Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that affects a significant portion of the population. While not directly causing weight loss or gain, IBS can indirectly influence weight management through dietary restrictions, stress management, and lifestyle modifications. This article explores the complex relationship between IBS, diet, and weight, providing practical strategies for maintaining a healthy weight while managing IBS symptoms.
Understanding IBS
IBS affects the large and small intestines, and because some of their functions are regulated by the brain, IBS is often referred to as a brain-gut disorder. The cause of IBS isn't completely understood, but genetics or past stressful life experiences (like trauma) are thought to play a role. Symptoms can include cramping, gas, bloating, diarrhea and/or constipation and can range from moderate to severe. These symptoms can be similar to other digestive conditions, such as celiac or Crohn's disease, so a doctor would need to rule out these conditions before diagnosing someone with IBS, says Sophie Balzora, MD, a gastroenterologist at NYU Langone.
The Link Between IBS and Weight
IBS itself is not the direct cause of weight loss or gain. However, people with IBS may struggle to keep weight on or take it off due to the dietary and lifestyle changes they make to manage their symptoms.
Can IBS Cause Weight Loss?
Weight loss can occur in people with IBS, but it isn't an actual symptom of the disorder. Instead, it sometimes happens as these people try to manage the disorder's triggers, including certain foods and stress, according to Harvard Health Publishing.
It's believed that what you eat has the biggest effect on IBS symptoms, so limiting or avoiding certain foods like alcohol, caffeine, chocolate and fatty foods is suggested. Then there are the FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols) - short-chain carbohydrates that may not be digested well and often trigger IBS symptoms.
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Adopting a low-FODMAP diet is highly recommended. But if you're completely eliminating certain foods and not under the guidance of a medical professional, unwanted weight loss may occur because you may be cutting too many calories unknowingly.
There's also a psychological and emotional side to IBS that can affect a person's weight. Some people with the condition may begin to fear food, which, according to the Anxiety and Depression Association of America, fuels social discomfort, anxiety, caution and hypersensitivity. All of this stress can aggravate IBS symptoms and could lead to weight loss if the person becomes terrified to eat.
Often, people with IBS will avoid eating certain foods if they fear they may cause pain and discomfort. Those trigger foods vary with each individual," says Jim White, RDN, registered dietitian and owner of Jim White Fitness and Nutrition Studios. "Stress, rather than a particular food, can also trigger pain. If a patient is under stress, they may choose not to eat as a pain-avoidance mechanism."
Can IBS Make It Harder to Lose Weight?
On the flip side, many people with IBS have trouble losing weight because they may stick with "safe" foods that aren't all that healthy. Indeed, a study published December 2012 in the Journal of Gastrointestinal and Liver Diseases found that IBS patients often ate unhealthy canned food, processed meats and sweets alongside only some grains, fruits and vegetables.
Unfortunately, many healthy foods that are high in FODMAPs - like wheat products, legumes, cruciferous veggies, mushrooms, yogurt and certain fruits - can trigger IBS symptoms, according to the Academy of Nutrition and Dietetics. In other words, someone will feel "normal" - with no IBS symptoms - eating a plate full of white potatoes instead of a lower-calorie, more nutrient-dense helping of broccoli.
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People who have IBS may also avoid exercise, White says, because they don't want to be embarrassed by their symptoms while at the gym or outside where facilities are not available.
Strategies to Manage Weight with IBS
1. Tweak Your Diet
To help manage their weight and make sure they're getting the right nutrition, most experts recommend people with IBS follow a low-FODMAP diet with the help of an expert, per Harvard Health Publishing.
The low-FODMAP diet has two phases: First, you eliminate all FODMAP foods for two to four weeks. The second phase is gradually reintroducing those foods one by one over six to eight weeks, depending on your tolerance. This helps you figure out exactly which foods trigger your IBS symptoms and which ones you can still enjoy without stress.
"I find with my IBS patients that working on small and frequent meals of tolerable foods can help to keep weight on," says Isabel Smith, RD, CDN, a New York City-based registered dietitian. "Small portions of higher-calorie foods like nut butter, avocado, coconut oil and olive oil (all as tolerated and mixed in) can help boost calories. Smoothies work well, too, to help meet calorie needs."
Understanding FODMAPs
FODMAP stands for "Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Researchers discovered that the small intestine does not absorb FODMAPs very well. They increase the amount of fluid in the bowel. They also create more gas. That's because bacteria in the colon they are easily fermented by colonic bacteria. The increased fluid and gas in the bowel leads to bloating and changes in the speed with which food is digested. This results in gas, pain and diarrhea.
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The idea behind the low FODMAPs diet is to only limit the problematic foods in a category - not all of them.
