Irritable bowel syndrome

March 4, 2003 in Gastrointestinal Health

Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a relatively common disorder of the gastrointestinal tract that often develops during periods of stress or emotional conflict. IBS causes changes in bowel habits that result in constipation, diarrhea, gassy pain and bloating. IBS does not cause any permanent harm to the gastrointestinal tract. Nor does it lead to serious diseases, such as cancer. In most cases, IBS symptoms can be managed with simple changes to lifestyle and diet.

What causes IBS?

So far, researchers have not identified the exact cause of IBS. Abnormal bowel motility, psychological stress and food intolerances have all been implicated. Although the symptoms can be painful and persistent, there is usually no evidence of disease, injury or structural damage to the gastrointestinal tract in people with IBS. In fact, most people with IBS appear quite healthy. Because the function of the bowel is disturbed for no apparent reason, IBS is referred to as a functional disorder.

People with IBS appear to have very sensitive colons. Even the mildest stimulation can cause the colon muscle to overreact, triggering cramps and spasms. Irritants such as drugs, hormones, certain foods and stress can aggravate the condition and intensify bowel spasms. For some people, these muscle spasms delay the passage of food through the intestine, causing constipation. In others, the muscle spasms cause urgent diarrhea by forcing food through the intestine much too quickly.


Gastrointestinal discomfort that persists for at least three months may indicate IBS. Symptoms include:
  • crampy abdominal pain, usually exacerbated by a meal and relieved by a bowel movement
  • painful constipation or diarrhea periods of alternating constipation and diarrhea
  • passing mucus with a bowel movement
  • bloating, gas and nausea
  • headaches, fatigue, depression and anxiety

Who's at Risk?

It's estimated that as many as one in five North Americans suffers from this distressing condition. Women are affected three times more often than men. IBS symptoms may increase during a woman's menstrual period. The disorder usually begins in late adolescence or early adulthood, and rarely appears for the first time after the age of 50. IBS often surfaces during times of emotional stress.


Dietary Strategies for Irritable Bowel Syndrome

One strategy that is relatively easy to implement is to eat slowly. Poorly chewed foods are more difficult to digest and may lead to impaired absorption and intestinal discomfort. Eating too quickly can also lead to swallowed air and gas. Chew foods thoroughly: aim to take 20 minutes to finish a meal.

Food intolerances. Foods may trigger or worsen the symptoms of IBS. Many people with IBS, especially those who suffer from diarrhea, report adverse reactions to certain foods and improvement once these foods are removed from their diet. To avoid unnecessary food restrictions, keep a food and symptom diary for two to four weeks to help pinpoint problem foods. While dietary intolerance varies from person to person, the following foods may cause distress:

  • Lactose-containing foods such as milk, yogurt and soft cheeses. These foods often cause symptoms in individuals with IBS. When the milk sugar lactose cannot be properly absorbed in the intestine, the result can be abdominal pain, bloating, gas and diarrhea. Lactose-free milk and yogurt (e.g., Lacteeze, Lactaid) are available, and taking lactase pills with a meal that contains milk will also help if you have a lactose intolerance. Many people with a mild or moderate lactose intolerance can eat yogurt and cheese without experiencing any discomfort, since these foods contain much less lactose than milk.
  • Fructose- and sorbitol-containing foods such as fruit drinks, fruit juices, dried fruit, hard candies, cough drops, throat lozenges and dietetic cookies and wafers. Colonic bacteria will ferment the sugar fructose when it is in the colon, causing gas and bloating. Sorbitol is a sugar alcohol used to sweeten foods. Sorbitol is not absorbed as readily as sugar, which means that when you eat such foods, some sorbitol reaches the colon and may exacerbate IBS symptoms.
  • Gas-producing foods such as dried peas and beans, lentils, bell peppers, cucumber, onions, chives, garlic, broccoli, cauliflower, cabbage, turnip, melon, pickles, eggs, carbonated beverages and chewing gum.
  • Alcoholic beverages and caffeine (coffee, tea, colas, chocolate, certain medications

Dietary fat. Meals that are high in fat and/or calories can bring on symptoms of IBS. A low-fat diet can normalize bowel function by reducing contractions in the colon that occur in response to a meal. Avoid fatty foods such as whole milk, cream, cheese, butter, margarine and fatty cuts of meat (rib eye steak, spareribs, sausage, salami). Use smaller portions of healthy fats such as avocado, peanut butter and vegetable oils.

Eating large volumes of food at one time can cause abdominal distension and discomfort. It is better to eat small, frequent meals than three large ones. Avoid skipping meals, since this is likely to trigger overeating at the next meal.

