Are you experiencing symptoms of IBS? Do you feel lost reading about different dietary and other treatments for IBS? I have good news for you. Some research evidence may give you some new insight into the treatment options for IBS.
In this article, I want to talk about the best dietary treatment options for IBS. You will learn about how the low-FODMAP diet for IBS, the low-gluten diet for IBS, and UK traditional dietary advice for IBS compare. I will also discuss new research evidence on the potential benefits of fecal transplant treatment for IBS.
What Is IBS?
Irritable bowel syndrome (IBS) refers to a group of gastrointestinal symptoms that occur together. These symptoms include abdominal pain and changes in bowel movements, such as constipation, diarrhea, or both. While you may experience chronic symptoms, in IBS, there are no signs of clear gastrointestinal damage or disease. Over 10% of the population has IBS (1, 2, 3).
IBS should not be confused with irritable bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis. IBDs are autoimmune diseases that affect the gastrointestinal tract. Though some symptoms may be similar to IBS symptoms, IBDs tend to be more serious, and there is clear damage and autoimmune reactions in your body.
IBS is a functional gastrointestinal disorder. This is also known as a disorder of gut-brain interactions. Your gut and brain affect one another and work together. This is known as the gut-brain axis. Problems within this closed system can make your gut more sensitive and affect the muscles within your bowel track. This may lead to pain, bloating, and other symptoms of IBS.
Types of IBS
There are 3 different types of IBS:
- IBS with constipation (IBS-C): This type of IBS is characterized by constipation. To receive this diagnosis, your stools should be at least 25% of the time hard or lumpy and less than 25% watery or loose when you have abnormal bowel movements.
- IBS with diarrhea (IBS-D): This type of IBS is characterized by loose stools. To receive this diagnosis, your stools should be at least 25% of the time loose or watery and less than 25% hard or lumpy when you have abnormal bowel movements.
- IBS with mixed bowel habits (IBS-M): If you have this type, you may experience both diarrhea and constipation. To receive this diagnosis, your stools should be over 25% loose or watery and over 25% hard or lumpy when you have abnormal bowel movements.
Understanding the type of IBS you have may help to find the best treatment strategy. Even if you don’t fit the exact criteria, your doctor may still diagnose you with IBS if you have digestive issues without a clear reason or disease present.
Symptoms of IBS?
Your symptoms of IBS may depend on the type of IBS you have. Symptoms of IBS may include:
- Abdominal pain
- Constipation or diarrhea, or both
- A feeling that you haven’t completed a bowel movement
- Mucus in stool
- In females, worse IBS symptoms during their period
Best Diet for IBS
You are what you eat. You’ve probably heard this saying before. It is not just a cliche, but there is a lot of truth to it. Your diet can either improve or worsen your symptoms of IBS and other health issues. So what is the best diet for IBS?
In the United States, the low-FODMAP diet is the most commonly recommended nutrition plan for IBS (4). It is a similarly common recommendation in Canada as well (5). It is recommended by both traditional and functional medicine practitioners alike.
FODMAPs refer to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAPs are short-chain carbohydrates that the small intestine doesn’t absorb well. Some people experience digestive issues consuming food high in FODMAPs. A low-FODMAP diet is commonly used to help improve irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and other digestive issues (6, 7, 8). I’ve written about how it may even help those with histamine intolerance here.
In the United Kingdom, the most common recommendation is the traditional dietary advice (TDA). These guidelines include avoiding large meals, regularly eating, hydrating your body well, reducing caffeine, alcohol, and sugary drinks, avoiding too spicy, fatty, and processed food, avoiding gas-producing foods (e.g., beans, artificial sweeteners, bread, baked goods), removing food sensitivities, and eating only three servings of fruit or less per day (9).
Another common recommendation for IBS is avoiding or limiting gluten. Non-Celiac gluten sensitivity is a common issue that may contribute to symptoms of IBS. If you are sensitive to gluten, reducing or avoiding it may be enough to improve your complaints. However, simply removing gluten may not be enough for everyone (10).
Low-FODMAPs, TDA, and gluten-free may all offer relief for symptoms of IBS. But which one is the most effective?
A recent, 2022 study published in Clinical Gastroenterology and Hepatology may have some answers (9). In this study, researchers compared the effects of the low-FODMAP diet, TDA, and a low-gluten diet for IBS.
