February 2, 2024

Navigating Dietary Management for IBS: A Functional Medicine Perspective

Written By

Medically Reviewed by

Updated On

September 18, 2024

Irritable bowel syndrome stands as a prevalent gastrointestinal disorder, affecting up to 16% of the United States population and significantly impacting individuals' quality of life. IBS challenges patients and healthcare providers to find effective management strategies. Amidst the various approaches to IBS treatment, dietary interventions emerge as a cornerstone, influencing symptom severity and overall well-being. In this context, a functional medicine perspective gains prominence by highlighting the importance of individualized care. Dietary management for IBS in functional medicine tailors nutritional interventions to address specific dietary triggers and considers the broader interplay of lifestyle and underlying health factors.

[signup]

Understanding IBS and Its Symptoms

Irritable bowel syndrome (IBS) is a functional motility and sensory disorder of the gastrointestinal (GI) tract, characterized by recurrent abdominal discomfort accompanied by a change in bowel habits. Common symptoms include abdominal pain, bloating, gas, and altered bowel habits, such as diarrhea, constipation, or a mix of both. IBS is classified into subtypes based on predominant bowel habits: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed).

Diagnosing IBS poses challenges, as no specific biomarkers or definitive tests can be relied upon for diagnosis. Unlike other GI disorders, such as inflammatory bowel disease (IBD), there are no detectable structural intestinal abnormalities or reliable biomarkers that can be used to diagnose IBS definitively. This leaves clinicians to rely upon patient-reported, non-specific symptoms to make the diagnosis. The Rome IV criteria, which include recurrent abdominal pain or discomfort for at least three days per month in the last three months, along with changes in stool frequency or form, are commonly used for diagnosis.

Patients with IBS often experience a significant impact on their quality of life due to chronic symptoms and the unpredictability of flare-ups. IBS patients have an increased prevalence of psychiatric disorders, especially depression and anxiety, and somatic symptom disorders. According to a study published in 2000, patients with IBS have a health-related quality of life that is significantly worse than the general population and patients with gastroesophageal reflux disease (GERD), diabetes mellitus, and end-stage renal disease.

The complexities of IBS diagnosis and management underscore the need for a comprehensive and holistic approach to identifying IBS triggers and managing symptoms.

Functional Medicine Testing in IBS

Identifying IBS triggers through elimination diets, stress management, and gut microbiome assessment can enhance treatment efficacy. Emerging research emphasizes the role of the gut-brain axis in IBS, highlighting the interconnectedness of the gut and nervous system. Functional medicine testing assists practitioners in identifying underlying causes of IBS so that individualized interventions can be implemented to manage IBS and improve patient well-being effectively.

Comprehensive Stool Analysis

Under normal conditions, the intestinal mucus barrier acts as a protective shield, confining microbes to the intestinal surface and promoting homeostatic immune responses. However, when the barrier is breached, it leads to inflammation, weakened intestinal tight junctions (i.e., intestinal permeability), and alterations to the composition of the gut microbiome. (6)

Dysbiosis, characterized by disruptions to microbial diversity and abundance, is common in IBS patients. Studies consistently find lower fecal levels of Lactobacillus and Bifidobacterium in fecal samples of IBS patients compared to those of healthy controls. Emerging evidence also suggests the involvement of mycobiome alterations in IBS patients, indicating that fungal dysbiosis may play a role in IBS pathogenesis. (6)

A comprehensive stool analysis, such as the GI-MAP + Zonulin by Diagnostic Solutions, can detect intestinal microbial imbalances and quantify the degree of intestinal permeability to help target specific probiotic, antimicrobial, and gut-healing therapies for patients with IBS.

SIBO Breath Test

Small intestinal bacterial overgrowth (SIBO) is an overgrowth of microorganisms in the intestines. A growing amount of evidence suggests SIBO as a possible underlying cause of IBS. Over 80% of IBS patients test positive for SIBO, and, more importantly, research demonstrates that eradication of SIBO results in 75% of IBS symptoms. Elevations of hydrogen (H2) and hydrogen sulfide (H2S) gases on the SIBO breath test are linked to IBS-D, whereas elevations in methane (CH4) gas are correlated to IBS-C.

Several SIBO breath tests are available on the market, varying in their administered substrate and testing duration. The trio-smart SIBO Breath Test, by Gemelli Biotech, is the only available test currently on the market that can directly measure all three gas types associated with SIBO.

