What is IBS ?

IBS is considered a functional intestinal disorder in which the normal digestive function of the bowel is disrupted.
This leads to consistent uncomfortable ailments such as abdominal pain and other intestinal symptoms like diarrhea, constipation and flatulence that can range from mild to severe.

Symptoms of IBS

This intestinal malfunction does not show any visible or measurable organic damages of the intestinal tract. IBS patients usually suffer from a mixture of symptoms that can range from mild to severe. The main criteria which is used to diagnose IBS is the experience of a reoccurring abdominal pain or cramps, often accompanied with indigestion. According to the current publication of the Rome Criteria a patient is diagnosed with IBS if recurrent abdominal pain (1 day/week in the last 3 months) is associated with two or more of the following criteria: 

 Strained
defecation

 A change in
frequency of bowel movements

A change in form (appearance)
and consistency of the stool
(watery, lumpy, hard, dry)

Other health problems that share similar symptoms with IBS

Celiac disease

Food intolerances

Inflammatory Bowel Disease

Crohn’s disease

Ulcerative colitis

Subtypes of IBS

IBS can be divided into 3 main subtypes that can be identified based on the frequency of stool passage and the stool consistency (loose or hard stools) as well as appearance.

IBS-D

Diarrhea-predominant IBS patients suffer mainly from bouts of diarrhea. IBS-Diarrhea patients experience frequent feelings of urgency, abdominal strain as well as loose and watery bowel movements. These occur 3 or more times within a day. 

IBS-C

Constipation-predominant IBS patients mostly complain about aggravated bowel movements. Often bowel movements are reduced to less than 3 times a day.

IBS-M

Mixed-type IBS patients experience alternating episodes of diarrhea and constipation. This can occur monthly, weekly or even daily.

Causes for IBS

While the exact cause for the development of IBS is not fully understood, researches try to explain the
underlying multifactorial causation for IBS and suggest multiple factors for IBS: 

Disrupted intestinal motility
Hypersensitivity
Inflammation along the digestive tract
Impaired gut-brain communication
Leaky gut syndrome
Imbalanced microflora

Ways to counteract IBS

IBS is definitely not an issue you are dealing with alone. Improving IBS is not a one-way approach since there is no one one-size-fits-all therapy. IBS requires a personalized combination of various treatment approaches including lifestyle and diet changes. Note that before starting your own therapy strategy, it is always best to consult your health practitioner in order to confirm a diagnosis of IBS and to discuss the next steps.
Given that IBS can usually not be “healed”, a therapy approach in IBS generally combines two pillars: trigger prevention and symptom treatment.
Prevention addresses controllable triggers, symptom treatment relieves chronic persistent complaints.

IBS prevention from head to toe - find your triggers

Besides lifestyle-associated triggers like getting enough sleep or exercise, nutrition has a major impact on digestive well-being.

The first approach in IBS should always be a lifestyle change to evaluate preventable triggers before seeking mild medicinal support.

Promote digestive health from a holistic view

There may not be just one trigger for stronger IBS symptoms. Often a bunch of small details leads to a major deterioration of overall health, the entirety of decisions and food choices may determine your condition. Try to improve your lifestyle constantly to maintain your overall well-being. Improving everyday life situations can be life-changing for IBS patients.
If you can deal with your symptoms right after doing several lifestyle improvements, great! If there are still complaints, try to find out your personal causes for complaints and a suitable therapy together with your doctor. 

Emotional health

Are you tired, stressed out, or constantly sticking to negative thoughts and pessimism? And maybe, your problems with digestion get worse with these issues? If you answer these questions with “yes”, there´s a definite need for action, not only for the sake of digestive balance. Try some relaxing techniques like yoga, go for a walk for a few minutes, or try meditation. Certainly, there is something that helps you cool down and get some rest. And after that, the intestinal system should be calmer as well.

Systemic health

Do you have cardiovascular or other organic problems? Do you have to take strong medicines? Are you smoking? All of these factors can affect your digestion in a negative way. Ask your doctor if there can be a connection and there can be some adaptations which reduce the burden on your body and your digestive system.

Lifestyle and diet

Exercise regularly to support your digestion

No nutrient-rich and balanced diet, as healthy as it may be, can compensate a lack of exercise or even sedentary lifestyle. Keep on moving to promote natural bowel activity! Find out what suits you and, after all, is fun enough to be continued on a regular basis and to make it your new habit! You will not keep doing exercises you started to do only because you “have to”. Besides finding a new favorite sport, it can be helpful to change the little routines in everyday life. Taking the stairs, going to work by bike, walking a mile instead of taking the car or bus… all of that makes a big difference in the long term. 

