Nutritional Intervention for IBS

Background Prior to medical school when I was a practicing dietician, I had the privilege of working with many patients who had irritable bowel syndrome (IBS). I found the subject of nutritional intervention related to IBS to be very rewarding and often challenging because there is no “perfect” diet for this syndrome. In light of the different etiologies potentially at work in each patient with IBS, nutrition therapy should be carefully and thoughtfully tailored to each person. This can be likened to times past when a cobbler hand-made each person’s shoes. Since each IBS patient can differ dramatically, careful documentation of exacerbating factors listed in the IBS diary maintained by patients may yield important clues to an effective approach to diet and nutrition. One of the issues is that patients with IBS may have a lower threshold to stressors compared to people without IBS. An example of this is patients with carbohydrate intolerances as well as a diagnosis of IBS, who experience an even greater response to problematic carbohydrates such as lactose or fructose as compared to someone who does not have IBS. Another important issue is being alert to unnecessary food aversions. Individuals may experience abdominal discomfort and associate this with eating a certain food, so they decide to avoid eating that particular item, even for life. This may lead to excessive food restriction and the potential for a full-blown eating disorder. What must be kept in mind is that IBS is characterized by increased gut and central nervous system (CNS) reactivity to stressors, and that these stressors can include any dietary excesses as well as sensitivities to particular foods that are unique to the individual rather than to the IBS condition. This article reviews some of the literature in this area and then presents some treatment options to be considered in the nutritional management of IBS. It should be noted that the research and peer-reviewed published literature regarding IBS and diet is still very limited and, therefore, some of the resources cited in this article will date back several years.