Research based tips to manage Irritable Bowel Syndrome (IBS) - Feature Article

What does the latest research tell you do to manage your Irritable Bowel Syndrome (IBS)?

IBS is an exhausting chronic condition that affects everything from your ability to be present with your family, navigate food choices, your bowel habits, ability to sleep and your work productivity.

IBS can be a painful reality and dealing with it for a long time can really stress you out. That stress can actually make your IBS symptoms worse, creating a frustrating loop.

If you are finding living with IBS challenging, here are some research-based tips to help you improve your IBS symptoms.

What is IBS?

IBS is a chronic health condition affecting 10 to 25% of people in the United States.

Symptoms can include:

·      fatigue

·      anxiety

·      intestinal gas

·      bloating

·      pain

·      diarrhea

·      constipation

·      fast or slow food digestion time

·      increased stomach pain

·      small intestinal bacterial overload

·      difficulty absorbing carbohydrates

·      inflammation in your intestines.

These clinical signs often lead to an imbalance in gut bacteria, ongoing abdominal pain, and troubled bowel movements. 

There are three types of IBS:

·      IBS-C is the constipation type.

·      IBS-D is the diarrhea type.

·      IBS-M is the mixed type which includes symptoms of both constipation and diarrhea.

If you have IBS-C it means that you experience constipation the majority of the time, rather, than diarrhea. If you have IBS-D, the opposite is true.

IIBS can impact your qualify of life, work output, and finances as you potentially spend more money on healthcare than your peers . However, as you will see below there are ways to heal and recover from IBS.

How are the brain and gut connected?

The gut and brain are intrinsically linked. This link can lead to IBS. The gut and the brain develop from the same tissue when you were growing in utero. They communicate constantly throughout our whole lives. They connect through the Vagus nerve, also known as the gut-brain connection.

The gut and brain need each other. For example, neurotransmitters released by the brain help inform the stomach when to produce and release stomach acid, when to digest food, and when to move waste into the intestines.

The gut sends information to the brain to let it know when to start eating (hunger), or stop eating (fullness), and may even send messages that inform our brain’s emotions.

If you have IBS, you may have a disconnect between your brain and your gut. Your gut can send a message to the brain that you are hungry or full when you are not hungry or not full. A sign of IBS can be feeling very little or no hunger due to incorrect communication.

Or the brain may send messages to the gut to release stomach acid, digest food, or start moving waste into your intestines at the wrong time or on a delayed time frame.

The gut-brain connection is also the link between the emotional and thinking centers of our brain to our digestive center. A key piece of the gut-brain axis is a type of chemical called serotonin.

Serotonin’s role in the body is regulating the time it takes to digest food, feelings of pain, and inflammation in the body. If there is less serotonin in the body, we can experience a slower or faster time digesting food, increased feelings of pain, and increased inflammation in the body.

Another piece to the gut-brain connection is how stress impacts IBS. Stressful things happening in your life, at school, work, or home, can mess with IBS. It’s a cycle with stress making your IBS act up and IBS, itself, making you more stressed out.

How can we treat IBS?

IBS treatment can include:

·      antibiotics – treat bacterial infections

·      prokinetics – help food move through your digestive tract

·      central neuromodulators – helps your central nervous system

·      peripheral neuromodulators – decreases long term pain

·      behavioral therapy – reduce stress and help food move through your digestive tract

·      probiotics – increase different types of helpful bacteria

·      dietary advice  – decrease physical reactions to foods

After evaluating you and discussing your symptoms and possible treatment options your Gastrointestinal doctor will determine the best treatment plan for you.

What medications can physicians prescribe?

GI doctors are usually involved with the treatment of IBS. GI doctors specialize in the entire digestive system and act as detectives to diagnose and treat stomach issues. They can recommend a variety of different medications to help with your IBS symptoms.

 Depending upon the type of IBS you are diagnosed with (IBS D, IBS-C, or IBS mixed) your doctor will have different recommendations. Consult with your doctor on which medications will work best for you. Medications are a tool to help reverse the effects of IBS.

How is behavioral therapy related to IBS?

