Control your IBSwith the Paleo diet
IBS (irritable bowel syndrome) affects at least 20% of the population and is the #1 diagnosed gastrointestinal disorder. (1) Unfortunately, IBS is often not taken seriously and is even often ridiculed by many people, including health professionals.
The Paleo diet is a good place to start for people with IBS, but it may not be enough.
I have to admit that myself, as a registered dietitian, believed at some point that people with IBS were overly sensitive or simply liked to complain… until karma caught up with me in 2010. Read more about my story here. To sum up, I got sick a few times when traveling in South America and my digestive system never fully recovered… I developed post-infectious IBS, one of the many forms of IBS. I now understand first-hand how debilitating IBS can be. It affects every aspect of your health, physical and mental, and can greatly compromise your quality of life. I am now passionate about digestive health and want to help people with IBS and related gut disorders learn how to manage their symptoms by modifying their diet, just like I did. For me, a combination of a low-carb version of the Paleo diet, low-FODMAP and GAPS diet has saved me, but everybody's situation is different. I can help you get there too!
What is IBS?
IBS is a disease of exclusion. In other words, IBS is not ONE condition. if your doctor can’t find anything that is anatomically wrong with your intestines, such as celiac disease, Crohn’s disease or ulcerative colitis for example, you will receive a diagnosis of IBS. It may be a convenient way for your doctor to label your symptoms and push them aside, but it is definitely not very enlightening for you in your quest to feeling better.
To be diagnosed with IBS, you need to have been dealing with abdominal pain/discomfort for at least 3 days for at least 3 months in the last 6 months and meet at least 2 out of the 3 following criteria (Rome III Criteria):
- Symptoms relieved by bowel movements, and/or
- Symptoms accompanied by a change in the frequency of your bowel movements, and/or
- Symptoms accompanied by a change in the consistency/appearance of your bowel movements.
Generally-speaking, IBS causes the following symptoms
- Bloating and abdominal distension
- Abdominal discomfort, pain and cramping
- Diarrhea, constipation or alternating diarrhea and constipation
- Flatulence and belching
Although pharmaceutical companies have tried to develop medications to manage some IBS symptoms by decreasing gas, increasing your transit time (if prone to diarrhea) or decreasing your transit time (if prone to constipation), there is currently no cure for IBS...
If you have IBS, you were probably recommended to increase your fiber intake and eat more whole grains, vegetables and fruits, but in many instances, it only makes things worse. And this is why some people with IBS don't improve or even feel worse on the Paleo diet.
Many doctors don’t even believe that IBS is a real problem and think it is all in their patients’ heads, so they don’t even properly address this problem with their patients.
I remember that a GI doctor, leader in IBS and gastrointestinal health research, said during an IBS presentation to registered dietitians that it doesn’t really matter what you recommend to IBS patients. As long as IBS sufferers believe that a specific recommendation can help, they can benefit from it, implying that if something works to improve IBS symptoms, it is only due to the placebo effect and nothing else…
But IBS is not all in your head. It might be common to have IBS symptoms, but IT IS NOT NORMAL. Although researchers have not identified any anatomic problems in the gastrointestinal tract of people with IBS, several scientific papers now show that IBS is associated with higher inflammation levels. (2-5) Fortunately, the Paleo diet eliminates a lot of pro-inflammatory foods, while promiting anti-inflammatory and antioxidants foods.
There is a lot you can do to ease your symptoms and improve your quality of life with IBS.
To better understand how you can improve your IBS symptoms, you need to first identify the cause. The cause and symptoms associated with IBS is different from one person to another. Here are a few of the most common causes of IBS:
Not all people with IBS are gluten intolerant and not all people with gluten intolerance experience IBS symptoms, but the two are often associated together. The most common tests used to check for gluten intolerance actually only checks for the autoimmune form of gluten intolerance called celiac disease (stool testing is more accurate than blood testing). Moreover, if you have not been eating gluten on a regular basis for the last few months, some of these tests can show that gluten is not a problem for you when it actually is! Gluten is a hard-to-digest protein found mainly in wheat, kamut, triticale, barley and rye that can damage your gut lining and contribute to leaky gut syndrome if you are sensitive to it. (6-7) Many people that are sensitive to gluten can also react to other similar hard-to-digest proteins found in other gluten-free grains and dairy for example. I can help you pinpoint food sensitivities.
An overgrowth of bacteria in your small intestines is not a good thing and could be causing your IBS symptoms. Research by Dr. Pimentel even shows that it could be one of the leading cause of IBS. (8-11) If you have SIBO (small intestinal bacterial overgrowth), any carbohydrates you eat (grains, potatoes, fruits, some vegetables and sugar) can feed the excess of bacteria and ferment in your intestines and trigger your IBS symptoms. Read more about what SIBO is and what you can do about it here: SIBO and the Paleo diet.
