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  • Understanding IBS
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Diet:

This is an educational overview. It is not a substitute for medical advice. Please consult a healthcare professional for personalized diagnosis and treatment.

Understanding the low FODMAP approach

What does FODMAP mean?

FODMAPs are types of carbohydrates that can trigger symptoms in people with IBS. The term stands for:

  • Fermentable: These carbohydrates are broken down (fermented) by bacteria in your gut, producing gas.
  • Oligosaccharides:  Found in foods like onions, garlic, and wheat. These include fructans and galacto-oligosaccharides (GOS), which are hard to digest.
  • Disaccharides:  The most common is lactose, found in milk and dairy products.
  • Monosaccharides:  Mainly fructose, found in fruits like apples, pears, and honey.
  • And
  • Polyols:  Sugar alcohols such as sorbitol and mannitol, found in sugar-free gums and some fruits like watermelon or stone fruits.

                     (Staudacher et al., 2011; Chumpitazi et al., 2015)

When FODMAPs aren’t well absorbed in the small intestine, they travel to the colon, where they draw in water and are fermented by bacteria, producing gas. This can lead to:

  • Bloating
  • Gas
  • Abdominal pain
  • Changes in bowel movements

(Halmos et al., 2014; Staudacher et al., 2011).


Think of FODMAP elimination like a science experiment where YOU are the most important lab!

Why avoid FODMAPs in IBS-C?

The Low FODMAP diet was originally designed for IBS with diarrhea (IBS-D), but it has also been shown to benefit many people with IBS-C, especially those who experience:

  • Bloating
  • Abdominal discomfort
  • Irregular bowel movements

FODMAP-Friendly Foods for IBS-C:

These are lower in fermentable carbs and may be better tolerated:

  • Oats
  • Chia seeds
  • Zucchini
  • Unripe bananas
  • Lactose-free dairy or plant-based alternatives

High-FODMAP Foods to Limit or Avoid:

  • Garlic and onion
  • Apples, pears, watermelon
  • Wheat (especially in large amounts)
  • Regular milk and yogurt with lactose
  • Sorbitol, mannitol (in sugar-free products)

The 3 Phases of the FODMAP Diet:

  1. Elimination: Avoid all high-FODMAP foods (2–6 weeks).
  2. Reintroduction: Slowly add back one group at a time to identify personal triggers.
  3. Personalization: Create a long-term diet tailored to your needs.

This should ideally be done with the help of a dietitian or nutritionist, to ensure balanced nutrition.

Fiber: the right kind matters

Soluble Fiber (Recommended)

This type of fiber dissolves in water to form a gel, which softens stool and makes it easier to pass—especially helpful in IBS-C.

Examples:

  • Psyllium (found in products like Metamucil): a gentle, non-fermentable fiber that helps relieve constipation without causing gas. 
  • Chia seeds, flaxseed, oats, kiwi

Note: This is a general guide—always consult your doctor before starting fiber supplements.

Insoluble Fiber (Caution)

This type doesn't dissolve in water and can worsen bloating and discomfort in some IBS-C patients.

Examples: raw vegetables, wheat bran, whole grains.

Pro Tip:

  • Start with small amounts of fiber.
  • Increase slowly, and drink plenty of water.
  • Aim for 20–30 g of fiber/day, under supervision if possible.

                                                                            (Moayyedi et al., 2014).

Medications: targeted relief

Laxatives (Short-term use)

Secretagogues (IBS-C-specific treatments)

Secretagogues (IBS-C-specific treatments)

Medications in IBS-C are chosen based on the dominant symptoms—usually constipation, bloating, and discomfort.


Laxatives (Short-term use)

Polyethylene glycol (PEG):  An osmotic laxative that retains water in stool; well-tolerated (Ford et al., 2018).
Lactulose:  A fermentable sugar that draws water into the colon but may produce gas due to 

Medications in IBS-C are chosen based on the dominant symptoms—usually constipation, bloating, and discomfort.


Laxatives (Short-term use)

Polyethylene glycol (PEG):  An osmotic laxative that retains water in stool; well-tolerated (Ford et al., 2018).
Lactulose:  A fermentable sugar that draws water into the colon but may produce gas due to bacterial fermentation (Ford et al., 2018).

These are not ideal for long-term use due to risks of dependency and side effects.

Secretagogues (IBS-C-specific treatments)

Secretagogues (IBS-C-specific treatments)

Secretagogues (IBS-C-specific treatments)

These medications increase intestinal fluid secretion, easing stool passage and relieving abdominal symptoms.

  • Linaclotide:  A guanylate cyclase-C agonist that improves stool frequency, bloating, and discomfort (Chey et al., 2012).
  • Lubiprostone:  Activates chloride channels to promote water secretion and soften stool (Johanson et al., 2008).

These medications increase intestinal fluid secretion, easing stool passage and relieving abdominal symptoms.

  • Linaclotide:  A guanylate cyclase-C agonist that improves stool frequency, bloating, and discomfort (Chey et al., 2012).
  • Lubiprostone:  Activates chloride channels to promote water secretion and soften stool (Johanson et al., 2008).

Evidence-backed benefits:

  • Improved stool consistency and frequency
  • Reduced abdominal pain
  • Better quality of life
    (Zhou et al., 2019; Black et al., 2019)

Antispasmodics (Optional in some cases)

Secretagogues (IBS-C-specific treatments)

Antispasmodics (Optional in some cases)

These drugs help relax gut muscles and may reduce cramping or pain, especially in patients with mixed symptoms.