Food Sensitivity Testing

Up to 65% of patients with IBS report their symptoms are related to specific foods; this is compared to an adverse food reaction prevalence rate of 20% in the general population. Several studies have been able to reproduce findings of symptomatic improvement in up to two-thirds of IBS patients, most notably those with IBS-D, with elimination diets lasting from 1-12 weeks. In these studies, milk, wheat, and eggs have been most commonly identified as trigger foods for IBS flares. While elimination-rechallenge diets are considered the gold standard for diagnosing food sensitivities, they can be difficult for patients to perform. Therefore, blood testing with panels that measure IgG and IgG4 antibodies, such as the 144 Food Panel: IgG/IgG4 by US BioTek, can be a helpful starting point for patients to identify potential food triggers and customize therapeutic elimination diets. (7)

[signup]

The Role of Diet in IBS Management

Per IBS treatment guidelines, dietary advice should be given to all patients with IBS as part of first-line management. Routine nutritional advice often includes:

Have regular meals and take time to eat
Avoid missing meals
Drink at least 8 cups of water daily
Restrict tea and coffee to 3 cups daily
Reduce intake of alcohol and carbonated drinks
Reduce intake of resistant starch
Limit daily intake of fresh fruit to three portions
Patients with diarrhea should avoid sorbitol and other artificial sweeteners
Adjust fiber intake as needed based on symptoms. Patients with IBS generally experience worsened symptoms with insoluble fiber (e.g., wheat bran) and better tolerate soluble fiber (e.g., oats).

For those who continue to experience IBS symptoms with first-line dietary advice, the progression to second-line dietary therapy, which includes therapeutic elimination diets to remove and identify individual triggers, is recommended. Specific foods that cause symptoms vary widely between patients. Identifying individual triggers through methods like food diaries, elimination diets, and food sensitivity tests empowers patients to make informed choices about their diet. Avoidance of food triggers can improve IBS symptoms. (39)

Common Dietary Approaches for IBS

Common therapeutic dietary strategies for IBS aim to modulate IBS symptoms by tailoring the intake of specific foods. By implementing various approaches, like the low-FODMAP diet or adjusting fiber consumption, these strategies seek to alleviate symptoms by minimizing the impact of osmotic, chemical, and mechanical factors, regulating neuroendocrine responses, and influencing the gut microbiome. Personalized dietary modifications are crucial in inducing positive digestive outcomes and improving the overall well-being of individuals with IBS. (36)

Low FODMAP Diet

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are short-chain carbohydrates that easily ferment and are poorly absorbed in the intestine. FODMAPs are commonly problematic for patients with IBS because they lead to increased intestinal gas production, distension, bowel water content, and intestinal transit.

The low FODMAP diet is a therapeutic elimination of high-FODMAP foods for 4-8 weeks. The elimination is followed by a FODMAP reintroduction and then the personalization of a long-term, sustainable diet based on individual tolerance. (36)

Randomized controlled trials that evaluate the short-term elimination of FODMAPs from the diets of people with IBS have demonstrated that up to 86% experience improvements in IBS-related symptoms, including abdominal pain, bloating, abnormal bowel habits, abdominal distension, and flatulence, following this diet.

Gluten-Free Diet

A small subset of patients that meet the criteria for IBS are confirmed to have celiac disease, which is an autoimmune disease of the small intestine triggered by exposure to gluten. Lifelong adherence to a strict, gluten-free diet (GFD) is the primary intervention for treating celiac disease.

However, accumulating evidence also suggests that there is another subset of IBS patients, in whom celiac disease has been ruled out, that have non-celiac gluten sensitivity (NCGS), which is characterized by intestinal and extraintestinal symptoms after exposure to gluten in the absence of wheat allergy or celiac disease. For example, in a study published in 2015, patients with IBS-D following a GFD experienced clinically significant symptom severity reductions after six weeks. Moreover, 72% of the patients continued long-term adherence to the GFD and remained in clinical remission at 18 months. While the mechanism behind symptomatic improvement with GFD is still under investigation, results like these suggest experimentation with the GFD may be beneficial for patients with IBS who haven't responded to first-line dietary interventions.

