Microbiome changes, GI infections, stress and issues with the way food moves through the gut can also contribute, Dr. Moshiree said.
What can help?
Finding effective treatments requires understanding the unique factors that contribute to each patient’s symptoms, Dr. Moshiree said, and often trying a combination of dietary, behavioral or pharmaceutical therapies.
Ms. Rosen often advises her clients to temporarily cut out foods that are high in certain sugars called FODMAPs, which are fermented by bacteria in the colon, resulting in gas and bloating that can worsen I.B.S. symptoms.
Many vegetables, fruits, dairy products, legumes, nuts, seeds and grains are considered high-FODMAP foods, making the diet very restrictive — and best attempted with the guidance of a registered dietitian and inappropriate for people with eating disorders, she said.
Ms. Rosen coaches her clients through three phases of the diet. First, eliminating high-FODMAP foods for two to six weeks (and no longer, because of the risks of nutrient deficiencies, microbiome changes and disordered eating). Then, if their symptoms have improved, she has them reintroduce high-FODMAP foods, one by one, to determine which ones trigger symptoms. Finally, she creates a personalized diet that includes all of the foods her clients can eat comfortably.
Over-the-counter enzyme supplements may help people more easily digest some high-FODMAP foods like dairy products, beans, lentils, garlic and onions, Ms. Rosen said.
Other nonprescription products that can improve I.B.S. symptoms include enteric-coated peppermint oil capsules, which can relax the smooth muscles of the gut, Dr. Moshiree said. Ms. Rosen added that psyllium fiber supplements can also be helpful.
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