Irritable Bowel Syndrome: What To Know About IBS & How To Manage It Naturally
An estimated 11 percent 1of the global population have IBS, making it the most common gut disorder in the world. And, according to some estimates, twice as many women suffer as men. What's more, over a third2 of cases actually go undiagnosed, meaning that many people are dealing with debilitating symptoms like diarrhea, bloating, cramps, and constipation, while having no idea how to manage their painful condition.
Think your unpredictable bathroom habits could be IBS? Here, learn more about what causes and influences IBS, how to treat it naturally with dietary changes and mind-body practices, plus a few gut-soothing supplements that can boost your chances of success.
What exactly is irritable bowel syndrome, or IBS?
IBS is a chronic condition defined by discomfort surrounding one of our most basic acts, going to the bathroom. It's characterized by regularly recurring bouts of constipation or diarrhea, sometimes alternating, which, according to the most recent classification, has lasted at least three months3. Often bloating and gassiness are added to this unpleasant mix.
"It's really very frustrating when your life is ruled by your bowels—you can't go, or you need to go all the time," says integrative nutritionist Kathie Madonna Swift, M.S., RDN, author of The Swift Diet: 4 Weeks to Mend the Belly, Lose the Weight, and Get Rid of the Bloat.
What causes IBS?
Even the term IBS is the tip-off that mainstream gastroenterology doesn't have a handle on what causes it or how exactly to treat it. It's not a "disease" but a "syndrome," or a collection of symptoms under the catchall umbrella term of IBS.
The problem with IBS, Swift says, is that so many things can cause it, or at the least contribute to it—from food sensitivities to an overactive gut immune system to stress, be it the everyday variety or a history of physical or sexual abuse. And while a serious case of IBS can make a body miserable, it doesn't create the obvious, visible physical damage inside the digestive system as potentially life-threatening conditions like inflammatory bowel disease or colon cancer. Additionally, the drugs that doctors have used to treat IBS have had only limited success4.
How do you treat IBS?
If you suspect IBS, make an appointment with a gastroenterologist. This step is important so you can rule out the possibility that your symptoms are actually signs of a more severe disease. After you get the "all clear" from a specialist, perhaps after a sigmoidoscopy or colonoscopy, any knowledgeable health care provider should be able to guide you in the use of over-the-counter products to help manage obvious symptoms—for instance, psyllium fiber products for constipation.
But to get at the root causes of what's ailing you, Swift says, you want a holistic approach and to experiment with a range of different therapies to address what's causing your IBS. Increasingly, integrative nutritionists are at the forefront of treating patients with IBS because—despite whatever else may influencing the syndrome—food is central to getting symptoms under control.
In a study5 in the American Journal of Gastroenterology, for instance, the vast majority of IBS sufferers reported their symptoms were triggered or exacerbated by eating a meal5. This is in sharp contrast to medical thinking only a generation ago, which regarded IBS as "all in your head," or more technically, "a digestive system manifestation of chronic stress and nervous tension." Today, the leading academic gastroenterologist William Chey from the University of Michigan regards food as "the main course to wellness and illness for IBS patients4."
Dietary therapies for IBS.
Eliminate common triggers.
Swift will start simple with a new patient, eliminating the "usual suspects" from the diet. Alcohol and caffeine are two excellent candidates to lose on a trial basis—they don't cause IBS, but they can certainly exacerbate it. With food, she usually begins with eliminating wheat and dairy.
Patients with celiac disease have a severe gastrointestinal reaction to eating wheat and other foods that contain gluten—and if celiac is suspected, it should be tested for. But far more common, Swift says, are food sensitivities or intolerances to gluten or other wheat proteins that, while less dire than celiac, are still a major driver of IBS symptoms.
The most common food sensitivity of all is to the sugar in dairy products, lactose. Some IBS sufferers will need to say goodbye to dairy for good, while others can tamp down symptoms by limiting their dairy intake or taking a lactase supplement, which contains a digestive enzyme that helps break down lactose in the body.
Try a low-FODMAP diet.
"There is a tried-and-true way to treat IBS and other gut conditions without drugs or other invasive procedures: a low-FODMAP diet," Vincent Pedre, M.D., gut health specialist and medical director of Pedre Integrative Health, told mbg.
FODMAPs are a family of carbohydrate sugars and fibers that may aggravate IBS:
The acronym stands for Fermentable (the process through which gut bacteria break down undigested carbohydrate to produce gases like hydrogen, methane, and carbon dioxide) Oligosaccharides (fructo-oligosaccarides found in wheat, rye, onions, and garlic) and Galacto-oligosaccharides (found in legumes/pulses), Disaccharides (a lactose found in milk, soft cheese, and yogurts), Monosaccharide (fructose in excess of glucose, found in honey and many fruits and vegetables), and Polyols (sugar polyols like sorbitol and mannitol, found in some fruits and vegetables and used as artificial sweeteners).
