How to Cure IBS Permanently
Is IBS curable? This might be the wrong question. Let me explain.
The “S” in “IBS” stands for “syndrome”. A lot of people think that “syndrome” is just another word for “disease”, but actually a syndrome is defined as a group of related symptoms with no specific (or single) cause.
IBS and other syndromes are often dismissed as “incurable” because, as there is no single cause, there is also no single treatment that resolves the problem for everyone.
But the notion of a single cure is overly simplistic for most of our modern chronic illnesses. I’ll go ahead and concede that there is no known “cure” for IBS, but that doesn’t mean that people can’t get better.
In my telehealth clinic, I’ve personally worked with many IBS patients who are able to heal their guts and get back to their normal lives with an individualized, root-cause focused, functional medicine approach.
Let’s dig into some of the best research-backed diet and lifestyle strategies, as well as supplements and pharmaceutical treatments, that may be able to help you heal from IBS.
How A Root-Cause Approach May Reverse IBS
The most important place to start when it comes to improving or potentially reversing irritable bowel syndrome (IBS) is to explore possible root causes.
IBS is different for everyone– a different combination of symptoms, different sensitivities and triggers, and different contributing factors and causes.
When conventional medicine sees that multiple possible causes may be behind a condition, they tend to throw up their hands and say “we don’t know what the cause is”.
It’s kind of like saying, “gosh, any of these 12 suspects may have committed this crime, I guess this means I can’t solve the case”. We may have to do a bit more detective work and dig a little deeper, but it’s worth it when it comes to your health.
Investigating an individual’s underlying causes through specialized testing can help us figure out how to treat those causes directly, and cut the problem off at the source.
Here are a few possible causes and factors that can contribute to IBS:
- Gut dysbiosis (an imbalance in the gut microbiome)
- SIBO (small intestinal bacterial overgrowth)
- Hormonal imbalances
- Dysmotility (an issue with the way your GI muscles move food through the digestive tract)
- Stress and/or history of trauma
- Past or current infections
- Food intolerances
- Leaky gut
- Yeast or fungal overgrowth
- Parasites
- Chronic or past antibiotic use
- Visceral hypersensitivity (hypersensitivity of the nerves in the gastrointestinal tract)
- Low vagal tone
In functional medicine we offer specialized tests that go deep into what’s going on with your gut, your hormones, and your body in general.
In addition to testing for underlying imbalances and problems when possible, identifying triggers and patterns can go a long way towards helping you and your clinician understand your specific case of IBS.
Common triggers include certain kinds of food (more on this below), alcohol, caffeine, and stress. Many women also find that IBS flare-ups coincide with their menstrual cycles. All of these clues are important – try to always listen to what your body is telling you!
Dietary Strategies
Diet is one of the most important components of IBS management and treatment. To support your digestive system and feel your best, the first step is to cut out or significantly cut back on across-the-board inflammatory foods like sugar and processed and fried foods.
Next, you’ll want to identify foods that trigger your symptoms and then remove them from your diet, at least while you work on healing your gut.
You can follow a general elimination diet framework here, or choose a different anti-inflammatory diet model like the Paleo diet, but the best option for many people with IBS is the low FODMAP diet.
The Low FODMAP Diet for IBS
Even conventional medicine recommends the low FODMAP diet, which has been shown in multiple studies to be effective for improving IBS symptom scores, abdominal pain, bloating, overall symptoms, and quality of life (1).
The low FODMAP diet eliminates a group of carbohydrates (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) that resist digestion and are fermented and consumed by gut bacteria.
Many high FODMAP foods are generally thought of as healthy, but for those who have certain gut issues, they can be problematic.
For those who have an overgrowth of bacteria in the small intestine (SIBO, one of the most common root causes of IBS), FODMAPs are essentially feeding the problem. And the gasses that are released as part of the fermentation process of FODMAPs can put excess pressure on the intestines, leading to symptoms like bloating, constipation, gas, and pain.
Here’s a basic overview of which foods to eat and avoid on a low FODMAP diet. I recommend keeping a list nearby to refer to as needed, and/or using the app from Monash University, a leading FODMAP research center, to help keep track of which foods are low or high in FODMAPs.
Foods to Avoid:
- Garlic and onions
- Some vegetables: Artichokes, cauliflower, mushrooms, peas, asparagus
- Some fruits: Watermelon, mango, pears, plums, apples, cherries, peaches
- Legumes: Beans, lentils
- Some nuts and seeds: Pistachios, cashews
- Dairy products: Cow’s milk and milk products, cheese, yogurt
- Some grains: Wheat, rye
- Sugar alcohols and sweeteners: Sorbitol, xylitol, erythritol
Foods to Enjoy:
- Protein: Fish, poultry, beef, eggs
- Some vegetables: Zucchini, cucumber, carrots, potatoes, green beans, bok choy, eggplant, green bell pepper, lettuce
- Some fruits: Pineapple, oranges, grapes, cantaloupe, kiwi, tomatoes
- Some nuts and seeds: Pumpkin seeds, walnuts
- Milk and dairy alternatives: Almond milk, lactose-free milk
- Some grains: Quinoa, oats, rice
You shouldn’t have to follow this diet forever (and actually it may not be advisable to). The best way to follow a low FODMAP diet is to treat it as a three-phase elimination diet. Here’s how it works:
Elimination phase: To begin, follow the low FODMAP diet as strictly as possible. Many clinicians will recommend only spending about 2-4 weeks in this phase, but I find that for people who have been experiencing symptoms for months or years, it’s often necessary to spend more time here while working on gut repair and healing. This may look like several weeks, months, or 1-2 years depending on your individual case. This is also why it’s a good idea to work with a functional medicine practitioner, who can help you determine what duration makes sense for you.