Eat the right way for healthy digestive functioning

It is essential to provide the body with enough vitamins, nutrients, the right amounts of food and water. Is your diet well-balanced, do you eat plenty of vegetables and do you ensure diversity on your plate? In case you are not sure if your vitamin and nutrient intake is appropriate, let a dietician assist you with analyzing and, where appropriate, improving your daily menu. It will be helpful to start an IBS diary to find connections between your diet and digestive conditions. Food and diet play a significant role for IBS patients. Choosing the right diet can be one of the most effective and natural ways to deal with IBS. IBS symptoms often occur right after the ingestion of certain foods or food components. Since every IBS patient reacts differently to the ingestion of certain foods and food components, it is vital to listen to your body and to find a diet pattern that works best for you. 

Learn to understand your bowel

Here you can download our IBS diary table that will help you to keep track of your meals and a possible link to your symptoms. If you document both patterns consistently every day for at least 2 weeks, you will most likely notice a pattern within your eating habits. Afterwards, you can discuss your findings with your doctor or dietician to figure out dietary measures, tailored to your needs.

For further information about IBS, you can download our IBS-Diary booklet. 

Dietary recommendations for IBS

While an IBS diet plan should always consider individual food triggers, there are some dietary guidelines and tips that have shown to widely improve IBS symptoms. Gradually increase your daily fiber intake. Good sources of fiber include:

Fruits

Nuts

Whole-grain products

Seeds

Vegetables

Although an adequate fiber intake is beneficial for maintaining a healthy digestive system, it may also generate gas and bloating, especially if your body isn’t used to the high amount of intake. A dose of 20 to 30 grams of fiber per day is commonly recommended. However, it is always advised to find the amount that works best for you and your digestive system.

Legumes

Peas or beans are a great source of fiber and nutrients but some IBS patients find them hard to tolerate since they contain a lot of insoluble fiber. Experiment to see if your gut can handle them or not.

Fruits and vegetables

Fruits and vegetables are an essential part of a healthy diet. If certain fruits or vegetables are hard for you to digest, try eating them without the skin and stick to those containing dominantly soluble fiber such as oranges, strawberries, blueberries, cucumbers and carrots. Those are also low in FODMAPs

Raw Foods

Raw foods might upset your gut, so try eating cooked foods. Cauliflower, broccoli and cabbage are an exception as they might still cause heavy bloating even after being cooked.

Food choice and preparation

Try not going for spicy, chili infused dishes but opt for the mild alternatives. Avoid heavily processed, greasy and sugar rich foods as well as refined carbohydrates. Exclude fast food, junk food, deep fried foods, white flour products, sweets, cakes, etc. from your diet. Not only is it better for your overall health but these foods tend to upset your digestion. Try more gentle preparation methods while cooking, like grilling, boiling or steaming. There are tons of good recipes found in books and online, showing you how to prepare wholesome meals that you can try out.

Water

Drink lots of water. At least 6 to 8 glasses per day.
This will not only prevent you from getting dehydrated caused by episodes of diarrhea but also prevent constipation and bloating.


Dairy

Many IBS patients feel better after cutting out dairy products from their diet. Try it out to see if it also works for you. 

Beverages

Stay away from alcoholic, carbonated and caffeinated drinks.

Sweets and artificial sweeteners

For all chocolate lovers out there - moderate your chocolate intake since it might irritate your bowel. It might be hard to do at the beginning but for your digestive tract it is definitely worth a try. Avoid artificial sweeteners. Artificial sweeteners have shown to promote bloating and diarrhea. Be conscious about what foods you buy and make sure to read the labels of the packaging before putting any of them into your shopping cart the next time you go grocery shopping. Artificial sweeteners are most often found in soft drinks, low-fat products, jams, chewing gums, diabetic food products etc.

"A man may esteem himself happy when that
which is his food is also his medicine." 

-Henry David Thoreau-

Personalized dietary therapy:
The Low-FODMAP diet

The Low-FODMAP diet is a dietary concept published by the Monash University in Australia. It follows the strategy of restricting foods that contain certain carbohydrates, known as FODMAPs, which have been shown to trigger digestive (IBS-related) symptoms in most IBS patients.

What are FODMAPs?

FODMAPs is the abbreviation for: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

FODMAPs are particular types of carbohydrates and sugar alcohols:

FOS and GOS

Fructo- and Galactooligosaccharides. 
These are sugar chains consisting of several glucose or fructose molecules. FOS and GOS are barely digestible due to their chemical bonds.

Lactose

Lactose can be found in milk and dairy. Unlike in manifest lactose intolerance, the digestibility of lactose can vary from day to day in IBS. Lactose is only present in milk from animals - there can never be lactose in plant-based milk replacement.