Low-Lactose Diet

Lactose is a sugar naturally present in milk and dairy products. Lactase, an enzyme produced in the small intestine, breaks lactose down into simpler sugars for absorption. Lactose intolerance occurs when the body produces insufficient lactase, leading to an inability to fully digest lactose and symptoms such as bloating, gas, and diarrhea after consuming dairy products. The global prevalence of lactose intolerance is approximately 70%. Given the similarities in clinical presentations between lactose intolerance and IBS and the high prevalence of both conditions, a lactose malabsorption breath test, such as the one offered by Commonwealth Diagnostics, should be performed in patients with IBS to determine if a lactose-free diet is appropriate. A low-lactose diet is recommended for lactose-intolerant people. Studies indicate that most people with lactose do not require a complete elimination of lactose and can tolerate up to 12-15 grams of lactose daily. (5)

Integrating Nutritional Interventions

Socioeconomic status, limitations in food choices, and diet-related anxiety are significant challenges for adherence to therapeutic elimination diets. Furthermore, nutritional deficiencies are an important concern that must be considered carefully, especially those following extensive, long-term eliminations. Patients following a GFD tend to consume less iron, fiber, and carbohydrates than those eating a gluten-containing diet. The low-FODMAP and lactose diets increase the risk of insufficient dietary intake of calcium. Furthermore, low-FODMAP and gluten-free diets have been shown to alter the gut microbiome, specifically reducing the concentration of beneficial bacteria, such as Bifidobacteria, while promoting the growth of opportunistic pathogens. (4, 30, 40)

In light of these findings, balancing nutritional interventions is essential. While elimination diets can be effective in managing conditions like IBS, it is crucial to integrate strategies to prevent potential negative consequences on overall health. Collaborating with a functional nutritionist or a registered dietitian becomes paramount in this context. These professionals can guide patients in learning specific dietary strategies, ensuring that nutritional needs are met despite restrictions. Additionally, they play a crucial role in addressing emotional factors related to elimination diets. These healthcare professionals provide expertise to mitigate the risks of dietary restriction, enhance nutritional status, and manage digestive symptoms.

The Impact of Lifestyle Factors

Lifestyle factors, including stress, sleep patterns, and physical activity, significantly influence IBS. Stress, often recognized as a trigger for IBS symptoms, can lead to heightened gut sensitivity and altered motility. Poor sleep negatively affects the gut-brain axis and increases visceral sensitivity. Sleep disturbances are common in patients with IBS, and poor sleep is correlated with gastrointestinal and somatic pain, worsened mood, and poorer overall quality of life. Physical activity, on the other hand, is associated with improved bowel function, microbiome diversity and abundance, and reduced intestinal inflammation.

Adopting strategies to address these lifestyle factors complements dietary management. Stress management techniques, such as mindfulness, yoga, or deep breathing exercises, can help mitigate the impact of stress on IBS symptoms. Establishing consistent and quality sleep patterns through sleep hygiene practices is essential for optimizing gut function and minimizing symptom flare-ups. Regular, moderate exercise, such as walking or low-impact exercises, can improve gastrointestinal motility and reduce stress levels.

A holistic approach to IBS management involves integrating these lifestyle strategies alongside dietary interventions. Patients can work with healthcare professionals, including psychologists, sleep specialists, and physical therapists, to develop a tailored plan that addresses the multifaceted nature of IBS. By comprehensively managing stress, sleep, and physical activity, individuals with IBS can enhance the effectiveness of dietary management, leading to better symptom control and an improved overall quality of life.

Patient Education and Self-Management

Educating patients about IBS is crucial for empowering them to actively participate in their healing journey. Providing information about the condition, its triggers, and potential management strategies fosters a sense of control and understanding. Tools like food diaries and symptom tracking enable patients to identify patterns and recognize specific triggers unique to their experiences. By systematically recording food intake and associated symptoms, individuals can gain insights into their personal triggers and make informed decisions about their diet. Symptom tracking enhances self-awareness to enable effective communication between patients and healthcare providers, facilitating a more personalized and effective treatment approach. Knowledgeable and engaged individuals are more likely to adhere to dietary and lifestyle recommendations. Creating a collaborative relationship between healthcare providers and patients encourages open communication, allowing for the continuous refinement of management strategies based on evolving symptoms and lifestyle factors.

[signup]

Dietary Management for IBS: Key Takeaways

Dietary management for irritable bowel syndrome recognizes the multifaceted nature of this condition. A comprehensive treatment strategy is essential – one that understands the intricate relationship between specific foods and symptom triggers, along with the impact of lifestyle factors. A holistic approach to IBS management encapsulates the core philosophy of addressing dietary nuances and considering the broader spectrum of lifestyle and underlying health factors. Individuals with IBS can embark on a journey toward better symptom control and improved overall quality of life with a treatment strategy that aligns with the principles of functional medicine.