Reintroduction phase: In the reintroduction phase, you’ll start to introduce foods you’ve eliminated back into your diet one at a time and monitor how you feel. You’re looking out for foods that trigger your symptoms, and those that don’t. Some people suggest introducing whole food groups or groups of foods at once, but I think there is a much greater chance of success when you stick to one single food at a time, every 2-3 days.
Personalization phase: Now that you hopefully have a solid understanding of your triggers, you can start to fine-tune your unique long-term eating plan. The idea is to avoid the foods that seemed to cause or worsen symptoms, and enjoy the ones that your body tolerated (or felt great with!). Keep in mind that while you can choose to reintroduce dairy and/or gluten as part of this process, I would typically recommend continuing to avoid them. These are very common IBS triggers and can lead to inflammation and GI distress for many people.
Other Dietary Tips + Tricks
There are a number of other dietary changes and strategies you can use to help improve IBS symptoms and restore your gut health.
Lifestyle Strategies
There are a number of lifestyle changes that can help to improve not only the symptoms of irritable bowel syndrome but the underlying issues that are affecting your gut health.
Exercise (But Not Too Much)
Exercise has been shown to reduce symptoms of IBS. Physical activity can help to reduce inflammation, improve gut microbiome balance, stimulate your gut’s natural motility, increase blood flow to digestive organs, and support overall digestion. (3, 4)
Keep in mind that more intensity is not always better – working out too hard too often puts stress on your body, including your digestive system.
Find Your Stress Management Practice
Which brings me to the next strategy: managing stress. I know this is easier said than done, but it’s so important (stress has a massive impact on gut health and IBS) and there are all kinds of approachable practices and techniques that can help. (5, 6)
Meditation, breathwork, therapy, yoga, and tai chi are just a few approaches you can take. And you can also find what works for you. It might not be an organized practice but something like simply taking a few moments for yourself in nature after a long day. You can learn more about how to work with your gut-brain axis and how to restore your gut-feelings connection in my book, Gut Feelings.
Prioritize Sleep
The next fundamental piece is good quality sleep. This is something that often slips through the cracks even for those who are otherwise living a healthy lifestyle.
But good sleep helps to support gut microbiome balance and immune system function, regulate the release of cortisol and other hormones, reduce inflammation, and keep your gut lining strong and healthy. (7, 8) It’s well worth working a healthy sleep routine into your protocol to give your gut its best chance of healing.
Other lifestyle strategies and techniques that may help with IBS include acupuncture, cognitive behavioral therapy (CBT), gut-directed hypnotherapy, and biofeedback.
LISTEN: How FODMAP Intolerance & SIBO Hurt Our Mood & Gut Health + What To Do About It | Dr. Will Cole
Supplements And Natural Treatments
Here are some of my favorite supplements and natural treatments for IBS. Ideally, your supplement protocol should be tailored to your individual case, and a functional medicine practitioner can help you develop a customized plan.
Probiotics
Probiotic supplements help to correct gut dysbiosis (an imbalance between beneficial and harmful bacteria in the gut) and support a healthy, thriving microbiome, which is essential when it comes to restoring your health. Research has shown that probiotics can help with IBS symptoms. (9)
Diversity also matters when it comes to your gut bacteria, and multi-strain probiotics have been found to be even more effective than single strain varieties. The Probiotic from my supplement line contains four targeted strains of beneficial bacteria to support a healthy gut microbiome.
Elemental Diet
An elemental diet is a type of meal replacement formula that is made up exclusively of pre-digested nutrients. It’s intended for use during times when your gut needs to rest and repair.
By consuming an elemental diet formula instead of regular meals for a couple of days or up to a few weeks (under medical supervision), you’re giving your body a break from digestion and a chance to focus on healing
Elemental diets can help to reduce inflammation and improve symptoms of IBS. One study found that replacing meals with an elemental diet formula for two weeks led to symptom improvement and normalized SIBO breath tests in 85% of participants with IBS and SIBO. (10)
L-glutamine
L-glutamine is another great option when it comes to targeting the root cause of digestive dysfunction as opposed to just treating the symptoms. This amino acid has been shown to help restore the gut lining and improve intestinal permeability (leaky gut). (11)
L-glutamine is found in certain foods including bone broth, beef, and red cabbage, but for extra gut lining support I would suggest a supplement in powder form.