Fructose

Fructose is found in fruit. In fructose intolerance, the sugar is absorbed but cannot be metabolized. In IBS or fructose malabsorption, fructose may not be absorbed properly and passes the intestinal system unassimilated.

Polyols

Polyols occur in fruit and vegetables, but also in sweets and chewing gum as synthetically produced sugar substitutes.
In higher amounts, polyols may not be digested.

How FODMAPs affect digestion

All FODMAPs are naturally difficult to digest, especially the FOS and GOS. Not only for IBS patients, but for everybody! FODMAPs are fiber, which are always indigestible – and form the food base for digestive microbiota.
The dose makes the poison. Many of us, even without IBS, will have a hard time with digestion after eating certain foods which contain indigestible components, like e.g. onions, kale or Brussel’s sprouts. The difference is that the bowel of IBS patients is more sensitive and therefore shows stronger irritation.

Course of FODMAPs through the intestinal system

1.
FODMAPs are not degraded in the small intestine and end up in the colon. The colon looks like a frame surrounding the small intestine.

2.
The accumulation of FODMAPs leads to a surplus of water and gases in the colon.

3.
The resulting abdominal pressure may not be handled by persons suffering from IBS.

4.
Abdominal pain, flatulence and other digestive problems can be the consequences. 

Find your personal IBS diet in 3 steps

The personalized low-FODMAP diet consists of 3 phases, beginning with a radical cut-out of all foods considered to be irritating, followed by a subsequent increase of particular food groups. Simultaneously, the ingested amounts and occurring digestive complaints are tracked to find out the personal limits for trigger foods. The final goal is a compromise of necessary restriction and dietary variety to maintain health and well-being. There is no general “IBS diet plan”, only the temporary phase of elimination can be guided in a standardized form for all patients: The low-FODMAP diet prevents dietary triggers and is a rebalancing therapy for your digestive system. After the elimination phase, the diet will develop individually. 

Phases of the low-FODMAP diet

Elimination:
Relieve your digestive system

All FODMAP-containing food will be cut our in this phase to keep all triggers away.

Uphold strict elimination phase for 2-6 weeks under medical supervision. Check if there´s a benefit: you should feel better! There is no purpose of keeping restrictions if there´s no consequential improvement.
Now you think you will have to starve in elimination phase? Far wrong! We prepared several healthy and tasty recipes for you, free of FODMAPs and easy to prepare.

Reintroduction:
Diversify your diet

Time to get back to normal step by step.

Leaving out all food containing FODMAPs would be too restrictive to maintain a healthy diet and a relaxed life. The remaining selection of food may hardly be able to provide the body with fiber, vitamins and valuable phytochemicals properly. Try to reintroduce FODMAP containing foods, one at a time, in a period of 8-12 weeks. Use our IBS diary as a support to track your meals and experiences, grasp connections.

Personalization:
Limit just as much as necessary

The goal is to find out which amounts of particularly irritating foods are individually tolerable.

You like chickpeas, but suffer from bloating after eating? Probably you don´t have to forgo them completely. Find the dose you can enjoy without regret and try to increase the dose of FODMAPs gradually. The intestinal system can slowly be accustomed to the total amount of fiber. Please note that for IBS patients, the tolerated amount of a FODMAP group may alternate from day to day!

Optimizing nutrition is being half way there, but...

1

IBS is not just
malnutrition.

Increased bowel sensitivity, stress and many other (often unknown) triggers cannot be evened out by particular food choices alone.

2

There is no one-size-fits all solution for every patient.

The low-FODMAP diet may not work equally effective each day and, additionally, not for every IBS patient.

3

Optimized diet: difficult to keep in day-to-day life.

Maintaining the "perfect" diet requires huge discipline and may not always be mastered. We are only humans. After all, can diet be perfect in IBS?

4

Even the greatest discipline may not control IBS.

IBS often stays erratic: Even the best diet and lifestyle may still not control chronic symptoms.

Restore your digestive balance.

Regulative symptom treatment stabilizes your digestive system.

The right medical treatment of chronic IBS symptoms like irregular bowel movements, bloating and abdominal cramps makes the bowel more resilient against exogenous irritation. Like in a house of cards, the total of odds which have not been rebalanced for too long can be decisive for the final breakdown: A handful of kale might usually not tip the scales, but probably in addition to pre-existing indigestion.

More success in Low-FODMAP diet

Your bowel might not cooperate well during FODMAP reintroduction when it´s already weakened! Try to maintain a stable basis and keep working on corrections and repairs, seek medical help – and prevent a derailment after which you have a longer and harder time to recover. The type of medical treatment can vary from phytochemicals to synthetic medicines. In general, phytochemicals usually have a milder effect and address the functioning of a complete organ system, while synthetic medicines act strongly against particular symptoms. 

Always ask your doctor for advice to find your optimal remedy.