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Clinically Proven Natural Treatments for IBS

Written by Dr. Michael Ruscio, DC on November 14, 2024

Written by Dr. Michael Ruscio, DC on November 14, 2024 — Reviewed by Kellie Blake

• IBS Facts and Figures|
• Taking FODMAPs Out of Your Diet|
• Probiotics|
• Other Natural Treatment Options|
• Calm Your Life to Quell Your IBS|
• Flares and Trickier Symptoms|

With issues that range from abdominal pain and bloating to irregular bowel movements and brain fog, the symptoms of irritable bowel syndrome (IBS) can significantly impact your quality of life. 

However, there are many positive things you can do to make living with IBS more manageable. Though every day won’t be smooth sailing, having an effective toolkit of natural treatments for IBS at your fingertips is really powerful and may even make you symptom-free again. 

In this article, I’ll walk you through using the low FODMAP diet and taking probiotic supplements, which are among the most researched and effective natural remedies for IBS. We’ll also look at some less common IBS treatments, which may be useful if your symptoms are a bit more difficult to shake off.

First, how do you know if you have IBS, and what are the distinguishing symptoms?

IBS Facts and Figures

IBS is really common, with estimates suggesting that 10% to 12% of people in the United States have it. Being female puts you at higher risk, with three times as many women as men having an IBS diagnosis 1.

The most common symptoms of IBS include abdominal pain and cramping and changes in bowel habits. Changes in motility (how quickly or slowly food moves through the gut) mean some people have diarrhea as the main symptom (IBS-D), and others have constipation as the main symptom (IBS-C). It’s also possible to have a mixture of the two. 

Bloating is also common in IBS, and you may also notice mucus in your poop. At the clinic, we’ve found that many people with IBS also report having brain fog, reduced concentration, and mood changes.

Disrupted communication between the gut and brain is thought to be the cause of many IBS symptoms 2 3 4, and an unhealthy gut microbiome may be behind this 5 6. Inflammation caused by gut microbiome imbalances could create problems in the cross-communication between the gut and brain, giving rise to symptoms. 

When you have IBS, altered levels of the brain neurotransmitter serotonin may also play a role in your gut being hypersensitive 7. Around 95% of serotonin is stored in the gut and too little or too much can make IBS symptoms like pain and tenderness worse. Too much serotonin is linked with IBS-D, and too little serotonin is linked with IBS-C 8.   

Food Sensitivities are Common in IBS 

Food sensitivities frequently contribute to IBS symptoms — for example, gluten 9, dairy products 10, and artificial additives or ingredients 11 have all been linked to IBS symptoms.

However, it is a category of fermentable carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) that may cause the most problems for people with IBS, increasing bloating and abdominal pain 12. 

When we consume FODMAPs, these carbs move relatively slowly through the small intestine, attracting water. When they reach the large intestine (bowel), gut bacteria use the FODMAPs as fuel, breaking them down in a process called fermentation that creates a large amount of gas. 

The gas and water associated with consuming FODMAPs cause the intestinal wall to stretch and expand. While this isn’t a problem for most people, if you have IBS you are more likely to react with abdominal pain and changes in bowel movements 13.

If you have IBS, it makes sense to try a short to medium-term low-FODMAP elimination diet. Multiple meta-analyses have determined that the low-FODMAP diet improves overall digestive symptoms, abdominal pain, and quality of life 14 15 16 17. Indeed, up to 86% of patients with IBS may find improvement in gastrointestinal symptoms following a low-FODMAPs diet 18, so it is always my first dietary recommendation if you have the condition. Let’s get into the details of what’s involved. 

Taking FODMAPs Out of Your Diet

In the first elimination phase of a low-FODMAP diet,  your aim is to remove all high-FODMAP carbs from your diet, to reduce your symptoms. The main FODMAPs categories are: 

• Oligosaccharides (fructans and galactooligosaccharides in foods like wheat and beans)
• Disaccharides (the lactose in dairy)
• Monosaccharides (the fructose in fresh and dried fruits and foods with added sugars, e.g, high fructose corn syrup)
• Polyols (e.g. sorbitol, mannitol, xylitol, erythritol, maltitol, found naturally in some fruits and also used as lower calorie sweeteners)

Below is a list of the high-FODMAP foods to avoid, as well as their lower-FODMAP alternatives. Bear in mind this is not a complete list, and some FODMAP food lists you find on the internet might not be accurate. For the most comprehensive and authoritative information on high FODMAP foods, I recommend the Monash University FODMAP Diet App, which has been put together by leading researchers in the field. 

Track for Success

After 2–6 weeks on a low FODMAP diet, your IBS symptoms will likely decrease, and you can move on to reintroducing foods.

Some people with IBS have really noticeable improvements after removing FODMAPs for just a couple of weeks. But if your results are not so dramatic, it helps to track your symptom changes during the low-FODMAP elimination phase. There is a feature within the Monash University low FODMAP app that allows you to do this, or you can simply rate your daily symptoms on a scale of 1 to 10 and note how that score changes after a minimum of 2 weeks and a maximum of 6 weeks on a low FODMAP diet.

