Spoiler alert! Unfortunately, there is no cure for Irritable Bowel Syndrome (IBS).
Not now, anyway.
Does that mean you should stop reading this article? Absolutely not.
There is good news. While there is no “cure”, there are ways to manage IBS.
In this article, we will address “How best to manage IBS”, which is one of the most important questions we can address.
What is IBS?
IBS, short for irritable bowel syndrome, is a disorder of the gut-brain interaction, once referred to as a functional gastrointestinal disorder. Like other disorders of gut-brain interaction, irritable bowel syndrome is related to: abnormal gastrointestinal (GI) motility, visceral hypersensitivity, changes in GI mucosal and immune function, an abnormal gut microbial environment in the digestive tract, and/or a physiological dysregulation of the gut-brain axis. In short, irritable bowel syndrome (IBS) is a complex, multi-faceted condition that stems from the connection between your mind and digestive system.
Irritable Bowel Syndrome (IBS) Symptoms
Specifically, irritable bowel syndrome is defined as recurrent abdominal pain (at least 1 day per week in the past 3 months) associated with a change in bowel movements, including form and/or frequency. You may experience other IBS symptoms such as gas, bloating, and nausea.
Four subtypes of irritable bowel syndrome:
- IBS-D (diarrhea-predominant)
- IBS-C (constipation-predominant)
- IBS-M (diarrhea-constipation mixed)
- IBS, unsubtyped
Outside of abdominal pain and irregular bowel movements, other IBS symptoms include excessive gas, bloating, abdominal distension, bowel urgency, spastic colon, incomplete evacuation, inconsistent digestive system, and/or nausea.
Given its non-specific definition, unknown pathophysiology and wide array of symptoms, it’s no wonder there is no single cure or treatment for IBS. We can’t expect one treatment will work for every IBS patient.
Inflammatory Bowel Disease
IBD is an umbrella term for other major digestive conditions that mimics IBS pain and other common symptoms that stem from IBS.
IBS Management — Where to Begin?
OK, so you have a new diagnosis of irritable bowel syndrome (IBS) and now you need to know how to best manage it.
As a GI dietitian, one of my first questions is, “Can we identify and/or correct the underlying issue?”
In other words, is there something else going on that’s masquerading itself as IBS like other digestive and kidney diseases?
GI conditions that can mimic IBS:
- Bile acid diarrhea
- Microscopic colitis
- Inflammatory bowel disease (IBD), such as Crohn’s or ulcerative colitis
- Celiac disease
- Chronic gastrointestinal infection
- Mast-cell activation syndrome
- Non-celiac gluten intolerance
- Sucrase-isomaltase deficiency
- Cow’s milk intolerance
- Small intestinal bacterial overgrowth (SIBO)
- Some Digestive and Kidney Diseases
These conditions can exist independently of or alongside irritable bowel syndrome (IBS), so it’s important for practitioners and patients to keep them in mind as potential causes for IBS symptoms. Most of these conditions effect the digestive tract in some way and can cause irregular bowel movements similar to IBS.
Doctors will rule out most of these conditions via clinical history, physical exam, and basic laboratory tests. However, some of these aren’t as detectable via routine exams, and will reveal themselves upon nutrition assessment(s)? and dietary changes with a well-informed GI dietitian. Others, such as microscopic colitis, require more invasive testing, such as a colonoscopy.
Now, assume we’ve ruled out any underlying cause for one’s irritable bowel syndrome (IBS). We can’t fix the fundamental problem, so let’s talk about how doctors treat IBS, how we can treat IBS, reduce symptoms, and improve quality of life via the least restrictive approaches possible.
Dietary Management for IBS
People with irritable bowel syndrome frequently identify foods as triggers for their GI distress. Food doesn’t cause irritable bowel syndrome, but certain foods can worsen symptoms. On the plus side, some foods can help symptoms, too! For example, eating two green kiwifruit per day can significantly ease symptoms of constipation and help regulate bowel movement.
Below, you’ll find popular dietary approaches to managing IBS. Remember, there is no one-size-fits-all diet for irritable bowel syndrome.
A Mediterranean-style diet is a well-balanced, high-fiber diet with an emphasis on plants (fruit, vegetables, beans, nuts, seeds, whole grains), balanced calories and minimal (if any) highly processed foods.
Research has shown that a Mediterranean-style diet with regular meal times can improve symptoms in some people with irritable bowel syndrome. Often, this is a terrific first-line approach before moving on to more restrictive diets, such as the low FODMAP diet.
FODMAPs are poorly absorbed, highly fermentable carbohydrates (sugars and fibers) that can lead to gas, bloating, diarrhea, abdominal pain, and other GI symptoms in some people with IBS. Examples of high-FODMAP foods and additives include beans, apples, watermelon, onions, wheat, garlic, inulin, and chicory root.
The low FODMAP diet is scientifically proven to manage symptoms and improve quality of life in individuals with irritable bowel syndrome. The low FODMAP diet comprises 3 phases: 1) The Elimination Phase, 2) The Reintroduction Phase, and 3) The Maintenance Phase.
Plenty of people with irritable bowel syndrome rely on a personalized low-FODMAP diet to manage their IBS. For best results, people should work closely with a GI dietitian who is well-versed in the low FODMAP diet who can help you learn how to treat IBS in the best way possible.
If your dietitian or healthcare provider has recommended dietary changes, specifically a Mediterranean or Low FODMAP diet, ModifyHealth can assist with home-delivered certified meals.
