Issue link: http://viewer.e-digitaledition.com/i/915948
F O O D F O R T H O U G H T For people with IBS, learning to cope with the condition may mean rethinking how and what they eat. They may want to abandon their three-meals-a-day routine in favor of smaller, more frequent meals, which are less likely to cause cramping and diarrhea. Lactose intolerance—not being able to easily digest lactose—can exacerbate IBS symptoms for many individuals, so they should be extra careful to avoid dairy products. Most importantly, patients should keep a detailed record of the foods they eat so they can determine which ones trigger IBS symptoms. Common culprits include fat-rich foods and those that produce gas, like cabbage, broccoli and beans. Another class of foods that can be problematic for certain IBS patients are those containing fermentable sugars collectively known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). FODMAPs are found in a variety of natural and processed foods, from certain fruits and vegetables to candy and foods containing high-fructose corn syrup. A diet designed to help patients avoid FODMAPs can be beneficial for some, according to Dr. Grosman, but it is best to try it only with a doctor's recommendation and guidance from a nutritionist. "The FODMAPs elimination diet can be challenging for patients to follow on their own," Dr. Grosman says. "A nutritionist can help them do it safely by ensuring that they get the nutrients they need while avoiding FODMAPs. Rather than asking patients to follow the diet, I often use it as a starting place to identify trigger foods. I show them a list of high-FODMAP foods and ask if they notice any that seem to cause their symptoms. That list can be a useful tool for identifying foods they should avoid." on whether patients are dealing with constipation or diarrhea. After classifying IBS, doctors turn their attention to clearing up another common misconception, which is that the condition currently has no cure and there is nothing they can do to reduce the symptoms. In reality, doctors have quite a few treatments to choose from. THERAPIES FOR BODY AND MIND "Treatment starts with lifestyle changes, especially diet and exercise," Dr. Mohanty says. "Patients who are dealing with constipation, for example, may need to eat a high-fiber diet and drink more water throughout the day to ensure that they stay hydrated. Those whose main symptom is diarrhea, or who have problems with bloating and gas, may need to eat less fiber. Keeping a log of what they eat can help patients identify the foods that trigger symptoms, which they can then avoid. Physical activity is very important for patients, as it increases energy and reduces stress." Keeping stress under control is an important aspect of managing IBS—one that goes hand in hand with dietary changes and an exercise routine. Techniques such as yoga, meditation or other activities that patients find relaxing can be helpful. "Certain people may benefit from psychotherapy or cognitive behavioral therapy with a behavioral health professional to learn more effective ways to cope with stress," Dr. Notar-Francesco says. "If patients also have a psychiatric condition, like depression or anxiety, treating it with therapy or medication may improve IBS." Medications to treat the symptoms of IBS can complement lifestyle changes and are additional options for patients who do not experience enough relief from diet, exercise and stress reduction. Doctors may prescribe laxatives to patients with constipation and anti-diarrheal drugs to patients who struggle with frequent loose bowel movements. Antispasmodics like hyoscine or dicyclomine and antidepressants like fluoxetine and sertraline can reduce abdominal pain, even in individuals who do not have depression. The development of more medications to treat the underlying mechanisms of IBS has Dr. Notar-Francesco hopeful about the future. "Medications like linaclotide can help regulate how much fluid the body secretes into and removes from the intestines, and they are showing increasing promise in treating patients with severe IBS," he says. "In time, we may be able to use those drugs in patients with mild symptoms. For a long time, doctors had nothing to offer IBS patients but changes in diet and laxatives. Now, we have more drugs working on the mechanisms of the condition that are proving beneficial, and I think we will see additional ones in the future." Experts agree that pinpointing the origins of IBS is crucial to developing more effective ways to help patients. "Improving our understanding of the underlying causes of IBS will lead us to tools to control the symptoms more successfully and consistently," Dr. Grosman says. "In the meantime, people with IBS should not feel like they have to find a way to live with it. We have come a long way in how we manage this disease. We can usually find a way to improve patients' quality of life." F IN D A D O C T O R 718 . 49 9.C A R E ( 2 27 3 ) 21