Irritable bowel syndrome (IBS) affects as many as 45 million people in the United States. It is the most common diagnosis in gastroenterology practices: 1 out of 3 patients seen are suffering from IBS. More people miss work as a result of irritable bowel syndrome than any other reason other than the common cold. This article explores the relationship between IBS and vegetarian diets, providing insights into how dietary choices can impact symptoms and overall well-being.
Understanding Irritable Bowel Syndrome (IBS)
IBS is a chronic condition that affects the large intestine, causing symptoms that range from mild to debilitating. It is considered a functional bowel disorder, which means the problem isn’t with the structure of the bowels; it’s with how they work. According to the Rome criteria, to be diagnosed with IBS, a patient should have abdominal pain and discomfort lasting on average at least one day a week for the last three months. The pain or discomfort should be related to defecation, associated with a change in frequency of bowel movements, and/or associated with a change in stool consistency. Other symptoms of IBS can include bloating, gas, passage of mucus, straining, urgency, or a feeling of incomplete evacuation.
The exact cause of IBS is not known, though we know at the root is a disturbance in the interaction between the gut, brain, and nervous system. Two of the biggest factors behind IBS are gut dysbiosis, an imbalance of the bacteria in the GI tract, and stress and anxiety. Studies show that people with IBS have unusually sensitive nerve endings in the GI system and are prone to feeling more intense pain at lower thresholds. This can lead symptoms to flare up in conditions-dealing with a stressful situation or even simply eating a meal-that would not trigger symptoms in those without IBS.
Vegetarian Diets: An Overview
Vegetarian diets (VD) involve the partial or total removal of meat, poultry, and fish from the diet. Vegans also exclude dairy products and eggs. VD patterns (in comparison to meat-based diets) are more sustainable because they use substantially less natural resources and are less taxing on the environment. The reasons for adopting this dietary profile are attributable to ethical, environmental, and social concerns. Health aspects of such a diet are also more and more emphasized. Indeed, health benefits of the VD, especially on ischemic heart disease and cancer have been widely reported by cross-sectional and prospective cohort studies during the last 50 years. Generally speaking, vegetarians tend to be more health conscious, with a lower body mass index (BMI), and in better health when compared with omnivores, giving this type of diet a clear appeal in the population of subjects suffering from chronic diseases.
The Interplay Between Vegetarian Diets and IBS
There is growing interest in using diet counselling in the management of patients with irritable bowel syndrome (IBS). Given the lack of scientific evidence supporting specific dietary advice for patients with IBS, they tend to adopt new diets, guided by various way of life (empirical, philosophical, etc), and spread via the media. These changes include exclusion diets like VD. Adopting a VD pattern could induce some effects on the digestion process, and even on digestive diseases: Crowe and colleagues have shown that consuming a VD and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.
Read also: Is a Vegetarian Elimination Diet Right for You?
The role of dietary fibres on IBS is complex. An increased proportion of certain types of carbohydrates in diet can also worsen IBS symptoms. In particular sugars (mono and disaccharides) and polyols which are slowly absorbed from the small intestine rather than digested, and can lead to a luminal distension by various mechanisms (water fermentation, rapid fermentation, gas,…). Although lactose malabsorption does not appear to be a cause of IBS or to be more prevalent in individuals with IBS than in the general population, lactose is not well digested and absorbed by a majority of adults throughout the world, and individuals with and without IBS may report increased symptoms, similar to those of IBS, following ingestion of lactose-containing foods. Thus, the low lactose intakes of vegetarians could help to improve IBS symptoms. Overall, the vegetarian diet presents both features that might improve and worsen IBS symptoms.
Potential Benefits of Plant-Based Diets for IBS
A whole-food, plant-based diet improves the gut microbiome, which can improve IBS symptoms. Fiber is considered a first-line therapy in treatment recommendations for patients with IBS, according to the 2021 American College of Gastroenterology clinical guidelines. Fiber adds bulk to stool, speeds up its transit through the colon, and can help regulate bowel movements. A 2018 study found that the more fiber participants consumed, the less likely they were to have IBS. Soluble fiber-found beans, oats, lentils, and certain fruits-may serve as a prebiotic, feeding beneficial bacteria in the gut. Research suggests that insoluble fiber, the “roughage” that whole grains and vegetables tend to be rich in, has a laxative effect that can relieve constipation.
Challenges and Considerations
Almost every week, I see a teenager who’s become a vegetarian and suddenly they have lots of gas, bloating, or diarrhea. Vegetarian and vegan diets rely heavily on plants and dairy products for protein. Foods like beans and legumes, yogurt and cheese, even broccoli and asparagus. The pain of IBS is real and can have potentially serious consequences. To try to control the symptoms, sometimes teens eliminate foods for their diet that are actually healthy, ending up with a less nutritious diet. Fortunately, this doesn’t have to be the case. Vegetarian and plant-based diets can be very healthy lifestyles.
Many plant-based foods are high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). These are short-chain carbohydrates that are poorly absorbed by the small intestine and can trigger IBS symptoms in some individuals. Whilst fibre is an essential part of the diet, increasing intake too quickly can lead to bloating and discomfort. Increasing or decreasing the amount of fibre in the diet depends on the type of IBS, so seeking professional guidance is really important.