Irritable bowel syndrome is a common gastrointestinal disorder, affecting up to 16% of the United States population and significantly impacting individuals' quality of life. Managing IBS can be challenging for both patients and healthcare providers. Among various approaches, dietary interventions are important as they can influence symptom severity and overall well-being. A functional medicine perspective emphasizes individualized care, tailoring nutritional interventions to address specific dietary triggers and considering lifestyle and underlying health factors.

[signup]

Understanding IBS and Its Symptoms

Diagnosing IBS can be challenging, as no specific biomarkers or definitive tests can be relied upon for diagnosis. Unlike other GI disorders, such as inflammatory bowel disease (IBD), there are no detectable structural intestinal abnormalities or reliable biomarkers that can be used to diagnose IBS definitively. This leaves clinicians to rely upon patient-reported, non-specific symptoms to make the diagnosis. The Rome IV criteria, which include recurrent abdominal pain or discomfort for at least three days per month in the last three months, along with changes in stool frequency or form, are commonly used for diagnosis.

The complexities of IBS diagnosis and management underscore the need for a comprehensive and holistic approach to identifying IBS triggers and managing symptoms.

Functional Medicine Testing in IBS

Identifying IBS triggers through elimination diets, stress management, and gut microbiome assessment can enhance management strategies. Emerging research emphasizes the role of the gut-brain axis in IBS, highlighting the interconnectedness of the gut and nervous system. Functional medicine testing assists practitioners in identifying underlying factors of IBS so that individualized interventions can be implemented to support patient well-being effectively.

Comprehensive Stool Analysis

Under normal conditions, the intestinal mucus barrier acts as a protective shield, confining microbes to the intestinal surface and promoting homeostatic immune responses. However, when the barrier is breached, it may lead to inflammation, weakened intestinal tight junctions (i.e., intestinal permeability), and alterations to the composition of the gut microbiome. (6)

SIBO Breath Test

Small intestinal bacterial overgrowth (SIBO) is an overgrowth of microorganisms in the intestines. A growing amount of evidence suggests SIBO as a possible underlying factor of IBS. Over 80% of IBS patients test positive for SIBO, and, more importantly, research demonstrates that addressing SIBO may result in improvements in IBS symptoms. Elevations of hydrogen (H2) and hydrogen sulfide (H2S) gases on the SIBO breath test are linked to IBS-D, whereas elevations in methane (CH4) gas are correlated to IBS-C.

Food Sensitivity Testing

Up to 65% of patients with IBS report their symptoms are related to specific foods; this is compared to an adverse food reaction prevalence rate of 20% in the general population. Several studies have been able to reproduce findings of symptomatic improvement in up to two-thirds of IBS patients, most notably those with IBS-D, with elimination diets lasting from 1-12 weeks. In these studies, milk, wheat, and eggs have been most commonly identified as trigger foods for IBS flares. While elimination-rechallenge diets are considered the gold standard for identifying food sensitivities, they can be difficult for patients to perform. Therefore, blood testing with panels that measure IgG and IgG4 antibodies, such as the 144 Food Panel: IgG/IgG4 by US BioTek, can be a helpful starting point for patients to identify potential food triggers and customize therapeutic elimination diets. (7)

[signup]

The Role of Diet in IBS Management

Per IBS management guidelines, dietary advice should be given to all patients with IBS as part of first-line management. Routine nutritional advice often includes:

Have regular meals and take time to eat
Avoid missing meals
Drink at least 8 cups of water daily
Restrict tea and coffee to 3 cups daily
Reduce intake of alcohol and carbonated drinks
Reduce intake of resistant starch
Limit daily intake of fresh fruit to three portions
Patients with diarrhea should avoid sorbitol and other artificial sweeteners
Adjust fiber intake as needed based on symptoms. Patients with IBS generally experience worsened symptoms with insoluble fiber (e.g., wheat bran) and better tolerate soluble fiber (e.g., oats).