To ensure you don’t unwittingly make mistakes while removing FODMAPs, try following these simple rules: 

• Avoid very large meals 
• Only eat meals you’ve prepared yourself at home
• Avoid processed foods containing sneaky high FODMAP ingredients, such as chicory root, fruit juice concentrate, and inulin
• Adapt recipes where necessary (so they don’t contain onion or garlic, for example)

What Does Success Look Like?

Keep in mind you don’t have to achieve perfection, and some symptoms, such as occasional gas and bloating, are a normal part of life for everybody.

Ultimately, only you can decide if your symptom response is enough to make continuing with a low FODMAP diet worthwhile. I encourage my clients to not give up too early and give it their best attempt. 

After a maximum of 6 weeks, it’s time to assess what the next step is, which will depend on your results:

• If you have significant improvement in your IBS symptoms, then you should move on to reintroducing high-FODMAP foods as per the Reintroducing Foods section below. 
• If you had some minor improvement but you feel this wasn’t significant enough to make continuing with a low-FODMAP diet worthwhile, you can go back to eating FODMAP foods if you want to (however, a varied low-FODMAP diet may be nutritionally sufficient for up to a year) 19. When you do add back FODMAPs, a gradual introduction is probably best to avoid any flare in your IBS symptoms.
• If you have no improvement at all, you can go back to your previous diet straight away and not worry about gradually changing back to high FODMAP foods.

If the low-FODMAP diet isn’t for you, it doesn’t mean you are stuck with your symptoms for good. You can skip the Reintroducing Foods section coming up, but that still leaves lots of other possibilities for symptom reduction, including probiotics, stress management, and natural herbal remedies (more on all these below). 

Reintroducing FODMAPs

Once you have achieved symptom reduction, re-introducing high FODMAP foods in a structured way enables you to hone in on exactly which foods exacerbate your IBS. 

It’s important to reintroduce each FODMAP separately. Working with a dietitian or using the Monash FODMAPs app can help you choose your challenge foods and doses. 

It’s best practice to do one FODMAP challenge at a time and to complete each challenge by eating a specific FODMAP once a day for a three-day period. Ideally, choose the same time each day (at a particular meal time or as a snack) to consume the high FODMAP food in question.

• On Day 1, eat a small to moderate amount of the challenge food (no more than half your normal portion size). 
• On Day 2, include a bigger serving of the challenge food (closer to the size portion you would normally eat) 
• On Day 3, consume the challenge food in a serving size that is as big, or bigger, than your usual serving.

If you get very significant symptoms on day one with a specific FODMAP it’s fine to stop that particular challenge early and to keep this FODMAP out of your diet, at least for now. 

If some symptoms start to develop as you increase the portion size, you have likely found your current threshold level for tolerance to that food. To minimize symptoms, you should try not to exceed this amount going forward. 

It’s helpful to take a break of a couple of days (or longer if you are waiting for symptoms to subside) between each 3-day challenge. 

The entire reintroduction process should take around 6-8 weeks to complete.

Maintaining Your Lower FODMAP Diet

The third and final stage of a low-FODMAP diet is moving forward with a diet that is tailored to the specific sensitivities you have uncovered. 

Your level of food reactivity may change over time however, so you can always experiment with reintroducing eliminated foods again in the future. Eating a low FODMAP diet isn’t meant to be forever, and as your gut health improves, it’s likely that you will be able to tolerate a wider variety of foods.

Probiotics for IBS

After a low-FODMAP diet, probiotics are the next natural treatment for IBS that I recommend to my clients. The research around probiotics and IBS is very solid, with several meta-analyses showing that probiotics can treat IBS symptoms with very few side effects 20 21 22 23 24 25 26.

Collectively these meta-analyses show that probiotics can improve bloating, abdominal pain, and flatulence while also improving energy levels and sleep. Probiotics can also help with both constipation and diarrhea, which are the symptoms of IBS that many clients find the most difficult to deal with.

One study showed that Bacillus species probiotics reduced diarrhea and stool frequency in IBS clients 27. Other studies showed that probiotics improved stool frequency and regularity in patients with constipation 28 29. 

Although any well-formulated probiotic will likely have a good effect on your IBS symptoms, taking more than one strain is almost certainly best. This approach is supported by two meta-analyses that found that a multi-strain mixture containing a blend of predominantly Lactobacillus and Bifidobacterium strains improved IBS symptoms 22 23.

In the clinic, we often take this multi-probiotics approach further because we’ve seen better results. More specifically, we’ve had the most success with IBS patients when they’ve taken one from each of these three main probiotic categories:

1. A Lactobacillus and Bifidobacterium blend (e.g. L. acidophilus, L. plantarum, B. infantis, and B. lactis)
2. Saccharomyces boulardii (a beneficial yeast)
3. Soil-based probiotics, usually Bacillus species 

Of course, everyone is different, and for some people, a Lactobacillus and Bifidobacterium blend is sufficient to help considerably with IBS symptoms. But others get more benefit when they add in one, or both of the Saccharomyces boulardii and soil-based categories, too.