Slippery elm
Slippery elm is an herbal supplement that works as a demulcent, meaning that it forms a protective film over mucus membranes to reduce inflammation and irritation. This may help with the protection and healing of the mucosal gut lining. Slippery elm is also considered a prebiotic, and can help support a healthy gut microbiome. (12)
Slippery elm is best for those who have IBS-C (constipation), as it has been shown to act as a natural laxative. (13)
Digestive enzymes
Those with IBS may lack or produce lower levels of the digestive enzymes that our bodies require to break down the food we eat into smaller pieces. Without sufficient digestive enzymes, digestion slows down, becomes less efficient, and can lead to symptoms like bloating, gas, or cramping after eating.
Supplemental digestive enzymes can help make up the difference, especially while you’re working on healing your gut. They’re also helpful to have on hand in case you happen to eat something that your body has a harder time with (such as dairy).
Other options
Other supplements and herbs that may help with IBS and its root causes include:
Pharmaceutical Interventions
Pharmaceutical interventions and medications for IBS are focused on symptom relief (as opposed to targeting the root cause of symptoms). However, they can be helpful especially in the short term, in conjunction with a more holistic, longer term strategy.
Prescription or over-the-counter medications that may be recommended include:
READ NEXT: What Stomach Growling (Borborygmi) Means + When To See A Doctor
Get Help From A Functional Medicine Expert
Working with a functional medicine expert can help you put all of the pieces of your IBS puzzle together so that you can heal your gut without overwhelm, and feel like yourself again.
As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.
The three subtypes of IBS are IBS-Constipation (or IBS-C), IBS-Diarrhea (or IBS-D), and IBS-Mixed (or IBS-M, for those who alternate between constipation and diarrhea).
Newer treatment options for IBS include fecal microbiota transplantation (FMT) as well as a number of different medication and supplement options.
Start Your Health Journey Today
FUNCTIONAL MEDICINE CONSULTATIONS FOR PEOPLE AROUND THE WORLD
- Marsh, A., Eslick, E. M., & Eslick, G. D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55, 897-906.
- Paukkonen, I., Törrönen, E. N., Lok, J., Schwab, U., & El-Nezami, H. (2024). The impact of intermittent fasting on gut microbiota: A systematic review of human studies. Frontiers in Nutrition, 11, 1342787.
- Johannesson, E., Simrén, M., Strid, H., Bajor, A., & Sadik, R. (2011). Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Official journal of the American College of Gastroenterology| ACG, 106(5), 915-922.
- Wegierska, A. E., Charitos, I. A., Topi, S., Potenza, M. A., Montagnani, M., & Santacroce, L. (2022). The connection between physical exercise and gut microbiota: implications for competitive sports athletes. Sports Medicine, 52(10), 2355-2369.
- Qin, H. Y., Cheng, C. W., Tang, X. D., & Bian, Z. X. (2014). Impact of psychological stress on irritable bowel syndrome. World journal of gastroenterology: WJG, 20(39), 14126.
- Leigh, S. J., Uhlig, F., Wilmes, L., Sanchez‐Diaz, P., Gheorghe, C. E., Goodson, M. S., ... & Clarke, G. (2023). The impact of acute and chronic stress on gastrointestinal physiology and function: a microbiota–gut–brain axis perspective. The Journal of Physiology, 601(20), 4491-4538.
- Han, M., Yuan, S., & Zhang, J. (2022). The interplay between sleep and gut microbiota. Brain research bulletin, 180, 131-146.
- Oligschlaeger, Y., Yadati, T., Houben, T., Condello Oliván, C. M., & Shiri-Sverdlov, R. (2019). Inflammatory bowel disease: a stressed “gut/feeling”. Cells, 8(7), 659.
- Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in irritable bowel syndrome: an up-to-date systematic review. Nutrients, 11(9), 2048.
- Pimentel, M., Constantino, T., Kong, Y., Bajwa, M., Rezaei, A., & Park, S. (2004). A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Digestive diseases and sciences, 49, 73-77.
- Perna, S., Alalwan, T. A., Alaali, Z., Alnashaba, T., Gasparri, C., Infantino, V., ... & Rondanelli, M. (2019). The role of glutamine in the complex interaction between gut microbiota and health: a narrative review. International journal of molecular sciences, 20(20), 5232.
- Peterson, C. T., Sharma, V., Uchitel, S., Denniston, K., Chopra, D., Mills, P. J., & Peterson, S. N. (2018). Prebiotic potential of herbal medicines used in digestive health and disease. The Journal of Alternative and Complementary Medicine, 24(7), 656-665.
- Hawrelak, J. A., & Myers, S. P. (2010). Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot study. The Journal of Alternative and Complementary Medicine, 16(10), 1065-1071.
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BY DR. WILL COLE
Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is also the host of the popular The Art of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, Gut Feelings, and The Inflammation Spectrum.
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