For those who continue to experience IBS symptoms with first-line dietary advice, the progression to second-line dietary therapy, which includes therapeutic elimination diets to remove and identify individual triggers, may be considered. Specific foods that cause symptoms vary widely between patients. Identifying individual triggers through methods like food diaries, elimination diets, and food sensitivity tests empowers patients to make informed choices about their diet. Avoidance of food triggers may help manage IBS symptoms. (39)

Common Dietary Approaches for IBS

Common therapeutic dietary strategies for IBS aim to modulate IBS symptoms by tailoring the intake of specific foods. By implementing various approaches, like the low-FODMAP diet or adjusting fiber consumption, these strategies seek to support digestive health by minimizing the impact of osmotic, chemical, and mechanical factors, regulating neuroendocrine responses, and influencing the gut microbiome. Personalized dietary modifications are crucial in promoting positive digestive outcomes and improving the overall well-being of individuals with IBS. (36)

Low FODMAP Diet

Gluten-Free Diet

Low-Lactose Diet

Lactose is a sugar naturally present in milk and dairy products. Lactase, an enzyme produced in the small intestine, breaks lactose down into simpler sugars for absorption. Lactose intolerance occurs when the body produces insufficient lactase, leading to an inability to fully digest lactose and symptoms such as bloating, gas, and diarrhea after consuming dairy products. The global prevalence of lactose intolerance is approximately 70%. Given the similarities in clinical presentations between lactose intolerance and IBS and the high prevalence of both conditions, a lactose malabsorption breath test, such as the one offered by Commonwealth Diagnostics, should be performed in patients with IBS to determine if a lactose-free diet is appropriate. A low-lactose diet is recommended for lactose-intolerant people. Studies indicate that most people with lactose intolerance do not require a complete elimination of lactose and can tolerate up to 12-15 grams of lactose daily. (5)

Integrating Nutritional Interventions

The Impact of Lifestyle Factors

Patient Education and Self-Management

Educating patients about IBS is crucial for empowering them to actively participate in their health journey. Providing information about the condition, its triggers, and potential management strategies fosters a sense of control and understanding. Tools like food diaries and symptom tracking enable patients to identify patterns and recognize specific triggers unique to their experiences. By systematically recording food intake and associated symptoms, individuals can gain insights into their personal triggers and make informed decisions about their diet. Symptom tracking enhances self-awareness to enable effective communication between patients and healthcare providers, facilitating a more personalized and effective management approach. Knowledgeable and engaged individuals are more likely to adhere to dietary and lifestyle recommendations. Creating a collaborative relationship between healthcare providers and patients encourages open communication, allowing for the continuous refinement of management strategies based on evolving symptoms and lifestyle factors.

[signup]

Dietary Management for IBS: Key Takeaways

Dietary management for irritable bowel syndrome recognizes the multifaceted nature of this condition. A comprehensive management strategy is essential – one that understands the intricate relationship between specific foods and symptom triggers, along with the impact of lifestyle factors. A holistic approach to IBS management encapsulates the core philosophy of addressing dietary nuances and considering the broader spectrum of lifestyle and underlying health factors. Individuals with IBS can embark on a journey toward better symptom management and improved overall quality of life with a strategy that aligns with the principles of functional medicine.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

Learn more

No items found.

Lab Tests in This Article

GI-MAP + Zonulin by Diagnostic Solutions

Stool

The GI-MAP is a comprehensive stool test that utilizes qPCR technology to detect parasites, bacteria, fungi, and more, allowing practitioners to create personalized treatment protocols to address gut dysfunction. This test also includes an add-on for the leaky gut marker zonulin.

trio-smart SIBO Breath Test by Gemelli Biotech

Breath

The trio-smart breath test measures the levels of hydrogen, methane, and hydrogen sulfide in a patient’s breath to determine if any are elevated abnormally. It aids in the identification of small intestinal bacterial overgrowth (SIBO), intestinal methanogenic overgrowth (IMO), and excess hydrogen sulfide. This test comes with a GLUCOSE substrate.

144 Food Panel: IgG/IgG4 by US BioTek

Serum

The 144 Food Panel is a comprehensive food sensitivity test that assesses IgG and IgG4 antibody reactivity across a broad range of culturally-diverse foods. This is the serum version of the test. It is also available as a blood spot test.

144 Food Panel: IgG/IgG4 by US BioTek

Blood Spot

The 144 Food Panel is a comprehensive food sensitivity test that assesses IgG and IgG4 antibody reactivity across a broad range of culturally-diverse foods. This is the blood spot version of the test. It is also available as a serum test.

