Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic condition that involves the digestive system manifested with abdominal pain and changes in bowel habits (constipation and/or diarrhea). People can experience different intensities of pain, and the abdominal area involved can vary from being generalized to being more localized.
The mechanism by which this process occurs is still uncertain. It has traditionally been hypothesized that the disorder is the result of motility issues of the digestive system, and hypersensitive intestines to normal stimuli. However, recent studies have suggested the potential involvement of bacterial overgrowth in the colon, alterations of the microbial flora, food insensitivities, and chronic inflammation.

How is IBS treated?

– Treatment is tailored towards the individual. Managing IBS can be difficult, but it is manageable nonetheless. It is a chronic condition that is variable from person to person, and the treatment for it is primarily lifestyle and dietary modifications.

Lifestyle modifications:

– IBS can be triggered by many factors, not just food. Anxiety (stress) is a major factor that plays a huge role in triggering or worsening symptoms. We all have a baseline stress level, but it is important to make sure that that stress level does not overwhelm our lives. Stress can be manifested in different ways, it is not just a psychological condition but can also manifest itself physically: some people experience back pains, others experience palpitations, chest pains, fatigue, headaches, just to name a few. The digestive system is no different. When stress levels increase, symptoms of abdominal pain, bloating, constipation, and/or diarrhea may result. Try to find the time every day for yourself, at least 30 minutes a day, to do the things that make you feel better to decrease that stress, whether it’s meditation, listening to music, going for a walk, jogging, playing with your pet, or reading a book, etc.

– Let’s talk about physical activity. Yes, exercise does lower stress levels. There have been numerous studies that have shown exercise as being not only effective in decreasing the severity of IBS symptoms, but also in preventing the symptoms from occurring. You might be wondering what kind of physical activity is being referred to. Everybody has a baseline level of activity that they can tolerate. It is important to listen to your body and understand how much you can handle and tolerate. Try not to overexert yourself. Keep a routine exercise schedule. Usually, the minimum recommended time of physical activity is 30 min a day.

– Integrative/complementary medicine:

  • Acupuncture: Some studies have shown that acupuncture can help alleviate chronic abdominal pain, and other symptoms of IBS including bloating, however, no definite conclusions from these studies have been drawn.
  • Hypnosis: Studies have shown that mind and body meditation and relaxation through hypnosis can actually decrease anxiety and calms the autonomic nervous system that controls the digestive system.
  • Yoga: This is a great form of relaxation, meditation, and a great form of physical exercise. There are many different types of yoga, an example of one that is very relaxing and meditative is Yin Yoga, which focuses on deep tissue muscle relaxation and stretching.
  • Herbal medicines: Certain herbal and natural remedies, such as fish oils, aloe vera, St. John’s wort, chamomile tea, flaxseed oil, have been shown to alleviate IBS symptoms, however, there are not enough studies as of now to support their safety and efficacy.
  • Peppermint oil: Most patients who take peppermint oil have shown improved symptoms overall. Peppermint oil can come in capsules and liquid forms. You can find them online or over the counter at your nearby pharmacies. The recommended dose is 10mg, 30 minutes before each meal, three times a day. It is thought that peppermint oil seems to relax the smooth muscles of the intestines, which helps decrease the hypersensitivities of the intestines and hence improve overall digestion.
  • Prebiotics and probiotics: The concept of using prebiotics and probiotics for the symptoms of IBS is to restore and rebalance the microbial flora that may be lacking in the intestines for proper digestion. Probiotics are live microbes that are intended to provide health benefits. Prebiotics on the other hand is non-living substances that are used to support the growth of healthy bacteria. It is still unclear as to which bacteria specifically would be beneficial for the treatment of IBS, and studies are still inconclusive on that subject. However, many patients do benefit from the use of probiotics in alleviating, if not preventing IBS symptoms. You may be able to find foods such as yogurts, or juices, with probiotics added, however, the majority of them simply do not have enough bacteria added in for long-term sustainability. It is important to note that not all probiotics over the counter may be safe or effective in taking, and the number of bacteria (or colony forming units) is also an essential aspect of choosing the right ones. Speak to your healthcare provider first about the use of probiotics and whether it is an appropriate regimen for you.

Dietary modifications:

– The most important thing is to start keeping a dietary journal of the types of foods that trigger the symptoms. This journal will over time be a reference guide to the types of foods to avoid.

– Certain patients may benefit from lactose-free and gluten-free products. However, the mainstay dietary modification to focus on is to avoid gas-producing foods, and most importantly, a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet.

– The low FODMAP diet: Short-chain carbohydrates, such as high fructose foods, apples, pears, wheat, barley, cauliflower, garlic, onions, peas, just to name a few) are not well absorbed in the intestines and get fermented very quickly, which ultimately results in symptoms of abdominal bloating and cramping sensations. The idea is to try to avoid as much as possible these types of foods for the first two months. Once symptoms improve, patients can gradually start reintroducing some of these foods into the diet and monitor tolerance over time.

– It is also important to adjust eating habits: eating small and frequent meals is much more beneficial than eating larger and less frequent meals. For instance, having five small meals a day (breakfast, lunch, dinner, and 2 snacks between main meals) poses less stress on the intestines, and reduces the risk of chronic intestinal inflammation, as compared to eating three large meals a day. In addition, eating meals slowly (i.e over 15-20 min) is also beneficial in avoiding the onset of IBS symptoms.

In summary, although many different regimens are available in managing IBS, ultimately it is mainly managed through lifestyle and diet. Speak to your provider about your symptoms so you can develop a treatment plan tailored to your needs.