Irritable Bowel Syndrome (IBS) affects about 10% of Americans, but the true figure is likely higher because 75% of people with IBS go undiagnosed. Despite the large number of people affected by this disease, many do not seek treatment or attention due to feelings of frustration and embarrassment associated with IBS. In this post, we are going to focus on IBS-D, including its causes, as well as discuss various non-dietary interventions and intuitive eating techniques that can help alleviate symptoms. 

What is IBS-D? 

IBS, also known as Irritable Bowel Syndrome, is a common gastrointestinal disorder characterised by chronic and recurring abdominal pain and changes in bowel habits in the absence of other gastrointestinal conditions. Some people regard it as a "rule-out diagnosis," requiring the exclusion of other conditions such as colon cancer, celiac disease, Crohn's disease, and ulcerative colitis before a diagnosis of IBS can be made. IBS patients typically experience stomach pain at least once per week for at least three months. IBS is classified into four types based on bowel habits and stool consistency: 

• IBS-D, which is characterized by diarrhea or loose stools, is the most common type of IBS, affecting 40% of IBS patients. 

• IBS-C is linked to constipation. 

• IBS-M is associated with both diarrhea and constipation symptoms. 

• IBS-U, where bowel changes cannot be classified into one of the other three groups (unclassified) 

This blog post focuses primarily on IBS-D, but many of the interventions discussed are applicable to all types of IBS. It's important to note that this post is only for educational purposes and is not meant to replace professional medical advice. It is always advisable to consult a doctor about your symptoms. 

What are the causes of IBS-D? 

The exact cause of IBS-D is unknown, but research suggests that several factors, including: 

• Microbiota imbalances in the gut, which refer to an imbalance in the proportions of good gut bacteria.

• Genetics, stress/anxiety, infection/disease, diet, drug use, and other unknown factors may all play a role in these imbalances. 

• Problems with communication between the brain and the digestive system, known as the "gut-brain axis". This two-way communication system helps to regulate digestion, hunger, and bowel movements.

• Disruptions in this communication can result in IBS-D symptoms such as pain and diarrhoea. 

• Immune system dysfunction, which can cause inflammation or irritation in the gut, leading to IBS symptoms. 

• A family history of IBS-D, as well as early childhood stress or trauma, may increase the likelihood of developing the condition. 

• Many people with IBS-D can also have depression and/or anxiety, and there is a link between these conditions and gut-related issues. However, it is unclear which condition comes first. 

• Eating disorders/disordered eating patterns are also associated with gastrointestinal complaints. It is unclear whether disordered eating causes GI problems or if GI problems cause disordered eating patterns. 

What are the symptoms of IBS-D? 

IBS-D symptoms vary from person to person, but common symptoms include lower abdominal pain and cramping, gas, bloating, diarrhoea/loose stools, and a strong desire to urinate. The nature of these symptoms can cause self-consciousness and have a negative impact on a person's quality of life. People with IBS-D may feel anxious about participating in activities where access to a bathroom is limited, and they may have to cancel plans, miss work or school, avoid long trips, and so on. 

Intuitive eating for IBS-D 

Given the variety of causes of IBS-D, there are numerous management options. Elimination diets, specifically the FODMAPS diet, have been studied specifically for treating IBS-D and can be useful in identifying food sensitivities. However, it's important to remember that elimination diets aren't meant to be followed long-term, but rather to reintroduce foods that you don't react to while avoiding or limiting those that do. 

One disadvantage of elimination diets is that they can sometimes lead to food obsession, fear of eating, and disordered eating. I've had clients tell me that following an elimination diet increased their stress and made their IBS-D symptoms worse. It's critical to find IBS-D management tools that don't add to the condition's stress. 

Intuitive eating is an alternative approach that can help support a healthy digestive system. Many intuitive eating concepts and principles align with promoting healthy digestion and balance. Here are some tips to aid in an intuitive eating approach: 

• Eating at 3-4 hour intervals throughout the day. I always tell my clients that eating regularly promotes regular digestion. 

• Trying to achieve balance by eating foods from all of the good food groups.

• Eating based on internal hunger and fullness cues (allowing yourself to reach extreme hunger or extreme fullness is bad for your GI system).

• Exercising in a way that makes your body feel good.

• Consuming foods that make you feel satisfied and satiated.

• Observing how your body reacts to different foods and limiting foods that make you feel physically and emotionally ill.

• Gentle nutrition, including gut-health-promoting foods like sauerkraut, miso, kefir, kombucha, yoghurt, and pickles, as well as prebiotics like asparagus, onions, leeks, apples, and oats. 

Non-dietary approaches for IBS-D 

It is common in our diet-focused society to immediately attribute digestive problems to food; however, other factors also play a role. People with IBS-D may benefit from a holistic approach to managing their symptoms, which includes non-dietary interventions. This is especially true if they have a history of disordered eating or are at risk of it. Here is a list of non-dietary approaches you can try for IBS-D and IBS in general: 

• Incorporate meditation, mindfulness practises, deep breathing, and restorative yoga into your daily routine. 

• Seeking help from a therapist or mental health professional.

• Taking medication as directed by a doctor. 

• Consider gut-mediated hypnotherapy, which has been shown to have similar long-term effects for IBS-D as the low FODMAP diet. 

• Speak with your doctor about taking a probiotic supplement to help manage gut microbiota imbalances. 

• Incorporating a soluble (psyllium) fibre supplement to bulk up stools and make them easier to pass 

• Prioritizing sleep and developing a nighttime routine to help you unwind before bed.

• Incorporating yoga poses that combine deep breathing with abdominal stretches to alleviate digestive discomfort.

• Using a stool to simulate a natural squatting position and help relax muscles for a complete bowel movement.