Lifestyle modifications

NUTRITION

  • More than 25% of people with IBS may improve on placebo (1)
  • In 80% of patients certain types of foods may aggravate the symptoms. Reduce or avoid factors that make the symptoms worse. It may include caffeine, fructose and lactose (1)
  • Low FODMAP diet: This diet is low in poorly absorbed short-chain carbohydrates (1). The diet may reduce diarrhoea, pain, bloating and flatus (1). 4-6 weeks on a low FODMAP diet is enough to consider if a person will respond positively on this diet (1). Three phases:
    • A) Reduced FODMAP for 4-6 weeks
    • B) Reintroduction of FODMAP foods
    • C) personalization of diet based on effects of reintroduction (1)
  • Probiotic: May benefit some patients with IBS. If a probiotic is tested it is recommended to use it in the dose that the manufacturer recommends for 12 weeks to evaluate the effect (1).
  • Soluble fiber (eg. beans, oat bran, barley, isphagula) may help with predominantly IBS with constipation, or IBS with alternating constipation and diarrhoea. Fiber dose: Begin with 3-4g/day and gradually increase to avoid bloating (1)
  • Insoluble fiber should be avoided by people with IBS (1)

PHYSICAL ACTIVITY

  • Regular physical activity may reduce some of the symptoms, including constipation (1)

STRESS

  • Lifestyle changes that reduce stress is recommended (1)

References

1) https://bestpractice.bmj.com/topics/en-gb/122/management-approach

Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

​Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

​Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

​Evidence based on observational / cohort studies is written in CURSIVE font