The Comprehensive Guide to IBS

The Comprehensive Guide to IBS


Are you tired of abdominal pain? Sick of constipation or diarrhea? Embarrassed by explosive wind at inconvenient times?

Irritable bowel syndrome, otherwise known as IBS, strikes almost one in four Americans​. Its effects can be profound. When patients first attend our clinic, many report reduced quality of life, missed workdays, and history of incomplete or absent recovery. The frustration is palpable: People are understandably sick of feeling sick.

Sadly, IBS is as common as it is misunderstood. Patients pack the consultation rooms of gastroenterology clinics around the world. But without in-depth knowledge, the core causes are never addressed. The gut remains unhealed. The legacy of suffering continues.

In this comprehensive guide, I want to halt the needless suffering IBS brings. I will walk you through what you need to know about irritable bowel syndrome: What it is? Why does it happen? The common and infrequent signs and symptoms. Then we’ll discuss treatment options that work, like powerful dietary best practices that help to trigger remission. In short, you’re about to learn the evidence-based advice and approaches I use to treat my patients.

IBS: The current definition

The current medical definition is based on symptoms alone. It is also a diagnosis of exclusion, meaning there is no other cause for your symptoms. The ​National Institute of Diabetes and Digestive & Kidney Diseases(NIDDK) ​defines IBS​ as “A group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both.”

When you are diagnosed with irritable bowel syndrome, you will likely be given a subtype: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with mixed bowel habits (IBS-M). These are as they sound.

IBS-C means that constipation is the primary stool type. On days where you have an abnormal bowel movement, 25% or more of your stools are hard. Less than 25% are loose.

IBS-D means that diarrhea is your main complaint. On days where you have an abnormal bowel movement, 25% or more of your stools are loose or watery. Under 25% are hard.

IBS-M means that constipation and diarrhea both occur frequently. On days where you have an abnormal bowel movement, more than a quarter of your stools are hard and more than a quarter are loose or watery.

But being labeled with IBS or one of its subtypes only describes your symptoms. You are well aware of these already! While a diagnosis can guide the medications prescribed, it really offers nothing by way of understanding the cause or any triggers. And if you don’t know the cause, you can’t adequately address this condition and it becomes nigh on impossible to achieve remission.

With this in mind, let’s look at what we really know about IBS.

Irritable bowel syndrome: Why does this common condition occur?

When we understand why IBS happens, we can look at eliminating its causes. Thorough investigation and evidence-based advice is how our patients achieve remarkable results. We must begin with the truth.

A study published in ​World Journal Gastroenterology ​noted that:

“Altered gastrointestinal motility, visceral hypersensitivity, post infectious reactivity, brain-gut interactions, alteration in fecal micro flora, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, and intestinal inflammation all have been implicated in the pathogenesis of IBS.”

As you can see, it’s a complex problem. One or several sources can underlie IBS. Understanding the triggers leads to relief but finding them can be difficult. Wonderfully, there are simple approaches and advice that help to solve the riddle and provide relief.

But first…

What are the common and less common symptoms of IBS?

IBS can cause:

  • Abdominal pain and cramping
  • Bloating
  • Brain fog
  • Constipation
  • Diarrhea
  • Excessive wind
  • Feelings of incomplete evacuation (when it feel like you haven’t completely emptied your bowel)
  • Food sensitivities
  • Insomnia
  • Joint pain
  • Mental illness, including anxiety and depression
  • Tiredness

The basics: What happens in the gut?

When most people think about the gut, their mind flicks to the inside of the body. But, in reality, the digestive tract is like the hole through a donut. It passes through us but its contents are not part of us. This is a good thing.

When we eat, we place food into the mouth, chew, and swallow. This propels partially digested food into the stomach. Here it is dissolved further to release its life-sustaining nutrients. When ready, the sphincter at the bottom of the stomach opens allowing the “food” to move into the small intestine.

Here, most of the nutrients are absorbed. The indigestible material is then pushed into the large intestine. The remaining water and nutrients are extracted. Feces are formed and shunted toward the exit point: the anus. It’s here, within the large intestine, that irritable bowel syndrome flares.

5 issues that underpin irritable bowel syndrome

There are a number of issues that contribute to irritable bowel syndrome. This is one of the reasons IBS can be so difficult to treat. To find respite, you must remove the problem. First you have to suspect it!