Dietary fibers are non-digestible carbohydrates found in plants. Humans lack the digestive tools to break down fiber, so it travels throughout the gastrointestinal tract more or less intact.
There are many types of fiber, but most people are familiar with the terms “soluble” and “insoluble”.
Soluble fiber can help form stool, improving both constipation and diarrhea, and reduce bowel urgency. Thanks to these characteristics, practitioners frequently recommend foods high in soluble fiber and/or soluble fiber supplements to help promote more formed, fully evacuated BMs in people with irritable bowel syndrome.
Insoluble fiber, also called “roughage” because of its coarse nature, can irritate the large intestine, triggering water and mucus secretion. The best way to gauge if food is roughage is by thinking about its texture or consistency. If it’s soft or pureed, it’s low roughage. If it’s tough to chew, it’s high roughage. Obvious sources of roughage include thick skins of fruits and vegetables, vegetable stacks, popcorn, whole nuts, and seeds.
Some people with irritable bowel syndrome, including those with constipation, fare better with gentler, lower roughage foods (i.e. soft foods).
Focus on Eating Behavior
Dietary management for irritable bowel syndrome isn’t just about what we eat, it’s about when we eat, how we eat, and how much we eat. Eating slowly and chewing food well are two of the most important things people can do to improve digestion and minimize IBS symptoms such as abdominal pain.
You might wonder about meal frequency — should you eat small, frequent meals? Or fewer larger meals? Regular mealtimes are best, but frequency might depend on the IBS subtype. For example, larger meals (especially those with fat and fiber), can stimulate the gastrocolic reflex. So, someone with IBS-C might need a larger meal to stimulate peristalsis to help promote a more complete bowel movement, whereas someone with IBS-D who struggles with bowel urgency after meals might benefit from smaller meals.
Eliminate obvious food triggers
Other popular recommendations include eliminating or limiting common food triggers, such as spicy foods, coffee, alcohol, artificial sweeteners, fatty foods, and sugary foods.
Also, some people with IBS report high-histamine foods as obvious triggers for their IBS symptoms. Think charcuterie board: aged cheeses, cured meats, and wine. Research has shown people with IBS to have increased mast cell activation compared to healthy controls, which might be why higher histamine foods induce symptoms. We have much to learn about the role of a low-histamine diet in managing IBS, but it’s something to keep on your radar!
Most IBS medications focus on reducing symptoms through various mechanisms. Many of them affect the motility of the gut — speeding up or slowing down intestinal transit — depending on one’s IBS subtype (e.g. IBS-D, IBS-C). Others attempt to soothe abdominal spasms.
One medication we’ll call out in this article is Rifaximin. Rifaximin (Xifaxin) is FDA-approved for IBS-D. It’s the first antibiotic approved for a non-infectious disease, and it addresses microbial-induced IBS.
On the topic of medications, it’s important to review active meds with your medical team to see if some of them might worsen your GI symptoms. This goes for supplements, too. Both can contain active and/or inactive ingredients that worsen IBS symptoms. Pay special attention to sugar alcohols, such as sorbitol or xylitol.
Recall that IBS is a disorder of the gut-brain interaction, so we must recognize the incredible impact mind-body approaches have on IBS symptoms.
Two of the most popular forms of gut-directed mind-body approaches include cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy. In fact, a 2016 study compared gut-directed hypnotherapy to the low FODMAP diet and found it to be just as effective at managing IBS symptoms such abdominal pain.
Mental health therapies have gained more traction in recent years as scientists have discovered the powerful connection between the brain and our digestive system. They are working on understanding this connection to figure out new ways to relieve IBS symptoms and manage IBS symptoms.
For now, there is no cure for IBS. But, don’t lose hope! Researchers are working hard to discover biomarkers to help clinicians better understand specific mechanisms leading to various IBS presentations so we can find more proven ways of relieving IBS symptoms. From there, clinicians can personalize treatment to address the root cause of the problem.
For now, it behooves us to focus on how best to manage IBS. As you can see from this article, there are many non-invasive, minimally restrictive approaches to help you feel better. We hope this information benefits all IBS sufferers and provides some clarity on the options available to control symptoms.
So, find yourself a knowledgeable GI dietitian and get to work.
Colleen D. Webb, MS, RDN
Colleen Webb, MS, RDN, is a registered dietitian and nutritionist with extensive experience in counseling patients with complex gastrointestinal conditions. She created the nutrition education program for patients, doctors, dietitians, medical students, and dietetic interns at the Inflammatory Bowel Disease Center at Weill Cornell Medicine in New York City, as well as The Ultimate Online Training Education for Registered Dietitians Treating IBD Patients — approved for 10 CPEUs by the CDR. Colleen runs a virtual private practice and is an adjunct professor at New York University where she teaches the graduate-level “Diseased Gut” course.
Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases. Lancet Gastroenterol Hepatol. 2021;6(2):139-148. doi:10.1016/S2468-1253(20)30212-0
Black CJ, Drossman DA, Talley NJ, Ruddy J, Ford AC. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 2020;396(10263):1664-1674. doi:10.1016/S0140-6736(20)32115-2
Haller E, Scarlata K. Diet Interventions for Irritable Bowel Syndrome: Separating the Wheat from the Chafe. Gastroenterol Clin North Am. 2021;50(3):565-579. doi:10.1016/j.gtc.2021.03.005
Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017;6(11):99. Published 2017 Oct 26. doi:10.3390/jcm6110099