Chronic health conditions like irritable bowel syndrome (IBS) may seem like a life sentence—that’s certainly how I felt in the first year after my diagnosis.
And yet after many nights spent doubled over on the floor, waiting for waves of agonizing gut cramps to subside, I was more than ready for a change.
Emptying out my pantry and throwing out common ingredients now identified as the culprit behind my many symptoms, I found myself wondering, “So what exactly am I supposed to eat now? Air?”
After a few weeks and a truckload of futility, I had formed a solid dependence on a sludgy meal replacement powder.
Choking down this sad substitute for food, it became apparent that if I was going to achieve anything approaching my pre-IBS quality of life, I would need to explore all my options.
What do we know about irritable bowel syndrome?
Irritable bowel syndrome is a chronic, disabling condition for which there is no definitive treatment. The condition reportedly accounts for half of all visits to gastroenterologists in the US.
IBS is classified as a Functional Somatic Syndrome (FSS), meaning it’s not unlike chronic fatigue or fibromyalgia syndromes.
A FSS in scientific terms is “characterized by the presence of one or multiple chronic symptoms that cannot be attributed to a known somatic [bodily] disease”.
The development of irritable bowel syndrome is believed to be multifactorial. That is, the condition has multiple contributing biological and psychological causes.
One such cause is a disruption and impairment of communication between the brain and gut as a result of stress. More details on the specifics in this clinical review of irritable bowel syndrome.
Living your best life after an IBS diagnosis
Typically after a diagnosis, you’ll work with a dietician to identify all your trigger foods, usually via the low-FODMAP diet.
Together you’ll then reintroduce individual FODMAPs to test tolerance for each, a process that can take weeks, if not months.
An appointment at the gastroenterologist’s office may also need to be set up for you to be screened for other conditions, such as SIBO.
After these processes of elimination, the way forward however starts to get a little hazy.
Our knowledge about irritable bowel syndrome is far from complete. Symptom causes and treatment can vary from individual to individual. What works for some may not work for all.
Through my experience as a long-term IBS sufferer, however, I have found that symptom relief success is largely determined by three things: education, experimentation, and self-advocacy.
In the next few sections, I’ll list some of my hard-won personal insights, citing a range of publicly available studies.
It is important to note however that I am not a medical professional. Any statements made here regarding the efficacy of particular treatments pertain to my personal experience only.
All changes to your personal treatment protocol should be conducted with the support of your medical doctor, dietician, and/or gastroenterologist.
First stop: the low-FODMAP diet
The low-FODMAP diet involves restricting the intake of certain carbohydrates known by the acronym FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols).
FODMAPs are present in anything from bananas to yogurt, to tea and garlic. Consuming more than the recommended amount can cause unpleasant symptoms, including diarrhea, constipation, cramps, gas, and bloating.
Some of the more well-known FODMAPs such as fructose and lactose are even known to trigger reactions among those without IBS.
The prevalence of lactose intolerance, for example, has already given rise to an entire industry of dairy alternatives, with products ranging from soy-based cheese, nondairy butter, and nut milks.
Given the complexity involved in low-FODMAP eating, it’s was with great relief that I discovered a smartphone app designed by the diet’s creators.
The Monash University FODMAP Diet app provides measurements of the FODMAP content for individual ingredients, as well as serving size recommendations.
The app is updated regularly, and serving size recommendations are known to sometimes change; in some cases, the kind of FODMAP listed may shift to another entirely.
For this reason, it’s crucial to always check the app when planning your next meal.
While the low-FODMAP diet can bring many with irritable bowel syndrome some relief, tolerances for each FODMAP, and other possible IBS trigger foods will still need to be monitored.
One effective way to identify one’s own triggers involves keeping a daily record of everything eaten, and the symptoms.
Not all IBS sufferers report resolution of symptoms while on the low-FODMAP diet, and so I must emphasize again the importance of working with a dietician to identify your triggers.
Other dietary suggestions for irritable bowel syndrome
Three meals maximum within this period I have found to be usually sufficient at keeping my appetite sated. I try to evenly space the meals out, with one meal at the beginning of the eating window, one in the middle, and one at the end.
If you’re eating foods with moderate amounts of FODMAPs, be warned that eating overly large portions or snacking in between can slow the transit of food through your system, resulting in FODMAP build-up and symptoms.
A low-FODMAP tea is helpful with managing your appetite during “off” hours. White, green, peppermint, mint, rooibos, honeybush, and licorice are all listed as safe.
Consider also adding a sweetener such as stevia if required. It’s zero-calorie and won’t break your fast.
Resistant starch: Resistant starch (RS) is a naturally occurring fiber. Some IBS sufferers report finding it can help with symptoms.
RS can be found in some milled grains, legumes, underripe bananas, cooked and cooled bread, potatoes, rice, and pasta, to name a few.
RS ferments slowly in the large bowel, compared to the rapid fermentation that results from eating FODMAPs, leading to the usual symptoms.
There are multiple forms of RS and your tolerance to each kind can vary. RS has been known to produce symptoms in some IBS sufferers.
RS as it turns out is my personal nemesis; nevertheless, I have found I can mitigate some RS-related symptoms with the help of the herbal remedies listed below.
Spicy foods: Spicy foods are a well-known IBS trigger. Chile is completely out for me, though I’ve found I can tolerate pepper and mustard.
Acidic foods: Vinegar is a big culprit here, to the extent that I’ve had to stop eating salad dressing.