It’s a mouthful, but for difficult IBS cases, low-FODMAP diets can be a total game-changer. Basically, on a low-FODMAP diet you eliminate or aggressively reduce high-fiber vegetables, high-sugar fruits, legumes, dairy, and sugar alcohols for a period of time.
There's also some compelling research to back it up: "One study found a low-FODMAP diet improved symptoms in about 68 to 76 percent6 of IBS patients—results I've seen in my own practice," said Pedre. "IBS aside, a low-FODMAP diet helps a variety of gut conditions including Crohn's disease, celiac disease, inflammatory bowel disease, and even small intestinal bacterial overgrowth (SIBO)."
Despite the success of the low-FODMAP diet, there are some important caveats. For one, it can be restrictive and difficult to follow correctly (unless you have a handy guide to a low-FODMAP diet). Plus, many people with IBS don't need such a restrictive diet over the long term. For people who do benefit, Pedre emphasizes that the goal should be the gradual reintroduction of healthy FODMAP foods like vegetables, legumes, and fruits.
To up your chances of success, Pedre recommends keeping a food journal. "Tracking your food intake becomes an excellent way to pinpoint where high-FODMAP foods and other food intolerances might creep in, and [to help you] target major offenders."
What does the microbiome have to do with IBS?
It all relates to fermentation. Much of the dietary fiber we consume is fermented, or broken down, by bacteria that live in the colon or large intestine—aka the gut microbiome. Too much fermentation results in the bloating, gas, and disordered bathroom habits that are the hallmark of IBS, and the low-FODMAP diet can help bring that under control.
But, researchers say, the right amount of fermentation helps protect a healthy gut—specifically, fermentation by-products help protect and repair the gut lining so that the microscopic contents of the gut don't spill into the bloodstream and trigger systematic inflammation7, or leaky gut.
That's why nutritionists say most people need to eat more fiber, not less—the bacteria in our gut may actually be out of balance or "dysbiotic" because we eat too much low-fiber junk food. But people prone to IBS often have to go slowly, limiting high-fiber foods at first and slowly increasing over time, or trying different fiber options to find out what works and what doesn't.
"It's all about individual experimentation," Swift says. "Maybe black beans will always overtax the digestive system, but chickpeas or lentils could be just right."
How the gut-brain highway influences IBS.
The traditional view of IBS as "in your head" wasn't all wrong, but the latest research has replaced this notion with a new understanding of gut function as part of a two-way conversation between the brain and the gut.
Yes, stress and anxiety can generate hormones and other chemical messengers that can upset the gut (we've all experienced butterflies in our stomach before a big event). But the gut's nervous system, the enteric nervous system (or "second brain"), which produces the same neurochemicals as the brain—an estimated 90 percent of the body's supply—can also influence our thoughts and emotions in ways researchers are only just beginning to understand (and it sheds some light on the association between depression and IBS).
The microbiome plays a kind of middleman here: A dysbiotic gut can throw off the production of the hormones generated in the enteric nervous system as well as signal the gut's immune system to overreact to what would otherwise be harmless food components, like gluten—which then triggers inflammation that may produce symptoms like depression or brain fog.
Mind and body solutions for IBS.
We are a long way from decoding the exact gut-brain crosstalk that's responsible for IBS in all of its various forms. But we can explore therapies that calm both mind and body and smooth out the conversation between them.
Swift recommends healing imagery exercises developed by Belleruth Naparstek that are specific to IBS. She also introduces many of her patients to the Asian movement discipline of qigong. Again, the idea is to find what works for you. For some that might be meditation, for others yoga.
There is also reliable research that suggests addressing IBS from the point of view of "mind" alone can be effective. In a 2015 meta-analysis,5 75 percent of subjects who received some sort of psychological therapy—from cognitive therapy to hypnosis—saw greater improvement in gut symptoms than the people who did not, potentially due to a reduction in stress.
Plain old exercise may help, too, and it's especially helpful in relieving constipation. But researchers have also found that intensive exercise can work in the opposite direction, promoting leaky gut, which drives inflammation and worsens IBS. As with everything else in the gut, balance is key.
Supplements for IBS.
Supplements can also complement all the healthful changes you're making to your diet and lifestyle. On Swift's personal list of got-to supplements for IBS:
- enteric-coated peppermint oil, which has a relaxing effect on the smooth muscle of the gut
- a probiotic such as Visibiome or Clinical GI Probiotic
- Iberogast, an herbal blend that includes peppermint, caraway, lemon balm, licorice, and others to help relieve cramps, bloating, flatulence, and nausea
- a melatonin supplement (3 mg at night) if sleep and an overactive enteric nervous system are problems
Because everyone (and everyone's IBS) is different, no one menu of therapies fits all. "I can't wave my magic wand and say, 'IBS be gone!'" says Swift. "It's very complex, but patients do get better."
Joseph Hooper is a Manhattan-based freelance writer with a degree from Stanford University. He frequently covers integrative health, the health sciences, and adventure sports for a variety of national publications, including Men’s Journal, Men’s Health and Elle. He is the co-author of Muscle Medicine and The Swift Diet.