Irritable Bowel Syndrome (IBS), is a functional disorder; meaning for those suffering from IBS there is a distinct and often severe difference in gut function without any evidence of disease to explain the symptoms.
IBS patients predominantly experience either constipation or diarrhea, although nearly a third of patients cycle between the two. Cramping, bloating, gas and abnormal stool frequency and/or form are also associated with IBS. The chronic and persistent symptoms suffered by the IBS patient can range from moderate to severe.
In many cases these symptoms disrupt important aspects of patient’s lives. These disruptions can affect productivity at work, the ability to attend social functions and even family life and relationships. Many IBS sufferers find it embarrassing to explain their situation to family members, friends and co-workers and can feel very alone in dealing with their condition.
Although the causes of IBS remain unclear, there are three primary triggers for symptoms:
- Food sensitivities
- Food intolerance
- Exaggerated response to stress/anxiety
Due to the complexity of IBS, its treatment requires a more comprehensive approach to maximize symptom relief. This may include diet therapy to identify and eliminate food intolerances and medications to relieve symptoms and reduce stress and anxiety.
Proper nutrition management is the missing component for many patients with IBS. Many elimination diets recommend patients remove the most common food triggers (gluten, dairy, soy, nuts) from their diet in hopes of reducing symptoms.
For most, eliminating one or more of these food items is not enough to substantially reduce symptoms. This is because food sensitivities are very individualized and most people with sensitivities are susceptible to multiple foods. To further complicate matters, it is difficult without proper blood testing to identify which foods one is sensitive to because symptoms can be delayed up to 72 hours after ingestion and can be dose dependent.
Food sensitivities are not detected by a standard food allergy test and some of the older food sensitivity tests have limited clinical value. An accurate, comprehensive blood test is necessary to know exactly which foods to eliminate from the diet for maximum symptom reduction in the shortest possible time. To detect these sensitivities, I recommend the Mediator Release Test (MRT) in conjunction with nutrition therapy, often called the LEAP program.
The FODMAPS approach is an effective way of treating the second dietary mechanism by which IBS symptoms appear, food intolerance. FODMAPS helps to reduce symptoms by eliminating specific sugar and carbohydrate molecules that may be poorly digested in the small intestine. Because of its effectiveness in treating IBS symptoms, many physicians are now recommending the FODMAPS diet to their IBS patients.
It is important for the diet to be implemented correctly to see optimal results. It has been shown that help from a dietitian experienced in this approach can make all the difference in its effectiveness. According to a study by Jacqueline S. Barrett and Peter R Gibson, “All patients complaining of IBS-like symptoms who have had all other gastrointestinal disorders excluded must see a dietitian for appropriate FODMAPS education. Educating the patient via a diet sheet alone, while attractive, has not been validated.”
At Arizona Digestive Health, our nutritional approach starts with an initial nutrition consultation. At this visit I will assess your health history, symptoms, and food and lifestyle preferences to determine the best course of action to take to resolve symptoms and improve the state of your health.
The next step is to begin an “inclusion diet” which not just eliminates all known trigger foods but only includes your non-reactive foods. With this approach most patients with IBS experience a significant reduction or elimination of symptoms within the first 10 days. Over the next 6-8 weeks, more foods are added to achieve the most nutritionally complete diet possible.