When personal trainer and nutrition coach Erik Ossner was diagnosed with irritable bowel syndrome (IBS), he says he felt almost betrayed: “The foods I consider paramount to my physical success are now turning against my body.” He says medicines haven’t helped much either, so he’s been experimenting with different foods and testing out an anti-inflammatory diet. None of those attempts have yet managed to end his first months-long IBS flare-ups.
What Is IBS?
IBS is “chronic abdominal pain with altered bowel movements in the absence of an identifiable cause,” says Aniruddh Setya, MD, a pediatric gastroenterologist at Kidz Medical Service in Hollywood, Florida. He’s careful to emphasize that IBS is different from inflammatory bowel disease (IBD), which is caused by inflammation.
To diagnose IBS, doctors must rule out other causes of irritation to the digestive tract, such as IBD or Crohn’s disease. Once they do, ideally, they work with you to determine a treatment plan that minimizes triggers and manages any remaining symptoms.
What Causes IBS?
Understanding and eliminating your triggers is crucial, explains Chanu Dasari, MD, a gastrointestinal surgeon in Las Vegas. “Diet, digestion, sleep, stress and exercise. Those are the big five” types of triggers, he says. Dasari himself adds that he, too, struggled with IBS, due to stress, lack of sleep and eating a lot of processed food when he was in medical school. “It was a problem, but it was totally managed by diet,” he adds.
How to Deal With IBS
“IBS is not something that you can treat as something you manage,” says Setya. If you’re experiencing IBS, your doctor should be asking about your diet and lifestyle to see if improving the quality of those “big 5” triggers that Dasari mentioned could help alleviate symptoms. However, to get an in-depth look at what’s causing your gastrointestinal distress, Setya suggests keeping a mood and food diary. Any time you have symptoms, look back over the past 24 hours and write down everything you ate and how you felt. Here are the questions you should ask yourself and answer in your diary, says Setya: Did you have a consequential meeting coming up? Did you have an important date? Did you get nervous about something? Or did you eat a gallon of ice cream?
Diets That May Help IBS Patients
Your food triggers aren’t always as obvious as a gallon of ice cream, however. This is where a detailed mood and food diary can come in handy. You can keep a handwritten journal or record your thoughts on an app like Cara. Doctors recommend several types of diets to help patients with IBS.
One of the most frequently recommended diets for IBS patients is the low-FODMAP diet, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are sugars that are thought to trigger irritation, and they’re in a variety of meat, dairy and wheat products and even in fruits and vegetables. The diet is extremely restrictive, so rather than it becoming a long-term strategy, most doctors recommend that patients start by eliminating all high-FODMAP foods first. Then, the next step is gradually introducing different types back into their diets to see which foods act as triggers.
Setya says that even that can be extremely difficult for someone who already has severe IBS symptoms. Instead, he offers them a list of high-FODMAP foods. “I tell them this is what can potentially be a trigger,” but not all of them are. Sometimes having a list can help a patient narrow it down, even if they don’t follow a strict low-FODMAP diet.
Some high-FODMAP foods to avoid are:
- high-fructose corn syrup
- soft cheeses
- soy milk
Note that this is not an exhaustive list. It’s best to work with your doctor to determine how and when to apply a low-FODMAP diet.
Some patients who experience gastrointestinal symptoms find that cutting down on foods that promote inflammation can provide some relief. Click here to download MedShadow’s anti-inflammatory diet guide, and check out these recipe ideas from Instagram if you think inflammatory foods might be triggering your IBS.
There are a number of studies suggesting that raising your intake of individual phytonutrients, chemicals found in herbs and plants such as fiber, terpenes, polyphenols and protease enzymes can help alleviate IBS symptoms. The idea that increasing your intake of these nutrients can treat IBS is gaining steam. Dasari is working on a paper and guidelines that will help organize all the piecemeal evidence to create a phytonutrient diet guide, and recently published a book on the topic. For now, he says, it’s best to make sure you’re eating a mostly plant-based diet, heavy in colorful foods and herbs.
One particular phytonutrient, fiber, may be especially helpful, particularly for those with constipation.
Which Medications Treat IBS Symptoms?
There aren’t any drugs designed to cure IBS, because symptoms vary from person to person, as do the disorder’s causes. Instead, if diet and lifestyle adjustments aren’t enough to provide relief, doctors will prescribe drugs based on your individual symptoms. For example, if you have constipation, your doctor may recommend a stool softener. If you have diarrhea, he or she may suggest an anti-diarrheal drug.
Antispasmodics, such as Bentyl (dicyclomine), are drugs designed to smooth muscle contractions in your intestines to help lessen pain and cramping. Because it can make you drowsy or cause blurred vision, it’s best not to drive until you know how it may affect you.
It can also cause:
- rapid heart rate
- difficulty staying awake
- mood changes
- flushed skin
If you experience any of these side effects, contact your doctor right away.
Laxatives, such as Dulcolax (bisacodyl),used to relieve constipation, can cause diarrhea and electrolyte abnormalities when overused.
Anti-diarrheals, such as Imodium (loperamide), can cause drowsiness and life-threatening heart rhythm changes, especially if you take more than the recommended dose. Other possible side effects include:
- skin reactions like redness, itching and hives
- difficulty breathing
- stomach pain or bloody stools
Proton-pump inhibitors, like Prilosec (omeprazole), are used to treat heartburn. If you stop using these drugs, you may experience a rebound effect of worse reflux for a short time. Over the long term, these drugs can weaken bones and raise risk for other conditions like kidney disease.
Can Taking Drugs Cause IBS?
Depression and anxiety are some of the most powerful triggers of IBS. In some cases, being on an antidepressant can help alleviate symptoms. Unfortunately, the drugs designed to treat mood disorders can also trigger IBS. “ Medication is one of the most significant causes of IBS,” says Dasari. He names sleep aids, antidepressants, antipsychotics and pain medications as some of the drugs most likely to lead to IBS.
That doesn’t mean, however, that you should discontinue using your antidepressants cold turkey. If you’re otherwise doing well on the drugs, it may make more sense to try changing your diet and sleeping habits first to see if your symptoms improve. If not, you and your doctor may decide to taper you off your antidepressant medication or switch to an alternative.
Supplements Can Cause IBS
Taking supplements can lead to problems, too. “I see a lot of people coming in [complaining of IBS symptoms while] on supplements,” says Setya. Some of these supplements contain sweeteners like sucralose or xylitol, which can upset the digestive system. Setya says protein powders and creatine are also common culprits. “They can work for some people, but for most people, it’s actually very disturbing to the GI [gastrointestinal] tract.”
If you’re experiencing IBS symptoms, work with your doctor to rule out possible causes of gastrointestinal distress. However, it’s helpful to bring as much information as you can to the appointment. Write down the drugs and supplements you use regularly and ask your healthcare provider if any of these could be causing your symptoms. Be sure to note any family history of diseases like Crohn’s or Celiac. To come up with a holistic view of your digestive health, Dasari emphasizes that your physician should ask about your current sleeping, eating and exercise habits as well as any extra stress you’ve been under.