IBS: What It Is and How to Treat It

Your Guide to Irritable Bowel Syndrome and What to Do About Your Symptoms

• What Is IBS?|
• Signs and Symptoms of IBS|
• An Unhealthy Microbiome Could Cause IBS|
• Is it IBS or Something Else?|
• The Best Ways to Treat IBS|
• Are There IBS Medications That Can Help?|
• Understanding IBS Is Key to Feeling Better|

When you have irritable bowel syndrome (IBS), it can sometimes feel like your gut is throwing a wild party without your permission.

IBS can make your belly hurt and lower your quality of life, and it could mean you have to spend some days close to the bathroom. On the bright side, the condition doesn’t create any permanent damage to your digestive tract.

Nevertheless, having a painful and unsettled gut is distressing. It can also lead to fatigue and mental health issues, including anxiety and depression.

So what is IBS? How does it differ from, or overlap with, other gut ailments? More importantly, what is the best way to prevent and treat unpleasant IBS symptoms? 

Let’s do a deep dive into irritable bowel syndrome and investigate the best ways to put an end to the rager in your gut and bring back the calm.

What Is IBS?

Irritable bowel syndrome is a functional gastrointestinal disorder, or FGID [1]. In FGIDs, the digestive tract stops working properly, despite there being no damage or identifiable disease [2].

In the past, IBS was known as “spastic colon,” which stemmed from the oversimplified hypothesis that muscle spasms within the GI tract caused abdominal pain and other IBS symptoms. We now understand that the mechanisms behind IBS are more complex.

More specifically, IBS isn’t caused by any structural irregularities or obvious disease. Instead, it’s thought that IBS symptoms may arise from disturbances in how the gut and brain “talk” to each other [3, 4, 5].

For example, in some people with IBS, a disruption in their gut-brain relationship may mean food moves too slowly, or too quickly, through the digestive tract. In others, their brain may strongly perceive gut discomfort even when there are normal amounts of gas or stool in the gut. Altered levels of the neurotransmitter serotonin may play a role in such hypersensitivity [6]. 

The gut-brain imbalances in IBS don’t just come from nowhere. There’s plenty of evidence to suggest that an unhealthy gut microbiome, which creates inflammation, may be an underlying cause [7]. Inflammation could essentially cause glitches in the cross-communication between the gut and brain, giving rise to symptoms. 

Let’s get into how IBS makes you feel, and then I’ll discuss how the gut microbiome plays into inflammation and IBS symptoms in more detail. 

Signs and Symptoms of Irritable Bowel Syndrome

The most common symptoms of IBS are [3]:

• Abdominal pain and cramping 
• Changes in bowel habits, such as intermittent diarrhea or constipation (sometimes alternating) 

Other common symptoms may include:

• Bloating
• Feeling like you haven’t finished a bowel movement
• Seeing mucus in your poop

Estimates suggest that 10% to 12% of people in the United States have IBS, and females are three times as likely as males to be diagnosed with the condition [1].

An Unhealthy Microbiome Could Cause IBS

Several studies suggest that gut microbiome imbalances—particularly small intestinal bacterial overgrowth (SIBO)—are very common in people with IBS and could contribute to IBS symptoms [8, 9, 10, 11]. For example, a meta-analysis (highest quality research) that reviewed 50 clinical studies found that [8]:

• More than one-third of IBS patients tested positive for SIBO.
• IBS patients were nearly five times more likely than healthy controls to test positive for SIBO. 

SIBO can increase inflammation, which could be what disrupts the gut-brain crosstalk that leads to IBS [12].

One type of IBS—diarrhea-predominant IBS, or IBS-D—is more significantly associated with SIBO than the other types [13]. Around a third of people with IBS have IBS-D, a third have the constipation-predominant type (IBS-C), and a third have mixed symptoms (IBS-M). The gut microbiomes of people with IBS-D may be more likely imbalanced by SIBO.

Whether it comes from SIBO or not, poor microbiome health can result in a leaky gut,  which may contribute to some IBS symptoms [14]. A leaky gut allows food particles, bacteria, and toxins to escape into your bloodstream, causing inflammation and immune responses that lead to IBS-type symptoms.

Not only that, but unhealthy or imbalanced gut microbes seem to stimulate IBS symptoms while also sending signals to the central nervous system that trigger mood changes. For example, a higher-than-average proportion of people with IBS develop depression and anxiety, adding weight to the concept of a gut–brain relationship [15]. 

