Irritable bowel syndrome (IBS)
What is irritable bowel syndrome?
“Irritable bowel syndrome (IBS) is sometimes called “spastic colon”. IBS affects approximately 13 to 20% of the population. However, only about one-third of people with symptoms consistent with IBS seek medical help.
The most common symptoms include: pain, bloating, abdominal discomfort with a fluctuating stool pattern (more than three times a day or less than three times a week, frequent diarrhea and/or constipation or an alternation of both), abnormal stool consistency (very soft/watery or very hard).
Other possible symptoms may include: nausea, poor digestion and repeated burping, fatigue, urinary complaints.
The symptoms are often long-lasting, occur in episodes and typically vary in kind.
We divide this large group of patients into three groups: patients with mainly diarrhea (IBS-D), with constipation (IBS-C) or both (IBS-M).
The Bristol Stool Chart
The Bristol Stool Chart was developed at the University of Bristol and first published in 1997 in the Scandinavian Journal of Gastroenterology. It is a tool that classifies stool into seven different categories based on appearance and consistency.
- Type 1 and 2 refer to constipation
- Type 3, 4 and 5 refer to healthy bowel movements
- Type 6 and 7 tend toward diarrhea
Cause
To this day, the exact cause of Irritable Bowel syndrome remains unknown. It is likely not due to a single cause, but rather a combination of factors that contribute to the development of symptoms.
In recent years, it has became clear that many patients have a low-grade inflammation in the intestinal wall. This can disrupt intestinal motility, increase sensitivity (hypersensitivity) in the gut, or lead to increased intestinal permeability (leaky gut).
Various treatments targeting sensitivity, motility and the contents of the intestines have been investigated with mixed results. Unfortunately, there is no definitive cure for IBS at the time.
However, the condition can be influenced in other ways. By adjusting the diet, we can modify the contents of the small and large intestines to reduce bloating and pressure. It is always important to seek advice from a qualified healthcare professional to ensure you receive the most effective guidance and support.
Some general tips after an IBS diagnosis
In general, it is important to be monitored by an expert. Each case of IBS is unique and requires a tailored approach to control the symptoms in a healthy way. However, we’re happy to share a few general tips:
- Certain eating habits can help reduce symptoms. It is recommended to take your time while eating, chew thoroughly and eat at regular times. A consistent routine supports healthy bowel function. Avoid artificial sweeteners (e.g., sorbitol) and insoluble fiber.
- Try to minimize air intake as swallowing air can lead to cramps, gas or bloating. This can happen when chewing gum, drinking through a straw or smoking. Also be mindful of carbonated drinks.
- Limit your intake of alcohol, coffee (max. 3 cups per day) and more than 3 pieces of fruit per day.
- It is recommended to stay active. Stress is an important factor that can increase symptoms, so regular relaxtion is also key.
- Finally, do not use laxatives or anti-diarrheal medication on your own initiative. Always consult you doctor before using these products.
What is FODMAP-diet?
Limiting FODMAPs (low-FODMAP diet) significantly reduces gas and fluid in the intestine. FODMAP is short for Fermentable Oligosaccharides (fructans and galacto-oligosaccharides), Disaccharides (lactose), Monosaccharides (fructose) and Polyols (Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt). These are complex names for a collection of compounds found in our daily diet.
These specific molecules are poorly absorbed in the small intestine and therefore continue their journey along the digestive canal into the large intestine. Because they are not absorbed, they attract water which causes the intestines to expand. Furthermore, in the colon, they act as a food source for the bacteria that normally live there. The bacteria ferment these FODMAPs which in some people, with higher sensitivity, can lead to the symptoms of irritable bowel syndrome (IBS) such as distension, pain and changed bowel movements.
Solid research has shown that following a low FODMAP diet reduces gas production in the colon and other symptoms. The low-FODMAP diet is therefore considered one of the major breakthroughs in the treatment of IBS.
When following this diet, foods rich in these carbohydrates are temporarily restricted. This is not always easy since we find these carbohydrates in many foods that are important for a healthy and balanced diet.
Thus, it is important to follow this diet under the guidance of a dietitian to avoid deficiencies in fiber, vitamins and minerals. The low-FODMAP diet is a personalized diet. This means it may be different for everyone. The intention is to eliminate only FODMAPs that cause symptoms for you.
According to Holland & Barret, we can divide the low-FODMAP diet into 3 phases:
1. In the elimination phase, all foods rich in FODMAPs are eliminated for 4 to 8 weeks.
2. In the reintroduction phase, FODMAP-rich foods are gradually allowed back in. In this phase, we can find out which FODMAPs are causing symptoms and which are not.
3. In the personalization phase, you can create a personalized diet by eliminating only the FODMAPs that cause symptoms for you.
The different FODMAPs
Fructans are chains made up of different fructose molecules. These chains can vary in length.
Fructans are poorly absorbed by all humans. The small intestine does not have the ability to break down the chains. Limiting these particles in the diet is helpful for most people with IBS.
Main sources: wheat and rye, various fruits and vegetables, added ingredients, including fructo-oligosaccharides (FOS), oligofructose or inulin (sometimes called prebiotics).
Galacto-oligosaccharides are chains of different lengths made of a sequence of galactose molecules.
GOS, like fructans, are poorly absorbed by all humans given the small intestine cannot break down the chains. Limiting these particles in the diet is helpful for most people with IBS. The main sources are legumes.
Polyols are sugar alcohols. They occur naturally in foods, but are also often added as sweeteners by manufacturers. Polyols are poorly absorbed by many people and can trigger IBS symptoms.
Main sources: various fruits and vegetables, sugar-free gum and mints.
Fructose is a monosaccharide. Fructose is poorly absorbed by some people, but in principle should not be avoided by everyone. Main sources: various fruits and fruit juices, honey and agave syrup.
Glucose, another monosaccharide, helps in the absorption of fructose. Thus, when a food contains a good ratio of glucose/fructose, it can be eaten.
Lactose, or milk sugar, is a disaccharide composed of glucose and galactose.
Lactose is poorly absorbed by some people, but in principle should not be avoided by everyone. Some patients lack the enzyme lactase and should definitely avoid lactose in their diet. Main sources: milk, yogurt, soft cheeses.
Which products are rich in FODMAPs?
Fructans
– breakfast cereals
– bread
– pasta
– onion, garlic
– leek
– in some milk drinks and yogurts
– in some fiber preparations as prebiotics
Lactose
– cow’s milk
– chocolate milk
– yogurt
– buttermilk
– ice cream
– cream
– cottage cheese- butter
– solid cheeses (+8 months)
– pancakes
– instant cocoa
– pudding
– bread and cakes
– medication (tablets, capsules)
– ready-to-eat meals
– bouillon cubes
Polyols
– sugar-free chewing gum (xylitol)
– Other “sugar-free” products (candy, licorice, throat lozenges)
Galactans
– legumes (beans, lentils, chickpeas)
– pistachios, cashews
Fructose
– fruit (apple, pear)
– honey, sweeteners
TIP : Know the causes of your triggers and get guidance from experts. An appropriate diet is the basis, digestive enzymes can provide additional support for certain triggers (e.g., lactose).
TIP : Always analyze the label before taking foods and watch out for the names below that also indicate the presence of FODMAPs:
- Polyols: sorbitol E420, maltitol E965, mannitol E421, xylitol E967 and isomalt E953.
- Fructose: fructose, fructose syrup, glucose-fructose syrup, fructose-glucose syrup, fructose-rich corn syrup.
- Fructans: Fructo-oligosaccharides (FOS), inulin, oligofructose, prebiotics.