The Low-FODMAP Diet and Veganism
Veganism for IBS may incorporate the low FODMAP diet. This acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are the fermentable short-chain carbohydrates and sugar alcohols that may irritate your GI system. The low FODMAP diet does not exclude meat and dairy products, but you can adapt it so that it aligns with the principles of veganism. The low FODMAP diet measures foods by their ability to break down in the small intestine. Foods low in FODMAPs cause fewer GI reactions because your body breaks down food before it reaches the colon.
Read also: Healthy Vegetarian Eating
A 2016 study found that up to 86 percent of participants with IBS had fewer GI symptoms when eating the low FODMAP diet. However, the study emphasized that those following the diet needed to adhere to it closely and work with dietary professionals to get the best nutrition.
Practical Tips for Managing IBS on a Plant-Based Diet
Gradual Transition: Most people with IBS will need to go slowly when beginning a plant-based diet. It’s OK to go gradually, to slowly increase fiber intake and slowly transition to a whole-food, plant-based diet, especially if they experience gas and bloating to begin with. It’s important to counsel our patients that when they are transitioning to a whole-food, plant-based diet they might experience some worsening of their gas and bloating. That is expected. It is not harmful.
Identify Trigger Foods: It can be helpful for patients with IBS to keep a food diary to uncover their personal food triggers. However, it is important to not jump to conclusions, because foods aren’t the only triggers. It is always worth reintroducing and retrying foods to see if it’s the food or that environment-like eating too quickly that day-causing the issue.
Consult a Professional: For severe cases of IBS, Pasricha recommends working with a plant-based dietitian. Consider working with a registered dietitian nutritionist or a doctor if you live with IBS and experience uncomfortable symptoms. Changes to your diet that include veganism or a low FODMAP diet may be healthy options for you. A professional’s expertise can help you plan a well-rounded diet that takes into account your nutritional needs.
Stay Hydrated: Ensure that you increase your water intake. Drink 6 to 12 cups of water per day.
Read also: Is a Chicken-Inclusive Vegetarian Diet Right for You?
Mindful Eating: Listen to your body. Eat slowly and chew your food carefully before swallowing.
Addressing Potential Nutrient Deficiencies
Many vegetarians and vegans miss out on the essential nutrients that meat, fish and dairy would provide. Ensure that you get sufficient iron, calcium, vitamin B12 and other vitamins and minerals.
- Protein: While traditional vegetarian diets often rely on legumes (beans, lentils, soybeans, etc.) many of these legumes are high in FODMAPs and limited on the low FODMAP diet.
- Calcium: A critical part of your diet and much easier to enjoy on a low FODMAP diet now that there are so many lactose-free options available.
- Iron: It’s important to optimize your body’s ability to absorb iron - especially when you are relying on the vegetarian forms, which are harder for the body to absorb. You can increase iron-absorption by pairing it with a source of vitamin C such as tomatoes or bell peppers if you’re making something savory, or oranges, kiwifruit, or strawberries if you’re making something sweet.
The NutriNet-Santé Study: Insights into Vegetarianism and IBS
The NutriNet-Santé Study is a web-based prospective observational cohort that aims to investigate the relationships between health and nutrition. In this study, 57,037 individuals filled the FGIDs questionnaire. Among them, 52,028 completed information on VD before answering the FGIDs questionnaire. Among them, 50,446 subjects had at least three 24H records available for analysis. The 8,538 participants that reported any organic diseases (stomach, esophagus or colorectal cancers, familial adenomatous polyposis coli, Crohn’s disease, coeliac disease, ulcerative colitis) or alarm symptoms (melena, hematemesis, rectal bleeding or significant unintentional weight loss in the past 3 months) were excluded. The final sample included 41,682 subjects. Subjects included were mainly women (78.0%) and the mean age was 49.8 +/-14.3 years. Overall 2,264 (5.4%) subjects reported an IBS, with a higher prevalence in women compared to men (5.6% vs 4.8%, p = 0.03). Overall 1.9% (n = 805) subjects declared they followed a VD, mostly women (2.1% vs 1.4%, p<0.001).
No significant association was observed between vegetarians and IBS. When studying vegetarians who declared at least three times they followed a VD, significant associations were shown with IBS (aOR 2.60 95%CI: 1.37-4.91), with IBS mixed (aOR 2.97 95%CI: 1.20-7.36), and with IBS-diarrhoea (aOR 2.77 95%CI: 1.01-7.59). Sensitivity analyses, including vegans showed similar results, plus an association between VD and IBS diarrhoea (aOR 1.55 95%CI: 1.02-2.34).
Additional IBS Treatments
While a change in diet is the first powerful step in alleviating symptoms of IBS, studies have found improvements with a range of lifestyle strategies including exercise, yoga, stress reduction, biofeedback, and psychological therapies such as cognitive behavioral therapy. “IBS requires a multifactorial approach to treatment and management,” says Pasricha. “Mind, body, soul, and gut health care are all important.” For people suffering from more severe IBS, treatment may include prescription antispasmodic or antidiarrheal medications, or low-dose antidepressants.
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