Irritable bowel syndrome (IBS) can be difficult to treat, but diet plays a significant role in managing its symptoms. Food can be one of the most effective ways to ease IBS symptoms like bloat, gas, abdominal pain, and abnormal bowel movements. A registered dietitian (RD) is the most qualified nutrition professional to help treat irritable bowel syndrome. Over 90% of gastroenterologists feel that dietary therapies are at least as good as or better than other treatments for IBS, with more than three-quarters recommending dietary changes to their IBS patients.
The Role of Diet in IBS Treatment
Diet is often the first line of treatment for IBS. IBS is a generalized diagnosis, meaning there are many different foods that might irritate some people but not others. Similarly, there are some dietary treatments that might work for some and not others. Recent randomized, controlled trials suggest that diet therapies provide adequate relief to 50-70% of IBS sufferers, meaning diet has a pretty good chance of improving your symptoms.
Understanding IBS and Its Symptoms
Irritable bowel syndrome (IBS) is a blanket diagnosis for general digestive issues. Symptoms of IBS include diarrhea, cramping, and bloating. IBS is usually diagnosed by a gastroenterologist and can be treated by both a GI doctor and a registered dietitian. One hallmark of irritable bowel syndrome is the variety of symptoms. One of the main goals of IBS treatment is to determine what foods, if any, may be triggering symptoms.
Common Dietary Approaches for IBS
Several dietary approaches can help manage IBS symptoms. These include the low FODMAP diet, gluten-free diet, lactose-free diet, or generally removing other gas-producing foods.
The Low FODMAP Diet
One of the most-recommended diets for IBS is the low FODMAP diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols - short-chain fermentable carbohydrates that exist in fruits, vegetables, legumes, lactose, and grains. These carbs often ferment in the gut and cause excess gas and bloating. The elimination diet removes all high FODMAP foods then slowly reintroduces each group to see which might irritate IBS symptoms.
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Other Dietary Considerations
In addition to the diet considerations listed above, limiting excessive fat intake may also help improve symptoms.
How a Dietitian Can Help with IBS
Working with a GI dietitian is one of the most effective ways to treat your IBS symptoms and improve your quality of life. RDs have the knowledge and experience to analyze your symptoms, flare-ups, and behaviors to design the best IBS diet for you. Over 70% of gastroenterologists believed having direct access to registered dietitians with an IBS focus would enhance the delivery of dietary therapy. As board-certified nutrition providers, RDs are some of the most qualified professionals who can help with IBS and other gastro issues.
Key Ways Dietitians Can Assist
Here's how IBS dietitians can help:
- Assess your current diet and lifestyle as well as symptoms and known triggers
- Create a personalized IBS diet plan, which can include symptom management, symptom tracking, and/or an elimination diet
- Check-in regularly to monitor your symptoms and progress
- Make changes as needed
- Provide IBS education to empower you to take care into your own hands, as well as provide all the support you need along the way
Ensuring Nutritional Completeness
Due to the restrictive nature of the low FODMAP diet, many people may not get all the necessary vitamins and minerals. An IBS dietitian helps ensure clients have a nutritionally complete and balanced diet while following a FODMAP diet protocol. They identify appropriate meal choices while assisting with meal planning and prep ideas.
Coping Strategies and Guidance
Following a FODMAP diet can be challenging. Until the IBS patient’s FODMAP triggers are determined, the diet can restrict the ability to eat out with friends and family. IBS dietitians help their clients with coping strategies and guidance for traveling and eating out.
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Preparing for Your Appointment with an IBS Dietitian
Once you've booked an appointment with an IBS dietitian, there is some prep you can do to make the most of your appointment.
Keep a Food and Symptoms Log
Most dietitians will ask about your standard diet. One of the best ways to report this accurately is by keeping a food diary and symptom log where you track what you eat and how you feel over the course of a few days. Rest assured: your dietitian isn't judging your diet! They simply need to see what you're eating in order to make recommendations.
