‘I’m a Gastroenterologist, and Here’s Why Managing IBS Is About Far More Than What You Eat’

If you're one of the millions of people with irritable bowel syndrome, also known as IBS, (between 10 and 15 percent of people in the U.S. have it), there's a good chance you've heard of an eating plan called the low-FODMAP diet. This eating plan was created in 2005 by experts at Melbourne's Monash University who were insightful enough to figure out that, for many, foods with short-chain carbs are poorly absorbed, leading to bloating and other digestive woes.

The low-FODMAP diet is a complicated eating plan and takes many nutrient-rich foods off the table, which is kind of a bummer. But many people with IBS have found that it does help with their symptoms, so it's become *the* eating plan G.I. docs prescribe to many people who walk into their office experiencing bloating, constipation, or diarrhea on the reg.

Even if you haven't officially gone low-FODMAP, if you have IBS you may have attempted to avoid flare-ups by cutting certain foods like gluten or dairy. While scientific studies have shown that certain foods can exacerbate IBS symptoms, a new study found that food may play less of a role in managing it than people have long believed. Published in the Journal of Clinical Nutrition, researchers found that cutting gluten and FODMAPs didn't actually help with symptoms all that much. The researchers split a group of 110 people with IBS into two groups. One group nixed FODMAP foods and foods with gluten completely. The other group didn't. They found that FODMAP foods did seem to make symptoms worse, but not as much as researchers previously thought. As for the gluten? It didn't seem to have an effect either way.

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This is a small study; just 110 people. Also, there are other studies out there that have found that cutting FODMAPs and gluten can be beneficial for IBS. But what the study does make clear is that managing IBS is about more than food alone. Here, two gastroenterologists explain why diet is just part of the solution.

What causes IBS?

Before we get into the best way to treat IBS, it's helpful to know what IBS even is. "Irritable bowel syndrome has formal diagnostic criteria that must be met to receive a formal diagnosis," says gastroenterologist Marvin Singh, MD. Basically, this formal diagnostic criteria asks a lot of questions about your poop. What it looks like, how often you're going, if you're in pain... "There's a calculator that takes [symptoms] into account and helps determine if it meets an official diagnosis," Dr. Singh says. Gastroenterologist Rabia De Latour, MD, adds that there are also subcategories, IBS-Diarrhea and IBS-Constipation.

This is important to know because it shows that IBS isn't simply what someone with any type of digestive distress has if doctors can't figure out what else it could be or if you're experiencing a bit of bloating after eating; certain criteria must be met. If you think you may have IBS, meet with a gastroenterologist so you can know for sure.

While there's clear, set criteria about what IBS is, both experts say that what causes it is less straightforward. "IBS is multi-faceted; it's not that simple," Dr. Singh says. "Food, stress, sleep, and other lifestyle factors have all been found to affect the microbiome, causing issues that eventually lead to an IBS diagnosis." Dr. De Latour says one factor that scientific studies have particularly found connected to IBS is stress. "There's a very strong link between IBS and mental health," she says. "It's been well-established by many gastroenterologists anecdotally that a person who is experiencing a lot of personal stress or anxiety has worse symptoms of IBS." She adds that it's yet another example of how intertwined the mind and gut really are.

This is exactly why both G.I. docs say that food is only one part of the solution for managing IBS.

How to manage IBS besides changing what you eat

If you have IBS, Dr. Singh and Dr. De Latour say stress management must be part of the solution. "The brain has a direct influence on the composition of the microbiome. If you feel anxious on a regular basis, not only can that alter the bacteria makeup in the gut, it can also cause the digestive tract to work faster or slower," Dr. Singh explains. "This can lead to symptoms like constipation, diarrhea, or bloating." So, if you've ever experienced some unpleasant tummy troubles before a big presentation or meeting, you've seen this powerful connection firsthand.

This is why both doctors advise finding some way to manage stress and anxiety on a regular basis. They say this will look different for different people. Maybe your go-to stress reliever is going for an outdoor run after work. Maybe it's breathing or stretching exercises. It could be a luxurious bubble bath. The key is to find something. Many of these stress relievers have scientifically been found to help improve IBS symptoms, such as yoga and meditation. Others still need to be studied to confirm a connection. (Where's the signup sheet for the luxurious bath study?) But both doctors say managing stress is key.

Of course if you experience flare-ups regularly after you eat, the simple act of feeding yourself can be stressful. If this is the case for you, Dr. De Latour suggests working with a therapist in addition to a gastroenterologist, specifically one who specializes in disordered eating. These experts can give tips on how to actually enjoy mealtime instead of getting stressed out by it while also making sure you're getting the nutrients your body needs.

Besides managing your stress, Dr. Singh says making sure you're getting enough sleep is also important for managing IBS. "Alterations in the sleep cycle is another factor that can alter the microbiome," he says. To his point, scientific studies have found that some people with IBS also have a sleep disorder.

If you're taking medication, Dr. De Latour says this is something else to be mindful of as some can make IBS symptoms worse. For example, some pain medications, cough medications, and anti-depressants can exacerbate symptoms. For this reason, she says it's important to tell your primary care doctor (or other specialists) you have IBS before getting a prescription med; IBS isn't just something to talk about with a G.I. doc.

So, what about food? Does it still play a role in IBS management? Both doctors say it does—just not the only role. "The low-FODMAP diet isn't meant for someone to follow forever because it does exclude a lot of healthy foods, so I work with patients by introducing FODMAP foods back in very slowly, having them track how different subgroups make them feel," Dr. Singh says.

What's clear is that taking care of your gut goes beyond diet; you have to take care of your mental health too. That's the only way you can keep IBS from getting in the way of living your best life. The most encouraging news of all is that it can be managed. It just takes a little extra self-care—and that's something everyone can benefit from.

—reviewed by Jennifer Gilbert, MD, MPH