Expat Life

Oh my aching gut! Is it IBS?

Irritable Bowel Syndrome (IBS) is one of those mysterious conditions that can’t be defined by just one symptom. It’s called a “syndrome” because it’s a cluster of symptoms, including diarrhea, constipation, gas, bloating and/or cramping. You may have one, or all. You may have them chronically or only occasionally.

chl susan logo2IBS affects about 11% of the world’s population, but about 20% of U.S. Americans report symptoms of IBS.  Some studies show that the highest incidence of IBS (21%) is in South America. One study notes that because many patients don’t consistently seek medical attention for symptoms of IBS it makes it difficult to get an accurate assessment of prevalence.

In most populations, women are up to three times more likely to report symptoms. IBS occurs in all age groups, including children and seniors, however, 50% report having their first symptoms before age 35. Seniors over 65 also report having symptoms for a year or more before seeking treatment.

Until recently, experts did not have a good handle on treatment, and typically treatments were directed at alleviating symptoms. However, addressing the possible causes of IBS is a different and more practical approach.

monash-fodmapSince IBS is not a disease, it’s not life-threatening, however, it can play havoc with your quality of life, and certainly having to stay close to the bathroom is frustrating and inconvenient.

There are risk factors that are out of your control, such as your sex — females may be more at risk because of hormonal fluctuations, especially around the menstrual period. However, according to MayoClinic.org, although research has not pinpointed exactly what causes IBS, there are a number of modifiable factors that may contribute:

Stress: many with IBS find their condition exacerbated by stressful situations, such as final exams or upsetting work or family issues.

Other illnesses: SIBO (small intestinal bowel overgrowth) or stomach flu or other gastroenteritis could trigger IBS.

Foods: If you’re eating a diet full of refined and processed foods, feasting frequently on deep-fried meats, and drinking a lot of sugary beverages, that can contribute to gastric symptoms. Some people can eat very spicy foods or known IBS triggers and not think twice about it; others have immediate and unpleasant reactions. Foods such as spices, fats, fruits, beans, cabbage, cauliflower, broccoli, dairy, carbonated beverages and alcohol may be problematic.

Eat to Live

An Australian research team has developed a new dietary management approach – the Low FODMAP diet – to control symptoms associated with IBS.

FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides and Polyols. These are types of carbohydrates (sugars) naturally present in foods. FODMAPs are osmotic, which means that they pull water into the digestive tract and for some people, eating foods rich in FODMAPs can lead to the digestive symptoms that may range from just being unpleasant to being severe.

Here is a detailed breakdown of the FODMAP acronym.

Fermentable: describes the process through which gut bacteria work upon undigested carbohydrate to produce gases: hydrogen, methane and carbon dioxide.


Fructo-oligosaccharides (FOS): wheat, rye, onions, garlic

Galacto-oligosaccharides (GOS): legumes, dried beans, lentils, soybeans

Di-saccharides: Lactose in milk, chocolate, ice cream, sour cream, soft cheeses, yogurts

Mono-saccharides: Fructose (in excess of glucose): honey, apples, dates, pears, and high-fructose corn syrup

Polyols: sugar polyols that end in “ol” like xylitol, rome-iii-diagnostic-criteriasorbitol, mannitol used as artificial sweeteners; some stone fruits like peaches, cherries, plums.

Is a LOW FODMAP Diet a Forever Diet?

Importantly, FODMAP experts emphasize that the low FODMAP diet is not a “no FODMAPs ever again” diet.  Some FODMAP foods promote the growth of “good bacteria” and help with digestion.

The best advice is to work with a registered dietitian, who’ll help you adhere to an elimination diet for six to eight weeks. By journaling your reactions to specific foods, you determine which high FODMAP foods produce symptoms and should be avoided, and which high FODMAP foods you can tolerate.

Some foods might not be tolerated at all while some are OK just in small amounts.

It’s not an “all or nothing” proposal, rather, it’s a guide to finding out the foods that best suit your individual needs.

Mind/Body Approaches for controlling IBS

Research shows that IBS may be helped with psychological activities that emphasize stress management, self-empowerment and positive. Hypnotherapy has also shown particular promise, as has yoga.

ibs-cartoonWhile there are general guidelines for a low FODMAP diet, to tailor it to your individual lifestyle and food likes and dislikes, work with a registered dietitian to make sure your diet doesn’t lack essential nutrients to stay healthy. Like type 2 diabetes, following a prescribed “diet” for IBS can improve your health and lower your gastric symptoms, but the diet does not “cure” IBS, anymore than eating a prescribed diet won’t “cure” diabetes. A healthy diet and activity can reverse symptoms of high blood sugar and have other happy consequences — weight loss, more energy, better sleep. And the same goes for modifying your diet to avoid symptoms of IBS.

Remember, the diagnosis of IBS is an exclusionary one, and it’s important to consult with your primary doctor and a gastroenterologist to rule out other diseases or conditions that may be causing gastric symptoms such as ulcers, infections, tissue inflammation, intestinal obstruction, or even cancer. Lactose intolerance, celiac disease, parasites, or SIBO symptoms are similar to IBS symptoms. Read more here. The “Rome Criteria”, a classification system currently in use for all the functional gastric disorders including IBS, and was recently revised in 2016.  In the absence of certain “red flags” such as blood in the stool or fever, your doctor can generally diagnose IBS. Read more here.

For more information about FODMAP foods, click here.


AboutIBS.org. Five low FODMAP diet pitfalls (and what you can do to avoid them.) http://www.aboutibs.org/low-fodmap-diet/five-low-fodmap-diet-pitfalls-and-what-you-can-do-to-avoid-them.html

Clinical Epidemiology. The epidemiology of irritable bowel syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/

Delicious Living. Breaking down the low FODMAP diet. http://deliciousliving.com/health/breaking-down-low-fodmap-diet

eMedicine Health. Small Intestinal Bacterial Overgrowth: What is the relationship between SIBO and Irritable Bowel Syndrome (IBS)? http://www.emedicinehealth.com/small_intestinal_bacterial_overgrowth/page7_em.htm#what_is_the_relationship_between_sibo_and_irritable_bowel_syndrome_ibs

Evidence-Based Complementary and Alternative Medicine. Mind/Body Psychological Treatments for Irritable Bowel Syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249749/

International Foundation for Functional Gastrointestinal Disorders. Making the Diagnosis. http://www.aboutibs.org/diagnosis-of-ibs.html

MayoClinic.org. Irritable bowel syndrome. http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/tests-diagnosis/con-20024578

Monash University. Low FODMAP diet for Irritable Bowel Syndrome. http://www.med.monash.edu/cecs/gastro/fodmap/

Pain Research and Management. A randomized trial of yoga for adolescents with irritable bowel syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673138/


Susan Burke March

Susan Burke March

Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is... Read More

  • LadyMoon

    Interesting article…hope some folks recognize themselves here and get some help.