Medical Compass: Managing irritable bowel syndrome (IBS)

Studies suggest lifestyle approaches to improve symptoms

By David Dunaief, M.D.

Irritable bowel syndrome (IBS) symptoms, such as abdominal pain, cramping, bloating, constipation and diarrhea, can directly affect your quality of life. If you are among the estimated 10 to 15 percent of the population that suffers from IBS symptoms, managing these symptoms can become all-consuming (1).

While diagnosing IBS is challenging, physicians use discrete criteria physicians to provide a diagnosis and eliminate more serious possibilities. The Rome IV criteria comprise an international effort to help diagnose and treat functional gastrointestinal disorders. Using these criteria, which include frequency of pain and discomfort over the past three months, alongside a physical exam helps provide a diagnosis.

Fortunately, there are several approaches to improving symptoms that require only modest lifestyle changes.

How is IBS affected by mental state?

The “brain-gut” connection refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (2). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

Could gluten be a factor in IBS?

Gluten sensitivity may be an important factor for some IBS patients (3). In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively (4). These results were highly statistically significant, and the authors concluded that nonceliac gluten intolerance may exist. 

I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets slowly to see the results.

Does fructose play a role in IBS?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to examine this possibility (5). The results were dose-dependent, meaning the higher the dose of fructose, the greater the effect researchers saw. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included gas, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in some IBS patients.

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (6). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

Are lactose intolerance and IBS connected?

Another small study found that about one-quarter of patients with IBS also have lactose intolerance (7). 

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptoms at both six weeks and five years when placed on a lactose-restricted diet.

Though the trial was small, the results were statistically significant, which is impressive. Both the patient compliance and long-term effects were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is probably worthwhile to test patients who have IBS symptoms for lactose intolerance.

Will probiotics help with IBS?

A study that analyzed 42 trials focused on treatment with probiotics shows there may be a benefit to probiotics, although the objectives, or endpoints, were different in each trial (8).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

Is there a link between IBS and migraines?

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was distinct from healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (9).

All of these studies provide hope for IBS patients. These are treatment options that involve modest lifestyle changes. Since the causes can vary, a strong patient-doctor connection can help in selecting an approach that provides the greatest symptom reduction for each patient.

References:

(1) American College of Gastroenterology [GI.org]. (2) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (3) Am J Gastroenterol. 2011 Mar;106(3):516-518. (4) Am J Gastroenterol. 2011 Mar;106(3):508-514. (5) Am J Gastroenterol. 2003 June;98(6):1348-1353. (6) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (7) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (8) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413. (9) American Academy of Neurology 2016, Abstract 3367.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.