dosage, a good quality product and storage. Probiotics should be consumed daily in order to gain full potential; they only survive in the gut for one to two weeks.
Research shows fibre alone is unlikely to treat IBS but it can help minimize symptoms. IBS triggers can vary significantly between individuals. The American College of Gastroenterology states it may not be effective for everyone and some individuals may even experience more bloating. Either way it’s worth trying.
For those who find relief in adding fibre, aim to get at least 25 grams of fibre from a variety of both insoluble and soluble sources. Soluble fibre acts like a sponge and absorbs water by forming a gel and slows down digestion therefore decreasing episodes of diarrhea as well as helping with constipation. Soluble fibre includes oat bran, psyllium (including Metamucil), legumes (black beans, lentils, kidney beans), soy products, fruits and vegetables. Insoluble fibre does not absorb water but rather adds bulk to the stool. It can help alleviate diarrhea but is most helpful for its laxative role in constipation. Insoluble sources include wheat bran, whole grain products, flax seed, vegetables and kidney beans. Many fibre-rich foods provide a source of soluble and insoluble fibre.
Research shows psyllium (even over wheat bran) is the most effective fibre-rich food. You can purchase psyllium husks from bulk stores or in the organic section of the grocery store. Add it to water or juice (drink quickly before it gels) or sprinkle over food. There are also psyllium-fortified products such as Bran Buds cereal or an over the counter supplement such as Metamucil. Remember to increase your fibre slowly and drink plenty of fluids or it could worsen your symptoms of bloating, constipation and flatulence.
Exercise is thought to play a role in improved intestinal transit time and decreased gas. One study showed that the individuals who exercised (20- to 60 minutes of moderate to vigorous exertion three times a week) had fewer symptoms than the group that didn’t exercise at all.
Avoiding or minimizing intake of certain foods or doing an elimination diet can be a good method to determine your trigger foods. For those who suffer from bloating, it may be helpful to avoid gassy and/or harder to digest foods such as broccoli, cauliflower, cabbage, artificial sweeteners, chewing gum, alcohol, fatty foods and carbonated beverages. Some individuals may be gluten (wheat and barley) and/or lactose intolerant, triggering various GI symptoms.
Originating from Monash University in Australia, the evidence-based FODMAP diet has received a lot of recognition for its 75- to 85 per cent effectiveness in minimizing or eliminating IBS symptoms. The diet focuses on certain carbohydrates/sugars and fibres that are hard to digest. These inadequately digested sugars travel to the intestine where the sugar-loving bacteria feed off them and pull more water into the intestine, creating bloating, flatulence, and changes in bowel movements.
The FODMAP diet helps figure out which foods trigger symptoms and in what quantity. An elimination diet clears out your system by avoiding all potential triggers over the course of several weeks, and then re-introducing one group at a time and tracking symptoms. Like most elimination diets, they can be complicated and challenging to follow. It’s best to received guidance from a registered dietitian.
There is more and more research showing the strong connection to mind (stress, depression, anxiety) and the gut. Mood has always been believed to directly impact gut function but more research is showing it may be the other way around, where symptoms in the gut cause the shift in mood. Whether it’s the chicken or the egg, it’s important to manage both mental and gut health.
The topic of nutrition and health can be complicated, misleading and frustrating—especially for a condition without a ‘one treatment fits all.’ The good news: IBS can be managed; it doesn’t have to rule your world.
Maureen Tilley is a registered dietitian and author of Hold the Salt! and Hold that Hidden Salt!