According to research by Northwestern University, current treatment guidelines for IBS include brain-gut behavioral therapy. There are different types of behavioral therapies. The therapists recommended for IBS are cognitive behavioral therapy (CBT) and gut directed hypnotherapy.

Behavioral therapy is shown to retrain the gut-brain connection. This therapy reduces stress and inflammation and helps to move food through the digestive tract in a timely manner.

Overall, research seems to shows that if you attend in person therapy sessions you will have the best outcomes. It’s important to have a therapist play an active role in your treatment.

However, a few different apps have been created including Nerva and Zemedy. Clinical data from research trials supports the use of these self-guided treatments. One of the apps is called Nerva which uses the gut-directed hypnotherapy technique. Another app uses CBT and it’s called Zemedy.

Both apps have are backed by research, are cost-effective, and are easily to access compared to in-person or remote therapy sessions with a therapist. There are additional web based products including Mahana IBS, and Regulora.

Do probiotics help IBS symptoms?

In general, research shows that probiotics help improve the variety of good bacteria in your gut, reduce IBS symptoms, and abdominal pain. The recommended length of time to use probiotics is at least 12 weeks before you decide if they are helpful.

Saccharomyces boulardii is the top probiotic recommendation for patients with IBS. Symptoms improve after 30 days of treatment according to a research review from the Mayo Clinic.

What is the best diet for IBS?

 The best diet for you to manage IBS symptoms is the low fodmap diet. The diet has you exclude all foods that are “high” in fodmaps which include foods with lactose (e.g. cow’s milk), fructose (e.g. apples), fructans (e.g. artichokes), GOS (e.g. chickpeas) and polyols (e.g. blackberries).

For a full list of foods check out Monash University. Additional research demonstrates that the low fodmap diet as a safe, helpful, and long-term option for the management of IBS symptoms.

Other diets such as the Mediterranean diet (MD) have been researched to see if it is a good option for IBS. A research article in Clinical Gastroenterology and Hepatology finds that a standard MD may not be helpful for patients with IBS and certain foods on the MD made IBS symptoms worsen.

A gluten-free diet has also been explored, however, researchers need more evidence before recommending the gluten-free diet as a treatment option.

According to an expert review in the Journal of Gastroenterology and Hepatology, common trigger foods to avoid include dairy products (e.g. milk), foods with carbohydrates that are difficult to absorb (e.g. processed breakfast cereal), spicy foods (e.g. curry), fatty foods (e.g. French fries), wheat products (e.g. bread) and foods that are associated with histamine release (e.g. fermented foods).

Avoiding your trigger foods, eating regular meals, focusing on whole foods, and reducing processed food consumption, sugar, and alcohol are recommended best dietary practices. IBS trigger foods are different for each individual and keeping track of this in a journal can help you.

Next steps – new research?

A new study published in the Journal of Agricultural and Food Chemistry on anemic animals showed the possibility of using fermented goat milk as a tool to restore a healthy gut microbiome. Anemia is a condition where your body doesn’t make enough red blood cells or your red blood cells are not working right.

This could mean providers will recommend goat milk kefir in your diet to help with IBS symptoms. Goat milk is more similar to human breast milk than cow’s milk.

Another potential treatment option includes fecal transplants (FMT) however, further research is needed before FMT can be recommended as a treatment option for patients with IBS. A comprehensive review published in the Journal of Clinical Medicine indicates conflicting evidence on if this treatment actually changes the bacteria inside your gut.

In this method, a healthy donor would donate stool to the colon of an individual with IBS with the hopes of changing their gut microbiome.

According to a study published by the World Journal of Clinical Cases modifying the gut-brain axis seems to be a promising target for the development of new therapy techniques for IBS.

IBS can be a difficult disease to manage but there are lots of great evidence based treatments to try. Finding a provider you can work with is important. Researching your treatment options before your appointment can help you be aware of your treatment options.

Consult with your primary care physician to find a well-known GI doctor in your area. Functional medicine doctors are another option. Look for a functional medicine doctor who also has their medical degree.

Talk to your doctor and explore all the treatment options. Medications, probiotics, diet and behavioral therapies like CBT and hypnotherapy work to treat IBS.