- Fructose Malabsorption and FODMAPs
Another common cause of IBS is fructose malabsorption and/or FODMAP intolerance. Just like eating carbohydrates causes excessive fermentation in SIBO, foods high in fructose or FODMAPs, which are a group of short-chain fermentable carbohydrates, can also be excessively fermented in you colon (if you only have fructose malabsorption / FODMAP intolerance) and/or in your small intestines (if you also also have SIBO). Onions, garlic, apples, pears, watermelon, cabbage and dairy products are examples of common Paleo foods that can trigger IBS symptoms in people with fructose malabsorption and FODMAP intolerance. (12-13) Read more about it here: Fructose Malabsorption, FODMAPs and the Paleo diet.
Up to 1/3 of gastrointestinal infections from bacteria or parasites (and/or the often concomitant administration of antibiotics) results in persistent gastrointestinal problems, including IBS, and over 25% of IBS sufferers identify the onset of their symptoms to a gastrointestinal infection. (14-15) The first step is to get tested to make sure that the bug that infected you is gone. Following the Paleo diet won't help you if you still have nasty bugs in your intestines. If you still suffer from IBS symptoms even once you are not longer infected, it is most likely because of long-term or even permanent changes to the way your intestines function, alterations in your gut flora and/or an increase in your intestinal permeability (leaky gut). Post-infectious IBS can be improved by healing your leaky gut (see below) and experimenting with your diet to identify your trigger foods (gluten, grains, FODMAPs and/or most carbohydrates/fibers).
What can you do?
Receiving a IBS diagnosis is not a life-sentence of wearing loose pants, running to the toilet or not feeling at your best. Use your IBS diagnosis as a starting point to build your own optimal diet that to manage your symptoms, feel better and improve your health. I can help you if you need support and coaching.
Your goals are to:
Diet Options to Control Your Symptoms
- eliminate trigger foods,
- heal and seal your gut,
- lower inflammation, and
- restore your gut flora.
The Paleo diet is a good place to start with IBS and anecdotal evidence shows that it has helped hundreds of people feel better than they have in years by removing the most common dietary culprits: gluten, grains, legumes, soy and dairy.
However, some people with IBS actually get worse on the Paleo diet, simply because they start eating more nuts (including nut butters, coconut flour and nut-based treats) and high-FODMAP vegetables, which can both cause IBS symptoms.
Whether you have tried the Paleo diet or not to help your IBS, here is a list of the common pitfalls made by people with IBS:
If your IBS symptoms improve on a gluten-free diet, that is all the proof that you need to determine that you are gluten intolerant and keep it out of your diet 100% of the time. The Paleo diet is, in theory, gluten-free, but gluten can easily sneak its way into your diet. If you are sensitive to gluten, you will need to go beyond eliminating breads, pasta, crackers and baked goods.
Read ingredient lists carefully and make sure you are not being glutened by non-obvious sources of gluten, such as in salad dressings, sausages, deli meat, communion wafers, envelope glue or even your lipstick and makeup. Many ingredients other than wheat, flour and gluten can hide gluten, so your best bet is to avoid processed foods and stick to real foods that don’t contain complicated ingredients. If you eat a clean Paleo diet based on tubers, vegetables, fruits, plain animal protein and healthy fats, you will be better able to keep gluten out of your diet without having to spend hours reading food labels!
In addition, make sure that you are not cross-contaminating your foods by using the same utensils and cutting board used to prepare gluten-containing foods and ask that your foods be prepared separately when eating out. Remember that the amount of gluten found in just a tiny breadcrumb is enough to trigger symptoms and damage your intestines. Avoid gluten-free “food products” too. Even though they are gluten-free, they contain other grains and many processed ingredients that could be problematic.
For many people, avoiding high-FODMAP fruits, vegetables and sweeteners can be the missing ingredient to perfect digestive health on your Paleo diet. Download the free PDF FODMAP food list here. By starving bacteria in your intestines from the fermentable short-chain carbohydrates that are FODMAPs (fructose, fructans, galactans, lactose and polyols), if you have fructose malabsorption of FODMAP intolerance, you can finally start controlling your IBS.
For some people, if a 100% gluten-free diet and low-FODMAP diet is not enough, cutting down on your carb intake on the Paleo diet may be a valid option to try. If you have SIBO (an excess of bacteria in your small intestines), any carbohydrates and fiber you eat risk being fermented in your gut, causing the unpleasant gastrointestinal symptoms you are already well too familiar with. Starving these bacteria off their preferred foods can help you control your symptoms and start getting rid of the excessive bacteria that shouldn’t be in such large numbers in your small intestines. Read more about the best diet to adopt and download the free PDF SIBO protocol here.
Heal Your Gut
Once you find the right diet that works for you to manage your IBS symptoms, you can start healing your gut. Eliminating trigger food and controlling your symptoms while following the Paleo diet will help the healing starts, but you can further encourage the healing process by including the following:
- Probiotics/Fermented Foods
Most people with IBS have a deranged gut flora. Include gut-friendly probiotics from high-quality supplements or, even better, from fermented foods. Fermented foods like sauerkraut, fermented carrots or fermented pickles are good Paleo options. If you tolerate dairy, you can experiment with yogurt, kefir and crème fraîche. You can even try fermenting coconut milk with appropriate non-dairy cultures for a dairy-free yogurt-like alternative. If you choose probiotics, try different brands and doses until you find what works for you.