Here are five issues I see often that contribute to irritable bowel syndrome in my patients…

Altered gastrointestinal motility: Is your gut speed off?

Motility describes the ​muscular contractions​ that mix and propel the contents of the digestive tract. In health, the gut muscles happily contract and relax. This moves food from the stomach to the small intestine to the large intestine and then out. At the right pace, this allows for optimal nutrient and water absorption and pain-free passage.

Sometimes, though, motility becomes altered. ​Accelerated intestinal transition​ happens when the muscles propel the contents too quickly. The increased speed means that excess water remains in the stool and diarrhea results. Delayed intestinal transition can also occur, resulting in increased water removal and the hard, dry stools of constipation.

Visceral hypersensitivity: Is your gut too sensitive?

Visceralsimply relates to the organs and ​hypersensitivityto being overly responsive or aware. So, in IBS, visceral hypersensitivity means that people respond more readily to the changes that occur in the bowel. They sense and feel them more.

Just as some people are hypersensitive to emotional events, in some people the bowel is hypersensitive to internal pressure. When you also have this kind of sensitive gut, there is a lower threshold for the awareness of stimulation. Internal pressure is, therefore, sensed as pain. This is sadly not theory: Research shows that when mechanical pressure is applied to the large bowel, ​IBS symptoms​ can be reproduced.

Visceral hypersensitivity can also result from an inflammatory process following a gut infection. It’s a little like when you stub your toe. It becomes tender to touch; whereas, before the injury, it just felt like a normal toe. If your IBS started after a gastric infection, this may be why.

Your brain and your gut talk too!

I find it odd that many health professionals only look at the gut in IBS. I can all but guarantee this will fail; It will miss important pieces that are needed to complete the healing puzzle.

We humans are intricate and complex. By design, the body and brain continuously “talk.” Sending information back and forth is how we are able to respond so quickly and precisely to a threat or a change. When this communication happens between the digestive tract and the brain it is called brain-gut interaction​.

We constantly consciously and subconsciously change our responses because of this shared information. This is why psychological stress can trigger IBS symptoms. It also plays a role in visceral hypersensitivity; the brain increases awareness of the gut’s inner workings.

An imbalanced gut microbiome

There is an incredible array of gut bugs thriving in your bowel. In fact, up to 100 trillion tiny living creatures call this organ home. But when an imbalance in the quantity and type of bacteria, viruses, and fungi occurs, the gut can suffer.

A change in bacterial communities is referred to as dysbiosis. It triggers the gut’s immune system and may create ​low-grade inflammation​. As I’ve written above, this is linked to visceral hypersensitivity and increased IBS symptoms. But it’s so much more than this…

An increase in the “bad” bugs can creep upstream. This movement from the large and into the small intestine is called small intestinal bacterial overgrowth, or SIBO. The consequences include gastrointestinal symptoms, immune activation, motility problems, increased visceral sensitivity, immune activation, trouble digesting and absorbing carbohydrates, and increased intestinal permeability.

Think back to the earlier study from the ​World Journal Gastroenterology. It becomes quite obvious that the large and the small gut and the experience of IBS are deeply linked.

Increased intestinal permeability: Is your gut leaky?

To summarize, increased intestinal permeability seems to play an important role in IBS. What natural healers have called leaky gut for eons, science has more recently dubbed increased intestinal permeability.

The gut is covered by a one-cell thick lining. Its incredible structure allows water and nutrients to cross while stopping potentially harmful products, like foreign invaders. In a leaky gut, the digestive tract acts like a sieve rather than a funnel. Damaging compounds can pop through these holes. In doing so, they move from the relative safety of the inside of the gut and into our body proper.

As a study published in the journal ​Pain ​noted:

“Increased intestinal permeability allows the passage of bacteria and antigens through the mucosal layer of the gut. This may then lead to activation of mucosal immune responses and subsequent chronic diarrhea and abdominal pain seen in IBS patients.”

This means, in essence, that a leaky gut can cause downstream problems and cause or contribute to irritable bowel syndrome.

So how can we fix these problems?

Relief: The IBS treatments that work

As you can imagine, successful remedies need to target the cause or causes of IBS and soothe the problems that they produce. A mismatch here is why many treatments fail. Getting this right matters.

