Irritable Bowel Syndrome and a Low FODMAP Diet

Introduction

In recent years, “Irritable Bowel Syndrome (IBS)” or spastic colitis has become so common worldwide, as it is a disorder that affects the gastrointestinal system and mainly the Western population. Both the public and health professionals should be able to recognize the possible symptoms that appear so that a valid diagnosis can be made, leading to the adaptation of appropriate treatment through specific management approaches.

What is IBS?

More specifically, it is one of the most common diseases of the digestive system, also known as an intestinal disorder, which is characterized by irregular changes in bowel movements accompanied by abdominal pain and other associated symptoms that are considered indications of this syndrome. It is important to note that it involves one of the most complex interactions between the gut and the brain.

Diagnosis and Prevalence

On average, based on valid and recent scientific studies, 1 in 7 people suffer from IBS, consequently experiencing gastrointestinal problems in their daily lives. As mentioned above, early diagnosis can contribute to direct treatment or reduction of the disorder’s progression. A proper and comprehensive diagnosis includes the full assessment of the patient by a certified clinical dietitian, where a detailed discussion will take place regarding medical history, dietary data, habits, genetic background, and psychological condition (for example, the presence of possible stress). Other parallel disorders that might affect the diagnosis should also be ruled out. Finally, scientifically based diagnostic tests such as colonoscopy, blood tests, celiac antibody screening, or the use of Rome IV diagnostic criteria can be applied. According to the updated Rome IV diagnostic criteria (e.g., Bristol Stool Chart), the global prevalence reaches 3.8%–12%, of which 60–70% are women under the age of 50.

Symptoms

There are three types of IBS: IBS with constipation, IBS with diarrhea, and IBS with alternating diarrhea and constipation. The only certain thing is that a variety of symptoms are observed, such as abdominal pain that usually subsides immediately after defecation, bloating or gas, lower back pain, a feeling of early fullness, nausea, irregular bowel movements, difficulty in defecation despite the urge, and possible presence of mucus in the stool.

Causes

IBS can be caused by several factors, including hormonal imbalances due to daily stress, prolonged fatigue, problems in the brain–gut axis, increased visceral sensitivity, reduced physical activity, and impaired motility disorders. An important risk factor, however, is diet.

Management Approaches

Treatment for this syndrome is essential in order to significantly reduce its frequency, as well as the accompanying disorders involved. According to meta-analyses, there is no single approach that can serve as a cure for this condition. What exists and should be applied individually depending on the type and symptoms presented by the patient is proper attention to three main areas: diet, psychological therapy including physical activity, and medication when necessary.

Nutrition: The golden pillar as part of IBS management

Many people may notice flare-ups or symptoms after consuming certain foods, which might not affect another person with IBS in the same way. Based on current scientific studies on nutrition for IBS, there is a need to follow a diet low in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols), which are foods containing poorly absorbed short-chain carbohydrates, or even a gluten-free diet compared to a regular one.

The mechanism of these dietary models focuses mainly on reducing abdominal pain and bloating. In a recent Belgian study from 2022, evidence was presented for a possible pathophysiological mechanism that may trigger specific symptoms after consuming certain foods, such as gluten-containing foods or foods rich in histamine, like dairy, peanuts, oranges, unripe bananas, eggplants, and legumes such as lentils or chickpeas, which may worsen the symptomatology.

The low FODMAP elimination plan is implemented with the consent of a clinical dietitian or gastroenterologist and can last from 2 to 6 weeks.
The main foods that should be avoided are:

Fatty foods (fried foods, pizza, sausages, yellow cheeses, etc.)
Dairy products due to possible lactose intolerance
Seeds and whole grain flour
Raw fruits and those containing pits
Vegetables such as onion, pepper, eggplant, cabbage, cauliflower, broccoli, beans, etc.
Sweeteners that promote further gas formation
Beverages such as soft drinks, alcohol, and coffee
Spices such as chili or garlic
Nuts and chocolate

A good solution for monitoring meal consumption is keeping a food diary, recording what was eaten, in what quantity, which spices were used, and what feelings occurred afterward.

On the other hand, the foods that should be preferred are those rich in fiber (be cautious in cases of diarrhea or constipation), such as psyllium (soluble fibers) and not wheat bran (insoluble fibers), as well as probiotics found in foods like kefir, goat yogurt, pickles, and miso soup.
This helps identify the triggers, leading to temporary reduction or elimination to relieve symptoms.

Psychological therapy and physical activity

Another important part of treatment is improving psychological well-being through cognitive behavioral therapy, which helps reduce symptoms by 60–80% by changing behavior and thought patterns.
Part of this therapy also includes physical activity so that the mind can relax and disengage from the problem. Activities such as yoga, pilates, meditation, relaxation therapy, or hypnotherapy for at least 20–60 minutes, 3–4 times per week, can be very beneficial.

The last option includes prescribed medication such as antispasmodics, pro-secretory drugs, and prebiotics/probiotics/symbiotics to modify the gut microbiota.

Conclusion

When the above approaches are properly followed, improvement in symptoms and overall daily well-being will certainly be observed. Awareness must be developed for the immediate management of the condition so that early prevention can occur before further gastrointestinal abnormalities appear.

References

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