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While irritable bowel syndrome (IBS) is not life-threatening for most patients, it has enormous influence on quality of life and mental health, with symptoms like severe fatigue, gastrointestinal (GI) distress and urgency, difficulty being outside of the house, and regular flareups.^1-5 A recent study revealed that IBS patients have not only lower quality of life but also higher depression scores than their non-IBS counterparts.^1,4 Symptom severity in relation to bowel function or abdominal pain has the most significant impact on reducing the quality of life in IBS patients.²

Just how prevalent is IBS? Globally, the estimated prevalence rates are 9.2% and 3.8% based on ROME III and IV diagnostic criteria, respectively.⁴ The available data from regional studies have shown that the prevalence of IBS is increasing across many countries: 10-15% in Europe and North America; 6.6-22.1% across countries in the Asia Pacific region.⁴ In the United States, estimated prevalence is between 7% and 16%, with annual direct costs believed to be more than one billion dollars.⁶ IBS is prevalent across ages (from 15 to 65 years), especially among adults (18 years and above), with the first presentation of patients to a healthcare professional usually in the adult (30 to 50 years) age group.⁴

From a functional medicine perspective, a variety of treatments, including lifestyle modification, may improve the quality of life and clinical outcomes for these patients. The functional medicine model for health care involves understanding the underlying factors that contribute to dysfunction and applying treatments that address those causes. In other words, functional medicine is concerned less with the disease itself and more about the dynamic processes that resulted in the person’s dysfunction.⁷ While IBS can seem like an intractable problem to many patients, modifiable lifestyle factors can influence it, including eating habits, diet, exercise, and other factors such as stress management.⁸

In the video below, IFM educator Tom Sult, MD, describes his functional medicine approach to IBS, which focuses on diet and lifestyle.

Diet & IBS

The last 20 years has seen an increasing amount of research on the role of modifiable lifestyle factors in improving symptoms for patients with IBS.⁹ Principal among this research is the growing recognition of food and cognitive/emotional factors as important triggers for symptoms in these patients.⁹ Studies suggest that diets high in fat, carbohydrates, milk products, spicy food, alcohol, and coffee may exacerbate IBS symptoms.¹⁰ In fact, surveys on perceived food intolerance show that 64-89% of IBS patients report their symptoms to be triggered by meals or specific foods. Using the IFM Elimination Diet may help patients identify food triggers. Both retrospective and prospective open studies have shown reduced IBS symptoms after introduction of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet in patients with suspected or proven fructose or lactose malabsorption.¹⁰

Recent meta-analyses provide high-grade evidence for improved general symptom scores among patients with irritable bowel syndrome who have maintained a low-FODMAP diet compared to those on a traditional IBS diet.^11-13 In January 2021, the American College of Gastroenterology released clinical guidelines for the management of IBS and recommend (among other treatments) a limited trial of a low-FODMAP diet in patients with IBS to improve global symptoms.³

The use of probiotics in the diet to help improve IBS symptoms has also been studied, and while the exact mechanisms of probiotics in the body are not fully understood, some research suggests that probiotics may improve IBS symptoms through manipulation of the gut microbiota.¹⁴ A 2019 systematic review of the literature over the last five years suggests that multi-strain probiotics supplemented over a period of time have the potential to improve IBS symptoms.¹⁴ Interest in the role of gluten intolerance (and the possible benefit of a gluten-free diet) in IBS has been increasing in recent years;¹⁰ however, only a limited number of studies with a small number of participants have evaluated the effectiveness of a gluten-free diet.⁹ One systematic meta-analysis found a pooled prevalence for celiac disease up to 4% among IBS patients.¹⁵

Exercise & Other Lifestyle Modifications

A study in China found that patients who were physically inactive were about 3.6 times more likely to suffer from IBS than those who were physically active.¹⁶ This accords with an earlier study, published in 2011, that found that increased physical activity improves gastrointestinal symptoms in IBS and suggests that exercise should be used as a primary treatment modality.¹⁷ In 2018, a study of 683 patients with IBS from 14 randomized controlled trials suggested that exercise interventions like yoga, walking/aerobic activity, tai ji, mountaineering, and Baduanjin quigong activity had significant benefits for patients with IBS.¹⁸

