Irritable bowel syndrome (or IBS) is characterized by a group of gastrointestinal symptoms that happen together in a person. The symptoms as well as the severity of the same might differ from person to person. IBS is considered as a functional disorder, meaning that the gastrointestinal tract functions abnormally on account of receiving mixed signals from the brain.
Common symptoms of IBS
The common symptoms of IBS include abdominal pain, bloating, flatulence, altered bowel movements and constipation/diarrhoea.
For a pro-athlete, symptoms like bloating and abdominal pain can be very uncomfortable and can impact the training and performance abilities. It is recommended to get a proper evaluation done by a physician based on the symptoms.
It must be noted that there is no specific diagnostic test to determine IBS. The earliest point of reference to diagnose/identify IBS was the Manning criteria in 1978. In 1989, the Rome criteria was formulated by expanding the Manning criteria for use by physicians.
Risk factors for IBS
Stress, food sensitivities, family history and the use of medications (like antibiotics) are some of the risk factors for developing IBS.
Here below we look at some ways to counter IBS:
Limiting FODMAP-containing foods
The first step in dealing with IBS is to identify the foods that may worsen the symptoms. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), which refers to the different types of carbohydrates that most easily ferment in the gut, is one such category of foods that may worsen the symptoms of IBS. These include:
- Oligosaccharides: Fructans and galactans (found in wheat, barley, rye, lentils)
- Disaccharides: Lactose (found in milk, cheese, ice cream, etc.)
- Monosaccharides: Fructose (found in apples, cherries, figs, mangoes, pears, watermelon)
- Polyols: These are also known as sugar alcohols (found in cauliflower, mushrooms, snow peas as well asin sweeteners such as sorbitol, mannitol, xylitol, which are often used in sugar-free gums, mints and other, ‘diet’ products)
FODMAP-containing foods are osmotic in nature, meaning they increase the intestinal fluid volume, tend to digest poorly in the small intestine and are overall susceptible to bacterial fermentation in the gut. Due to their tendency to digest so poorly, they cause excess production of carbon dioxide, hydrogen and methane, which causes effects such as bloating, flatulence, diarrhoea and abdominal pain.
Intervention in case of irregular FODMAP levels is done in the following phases:
- Elimination: In this phase, high FODMAP foods are limited/removed from the diet.
- Reintroduction: In this phase, high FODMAP foods are added back in and observed.
- Integration: This is a long-term plan, based on individual FODMAP tolerance.
Since the FODMAP issue is a bit complicated to understand, it is best to consult a dietitian/nutritionist to understand the duration required to limit these foods, and especially with regard to supporting the training/performance needs of pro-athletes, since proper fueling and meeting the nutritional demands are crucial for this demographic.
Maintaining a food diary
Log each meal and observe the foods that trigger your IBS symptoms. If you are able to identify any such trigger that is causing you symptoms, let your nutritionist/dietitian know and find out how to deal with the situation—whether particular foods need to be eliminated from your diet for a certain period of time and, if yes, when to reintroduce them back.
Exercise and yoga
Some studies indicate that low-to-moderate-intensity exercise may help improve IBS symptoms, particularly in constipation-predominant cases. One review study with over 250 IBS patients found that participation in yoga was associated with decreased severity of IBS symptoms, anxiety as well as improvements in the overall quality of life.
Stress impacts the signalling between the brain and the gut and plays a role in IBS. Yoga can therefore have benefits that extend to both the body and mind by helping to regulate stress. While low-to-moderate intensity exercise and yoga have favourable outcomes with IBS, high-intensity exercise is linked to increased gastrointestinal symptoms.
Gastrointestinal symptoms are especially common in endurance athletes and their existence might be explained by the physiological changes that occur during exercise, including decreased blood flow to the intestines.
Staying hydrated
In addition to adequate fuelling, adequate hydration is also crucial in IBS management. Dehydration can have a range of negative effects on your health, such as worsening constipation. For athletes who sweat out excess fluids in their daily workouts/training (and who have decreased sensitivity to thirst during exercise), this is even more important to be aware of.
It is important to note that while coffee does contribute to your daily fluid intake, caffeine can also increase gastric motility. If you have diarrhoea-predominant IBS, skipping coffee may help in avoiding abdominal discomfort.
Stress management
Add strategies for stress management into your daily life to help keep your IBS symptoms under control. As mentioned above, yoga can play a positive role in symptom management. There are other ways to reduce stress such as meditation and various deep-breathing exercises. Even setting aside five to ten minutes to take a moment to sit quietly when starting a day can make a big difference in managing stress.
Proper eating and mealtime habits
It is ideal to eat a minimum of two hours before training/exercise to give your body time to digest and to reduce discomfort. For some athletes, a minimum of three hours before training may make them feel comfortable. So be open to experimenting with your meal timings and make a note of how your body feels.
Have your pre-workout snack at least forty-five minutes before exercise and choose foods that are easy to digest and are the quickest source of energy for exercising muscles. Foods high in protein, fibre and fat may take longer to break down, so it is ideal not to consume them too close to a workout.
If eating large meals can trigger symptoms in you, try to have mini meals that may be better tolerated, but please note that if you’re eating smaller meals, you’ll need to eat more frequently to meet your energy demands. If food high in fructose (a type of carbohydrate that can trigger IBS symptoms) has to be consumed, consider decreasing the portion size of the fruit. As always, consult your dietitian before making any changes to your diet.
Conclusion
IBS symptoms are individualized and may vary from one person to another. For a pro-athlete, the symptoms have the potential to impact the overall performance and or/training ability. It is therefore important to understand the underlying causes that are aggravating the symptoms and work with a healthcare provider/nutritionist and trainer to determine the best way forward for you to deal with IBS.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns and before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
References
- Diana L. Heiman et al. ‘Irritable Bowel Syndrome in Athletes and Exercise’, Current Sports Medicine Reports: March 2008, Volume 7, Issue 2, pp. 100–03
- Su Youn Nam, M.D., Ph.D et al. ‘Prevalence and Risk Factors of Irritable Bowel Syndrome in Healthy Screenee Undergoing Colonoscopy and Laboratory Tests’, J Neurogastroenterol Motil. 2010 Jan; 16(1): 47–51
- Lauren A. Killian and Soo-Yeun Lee. ‘Irritable bowel syndrome is underdiagnosed and ineffectively managed among endurance athletes’, Applied Physiology, Nutrition, and Metabolism, 2019
- A.J. Daley et al. ‘The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomized controlled trial’, Int J Sports Med. 2008 Sep;29(9):778–82
- Dania Schumann et al. ‘Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review’, Clinical Gastroenterology and Hepatology, 2016;14:1720–731
