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
• 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.