The paradox of holding an IBS awareness month (though an undoubtedly important recognition of a common ailment) is that despite years of research, medicine still has very little understanding of what causes Irritable Bowel Syndrome (IBS) or how to treat it. You see, IBS is what we call a “diagnosis of exclusion,” meaning if you meet certain standard symptomatic criteria and your doctor can find no other cause, you may be diagnosed with IBS. In essence, it is nothing more than a complex of symptoms without a known cause. This leaves the estimated 10-20% of US sufferers (20-50% of gastroenterology referrals relate to this symptom complex) with more questions than answers, which can be incredibly frustrating.[i]
While many things can cause the symptoms of IBS, one diet stands out in limiting the discomfort patients experience and in allowing an opportunity to find those causes. This diet is called the FODMAPs diet, and we will discuss it shortly.
First, let’s talk about where these symptoms may come from.
What might be the cause?
The short answer is that we still don’t quite know. There are, however, several emerging theories with a strong likelihood of contribution. IBS is a multi-factorial process (and one of those factors is genetic predisposition). Below is a list of what might cause IBS symptoms.
So, what is FODMAPs and does it work?
Changes in gastrointestinal muscle activity: this includes increased frequency of GI muscle contraction, increased amount of time it takes to pass a bowel movement (causing constipation), and increased sensitivity to intake of food due to hormone and enzyme release (causing diarrhea).[ii]
Digestive hypersensitivity: this means more pain and discomfort in response to distention from food intake or from bloating caused by gas.[iii]
Inflammation: though not classically recognized as an inflammatory disease, individuals with IBS do tend to have more inflammation.[iv]
Altered gut flora: individuals with improper balance of GI bacteria are more prone to IBS symptoms.[v]
Food sensitivity: many who suffer with IBS symptoms report being sensitive to certain foods, especially carbohydrates (including foods containing gluten) and certain fats. This is in addition to sensitivity to all of what we consume when we eat processed foods.[vi]
Mental and emotional stress: Those who are more prone to anxiety, depression, and other forms of psychological distress are more likely to experience IBS type symptoms.[vii] Those who have difficulty sleeping are also prone to these symptoms.[viii]
Well, while you work with your Naturopathic Physician to address these and other underlying causes, he or she may also discuss initiating a FODMAPs diet. FOD-what?
This is an acronym for fermentable oligo-, di-, and mono-saccharides and polyols; examples include fructose, lactose, galactans, fructans, and mannitol. Basically, these are short chains of carbohydrates (sugars), which are poorly absorbed and strongly related to many of the symptoms of IBS. Research is showing that while these substances found in food (and often even otherwise healthy foods like fruits and vegetables) are not the cause of the symptoms, they do trigger them. This is because they are highly fermentable (broken down by bacteria which produce gas) and osmotic (influence how much fluid is present in your intestines). They also influence the types of bacteria which may grow in the gut (either beneficial or not). People who follow a FODMAPs restricted diet (taking some or all of these substances out in a systematic way, under physician supervision) tend to report improvement in how they feel.[ix]
FODMAPs isn’t right for everyone
Now, this doesn’t mean that you should go do an internet search and cut out all of the foods which contain these carbohydrates, as there is a wide range in individual ability to absorb these foods. For example, about 40% of the population has difficulty absorbing fructose (found in fruit). Another 15-100% of people (based strongly on our ancestors’ country of origin) are unable to digest lactose (found in dairy). Strict dietary restriction for an extended of period of time is not generally recommended for anyone. However, the goal is to allow your body an opportunity to heal while limiting these common dietary triggers.
Speak to your naturopathic physician about whether or not eliminating FODMAPs for a short time may be right for you.
Changes you can make today
Whether or not you have the symptoms of IBS, it is important to be proactive about your digestive health. Here are some things you can do right now to improve your digestion:
Increase your intake of soluble and insoluble fiber, aim for 25-30g combined per day
Increase your intake of fermented food and drinks such as sauerkraut, natto, tempeh, kimchi, kefir, or kombucha
Maintain regular bowel movements:
Set a regular time every day to train your intestines. First thing in the morning works very well
Exercise! The more you move, the more you’ll move your bowels.
Stool hygiene: buy an 8-10” step stool to keep near your toilet, and place your feet on it when you go to the bathroom. This changes the shape and position of your sigmoid colon, allowing for a more natural process. Remember, our ancestors tended to squat when they did their business, so it is best to mimic our evolutionary tendencies.
Eat regular meals, and aim to separate carbohydrates and proteins when possible
Maintain regular sleep times. Sleep is reparative, and those who don’t get enough are preventing their immune systems from functioning optimally.
Medscape Database: Irritable Bowel Syndrome
Kumar D, Wingate DL. The irritable bowel syndrome: a paroxysmal motor disorder. Lancet. 1985;2(8462):973.
Bouin M, Plourde V, Boivin M, et al. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology. 2002;122(7):1771.
Liebregts T, Adam B, Bredack C, et al. Immune activation in patients with irritable bowel syndrome. Gastroenterology. 2007;132(3):913.
Kassinen A, Krogius-Kurikka L, Mäkivuokko H, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. 2007;133(1):24.
Simrén M, Månsson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63(2):108.
Nicholl BI, Halder SL, Macfarlane GJ, et al. Psychosocial risk markers for new onset irritable bowel syndrome--results of a large prospective population-based study. Pain. 2008;137(1):147.
Morito Y, Aimi M, Ishimura N, et al. Association between sleep disturbances and abdominal symptoms. Intern Med. 2014;53(19):2179-83.
Mansueto P, Seidita A, D'Alcamo A,et al. Role of FODMAPs in Patients With Irritable Bowel Syndrome: A Review. Nutr Clin Pract. 2015. [Epub ahead of print]