Navigating the world of irritable bowel syndrome (IBS) can be damn confusing. For a long time, it seemed like there wasn’t much advice out there, and even today there are only a handful of people who really get how complicated each individual’s reaction to IBS is.
As someone who was diagnosed with IBS in 2007, I know what you’re going through and am here to partner with you to get your symptoms under control and get you feeling good again.
Researchers and doctors are now distinguishing between different subtypes of IBS, which is great because for those of us that have suffered with IBS, we know some of this traditional advice actually made things worse. By identifying your sub-type, we can clarify what strategies will improve your bowel movements.
How did your doctor come to the conclusion that you have IBS?
Currently, people are diagnosed using a number of diagnostic tools including, the ROME III criteria, which determines the presence of IBS and the subtype. NOTE: IBS IV criteria was released just recently, but not all MD’s may be using this yet.
There are four main types of IBS: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), IBS mixed type (IBS-M), and IBS un-subtyped (IBS-U).
The team and I have done loads of research and paired this with my clinical experience working with clients over the last 5+ years to improve bowels… and VOILA! This article.
The Sub-types of IBS and How They Affect Symptoms
Irritable Bowel Syndrome with Constipation (IBS-C)
IBS-C is characterized by constipation that can last days or months. If you’ve been diagnosed with IBS-C you may experience the following symptoms on a regular basis:
- Infrequent bowel movements
- Lumpy or hard stools (type #1 or #2 on the Bristol stool chart)
- Straining while trying to have a bowel movement
Irritable Bowel Syndrome with Diarrhea (IBS-D)
On the other hand, IBS-D is characterized by diarrhea or loose, watery stools. If you’ve been diagnosed with IBS-D you may experience these symptoms:
- Frequent bowel movements
- Loose or watery stools (type #5, #6, or #7 on the Bristol Stool chart)
Important Note: It is important to see a doctor if you are experiencing any of these symptoms and have not been diagnosed. There are numerous diseases or conditions with similar symptoms that should be ruled out with a comprehensive exam before moving forward with treatment, which includes changes to your diet.
Can People Switch Between Subtypes?
The short answer to this question is yes, they can.
Most people will have a predominant type that will be stable for a period of time. However, since IBS is a chronic condition, during certain points in your life you may switch between subtypes. For instance, anxiety, stress, and travelling can affect your gut and change stool patterns.
Research has found that it is common to switch between IBS-C and IBS-M. The ability to switch between subtypes stresses the importance of monitoring your IBS symptoms with a food and symptom journal so you can alter your plan depending on your symptoms.
How Can I Improve IBS?
There are many strategies that can help you improve the Irritable Bowel Syndrome. One very important dietary change to make is to follow the Low FODMAP diet.
The Low FODMAP diet is an elimination diet designed to be followed along with the assistance of a registered dietitian for 2 to 6 weeks. In my practice, clients may follow it for up to 12 weeks. Once you’ve completed the elimination phase and are ready to bring high FODMAP foods back into your diet, you can re-introduce them one at a time.
How Can I Improve my Sub-Type of IBS?
The first, most important thing to do when making changes to your diet, lifestyle and hopefully to improve symptoms is to keep a food and symptom journal. No matter what sub-type you have, this is an important step not to skip.
In the Guide to Improving Bowel Movements, I’ve included a sample template for a food and journal the team and I use with our clients. Sign up to receive a copy of this guide below.
As we discussed earlier, it is very important to remember that not all people with IBS will experience symptoms in the same way. So you need to keep this in mind when reading strategies, tips and advice online or receiving it from health professionals.
You and your body are unique. IBS is individualized to the person depending on a number of factors and causes. This is a big reason why we try and share so much quality advice here on the blog and why we HIGHLY RECOMMEND working with a dietitian (RD) that understands the complexities of IBS can help you find relief and get your life back to normal.
Considerations for IBS-C and IBS-D: Gut Stimulants and Fibre
There are two very important traditional recommendations that we need to look at and actually re-think. They are:
- Avoid gut stimulants like caffeine and alcohol
- Eat more fibre
The IBS symptoms you suffer from most often will help you predict how your body may react when you consume either gut stimulants or foods containing fibre.
These two things can affect gut transit time… so we need to understand how your body works and how these items work before we give a recommendation.
The two traditional recommendations DO NOT APPLY to everyone. They are too vague and actually can be more hurtful. You know your body best, so let’s dig in to understand what you should do next.
Gut Stimulants and Irritable Bowel Syndrome – Diarrhea (IBS-D)
If you suffer from IBS-D, this means your bowel is probably a little speedier than others bowels. Things move through very quickly at times. Perhaps you’ve even seen pieces of food and you’ve wondered… how is this possible?
Triggers can actually cause you body to dilute and flush them out.
So if you have increased “transit time”, meaning your bowel moves quickly, avoiding gut stimulants is going to probably be very beneficial fro you. By avoiding the gut stimulants, alcohol, caffeine and nicotine, you may see symptom-improvement.
So keep these out of your diet while you are working on improving symptoms of digestive distress.
Once you are symptom-free, you can try adding small amounts back in to learn your tolerance.
Gut Stimulants and Irritable Bowel Syndrome – Constipation (IBS-C)
For those with IBS-C, this is where it gets interesting. Because that traditional advice of “avoid gut stimulants” may not apply to you.
If you have constipation, than most likely your GI tract is slow moving, so gut stimulants logically seem like they should help things along, right?