Citric acid is another culprit that turns up in a variety of food, from candy to canned tomatoes. These days, I avoid it completely.
Fat & oils: Eating anything high in fat or containing small amounts of oil I’ve found to be a major trigger. And apparently, I’m not the only one.
Note that cooking without fat and oil is possible, but requires some creativity. For example, I have found frying vegetables using a wok using a small amount of water can work.
When it comes to baking, you can also consider substituting oil with a low-FODMAP pumpkin variety or mashed unripe banana.
Medicine & supplements
Antispasmodics: Drugs such as dicyclomine (Bentyl) and hyoscyamine (Levsin) are commonly prescribed treatments for gut cramps. I make sure to carry a few pills with me at all times.
Antidepressants/Antianxiety medications: One meta-analysis found that tricyclic antidepressants can help soothe global IBS symptoms.
Another study concluded that selective serotonin reuptake inhibitors (SSRIs) are effective in treating co-occurring anxiety, depression, and psychological distress. This may in turn lead to improvements in global IBS symptoms.
A psychiatrist will be able to assist with determining whether this form of treatment is appropriate for you.
One study recommends consuming no more than 5g of whole psyllium husk daily. I have found fiber supplements only exacerbate my symptoms.
Probiotics: A course of antibiotics is usually recommended when treating secondary conditions such as small intestinal bacterial overgrowth (SIBO). Probiotics can help counteract the havoc these drugs wreak on your gut microbiome.
There is evidence multi-strain supplements taken over an eight-week period can improve IBS symptoms regardless of antibiotics, though I have not experienced much success in taking them.
(Interestingly, fecal microbiota transplants are being explored as a possible treatment for IBS.)
Peppermint oil: This product is available in capsule format and can treat IBS-related symptoms. On the rare occasion I dine out, I’ll take two pills to minimize the impact of eating high-FODMAP ingredients.
Carminative (anti-gas) herbs: A new study has found that a herbal compound containing essential oils derived from Shirazi thyme, ajwain, and dill can significantly improve IBS symptoms.
When consuming foods high in resistant starch I usually take half a teaspoon of a similar three-seed combination: ajwain, dill, and anise.
As Shirazi thyme is not widely available online, I decided to sub it with anise seed, another carminative.
Note that the exact FODMAP content of these seeds has not yet been measured. It is possible that consuming them could cause you to exceed your FODMAP limits.
Activated charcoal: There is some evidence that activated charcoal can help with the absorption of gas in the bowel. I take 3x 780mg charcoal pills, twice daily, along with the three-seed combo described above.
Digestive enzymes: Broad-spectrum enzymes may support digestion among some IBS sufferers, but again more studies are required.
The good news is that there are commercially available enzymes targeting select FODMAPs: xylose isomerase (for fructose), alpha-galactosidase (for galactooligosaccharides, or GOS), and lactase (for lactose).
While I avoid dairy completely due to the fat content, lactase is an effective aid for those who suffer lactose intolerance.
There is evidence that enzyme treatment using alpha-galactosidase enables IBS sufferers to consume nuts, legumes, and beans without any of the usual side effects. Taking one 400 GALU tablet with each meal has proven a godsend for me.
For a complete list of which food items the alpha-galactosidase enzyme targets, check out the Monash University FODMAP diet app.
I have found taking a handful of highly concentrated lipase tablets can help mitigate some of the worst symptoms from eating fat.
Addendum: As the resistant starch and fat content of nuts, legumes, and beans can cause symptoms for me, I continue to limit my intake.
In one trial, increased physical activity over a 12-week period was shown to improve irritable bowel syndrome symptoms.
For those of us who spend too long sitting, the current recommendation is to get 30-40 minutes of vigorous exercise daily.
Exercise is also known to improve general mental health. Given many IBS sufferers experience anxiety and depression, there’s a strong argument as ever for getting your daily steps in.
Stress: IBS is a stress-sensitive disorder that can bring your GI tract to a standstill, triggering symptoms such as gas and bloating.
I have found strenuous activities like hikes, traveling long distances, or attending an unfamiliar or anxiety-inducing setting can trigger tummy upset.
Having a comfortable environment and routine can go a long way to ensuring healthy bowel activity.
Seeking support with irritable bowel syndrome
Community: Reach out to friends you’ll know will be understanding and accommodating of your condition.
Find a community of fellow IBS sufferers online, or in your local city. Don’t go at it alone.
Meditation: I have found 2x 20-minute meditation sessions a day helps ease stress and anxiety. Consider trying some of these free guided meditations.
Gut-directed hypnotherapy: This has been shown to have long-term benefits for irritable bowel syndrome sufferers.
A range of gut-directed hypnotherapy prerecorded tracks can be purchased online. (Alternatively, you can access several free general hypnotherapy tracks here.)
If you’re drowning in information right now, my suggestion would be to start small.
Trial run one or two of my suggestions. If, after a period of careful monitoring, your symptoms don’t improve, I would invite you to test another.
Pick and choose what works best for you, but always remember to seek professional insight into any new treatment protocol.
The National Center for Biotechnology Information website is a good place to explore studies regarding current, emerging, and possible future IBS treatments.
Finally, know that experimenting brings with it the possible reoccurrence of symptoms.
Demoralizing as this can be, take heart in the knowledge that every risk faced on the path towards healing, within reason, may ultimately prove a risk well taken.