Anderson, S. (2022, June 6). How to talk to your patients about leaky gut: An overview. Rupa Health. https://www.rupahealth.com/post/what-is-leaky-gut
Andresen, V., Whorwell, P., Fortea, J., et al. (2014). An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries. United European Gastroenterology Journal, 3(1), 39–52. https://doi.org/10.1177/2050640614558344
Aziz, I., Trott, N., Briggs, R., et al. (2016). Efficacy of a Gluten-Free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype. Clinical Gastroenterology and Hepatology, 14(5), 696-703.e1. https://doi.org/10.1016/j.cgh.2015.12.031
Caio, G., Lungaro, L., Segata, N., et al. (2020). Effect of Gluten-Free Diet on Gut Microbiota Composition in Patients with Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients, 12(6), 1832. https://doi.org/10.3390/nu12061832
Cancarevic, I., Rehman, M., Iskander, B., et al. (2020). Is There a Correlation Between Irritable Bowel Syndrome and Lactose Intolerance? Cureus, 12(1). https://doi.org/10.7759/cureus.6710
Chong, P. P., Chin, V. K., Looi, C. Y., et al. (2019). The Microbiome and Irritable Bowel Syndrome – A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10(10). https://doi.org/10.3389/fmicb.2019.01136
Choung, R. S., & Talley, N. J. (2006). Food Allergy and Intolerance in IBS. Gastroenterology & Hepatology, 2(10), 756–760. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358086/
Cloyd, J. (2022, December 15). IBS-C: Diagnosis and Natural Treatments Options. Rupa Health. https://www.rupahealth.com/post/ibs-c-diagnosis-and-natural-treatments-options
Cloyd, J. (2023a, February 28). How To Test for Lactose Intolerance. Rupa Health. https://www.rupahealth.com/post/how-to-test-for-lactose-intolerance
Cloyd, J. (2023, March 30). An In-Depth Overview of the Three Types of SIBO: Hydrogen, Methane, Hydrogen Sulfide. Rupa Health. https://www.rupahealth.com/post/an-in-depth-overview-of-the-three-types-of-sibo-hydrogen-methane-hydrogen-sulfide
Cloyd, J. (2023, June 15). A Functional Medicine Lactose Intolerance Protocol: Specialty Testing, Elimination Diet, and Supplement Suggestions. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-lactose-intolerance-protocol-specialty-testing-elimination-diet-and-supplement-suggestions
Creedon, K. (2022, August 4). 6 Speciality Labs That Get To The Root Cause Of Insomnia. Www.rupahealth.com. https://www.rupahealth.com/post/6-speciality-labs-that-get-to-the-root-cause-of-insomnia
DeCesaris, L. (2022, June 6). What Is Gut Dysbiosis? 7 Signs To Watch For. Rupa Health. https://www.rupahealth.com/post/how-your-gut-bacteria-affects-your-overall-health
DeCesaris, L. (2023, December 1). Is Poor Sleep Quality Affecting Your Digestion? Rupa Health. https://www.rupahealth.com/post/is-poor-sleep-quality-affecting-your-digestion
DePorto, T. (2023, January 24). How to Become a Functional Nutritionist: One of The Fastest Growing Nutrition Career Fields. Rupa Health. https://www.rupahealth.com/post/how-to-become-a-functional-nutritionist-one-of-the-fastest-growing-career-fields
Gearry, R., Skidmore, P., O'Brien, L., et al. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and Experimental Gastroenterology, 9, 131. https://doi.org/10.2147/ceg.s86798
Gralnek, I. M., Hays, R. D., Kilbourne, A., et al. (2000). The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology, 119(3), 654–660. https://doi.org/10.1053/gast.2000.16484
Greenan, S. (2021, November 18). How To Do A Low FODMAP Elimination Diet. Rupa Health. https://www.rupahealth.com/post/what-are-fodmaps
Hausteiner-Wiehle, C. (2014). Irritable bowel syndrome: Relations with functional, mental, and somatoform disorders. World Journal of Gastroenterology, 20(20), 6024. https://doi.org/10.3748/wjg.v20.i20.6024
Irritable bowel syndrome in adults: diagnosis and management. (2008, February 23). NICE. https://www.nice.org.uk/Guidance/CG61
Johannesson, E. (2015). Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World Journal of Gastroenterology, 21(2), 600. https://doi.org/10.3748/wjg.v21.i2.600