It's important that you keep record accurately and with enough detail. Part of a day's entry might include:
- 7:00 AM - woke up with stomach cramps (5/10 pain)
- 7:30 AM - drank a cup of coffee
- 8:30 AM - ate an egg on whole wheat toast
- 10:00 AM - more stomach cramps (6/10 pain)
- 11:00 AM - diarrhea (3/10 severity)
Prepare Your Medical History
Your dietitian will ask about your medical history, including diagnoses and treatments. They will want to know about everything you've tried to treat IBS so far, including diets, medication, and other lifestyle changes. If you have notes from a gastroenterologist or another doctor, feel free to share them. The more information you can provide the better, as it will only help your RD create a more individualized IBS treatment plan.
Bring Questions
Your intake appointment isn't just about your RD asking questions about your history. It's also your opportunity to ask your own questions to ensure you feel as confident and knowledgeable as possible about your course of treatment. Questions can include:
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- Can I still eat my favorite foods?
- How important is meal timing?
- What should I do if I experience a flare-up?
- Should I be taking any supplements?
- What should I do about special occasions where I can't control exactly what I'm eating?
Your dietitian will provide support and guidance for all of the above and beyond. They are there not just to create an IBS diet but to support you as you try different avenues, like the low FODMAP diet, a gluten-free diet, or another elimination diet. There is no such thing as a bad question! Your RD wants you to feel confident in your treatment.
Ongoing Monitoring and Support
Following your intake appointment, you will meet with your RD on a regular basis to track what's working and what isn't. Be sure to continue taking note of symptoms and how they correlate with your intake so that you can accurately report what's going on. Helping IBS patients find relief from their symptoms takes time, support, and monitoring. They help patients monitor their food intake and symptoms, often using a food diary and symptom logs.
Finding an IBS Dietitian
When it comes to managing IBS symptoms, it's important to work with a professional who has expertise in GI disorders like IBS. Registered dietitians are some of the most qualified providers to treat IBS, and plenty of them specialize in IBS specifically.
Lifestyle Factors and Stress Management
Stress plays a significant role in worsening symptoms. Since your brain and gut are linked through many hormones and nerve connections, lowering your stress may reduce your GI symptoms. For effectively lowering your stress, try deep breathing exercises, meditation or journaling. There are many free stress management resources online, like this from the American Heart Association. Include at least one stress-reducing activity per day. Many VA facilities offer stress management resources, such as group classes or individual instruction.
Additional Considerations for Managing IBS
- Diet advice: Diet advice is ideally prescribed to patients with irritable bowel syndrome (IBS) who have insight into their meal-related gastrointestinal symptoms and are motivated to make the necessary changes.
- Referral to RDN: To optimize the quality of teaching and clinical response, referral to a registered dietitian nutritionist (RDN) should be made to patients who are willing to collaborate with an RDN and patients who are not able to implement beneficial dietary changes on their own.
- Poor Candidates for Restrictive Diets: Patients with IBS who are poor candidates for restrictive diet interventions include those consuming few culprit foods, those at risk for malnutrition, those who are food insecure and those with an eating disorder or uncontrolled psychiatric disorder.
- Trial Period for Diet Interventions: Patients should attempt specific IBS diet interventions for a predetermined length of time.
Success Stories and Testimonials
Many individuals have found relief from IBS symptoms by working with dietitians and following personalized plans. For example, Laura reported being 100% symptom-free for four months after working with a dietitian. Alexander found relief from extreme bloating and pain by regulating his bowel movements and understanding the root cause of his symptoms. Sharyn, who was terrified of food and scared to leave her house, finally found answers through a step-by-step process and hasn’t felt this good in three years.
The Importance of a Personalized Approach
People with irritable bowel syndrome all have different experiences, symptoms, and triggers. A dietitian begins working with their IBS patients by conducting a full assessment of the client’s health, medical history, lifestyle, and IBS symptoms. The customized plan considers medical needs, dietary restrictions, food preferences, and cultural considerations.
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