Other Contributors to IBS

Food intolerances are also common IBS triggers. Often, certain carbohydrates, known as FODMAPS will cause symptoms for people with IBS [16]. When we consume FODMAPs (or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), these sugars move slowly through the small intestine, attracting water. When they reach the large intestine, gut bacteria use the FODMAPs as a fuel, breaking them down in a process called fermentation that creates a lot of gas. 

While this happens in everyone, people with IBS are more likely to react with symptoms like abdominal pain or cramping, as well as excessive belching or flatulence and changes in bowel movements [17].

In some cases, IBS and food intolerances can result from the aftermath of acute gastroenteritis, or gut inflammation that arises from an infection [18]. Post-infectious IBS has similar symptoms to other types of IBS, but it’s more likely to cause diarrhea.

Is It IBS or Something Else?

It’s worth knowing that a number of treatable gastrointestinal disorders can be misdiagnosed as IBS. 

For example, a meta-analysis that looked at people diagnosed with IBS found that many actually had other conditions, which, if treated, would make their IBS-like symptoms dissipate [19].

Within the analyzed studies, SIBO was one of the most common conditions confused with IBS. Although I talked above about how IBS and SIBO often occur together, they can also occur separately. In other words, SIBO can be a potential root cause of IBS, but it may also be a different condition altogether.

The second main condition confused with IBS in the study was carbohydrate malabsorption (different from FODMAP intolerance discussed above). In carbohydrate malabsorption, carbohydrates cannot be fully absorbed (moved across the intestinal wall into the bloodstream), which creates excess fluid and gas [20].

Other conditions that were mistaken for IBS included:

• Bile acid diarrhea 
• Pancreatic exocrine insufficiency 
• Microscopic colitis 

Jumping too quickly on an IBS diagnosis can also make people overlook more serious gastrointestinal conditions like celiac disease and inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis. For those with persistent IBS symptoms, it’s worth investigating whether celiac disease or IBD is, in fact, the cause.

That said, unless you have red flags of colon cancer, like severe anemia, blood in the stool, or unintentional weight loss, I recommend not rushing in with a barrage of invasive blood tests, stool tests, or colonoscopy procedures. 

The best approach for most patients is to start improving your microbiome health and addressing food sensitivities with dietary changes and lifestyle changes. This will likely improve things considerably if you have IBS or a microbiome imbalance that is creating IBS symptoms. If things don’t improve after a few months of treatment, which I’ll describe below, it’s good to investigate other potential causes.

The Best Ways to Treat IBS

Research has revealed a number of effective natural ways, including diet changes, probiotics, and stress reduction techniques, to deal with IBS symptoms. In my clinical experience, not all of these work for everybody, but one or a combination of them will usually bring some relief. 

A Low-FODMAP Diet

FODMAPs are those carbs I mentioned above that can trigger digestive distress for those with IBS. 

A typical low-FODMAP diet begins with eliminating high-FODMAP foods, including:

• Apples, pears, mangoes, cherries, and dried fruit
• Artichoke, garlic, leek, onion 
• Mushrooms, cauliflower, and snow peas
• Bread and pasta (because of fructans, not gluten)
• Some legumes, such as kidney beans and split peas
• Soft cheeses, milk, and yogurt
• Cashews and pistachios
• Fructose and sweeteners containing sugar alcohols

After you’ve cut out high-FODMAP foods for a while, you should notice a considerable improvement in IBS symptoms like bloating and belly pain. However, it’s not a good idea to stay on such a limited diet long term. The most important phase in a low-FODMAP diet is therefore reintroducing higher-FODMAP foods one by one, and noting how your gut reacts. 

Over time, as you reintroduce foods, you will find out which carbohydrates you can tolerate better than others, and your diet can become more varied.

Monash University, in Melbourne, Australia, pioneered the low-FODMAP diet. They offer a very useful app that will familiarize you with high-FODMAP foods and help you work out how much (or little) you can tolerate before having symptoms.

You will probably become less sensitive to various foods over time as your gut health improves. However, it’s a good idea to keep some low-FODMAP foods around in the event of an unexpected IBS flare.

Probiotics

Five separate meta-analyses have shown that probiotics can effectively treat IBS with very few side effects [21, 22, 23, 24, 25].