The unfortunate answer to that question is no. It’s true; gut stimulants do stimulate your GI tract to move more quickly, however they also often cause inflammation in your colon, regardless of the type of IBS you have.
Too much inflammation can aggravate symptoms such as gas, bloating and abdominal distension, and can even slow things down further.
However, for many of my clients over the years, they often found that caffeine and alcohol, in small doses didn’t actually affect their symptoms.
So what do you do?
Well if you can avoid or limit these for a short-time, than great! Sticking to a plan to improve your digestive health with multiple strategies is best.
Then when you’re feeling better, you can add a little caffeine or alcohol back in.
However, if you really struggle without a cup of coffee or a glass of wine on Friday night, and you need to keep a small amount in your diet, it probably won’t affect your bowels.
Fibre and IBS: How Much is the Right Amount?
There are two main types of fibre; soluble and insoluble. We could chat for hours and hours on fibre, but in this article we will get straight the point.
Soluble fibre attracts water in your gut, forming a gel, slowing everything down.
Insoluble fibre is the ‘roughage’ in your diet that contributes to stool formation, and keeps everything moving along through your gut.
To learn more about fibre, please read the article “What’s the Fuss About Fibre?”
Before we talk about actual amounts of fibre, it’s important to note that you don’t want to cut fibre out completely. Fibre plays an important role in managing cholesterol and stabilizing blood sugar levels to promote steady energy throughout the day. However, reducing or increasing fibre may significantly affect symptoms.
To improve bowels both the type and amount of fibre matter.
Fibre and IBS-D
When experiencing symptoms of IBS-Diarrhea predominant, there are two things to keep in mind.
Soluble fibre is your friend!
Because soluble fibre forms a gel, it moves through the gut smoothly. There are loads of different sources of fibre, so choose what works in your diet.
Fluid is important for fibre. If you’re consuming the recommended 25-38 grams of fibre per day (depending on your age and sex), definitely make sure to have enough fluid. This is probably at least 2 litres, although everyone’s body requires a little more or a little less.
To learn more about fibre, and your specific recommended amount, please read the article “What’s the Fuss About Fibre?”
Fibre and IBS-C
Now again, with IBS-C, this traditional recommendation of “eat more fibre”, gets really interesting.
Yes, fibre is very beneficial for health and No, you shouldn’t cut it out completely. But if you are suffering from constipation, which is slow moving bowels, should you try and get the maximum recommended fibre amount per day.
I think not necessarily.
If you are consuming the recommended amount of fibre daily and you still suffer from constipation, you may decide to reduce the amount of fibre you are consuming to see if this helps.
Because fibre is not digestive well, it can actually slow the bowel down or even get stuck along the way.
Over the years, I’ve found that for some clients, reducing the amount of fibre they consume daily, HELPS IMPROVE constipation.
I highly recommend doing this along with the help of your doctor or dietitian, because suffering from constipation can be excruciating. You will benefit from expert guidance in doing so.
And remember to only cut fibre out a little at a time. Don’t jump from 25 grams per day to 5 grams per day!!! NOT A GOOD IDEA. Try reducing 3 to 5 grams at a time, for a couple days, and then monitor your body and bowels.
Be sure to consume foods containing soluble fibre, just as with IBS-D.
Final Thoughts on IBS-C vs. IBS-D
Sometimes the best thing in the morning is that steaming hot cup of coffee.
Sometimes the best thing on a Friday evening with friends is a glass of wine.
If you suffer from any sub-type of Irritable Bowel Syndrome (IBS), you know that that sometimes the best things in life can worsen symptoms.
So if you are experiencing symptoms, it’s best to stick to a plan, implement many strategies to improve your digestion and then add foods back in once you’re feeling better.
Work with an expert registered dietitian to really help you better understand your body and what works for you and get a solid plan to improve your health.
If you’re looking for support and more information to help you with the Low FODMAP diet, read more about the CLAIRITY Program. This is the best way to work with me in the program I offer to meet you where you are, provide you with credible, up-to-date advice and information to get you feeling better and get back to enjoying your life. I’d love to have you join us as a member.
Wishing you much love & wellness,
Dietitians of Canada; Food Sources of Soluble Fibre. http://www.dietitians.ca/getattachment/3bb6330f-0ab2-48fc-9d24-1303ad70003d/Factsheet-Food-Sources-of-Soluble-Fibre.pdf.aspx
International Foundation for Functional Gastrointestinal Disorders; About IBS, Dietary Fibre. http://www.aboutibs.org/ibs-diet/dietary-fiber.html
Help for IBS; Is Coffee an IBS trigger? http://www.helpforibs.com/news/newsletter/IBSQuickie/coffee_ibs.html
Guilera M, Balboa A and Mearin F. 2005. Bowel Habit Subtypes and Temporal Patterns in Irritable Bowel Syndrome:
Systematic Review. From: http://www.ncbi.nlm.nih.gov/pubmed/15842596
Cremonini F and Lembo A. 2014. Irritable Bowel Syndrome Subtypes: Constipation, Diarrhea and Mixed Bowel Pattern. From: http://www.ncbi.nlm.nih.gov/pubmed/24329945
Engsbro AL, Simren M, and Bytzer P. 2012. Short-term Stability of Subtypes in Irritable Bowel Syndrome From: http://www.medscape.com/viewarticle/757183
Videlock EJ and Chang L. 2007. Current Approach to the Diagnosis of Irritable Bowel Syndrome. From: http://www.ncbi.nlm.nih.gov/pubmed/17950443