Although more commonly used in IBS-D, they may be considered in IBS-C with significant pain.

Examples:

  • Hyoscine
  • Mebeverine
  • Peppermint oil capsules

Peppermint oil has shown benefits for IBS symptoms including pain and bloating (Khanna et al., 2014).

Our gut is unique - what works for others might not work for you, and that's okay!"

Lifestyle Modifications

Sleep Optimization

Quality sleep plays a big role in gut health and IBS symptom control. Poor sleep is linked to worse constipation, more pain, and higher stress levels in people with IBS-C.


Tips for Better Sleep in IBS-C:

  • Go to bed and wake up at the same time each day
  • Avoid caffeine late in the day
  • Limit screen time 1 hour before bed
  • Try a calming nighttime routine: warm shower, herbal tea, or reading
     

Studies show that poor sleep quality worsens GI symptoms and reduces treatment response in IBS patients.
                                                                                                                        (Rotem et al., 2019)

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychological therapy that helps people identify and change negative thoughts and behaviors.

Though it's commonly used for anxiety and depression, it has shown proven benefits in IBS-C (Ford et al., 2019; Lacy et al., 2020).

How does CBT help in IBS-C?

  • Reduces symptom severity:  Can lessen the impact of bloating, constipation, and abdominal pain.
  • Manages emotional stress:  Helps you respond more calmly to stressors, which may lower the chance of symptom flare-ups.
  • Improves daily functioning and mood: By reducing the mental burden of chronic symptoms, CBT can enhance overall well-being.


Evidence shows CBT can significantly reduce IBS symptom scores and improve quality of life (Ford et al., 2019).

Mindfulness-Based Stress Reduction (MBSR)

MBSR is a structured program that teaches present-moment awareness without judgment through:

  • Breathing exercises
  • Body scan meditations
  • Gentle movement
  • Mindful awareness of emotions and sensations

How does MBSR help in IBS-C?

  • Lowers stress response:  Reduces activation of the gut-brain axis, which may help calm gastrointestinal symptoms.
  • Improves coping:  You learn to accept discomfort without reacting with fear or tension, which can lessen symptom intensity.
  • Supports long-term emotional health:  Helps with anxiety, frustration, and chronic symptom management (Lacy et al., 2020; Garland et al., 2012).


Mindfulness training is associated with reductions in IBS symptom severity and psychological distress (Lacy et al., 2020).

Exercise & Movement

Regular, moderate physical activity improves bowel motility, reduces stress, and boosts quality of life in IBS-C patients.

Exercise is recommended as first-line supportive therapy in IBS-C (Lacy et al., 2021).


General Recommendations:


Frequency: 3–5 days per week

Duration: 20–30 minutes per session


Type: Moderate, low-impact activities

Recomended exercises

Walking

Dancing or Aerobic Workouts

Walking

  • Gentle, easy to start
  • Helps stimulate the bowels

Try 20–30 minutes daily

Yoga

Dancing or Aerobic Workouts

Walking

  • Combines movement and relaxation
  • Poses like wind-relieving pose (Pavanamuktasana) and cat-cow stretch improve gut movement

Also reduces stress and anxiety

Cycling

Dancing or Aerobic Workouts

Dancing or Aerobic Workouts

  • Low-impact cardiovascular option
  • Improves digestion and mood
  • Try 30 minutes of stationary or outdoor biking, 3–5 times/week

Dancing or Aerobic Workouts

Dancing or Aerobic Workouts

Dancing or Aerobic Workouts

  • Fun and uplifting
  • Zumba, low-impact aerobics, or dancing at home can help stimulate gut function

Tips to Keep in Mind:

  • Avoid vigorous activity immediately after eating
  • Stay well-hydrated before, during, and after exercise
  • If a movement makes symptoms worse, modify or switch to a gentler option

A combination of physical activity and mind-body techniques improves IBS-C outcomes when added to dietary and pharmacological approaches 

                                                                                                                                                                                                                                                                              (Lacy et al., 2020; Black et al., 2019).

REFERENCES

  • Bertin, L., Zanconato, M., Crepaldi, M., Marasco, G., Cremon, C., Barbara, G., Barberio, B., Zingone, F., & Savarino, E. V. (2024). The Role of the FODMAP Diet in IBS. Nutrients, 16(3), 370. https://doi.org/10.3390/nu16030370 
  • Black, C. J., Yuan, Y., Selinger, C. P., Camilleri, M., Quigley, E. M. M., Moayyedi, P., & Ford, A. C. (2019). Efficacy of soluble fibre, antispasmodic drugs, and gut–brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. The Lancet. Gastroenterology & Hepatology, 5(2), 117-131. https://doi.org/10.1016/s2468-1253(19)30324-3 
  • Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2020). ACG Clinical Guideline: Management of Irritable Bowel Syndrome. The American Journal Of Gastroenterology, 116(1), 17-44. https://doi.org/10.14309/ajg.0000000000001036 
  • Zhou, S., Liu, X., Wang, X., Xi, F., Luo, X., Yao, L., & Tang, H. (2019). Pharmacological and non-pharmacological treatments for irritable bowel syndrome. Medicine, 98(30), e16446. https://doi.org/10.1097/md.0000000000016446 

The information provided on this site is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding your symptoms or any medical concerns.


Living with IBS is an independent educational project and does not provide personalized medical services.


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