They found that all three diets — low-FODMAPs, TDA, and low-gluten — are effective for symptoms of IBS. After only 3 weeks, around half of all participants found some relief from symptoms of IBS.
The low-gluten diet seemed the most effective. After 4 weeks, 58% found a reduction in symptoms following a low-gluten plan, 55% found relief from the low-FODMAP diet, and 42% found improvement using TDS.
However, this is not the only measurement they looked at. When we are talking about dietary or lifestyle changes, understanding the effectiveness is not enough. We need to know if people can stick to it.
Even if a diet works, not all clients follow through. Dietary plans can feel challenging and many patients give up. Chances are, you can relate to this. In this particular case, researchers found that patients’ ability to follow the plan didn’t line up with the effectiveness of each diet. It was actually the opposite.
Only about 61% of participants continued with the low-gluten diet. 67% continued with the low-FODMAP diet. And 70% continued following the TDS diet. It seems like the TDS diet may be the easiest to follow. Since without actually following a dietary strategy, you can’t expect long-term improvements (or in some cases, any improvement), it’s important to consider the entire picture. Your lifestyle, personality, food preferences, and willingness to follow a strict plan may all play a role when choosing the right option.
I may add that sometimes other factors play a role in IBS. For example, I see patients all the time with both IBS and histamine intolerance. If you have histamine intolerance, reducing histamine will be a critical part of your recovery. We need to look at other potential contributing health factors, your stress levels, lifestyle choices, and dietary triggers, to come up with an individualized treatment plan.
Fecal Transplant and IBS
Speaking of potential treatment options for IBS, fecal transplants are an interesting emerging option for IBS patients, especially if they are not responding to dietary changes or other treatment options. Yes, you’ve read that right. I’m talking about poop transplants.
A fecal transplant or fecal microbiota transplant (FMT) is a procedure that transfers stool from a healthy person to another person’s gastrointestinal tract to treat a certain health condition. FMT is an emerging treatment option for IBS, IBDs, Clostridium difficile (C Diff) and other GI infections, autism, and other health issues (11, 12, 13). It may be done through a colonoscopy, enema, nasogastric tube, or capsules (14).
Fecal transplant treatments have been the most studied for C Diff infections (15). However, there is some evidence that a fecal transplant may be a good treatment option for IBS and functional bowel diseases (16, 17).
A study published in Gastroenterology in 2022 followed up with patients 2 and 3 years after receiving FMT treatment for IBS or a placebo (18). They found that patients who received FMT treatment for IBS experienced a significantly higher improvement than those that received a placebo. FMT patients experienced fewer IBS symptoms, lower fatigue, and improved quality of life. Moreover, they also noted an improved dysbiosis index in the FMT group.
The authors noted that the selection of stool samples might play a role in the success of specific FMT participants. Following a healthy diet, a healthy lifestyle, and receiving a few antibiotic treatments may have also contributed to their success.
This suggests that receiving FMT treatment for IBS but following it up with an unhealthy lifestyle and receiving antibiotic treatments regularly may set you back and you will experience symptoms again. However, following your FMT treatment for IBS with a healthy diet and lifestyle with few to no antibiotic treatments may set you up for long-term success. Diet and lifestyle are critical for your long-term health.
If you are interested in a fecal transplant as a treatment option for IBS, don’t try it at home. The internet is full of DIY fecal transplant treatment advice for IBS and other issues, but these are not safe (19). It is important that your donors are screened properly. Otherwise, you may be risking your health. Doctors that perform fecal transplants have extensive training in safe preparation and treatment. The procedure is not yet readily available as it continues through clinical studies. Since research is still limited on FMT, it shouldn’t be your first choice, and should always be done safely with the guidance of a trained professional.
If you are experiencing symptoms of IBS, I recommend that you speak with your doctors first for more personalized health information and support. I invite you to schedule a consultation with me here to see if you can benefit from the strategies listed in this article.
If you are dealing with any chronic health issues, for advice on how to improve your nutrition and health, I welcome you to start a functional medicine consultation with me for further personalized guidance. You may book your consultation here.
Check out my Histamine Intolerance Course here. Learn on your own time, from anywhere. Get an inside look at the most helpful functional medicine tests for pinpointing imbalances, ways to identify and manage the most common (and sometimes surprising) mast cell triggers, and learn what to eat, what to avoid, and why.