Collectively these meta-analyses showed that probiotics can:

• Regulate bowel movements
• Improve bloating and abdominal pain
• Ease flatulence
• Improve energy levels and improve sleep

What’s great about probiotics is that they can help with symptoms at both ends of the spectrum of bowel movement frequency. For example, one study showed that Bacillus species probiotics reduced diarrhea and stool frequency in IBS patients [26]. Other studies showed that probiotics improved stool frequency and regularity in patients with constipation [27, 28]. And these benefits can last a long time, as demonstrated in a study in which participants had less constipation months after they stopped probiotic supplementation [25].

We don’t yet know which specific strains or species of probiotics might be best for IBS [24]. But as I discuss more fully in my book Healthy Gut, Healthy You, the most useful strategy is probably to take a few different high-quality strains. 

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 [21, 22].

Although any well-formulated probiotic is likely better than none, I’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 Bifidobacteria 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

Some patients find a Lactobacillus and Bifidobacterium blend is enough, but others get more benefit when they add in one, or both, of the Saccharomyces boulardii and soil-based categories, too.

For people who like this triple-therapy approach, my team has formulated a convenient combination product that’s stable at room temperature and easy to travel with. 

A Gut Reset

If you’re having an IBS flare and struggling to tame your symptoms, you might want to consider a gut reset. I’m talking here about replacing meals with an elemental diet shake that contains all your nutrients in a pre-digested form. Doing this or simply fasting for 24–48 hours can take the stress off your digestive system and reset your gut, kind of like when you power down and restart your malfunctioning computer. 

Limited research suggests that fasting can soothe an IBS flare [29]. But if you’d rather not fast, another study showed that consuming a liquid elemental diet can do the same [30].

At the clinic, we’ve found that many do well with a “half” elemental diet, in which you replace just one or two meals a day with an elemental shake. You can give this a try if you feel replacing every meal is a bit too much for you. You can also do a 24-hour full reset, followed by a half elemental diet. Essentially, even though the elemental diet may seem restrictive, it’s actually a highly flexible and effective tool for those with stubborn gut issues.   

Stress Reduction 

Emotional stress and stress that arises from poor sleep quality will often make IBS symptoms worse. 

Research suggests that stress management techniques, including meditation and diaphragmatic breathing [31], cognitive behavioral therapy [32, 33], and hypnotherapy [34, 35], can be helpful for IBS.

Another great tool for relieving stress and IBS symptoms is exercise, particularly zone 2 exercise. And if you like yoga, you’re in luck because it may also have specific anti-stress benefits for people with IBS [36]. 

As for reducing stress related to poor sleep quality, you can try making good sleep hygiene a priority. Simple steps like having a regular bedtime and sleeping in a quiet, dark space, will go a long way toward improving your sleep quality.

Natural Supplements

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 [37, 38, 39, 40, 41], even for IBS patients who don’t respond to other therapies [42].

A number of herbal remedies can also help with bloating and other digestive symptoms. In particular, peppermint oil supplements, peppermint tea, or the herbal supplement Atrantil can help to soothe digestive symptoms [43].

For those with mainly constipation symptoms, natural laxatives are also worth investigating. For example, the soluble fiber psyllium can be effective for improving stool consistency. However, fiber can worsen symptoms for some, so start slowly and drink plenty of water. 

Are There IBS Medications That Can Help?

Medication can be something to talk to your healthcare provider about for treating acute symptoms of an IBS attack. But keep in mind that most pharmaceutical IBS treatments simply provide symptom relief for digestive problems and do not address the cause of IBS flare-ups.

That said, for IBS with diarrhea, Imodium (loperamide) is an over-the-counter medication that relaxes the smooth muscles of the digestive system and can improve your stool consistency [44]. Antidiarrheal medications for IBS, including Viberzi (eluxadoline) and Lotronex (alosetron), are also available by prescription.

For IBS with constipation, over-the-counter osmotic laxatives, such as Glycolax or Miralax, can increase the water content of stool and help you poop more often [45]. As with any treatment you try, listen to your body to find out what does and doesn’t work for your special system.

Understanding IBS Is Key to Feeling Better

Once you know what triggers your IBS symptoms and have dealt with any potential underlying causes, you’re on your way to feeling better. The road to being symptom-free can have its ups and downs. But with the right gut health support, you’ll almost certainly have fewer and fewer symptoms over time.

If you incorporate the safe, natural treatments I outlined above, but your IBS symptoms don’t improve as much as you’d like, your situation may be more complex and 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.

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