Irritable bowel syndrome (IBS) refers to intestinal symptoms and discomfort typically brought on by consuming certain trigger foods. IBS is relatively common, according to the American College of Gastroenterology, it impacts approximately 15% of the population in the US alone, and it is more than twice as common in females than males. While there is no specific test to definitively diagnose IBS, a doctor is likely to start with a complete medical history, physical exam and tests to rule out other gastroenterological conditions (Irritable Bowel Diseases), such as Chron’s, colitis or celiac disease. IBS is not the same as inflammatory bowel disease (IBD) and it is also unrelated to other bowel conditions.
For each individual, the symptoms, duration and severity varies. The symptoms can last anywhere from at least 2-3 months and a minimum of 3-5 days per month. It is very commonly linked to people with chronic conditions, especially autoimmune related, particularly diabetes. IBS does not increase risk for gastrointestinal cancers, but it can still have a significant impact on quality of life and also impact the management of chronic conditions for those who live with them.
IBS is usually sub-divided into three types, based on symptoms; constipation-predominant (IBS-C), diarrhea-predominant (IBS-D) or a mix of the two. If you suffer from frequent digestive discomfort, irregularity and/or bloating, it is worth reaching out to your doctor to discuss this. Living in pain is not healthy and there are ways to manage the condition successfully. One key way to help IBS symptoms is through changes in diet. Avoiding certain foods that trigger symptoms and focusing on others that are better tolerated can lessen symptoms in some.
IBS and Constipation – Trigger Foods
Foods that can exacerbate IBS-related constipation include:
- Breads and cereals with refined grains
- Processed foods such as chips, crackers, cookies, other junk/snack foods
- Coffee, carbonated drinks, alcohol
- Diets high in protein
- Dairy, especially cheese
Optimal Foods for IBS and Constipation
Increasing fiber intake can help with IBS-C. The National Institute of Diabetes, Kidney and Digestive Disease recommends aiming to gradually boost fiber consumption until you are eating a minimum of 22 grams, up to approximately 35 grams per day, depending on age, body weight and gut tolerance. Great options include eating more fruits and vegetables, legumes and whole grains. Try to avoid foods that are higher in the sugar substitutes such as malitol, sorbitol or saccharin as these are known gut aggravators. It is also important to drink plenty of water when increasing fiber intake, otherwise too much fiber without enough fluids can exacerbate constipation.
IBS and Diarrhea – Trigger Foods
Foods that can exacerbate IBS-related diarrhea include:
- Too much fiber, particularly insoluble fiber, eg. skins from fruits and vegetables
- Food and drinks with chocolate, alcohol, caffeine, fructose, or sorbitol
- Carbonated drinks
- Excessively large portioned meals
- Fried and fatty foods
Optimal Foods for IBS and Diarrhea
If you have IBS-D, prioritize eating a moderate amount of soluble fiber. Excellent sources include whole natural unrefined grains such as oats, brown rice, fruit and natural air dried fruits (without added sweeteners). Try to limit consumption of cruciferous vegetables such as broccoli, Brussel sprouts and cabbage. Limiting the amount of beans, lentils and legumes consumed can also help as these are known to aggravate bloating. Aim to consume smaller meals more frequently and avoid fewer large meals each day. Drink plenty of water each day. You can also speak with your gastroenterologist about possible temporary elimination diets which help to identify trigger foods.
In addition to triggering foods, stress and anxiety can make IBS symptoms worse. Sources of stress and anxiety may include:
- Issues at home
- Financial worries
- Fear of things beyond your control
To minimize stress, prioritize healthy habits every day. Aim for at least 7-8 hours of sleep each night, engage in regular activity and eat a well-balanced diet that works for your IBS. Drink plenty of fluids,especially water, and avoid excessive amounts of caffeine, sugary beverages and alcohol.
In addition to this, lifestyle habits can also help to manage stress levels. This includes making time for leisure activities such as listening to music, reading, shopping, taking a walk, spending time with friends/family (or calling friends and family members to remain connected even when distance is a factor).
If you are having difficulty managing stress on your own, reach out for additional support. Seeing a mental health professional who can provide cognitive behavioral therapy can also be extremely useful to help learn healthy coping techniques to manage stress and anxiety. If you feel comfortable, speak with family members, friends or colleagues about your condition. When they know what is going on, they can support you and better understand how it affects you.
Medications as a Trigger for IBS
Certain drugs can aggravate IBS. People with IBS may have trouble with:
- Medicine made with sorbitol, such as cough syrup
If you suspect that a medication could be a cause, discuss this possibility with your healthcare team. Before changing any medication, consult with your doctor about switching to a drug that may not cause symptom flares. It is important to always ask your doctor before you stop taking any medication.
Hormones may also play a role in IBS. Women are twice as likely to suffer from IBS than men. Moreover, during monthly menstruation, or other large hormonal flucations, such as menopause, IBS symptoms tend to worsen. These hormonal fluctuations are unavoidable, but women can ease pain and discomfort by being extra careful to avoid trigger foods, in addition to prioritizing exercise, hydration and sleep during key hormonal fluctuations.
What to do next if you think you have IBS?
If you suspect you are dealing with IBS, work with your doctor to find optimal methods to manage your condition. It may require a combination of diet and lifestyle choices, and perhaps enlisting the help of certain medications approved by your doctor, if necessary. With some planning and consideration to your food and environment, it is possible to minimize flares and balance your day to feel as optimal as possible, as much of the time as possible.