Bone broth contains many gut-healing compounds that can help repair, heal and seal your gut. Don’t think that commercial broth can do. Not only do they NOT contain the gut-healing compounds you need, they also contain a lot of artificial ingredients, including MSG, that can trigger IBS symptoms. A daily cup or two of homemade bone broth as part of your Paleo diet (drinking on its own, in stews, soups or sauces), ideally made from the bones of pastured animals, can make a big difference in your gastrointestinal health.
Since inflammation is a key factor in IBS, it is even more crucial for you to keep your omega-6 to omega-3 ratio as low as possible. Fortunately, the Paleo diet is an anti-inflammatory diet. Avoid pro-inflammatory foods, including vegetable and seed oils, factory-farmed meats, most nuts and nut butters, and try to get more anti-inflammatory omega-3 from fish, seafood, grass-fed meat and eggs from free-range fowls.
Eating plenty of tolerated non-starchy vegetables, tubers and fruits, as recommended on the Paleo diet, can also help you get a variety of antioxidants to help fight inflammation.
Sleep at least 8 hours a night. Your body needs it to heal… make it a priority!
- Relax and Manage Your Stress
Stress interferes with your digestion. Take time to sit down and relax when eating. Chew your food well. Make time for relaxation/quiet time for yourself every day, think positive thoughts and be grateful for the things you have in your life. These factors are often dismissed and pushed aside, but they can make a tremendous difference in helping put your body in a state that promotes healing, proper digestion and better health. Following a Paleo diet that is adapted to your food intolerances is key, but you shouldn't downplay the importance of other components of your lifestyle.
- Get Vitamin D from the Sun
Go outside a few minutes every day to make sure you get adequate vitamin D. During winter, supplement with a good-quality vitamin D supplement or, even better, try fermented cod liver oil.
Although I don’t believe that supplements are mandatory, they may help some people if taken as part of a healthy Paleo diet. Fermented cod liver oil, high-quality probiotics and L-glutamine are example of supplements that can support your gut during the healing process.
Healing your gut takes time.
A few months to up to a few years
, depending on how long you have been dealing with IBS. The goal really is to first control your symptoms and allow you to live without having to worry about your intestines for once. Following this protocol, in conjunction with a healthy Paleo diet adapted to your individual food tolerances, should, with time, help you improve your tolerance and eventually allow you to increase your food variety, but be patient
to prevent relapses.
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(1) National Digestive Diseases Information Clearinghouse. Irritable Bowel Syndrome. (2) Öhman L and Simrén M. Pathogenesis of IBS: Role of Inflammation, Immunity and Neuroimmune Interactions. Nat. Rev. Gastroenterol. Heptaol. 2010; 7: 163-173. (3) Barbara G, et al. A Role for Inflammation in Irritable Bowel Syndrome? Gut. 2002; 51(Suppl 1): i41-i44. (4) Akiho H, et al. Low-grade inflammation plays a pivotal role in gastrointestinal dysfunction in irritable bowel syndrome. World J Gastrointest Pathophysiol. 2010; 1(3): 97-105. (5) Philpott H, et al. Irritable bowel syndrome - An inflammatory disease involving mast cells. Asia Pac Allergy. 2011; 1: 36-42. (6) University of Maryland School of Medicine: University of Maryland School of Medicine Researchers Identify Key Pathogenic Differences Between Celiac Disease & Gluten Sensitivity. [accessed online on April 16, 2012: http://somvweb.som.umaryland.edu/absolutenm/templates/?a=1474] (7) Wangen S. The Irritable Bowel Syndrome Solution. 2006. (8) Pimentel M. A New IBS Solution. 2005. (9) Kopacova M. Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology. 2010; 16(24): 2978-2990. (10)Siebecker A. About SIBO. Siboinfo.com. [accessed online: http://www.siboinfo.com/about-sibo.html] (11)Siebecker A. Small Intestine Bacterial Overgrowth: Clinical Strategies. Siboinfo.com. 2011. [recorded webinar: http://www.siboinfo.com/learning-more.html] (12)Shephred SJ, et al. Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management. J Am Diet Assoc.2006; 106: 1631-1639. (13)Gibson PR, et al. Evidence-Based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach. Journal of Gastroenterology and Hepatology. 2010; 25: 252–258. (14)DuPont AW. Postinfectious Irritable Bowel Syndrome. Clinical Infectious Diseases. 2008; 46(4): 594-599. (15)Ghoshal UC and Ranjan P. Post-infectious irritable bowel syndrome: The past, the present and the future. Journal of Gastroenterology and Hepatology. 2011; 26(Suppl. 3); 94–101.