Khakham, C. (2023, May 23). A Comprehensive Review of IBS-D: Differential Diagnosis, Specialty Testing, and Integrative Treatment Options. Rupa Health. https://www.rupahealth.com/post/a-comprehensive-review-of-ibs-d-differential-diagnosis-specialty-testing-and-integrative-treatment-options
Kopczyńska, M., Mokros, Ł., Pietras, T., et al. (2018). Quality of life and depression in patients with irritable bowel syndrome. Gastroenterology Review, 13(2), 102–108. https://doi.org/10.5114/pg.2018.75819
Kresge, K. (2022, October 31). IBS vs IBD: Know The Symptoms. Rupa Health. https://www.rupahealth.com/post/ibs-vs-ibd-know-the-symptoms
Kresge, K. (2022, December 22). Functional Gastrointestinal Disorders: Diagnosis and Treatment. Rupa Health. https://www.rupahealth.com/post/what-are-functional-gastrointestinal-disorders-diagnosis-and-treatment
Kunkel, D. C., Basseri, R. J., Makhani, M., et al. (2011). Methane on Breath Testing Is Associated with Constipation: A Systematic Review and Meta-analysis. Digestive Diseases and Sciences, 56(6), 1612–1618. https://doi.org/10.1007/s10620-011-1590-5
Lin, H. C. (2004). Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA, 292(7), 852. https://doi.org/10.1001/jama.292.7.852
Maholy, N. (2023, February 22). Improving Gut Health With Exercise. Rupa Health. https://www.rupahealth.com/post/improving-gut-health-with-exercise
Makharia, A., Catassi, C., & Makharia, G. (2015). The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma. Nutrients, 7(12), 10417–10426. https://doi.org/10.3390/nu7125541
Malone, J. C., & Daley, S. F. (2024). Elimination Diets. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK599543/
Matthews, R. (2022, September 21). You Could Be Gluten Sensitive And Not Know It. These Are The Signs. Rupa Health. https://www.rupahealth.com/post/non-celiac-gluten-sensitivity
Patel, A., Hasak, S., Cassell, B., et al. (2016). Effects of Disturbed Sleep on Gastrointestinal and Somatic Pain Symptoms in IBS. Alimentary Pharmacology & Therapeutics, 44(3), 246–258. https://doi.org/10.1111/apt.13677
Poslt Königová, M., Sebalo Vňuková, M., Řehořková, P., et al. (2023). The effectiveness of gluten-free dietary interventions: A systematic review. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1107022
Qin, H.-Y. (2014). Impact of psychological stress on irritable bowel syndrome. World Journal of Gastroenterology, 20(39), 14126. https://doi.org/10.3748/wjg.v20.i39.14126
Raskov, H., Burcharth, J., Pommergaard, H.-C., et al. (2016). Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes, 7(5), 365–383. https://doi.org/10.1080/19490976.2016.1218585
Rej, A., Aziz, I., Tornblom, H., et al. (2019). The role of diet in irritable bowel syndrome: implications for dietary advice. Journal of Internal Medicine, 286(5), 490–502. https://doi.org/10.1111/joim.12966
Rome IV Criteria. (2021, January 16). Rome Foundation. https://theromefoundation.org/rome-iv/rome-iv-criteria/
Teeter, L. A. (2023, March 16). Mind-Body Techniques for IBS Relief. Rupa Health. https://www.rupahealth.com/post/mind-body-techniques-for-ibs-relief
Understanding Irritable Bowel Syndrome with Diarrhea (also known as IBS-D). American Society for Gastrointestinal Endoscopy. https://www.asge.org/home/for-patients/patient-information/understanding-irritable-bowel-syndrome-with-diarrhea-also-known-as-ibs-d
Vandeputte, D., & Joossens, M. (2020). Effects of Low and High FODMAP Diets on Human Gastrointestinal Microbiota Composition in Adults with Intestinal Diseases: A Systematic Review. Microorganisms, 8(11), 1638. https://doi.org/10.3390/microorganisms8111638
Villanueva-Millan, M. J., Leite, G., Wang, J., et al. (2022). Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes. Official Journal of the American College of Gastroenterology | ACG, 117(12), 10.14309/ajg.0000000000001997. https://doi.org/10.14309/ajg.0000000000001997
Wang, L., Alammar, N., Singh, R., et al. (2020). Gut Microbial Dysbiosis in the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. Journal of the Academy of Nutrition and Dietetics, 120(4), 565–586. https://doi.org/10.1016/j.jand.2019.05.015
Weinberg, J. L. (2022, February 28). An Integrative Medicine Approach to Celiac Disease. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-celiac-disease