Dietary fiber. A high-fiber diet adds bulk to stool, reduces pressure in the colon, promotes normal bowel motility and can relieve constipation in IBS. Gradually increase your fiber intake to 25 to 35 grams per day by choosing more whole-grain breads and cereals, vegetables and fruit. It is important to add higher-fiber foods to your diet slowly to avoid an aggravation of abdominal pain and bloating. For instance, if you are adding a bran cereal to your diet, do so in 1/4 cup (60 ml) increments. Over the course of six to eight weeks, work up to 3/4 to 1 cup (175 to 250 ml). It takes a few weeks for the body to adjust to a higher-fiber intake. Insoluble fiber in wheat bran (Kellogg's All Bran, Post 100% Bran, Fibre One) is often better tolerated than soluble fiber in psyllium (Kellogg's All Bran Buds).

Avoid refined grain products such as white bread, white rice and pasta and breakfast cereals with less than 4 grams of fiber per serving. And be sure to drink plenty of fluids when eating a high-fiber meal or snack; fiber needs fluid in order to exert its beneficial effects in the bowel. Drink 8 to 12 glasses of water each day.


Herbal Remedies

Peppermint (Menthae piperitate aetheroleum). This herbal remedy is widely used to ease the symptoms of IBS. A number of studies have found it to significantly reduce pain, distension, stool frequency and flatulence in IBS sufferers. The volatile oils in peppermint are known to directly affect the smooth muscle of the digestive tract and reduce spasms. Compounds called flavonoids in peppermint stimulate the secretion of bile, aiding in the digestive process.

To ease bowel spasm, the recommended dose is one to two capsules (0.2 to 0.4 ml) three times daily, taken 15 to 30 minutes before meals. Peppermint oil can cause heartburn, so be sure to buy an enteric-coated product.

Peppermint tea may help ease digestion and can be consumed with and between meals. Steep 1 tablespoon (15 ml) of dried peppermint leaf in 2/3 cup (160 ml) boiling water for 10 minutes and then strain.

Do not use peppermint oil or peppermint tea to treat infant colic as it can cause jaundice and a choking sensation.

Psyllium and flaxseed. The seeds from both of these plants may help treat constipation in people with IBS. Flaxseeds and psyllium seeds are bulk-forming laxatives high in both insoluble and soluble fibers. The laxative properties of psyllium and flax are due to the swelling of the fibers when they come in contact with water. Once consumed, they form a gelatinous mass that keeps the feces hydrated and soft. The increased bulk stimulates a reflex contraction of the walls of the bowel and prompts evacuation.

Psyllium seed husks: Mix 1 to 2 tablespoons (15 to 30 ml) into 2 cups (500 ml) water; take one to three times per day. Ground flaxseed Take 2 tablespoons (30 ml) once daily. Mix into hot cereal, yogurt, applesauce or smoothies. Add ground flaxseed when preparing baked goods and casseroles.


Other Natural Health Products

Probiotics. Foods and supplements that contain lactic acid bacteria are called probiotics, which means 'to promote life.' These health-friendly bacteria are known collectively as lactic acid bacteria. The most widely studied are the Lactobacillus and bifidobacteria species. Researchers have found that a daily supplement of Lactobacillus plantarum for one month significantly reduced pain, bloating and flatulence in IBS sufferers.

Once consumed, these bacteria make their way to the intestinal tract, where they take up residence and prevent the attachment of harmful bacteria and yeasts. It is thought that people with IBS may have an imbalance in their intestinal bacteria (called the intestinal flora), which can lead to gastrointestinal symptoms. Changing the intestinal flora by taking probiotic supplements may ease or prevent IBS.

To supplement, buy a product that offers 1 to 10 billion live cells per dose. Take 1 to 10 billion viable cells, three or four times daily with food. Choose a product that is stable at room temperature and does not require refrigeration. This allows you to continue taking your supplement while traveling.


Recommended Resources

American College of Gastroenterology

International Foundation for Functional Gastrointestinal Disorders (IFFGD) (online self-help)

The Irritable Bowel Syndrome Self Help Group

National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK)

The above excerpt is from "Leslie Beck's Nutrition Encyclopedia" (Penguin Canada, 2001/2003), available at bookstores across the country. The following is copyrighted and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or means - electronic, mechanical, photocopying, or likewise.


All research on this web site is the property of Leslie Beck Nutrition Consulting Inc. and is protected by copyright. Keep in mind that research on these matters continues daily and is subject to change. The information presented is not intended as a substitute for medical treatment. It is intended to provide ongoing support of your healthy lifestyle practices.