Got Tummy Trouble…What Do I Do?-By Moninder Kaur

Do you struggle with the embarrassment relating to excess gas, abdominal bloating, pain or discomfort in the abdomen and have the urgency to use the bathroom right away either because of diarrhea and/or constipation? Has this been going on over a period of at least 3 months?

​If so, you may be suffering from Irritable Bowel Syndrome (IBS).
​

Image Credit: Do You have Celiac Disease and Suffer from IBS? By: Udi's Gluten free, Accessed November 2019

​Irritable Bowel Syndrome is a functional gastrointestinal disorder, that is, one that is not a result of any structural abnormalities or any underlying disease, instead it turns out that imbalance in brain-gut communication can contribute to IBS (Nelms, Sucher, & Lacey, 2016). Recent research performed by Rej and his colleagues Aziz, Tornblow, Sanders and Simrén (2019) highlighted that approximately 10% of people worldwide are affected by IBS. According to National Institute of Health (2017), women are twice as likely as men to develop IBS and individuals are frequently hit by this condition before the age of 50. Based on an individual’s bowel habit, IBS can be categorized into three subtypes: Constipation-predominant, Diarrhea-predominant and Mixed diarrhea and constipation (Nelms et al., 2016). IBS is thought to involve multiple factors including genetic predisposition; altered immune response stimulated by food sensitivity and an altered intestinal microbial environment; and an elevated inflammatory response to gastroenteritis (Rej et al., 2019; Nelms et al., 2016).

Diagnosis
Despite its wide spread, there is no test for Irritable Bowl Syndrome because of the lack of a good biomarker. Hence, it is very essential to reach out to an experienced physician and have it checked out. To diagnose, the physician will perform a physical exam and ask a series of questions related to your medical and family history. Depending on your symptoms and family history, a practitioner may decide to run a blood test, and perform a colonoscopy and capsule endoscopy to rule out other gastrointestinal disorders such as celiac disease, colon cancer and Crohn’s disease respectively (National Institute of Health. Definition & Facts for Irritable Bowel Syndrome). Based on the diagnosis, the physician may refer you to a registered dietitian who may be specialized to guide you through the process of managing the symptoms by following a specialized diet while ensuring your optimal nutritional intake.

Treatment
While there may be more than one approach to lessen the symptoms of IBS, one of the most popular and evidence-based dietary therapies is the Low-FODMAP diet. The acronym FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. The rationale for following a Low-FODMAP diet is that foods high in FODMAP are not well digested in the small intestines and produce gas. Foods that are high in FODMAP and may trigger IBS symptoms may include the following (Nelms et al., 2016):

• Fruits: Apples, blackberries, peaches, plums and mango
• Vegetables: Asparagus, Brussels sprouts, broccoli, cabbage, cauliflower, garlic
• Grains: Wheat, barley, rye
• Legumes: Beans, chickpeas and lentils
• Nuts: Pistachio and cashews
• Meat and protein products: Poultry, eggs, and fried meats
• Milk products: Milk, ice cream, and custard
• Other: Gum, beverages or foods sweetened with fructose or sorbitol

Following a Low-FODMAP diet can be challenging since you will have to exclude specific foods that contain FODMAP. As this can be overwhelming, it is essential that you reach out to a registered dietitian who can provide guidance on how to implement a Low-FODMAP diet by following a three-phase process (Rej, et al., 2016).

• Phase 1: The elimination phase is the initial phase that involves strict restriction of all high FODMAP foods for about 4-8 weeks.
• Phase 2: The reintroduction phase is the second phase in which high FODMAP foods are gradually reintroduced to determine the tolerance level.
• Phase 3: The personalization phase is the last phase that involves follow up over the long term to manage the IBS symptoms.

It is important to keep in mind that each individual varies, and you may react differently to Low-FODMAP than someone else. IBS etiology and pathophysiology differ among individuals and require that you work closely with a dietitian who can guide you through the process of eliminating FODMAP foods and reintroducing them as appropriate while ensuring optimal nutritional intake.
 
Reference
Do You have Celiac Disease and Suffer from IBS? (2016, May 24). Retrieved November 7, 2019, from 
https://udisglutenfree.com/2016/05/10/do-you-have-celiac-disease-and-suffer-from-ibs/.

National Institute of Health. Definition & Facts for Irritable Bowel Syndrome. (2017, November 1). 
Retrieved November 5, 2019, from https://www.niddk.nih.gov/health-information/digestive- diseases/irritable-bowel-syndrome/definition-facts#develop

Nelms, M., Sucher, K. P., Lacey, k (2016) Nutrition Therapy and Phathophysiology (3rd ed.). Boston,
MA: Cengage Learning.

Rej, A., Aziz, I., Tornblom, H., Sanders, D., & Simrén, M. (2019). The role of diet in irritable bowel
syndrome: Implications for dietary advice. Journal of Internal Medicine, 286(5), 490-502
 

​