New research suggests that cognitive behavioral therapy (CBT) may also be an effective treatment for sustained gastrointestinal symptom improvement compared with education alone.¹⁹ CBT has been found to be the most effective behavioral therapy in this brain-to-gut domain, with techniques that enhance the patient’s ability to downregulate pain pathways and reduce avoidance/isolation associated with symptoms.⁹ Acknowledging that levels of evidence vary, common techniques include diaphragmatic breathing, heart-rate variability biofeedback (through digital applications), progressive muscle relaxation, guided imagery, and mindfulness-based stress reduction.^20,21,3

Gut dysfunction compromises a patient’s health and diminishes vitality, but lifestyle modifications are showing promise in the treatment of chronic gastrointestinal diseases like IBS. Functional medicine takes a whole systems approach to evaluating and treating not only local gastrointestinal disease but the many systemic diseases that are linked to GI dysfunction. Learn more about IBS and the functional medicine model:

IBS development: primary causes and triggers

Stress, bile acids, and IBS symptoms

The gut-brain connection in IBS

References

1. Kopczynska M, Mokros L, Pietras T, Malecka-Panas E. Quality of life and depression in patients with irritable bowel syndrome. Prz Gastroenterol. 2018;13(2):102-108. doi:5114/pg.2018.75819
2. Corsetti M, Tack J, Attara G, Sewell M. IBS Global Impact Report 2018: Uncovering the True Burden of Irritable Bowel Syndrome (IBS) on People’s Lives. Canadian Society of Intestinal Research; 2018. Accessed July 27, 2022. https://www.badgut.org/wp-content/uploads/IBS-Global-Impact-Report.pdf
3. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:14309/ajg.0000000000001036
4. Shorey S, Demutska A, Chan V, Siah KTH. Adults living with irritable bowel syndrome (IBS): a qualitative systematic review. J Psychom Res. 2021;140:110289. doi:1016/j.jpsychores.2020.110289
5. Törnblom H, Emmanuel A, Goosey R, Wiseman G, Baker S. Understanding symptom burden and attitudes in patients with irritable bowel syndrome with diarrhea: results from a patient survey. Gastroenterology. 2017;152(5):S745-S746. doi:1016/S0016-5085(17)32588-X
6. Camilleri M. Diagnosis and treatment of irritable bowel syndrome: a review [published correction appears in JAMA. 2021;325(15):1568]. JAMA. 2021;325(9):865-877. doi:1001/jama.2020.22532
7. Bland J. Defining function in the functional medicine model. Integr Med. 2017;16(1):22-25.
8. Miwa H. Life style in persons with functional gastrointestinal disorders—large-scale internet survey of lifestyle in Japan. Neurogastroenterol Motil. 2012;24(5):464-471,e217. doi:1111/j.1365-2982.2011.01872.x
9. Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. Gastroenterology. 2020;160(1):47-62. doi:1053/j.gastro.2020.06.099
10.  Rajilic-Stojanovic M, Jonkers DM, Salonen A, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol. 2015;110(2):278-287. doi:1038/ajg.2014.427
11.  Varjú P, Farkas N, Hegyi P, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: a meta-analysis of clinical studies. PLoS One. 2017;12(8):e0182942. doi:1371/journal.pone.0182942
12.  Dionne J, Ford AC, Yuan Y, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018;113(9):1290-1300. doi:1038/s41395-018-0195-4
13.  Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2022;71(6):1117-1126. doi:1136/gutjnl-2021-325214
14.  Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA. Probiotics in irritable bowel syndrome: an up-to-date systematic review. Nutrients. 2019;11(9):E2048. doi:3390/nu11092048
15.  Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169(7):651-658. doi:1001/archinternmed.2009.22
16.  Guo YB, Zhuang KM, Kuang L, Zhan Q, Wang XF, Liu SD. Association between diet and lifestyle habits and irritable bowel syndrome: a case-control study. Gut Liver. 2015;9(5):649-656. doi:5009/gnl13437
17.  Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106(5):915-922. doi:1038/ajg.2010.480
18.  Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: a systematic review of randomized controlled trials. Neurogastroenterol Motil. 2019;31(2):e13461. doi:1111/nmo.13461
19.  Lackner JM, Jaccard J, Keefer L, et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology. 2018;155(1):47-57. doi:1053/j.gastro.2018.03.063
20.  Asare F, Störsrud S, Simrén M. Meditation over medication for irritable bowel syndrome? On exercise and alternative treatments for irritable bowel syndrome. Curr Gastroenterol Rep. 2012;14(4):283-289. doi:1007/s11894-012-0268-2
21.  Berrill JW, Sadlier M, Hood K, Green JT. Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels. J Crohns Colitis. 2014;8(9):945-955. doi:1016/j.crohns.2014.01.018