Irritable Bowel Syndrome: How an RDN Can Help

If you have IBS, getting your diagnosis might have been a journey. 

You may have been through imaging, interviewing, physical examinations, blood tests, stool tests, and breath tests. This process is essential for your doctor because numerous conditions can have IBS-like symptoms, such as (but certainly not limited to): 

• Immune dysfunction: Inflammatory bowel disease, food allergies, Celiac disease
• Dysbiosis and infection: Gastrointestinal infections, Small intestinal bacterial overgrowth (SIBO), Auto-brewery Syndrome
• Cancers: colon cancer, side effects of cancer treatment
• Nutrition problems: Vitamin and mineral deficiencies, an unbalanced diet or a very low fiber diet, Relative Energy Deficiency Syndrome (RED-S)
• Digestive deficits: hypochlorhydria, exocrine pancreatic insufficiency (EPI), Sucrase-isomaltase deficiency, lactose intolerance
• Anatomical or surgical factors: redundant colon, bariatric surgery
• Motility problems: Gastroesophageal Reflux Disease (GERD), Gastroparesis 
• Other: Thyroid disorders such as hypothyroidism, disordered eating or eating disorders, Postural Orthostatic Tachycardia Syndrome (POTS), Bile acid malabsorption
• Medication side effects

When other causes are ruled out, but your painful problematic pooping pattern persists, your gastroenterologist may diagnose you with IBS based on the Rome IV criteria. According to the Rome Foundation, IBS can be: 

• IBS-Diarrhea prominent
• IBS-Constipation prominent
• IBS-Mixed (diarrhea and constipation)
• IBS-Unclassified (doesn’t fit into other categories)

IBS can also be:

• Post Infectious-IBS
• Overlapping with other GI conditions

After your doctor's diagnosis, they may recommend lifestyle, diet, medication, and supplement changes. Never be afraid to ask your doctor for a referral to your trusty neighborhood Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) who specializes in gastrointestinal nutrition to help you determine the right nutrition interventions for your unique case. 

Here are eight ways an RDN can help someone with IBS:

#1- Personalized dietary plan and pattern.

Your RDN will recommend foods and meals for you to eat and times for you to eat them based on your symptoms, schedule, and preferences. For example, your RDN might recommend eating every four hours and evenly spreading your Calories rather than having a few large meals or grazing. 

#2- Education on trigger foods.

Healthy foods such as garlic, onions, wheat, lentils, avocado, and more could trigger symptoms in the right portion in specific individuals with IBS. Your RDN will help you figure out your trigger foods and the right level of restriction that could control your symptoms, whether it be elimination, limitation to a specific portion size, or no restriction at all. 

#3- Meal planning and portion guidance.

Diets designed for IBS, such as the Low FODMAP diet, can be tricky. They allow smaller portions of some but not all high FODMAP foods, even at the most restrictive phase. This can be really confusing. Your RDN can help you determine how to include the proper portions without unnecessarily eliminating foods. Plus, it is easy to forget to balance meals with protein, fat, fiber, and carbohydrates when focused on trigger foods and strategic portions. Your RDN will help you keep your plate and blood sugar balanced with the right mix of nutrients. 

#4- Gut-friendly foods.

An RDN can give you personalized recommendations for grains, nuts, seeds, herbs, spices, proteins, and produce to achieve your gut health goals. They can recommend foods you will likely tolerate, promoting gut health and fitting into your routine. 

#5- Stress management techniques.

An RDN can help recommend basic stress management techniques and mindset shifts related to food and nutrition. Some examples include breathing, gentle movement, journaling, and mindful eating exercises that promote the cephalic phase response. 

#6- Collaboration with other health professionals.

Your RDN can speak with your interdisciplinary healthcare team with your permission. They can also refer you to health professionals with other specialties who may be able to help with your unique IBS case. Therapists, physical activity specialists, pelvic floor therapists, or complementary medicine specialists could each play a role in the interdisciplinary team for individuals with IBS. 

#7- Guidance on supplements.

To say there are many “gut health” supplements on the market is a massive understatement. Your RDN can advise you on which supplements could actually make sense for you and which do not. They can also provide guidance on choosing quality supplements, when and how long to take them, and when to discontinue. 

#8- Ongoing support and follow-ups.

IBS nutrition care might take several visits with an RDN to establish the best approach, work through sequential dietary interventions, and overcome implementation obstacles. Follow-ups with an RDN will help provide support, strategies, ideas, education, and encouragement to implement nutrition and nutrition-related behavior changes that help you manage your IBS symptoms. 

When you have IBS or other GI conditions, it is not the time to DIY your medical nutrition therapy with Google and ChatGPT. The internet provides many resources… and a lot of nutrition misinformation and inappropriately applied nutrition interventions. All dietary changes and supplements come with risks that your RDN will be able to help you navigate as a trusted nutrition professional. 

1. _{Mayo Clinic Staff. (2023, May 12). Irritable bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064}  
2. _{Chang, L., & NIDDK. (2017). Diagnosis of irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/diagnosis}  
3. _{Mayo Clinic Staff. (2021, August 10). Celiac disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220}  
4. _{Pimentel, M., Saad, R. J., Long, M. D., & Rao, S. S. C. (2020). ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. The American journal of gastroenterology, 115(2), 165–178. https://doi.org/10.14309/ajg.0000000000000501}
5. _{Hypochlorhydria (low stomach acid): Symptoms, tests, treatment. Cleveland Clinic. (2022, June 27). https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria}  
6. _{Congenital sucrase-isomaltase deficiency. International Foundation for Gastrointestinal Disorders. (n.d.). https://iffgd.org/gi-disorders/congenital-sucrase-isomaltase-deficiency-csid/}  
7. _{Fox, J., & Foxx-Orenstein, A. (2021, June). Gastroparesis. American College of Gastroenterology. https://gi.org/topics/gastroparesis/}  
8. _{US Department of Health and Human Services. (2021, February 22). Thyroid disease. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/thyroid-disease}  
9. _{Hedrick, T. (2022). Nutrition Issues in Gastroenterology: The Overlap Between Eating Disorders and Gastrointestinal Disorders. (C. Rees Parrish, Ed.).Practical Gastroenterology , 32–46. https://doi.org/https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2022/08/August-2022-Eating-Disorders-and-GI-Disorders.pdf}  
10. _{Appendix A: Rome IV Diagnostic Criteria for FGIDs. Rome Foundation. (n.d.). https://theromefoundation.org/rome-iv/rome-iv-criteria/}