The Dietary Prescription for Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a condition of abdominal pain and discomfort with altered bowel function that is not often addressed until it has intruded upon years of a person’s life. The unfortunate symptoms include bloating, gas, abdominal pain, constipation, urgent onset of diarrhea, or a combination of all of the above. These symptoms can occur in IBS sufferers despite eating a fiber-rich diet with moderate-sized frequent meals and adequate fluid intake. IBS involves a complicated cycle of gut dysmotility, stress, and environmental triggers such as diet, infection, antibiotics or medications, and low-grade inflammation. Canada has one of the highest rates of IBS in the world with at least 5 million suffering from mild to severe symptoms, although only 40% seek medical care. About 80% of people with IBS are women.

The Rome III criteria for the correct diagnosis of Irritable Bowel Syndrome includes having two out of the three following symptoms for at least three days per month over the last three months:

Abdominal pain or discomfort that improves with a bowel movement
Abdominal pain or discomfort associated with a change in frequency of bowel movements
Abdominal pain or discomfort associated with a change in appearance of stool

In 1999, Australian Dr. Sue Shepherd recognized the role that certain fermentable carbohydrates have in the management of IBS symptoms. Certain carbohydrates are poorly digested or absorbed in some people, causing gas, bloating, irregular contractions of the intestine, and altered bowel movements. Thus, the “Low FODMAP Diet” was crafted, representing the temporary elimination of “Fermentable Oligosaccharides, Dissaccharides, Monossaccharides, And Polyols”. Excluding the possible triggers of IBS symptoms and then reintroducing the foods group by group helps patients to recognize which of the carbohydrates do not result in frequent and debilitating bouts of constipation or diarrhea.

Other treatment options besides modifying the diet include taking psyllium or other soluble fiber supplements, medications, healthy weight maintenance, avoiding caffeine and carbonated drinks, and receiving psychological counselling for anxiety or stress.

If you search online for a list of high and low FODMAP foods, you may receive a lot of conflicting information. On top of managing the many possible lifestyle contributors to IBS symptoms, planning a healthy diet around the temporary elimination of many common foods and seasonings can be overwhelming. Luckily, there are large varieties of foods on the “allowed” list. A well-organized reintroduction plan can help a person with IBS individualize their nutrition to fit their body’s unique needs.

*Complete treatment of IBS includes ruling out other possible conditions, diseases, and medical diagnoses. For more information on the low FODMAP diet and IBS, or to schedule your nutrition assessment and dietary prescription, please contact Brianna Jabusch, Registered Dietitian at brianna@nufitrx.com.

Management of Irritable Bowel Syndrome: Using dietary approaches including the low FODMAP diet. Presentation by Maitreyi Raman, MD. Dietitians of Canada Seminar, University of Alberta, January 28, 2015.
The Low FODMAPs Diet: New approaches for IBS. Presentation by Rory Hornstein, RD. Dietitians of Canada Seminar, University of Alberta, January 28, 2015.