Implementing a Low-FODMAP Diet
A low FODMAP diet involves reducing or avoiding certain foods that contain carbohydrates that are hard to digest. The low FODMAP diet involves two phases: elimination and reintroduction.
Elimination Phase: This involves strictly avoiding high-FODMAP foods for a period of 2-6 weeks to allow the gut to calm down and symptoms to subside.
Reintroduction Phase: This involves systematically reintroducing high-FODMAP foods one at a time to identify specific triggers and tolerance levels.
Low-FODMAP Foods
Examples of low FODMAP foods that may be better for people with IBS include:
- Fruits like bananas, blueberries, grapes, oranges, grapefruit, and strawberries
- Lactose-free dairy
- Lean proteins, including chicken, eggs, fish, and turkey
- Vegetables like carrots, celery, green beans, lettuce, and eggplant
- Sweeteners like aspartame, cane sugar, and maple syrup
High-FODMAP Foods to Limit
High-FODMAP foods that may worsen IBS symptoms include:
- Fructans, found in wheat, onion, and garlic
- Fructose, found in honey, high fructose corn syrup, and apples
- Lactose from dairy products
- Oligosaccharides, found in beans, asparagus, and artichokes
- Polyols from sweeteners like sorbitol
2. Manage Emotions
Finding ways to deal with stress and anxiety may also help people with IBS manage their weight. Counseling, yoga, meditation and cognitive behavioral therapy are all great ways to help people learn to cope with these feelings.
3. Ask About Medications
Your doctor may also recommend over-the-counter remedies (like fiber, laxatives, probiotics or loperamide) to help ease symptoms so you can eat normal meals without fear, or you may even be prescribed an antidepressant to reduce stress, according to the Cleveland Clinic.
How to Lose Weight With IBS
Of course, cutting calories while eating healthy is first and foremost when it comes to shedding pounds, per the Mayo Clinic. You can do this - again - by following a low-FODMAP diet and finding out which healthy foods are tolerable, and then replacing your not-so-healthy "safe" foods with them.
Next up: Find a physical activity that's enjoyable and stress-free. Sure, getting in regular workouts can add to the number of calories you burn each day, but there's another incentive here, too: Exercise has been shown to ease some symptoms of IBS, like constipation, and it can also help with reducing anxiety.
Focusing on symptom-resolve before weight loss can help promote success from a weight-loss perspective," Smith says.
The Role of Exercise
Regular exercise has been shown to decrease IBS symptoms. Physically active individuals have more-frequent bowel movements and more-rapid colon transit than sedentary individuals. A growing body of research suggests that yoga might be a safe and beneficial adjunct treatment for people with IBS. A qualitative analysis of results from six randomized controlled trials involving 273 patients showed that patients performing yoga experienced significantly decreased bowel symptoms, IBS severity and anxiety, compared with conventional treatment.
The Importance of Professional Guidance
For some people, the challenge of losing weight may be an added stressor that ends up making IBS symptoms worse, undermining their efforts. One of the hallmarks of IBS is anxiety, and I find focusing on the number on the scale can really exacerbate that anxiety and the condition, too," Smith says. "I always recommend working with an expert - it will make losing weight easier and more effective."
If you're looking for some guidance, try tapping a gastroenterologist or a registered dietitian who specializes in digestive conditions like IBS.
Additional Dietary and Lifestyle Considerations
Fiber Intake
Fiber may improve constipation in IBS because it makes stool soft and easier to pass. To help your body get used to more fiber, add foods with fiber to your diet a little at a time. Too much fiber at once can cause gas, which can trigger IBS symptoms.
In particular, soluble fiber may help with IBS symptoms. This type of fiber is found in foods including:
- Fruit
- Beans
- Oats
It’s best to slowly add fiber to your diet, which helps reduce the likelihood of gas. Aim to add between 2 to 3 grams of fiber per day while drinking plenty of water to minimize symptoms. An ideal daily amount of fiber for adults is between 22 and 34 grams.
Gluten Sensitivity
Your doctor may recommend avoiding foods that contain gluten-a protein found in wheat, barley, and rye-to see if your IBS symptoms improve. Foods that contain gluten include most cereal, grains, and pasta, and many processed foods.
Regular Eating Habits
Irregular eating is a behavior defined as not eating meals regularly each day, and having long periods between each meal, including breakfast, lunch, and supper. These subjective perceptions of irregular eating were more frequent among IBS patients (65.4%) than control subjects (36.7%). Subjects with irregular eating habits were 3.257 times more likely to suffer from IBS than those with regular eating habits.
Other Lifestyle Factors
Recent research demonstrates that a poor lifestyle and poor dietary habits, such as physical inactivity, sleep disturbance, and irregular eating, increase the risk of IBS. Studies confirm that subjects with good quality sleep were less likely to have IBS than subjects without good quality sleep.