Why Are Probiotics So Helpful for IBS?

Probiotics are so helpful because they help to correct the microbiome imbalances — including small intestinal bacterial overgrowth (SIBO)—that are common in people with IBS and can contribute to their symptoms 30 31 32 33. One meta-analysis found that more than one-third of IBS patients tested positive for SIBO, which is nearly five times more likely than healthy controls 30. 

Another reason why probiotics are helpful is that they may help reduce gut inflammation 34. Whether it stems from SIBO or a different form of microbiome disturbance, inflammation and gut leakiness could be what causes the disrupted gut-brain crosstalk that leads to IBS 6 35. 

Other Natural Treatment Options for IBS

If you still need help with IBS symptoms after trying the low FODMAP diet and probiotics, other potentially useful supplements include herbals like peppermint oil capsules, soluble fibers, immunoglobulins, and antimicrobials. 

Not all of these will work for everybody, and some come with downsides, so it pays to arm yourself with the facts before trying them.

Here’s a brief roundup of the main benefits and downsides of these natural treatments: 

Peppermint oil relaxes the smooth muscles in the digestive tract, helping to decrease pain, bloating, and bowel movement urgency (diarrhea) 36. However, it can also trigger heartburn or indigestion 37, so it is not recommended for those with reflux disease (GERD), severe constipation, or ulcerative colitis. 

Soluble fibers like psyllium or Metamucil can be very helpful for IBS patients with constipation 38 and may improve IBS symptoms more generally, not just stool consistency 39 40 41. However, for some with IBS, fiber supplements (and high-fiber foods like whole grains) can trigger bloating, gas, and abdominal pain 38, so increase any source of fiber slowly and drink plenty of water.

Immunoglobulins are a newer type of supplement that supports the immune system by binding to and neutralizing unhealthy bacteria in the gut. Clinical trials have shown that immunoglobulins can improve IBS symptoms 42 43 44 45 46], even for IBS patients who don’t respond to other therapies 45 47. 

Natural antimicrobials like oregano oil or even the mainstream antibiotic rifaximin can be very helpful in some IBS cases 48. The scenario where I would be most likely to recommend an antimicrobial is if your symptoms are related to a bacterial overgrowth (SIBO). 

Calm Your Life to Quell Your IBS

Stress will often make IBS symptoms worse, so working on lifestyle changes and stress reduction alongside other natural treatments can be really helpful.

A meta-analysis concluded that meditation and relaxation techniques were able to significantly improve IBS symptom severity, anxiety, depression, and quality of life 49. Meditation can be as simple as focusing on your breaths in and out as you sit quietly with your eyes closed. Cognitive behavioral therapy 50 51 and hypnotherapy 52 53 are other helpful interventions for IBS. 

Increasing your physical activity, particularly zone 2 exercise, is also great for managing stress. And if you’re a fan of yoga specifically, that’s great, as it can also have targeted anti-stress benefits for people with IBS 54. 

Troubleshooting Flares and Trickier Symptoms

Sometimes, even if your IBS symptoms are controlled most of the time, you can still get a flare-up of symptoms. If you are struggling to tame your symptoms, a one-off gut reset in the form of a 24 to 48-hour fast may be worth considering.

Limited research suggests that fasting can soothe an IBS flare 55. But if you find fasting too tough, consuming a liquid elemental diet may also calm your gut 56. Elemental diets are liquid diets that provide all the nutrients you need in a predigested form allowing your digestive system to rest. So, for example, in an elemental shake, the proteins are broken down into easier-to-digest amino acids or amino acid chains.

Even a “half” elemental diet, in which you replace just one or two meals a day with an elemental shake, works to calm symptoms for some of our clients.

Is it Something Else?

Another possibility to bear in mind with irritable bowel symptoms that don’t resolve themselves is that you could have a separate digestive disorder or reproductive system condition.

For example, inflammatory bowel disease (IBD), celiac disease, and endometriosis in women can all cause IBS-type symptoms. If other gastrointestinal disorders have not been ruled out, you may need to talk to your healthcare provider about appropriate screening tests.

Knowledge Leads to Relief

When you understand your triggers and address your gut health imbalances with the natural treatment approaches above, you can experience significant relief from IBS symptoms.

However, persistence and patience are key, as finding the right combination of treatments may require some trial and error.

If your IBS symptoms still don’t improve as much as you’d like after you’ve tried all the above suggestions, your situation may need a more detailed approach. One option is to follow the 8 steps in my book Healthy Gut, Healthy You. Or, for a private consultation with one of our highly experienced practitioners, please reach out to our Virtual Clinic.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.