Improve Patients’ Quality of Life With Lifestyle Interventions for IBS

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, abdominal pain, gastrointestinal (GI) distress and urgency, and mood disorders.^1-3 A recent meta-analysis found that patients with different subtypes of IBS (i.e., IBS with constipation, with diarrhea, or with mixed symptoms) had higher levels of depression and anxiety compared to healthy controls.⁴

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.⁵ IBS with mixed bowel habits and IBS with diarrhea have been the most commonly reported subtypes.⁵ 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.²

From a functional medicine perspective, a variety of treatments, including lifestyle modifications, 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. While IBS can seem like an intractable problem to many patients, modifiable lifestyle factors, from diet to stress management, may help to improve symptoms.^6,7

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

(Video Time: 2 minute) Dr. Tom Sult is a graduate of the UCLA School of Medicine and practices functional medicine at his clinic in New London, MN.

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. Principal among this research is the growing recognition of food intolerances and cognitive/emotional factors as important triggers for symptoms in these patients.^8,9 Using the IFM Elimination Diet may help patients identify food triggers. And both observational and intervention studies have indicated reduced IBS symptoms and improved quality of life after introduction of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet in patients with IBS.¹⁰ In January 2021, the American College of Gastroenterology released clinical guidelines for the management of IBS and recommended (among other treatments) a limited trial of a low-FODMAP diet in patients with IBS to improve global symptoms.¹

The use of probiotics in the diet to help improve IBS symptoms has also been studied, and while the exact mechanisms of probiotics related to IBS are not fully understood, some research suggests that probiotics may improve IBS symptoms through manipulation of the gut microbiota.^11,12 A 2022 meta-analysis of randomized controlled trials that compared probiotic and drug interventions for IBS treatment found that while additional large-scale trials are warranted, both probiotic and drug interventions improved IBS symptoms (RR=0.60; CI 0.51-0.92 versus RR=0.87; CI 0.81 - 0.92, respectively).¹² 

Interest in the role of gluten intolerance (and the possible benefit of a gluten-free diet) in IBS continues; however, only a limited number of studies with a small number of participants have evaluated the effectiveness of a gluten-free diet.¹³ Research studies indicate that IBS shares some similar gastrointestinal symptoms and gut microbiota profiles as celiac disease,¹⁴ and older studies have suggested an increased prevalence of celiac disease among patients with IBS symptomology compared to healthy controls.^15,16

Exercise & Other Lifestyle Modifications

Studies suggest that increasing levels of physical activities and reducing sedentary behavior may reduce IBS risk and may help improve IBS symptoms.^17,18 A 2019 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.¹⁹ A 2020 observational study investigated the relationship between GI symptoms and physical activity among patients with IBS and found that among 101 university students with IBS, increased walking activity (measured by wearing a pedometer for one week) was associated with reduced severity of GI symptoms compared to less activity.²⁰

New research suggests that cognitive behavioral therapy (CBT) may also be an effective treatment for sustained GI symptom improvement compared with education alone.²¹ 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.⁸ Acknowledging that levels of evidence vary, other common psychosocial-mind-body therapies for reducing IBS symptoms include diaphragmatic breathing, heart-rate variability biofeedback (through digital applications), progressive muscle relaxation, and mindfulness-based stress reduction.^22,23

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 at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP) course.