The right diet for a healthy gut

The best place to start is at the beginning: diet. The number one influence on gut health is diet. Healthy foods heal. Many of my patients find a ​low FODMAP diet​ therapeutic. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. While it is a mouthful to say, this diet restricts the foods known to increase gut distention and gas. The result is often relief from ​IBS pain and symptoms​.  In my opinion, avoid all processed foods, and high glycemic foods which cause bacterial imbalance. Also, meat, cheese, and wheat may cause some issues as well.

What foods are limited on a low FODMAP diet?

Fruits: apples, blackberries, cherries, Nashi pears, peaches, plums, figs, mangoes, and dried fruit.

Vegetables: artichoke, cauliflower, garlic, leek, onion, and spring onion.

Legumes: baked beans, falafel, red kidney beans.

Plus, wheat, cow’s milk, processed meats and honey.

What foods do I personally encourage for patients with IBS?

Phytonutrient rich foods: These are foods that have high amounts of polyphenols, flavonoids, terpenes, and chlorophyll. As a whole, these phyto-compounds will help boost gut health. They are found in many vegetables, but if you are having trouble intaking a substantial amount, you may consider caffeine-free herbal teas, such as Rooibos and Peppermint. One of my personal favorites is the “Three Mint” tea by Pukka. Some of my patients have reported drinking two cups a day of each tea (4 cups total) and seeing a noticeable difference in their digestion in 3 days.

Plant-Based Digestive Enzymes: These complex proteins elicit a bloating and immune response in the gut. I encourage the use of digestive proteases with large meals to help with this issue. Some of my favorite enzymes in this category can be found here.

Prebiotics: The foods that feed the good gut bugs are called prebiotics. These can be wonderfully therapeutic. Celery, chicory root, flax seeds, and seaweed are suitable options.

Probiotics: The term probiotic refers to microorganisms that are introduced to raise the good microbiome count. These can be taken in supplement form. They can also be consumed in foods like water kefir and almond yogurt. Even something as simple as a spoonful of fat-free greek yogurt four times a day is generally well tolerated (even in people with IBS and lactose intolerance).

Anti-inflammatory foods:Foods that ease inflammation calm the digestive tract, too. Find out more in my article, ​A Crash-course on Inflammation and Nutrition​.

Keep a food diary (date and time) of all problem foods, and when you experience symptoms. This is helpful for determining whether food preparation methods or certain combinations/timing of food is problematic. I once worked with a patient that had severe issues with pineapple, and raw spinach. Once she steamed lightly steamed the spinach, the problem went away. Cara is a low-cost app you can download to start tracking your symptoms today!

Stress management: Calming your body, mind and gut

Are you stressed? Does worry permeate your life and often?

Stress is known to ​trigger IBS symptoms​. But you likely know this already. This happens because psychological strain increases visceral hypersensitivity, reduces motility, changes the gut microbiota, alters gut-brain interactions and leads to leaky gut. This means managing stress well is crucial.

Simple enjoyable strategies to create calm include:

  • Mindfulness
  • Meditation
  • Focused breathing
  • Regular exercise
  • Sufficient sleep
  • Healing foods: Foods rich in B vitamins, zinc, and omega 3 fats are recommended. Wild-caught salmon, free-range eggs, and sunflower seeds are ideal.

Struggling with IBS? It’s time to finally get the help you deserve

As you’ve learned, irritable bowel syndrome is common. Yet, many needlessly suffer from life-changing symptoms. This is because IBS is a complex condition that requires a holistic, evidence-based approach. One pharmaceutical script may provide some relief but it cannot correct IBS at its core.

As a board-certified medical doctor and renowned surgeon with a passion for nutrition and its power to heal, I focus on what’s needed to get you well. A detailed history and time spent listening to your experiences and concerns allow me to uncover your IBS triggers. We can then, together, create a tailored treatment plan to bring much-needed relief. Remission is possible. To book your in-clinic or telehealth consultation, visit our Book Appointment tab from our ​home page now​.

We look forward to helping you to live a good life.

Dr. Chanu Dasari

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Dr. Dasari is board-certified by the American Board of Medical Specialties, American College of Surgeons, and is a qualified, licensed medical practitioner by the National Board of Medical Examiners and Federation of State Medical Boards. Dr. Dasari provides unparalleled expertise in minimally-invasive treatment options for digestive disease, chronic inflammation, and cancer.


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