# IBS Self-Directed Trials ## 1. Basic Lifestyle and Diet Changes - **Regular Meals and Eating Habits**: Eat 3-5 smaller meals daily instead of large ones to reduce bloating and cramps. Chew slowly and avoid eating late at night. - **Limit Stimulants**: Limit caffeine (coffee, tea), alcohol, carbonated beverages (fizzy drinks), and adjust total fat and caloric load. These can exacerbate symptoms. - **Physical Activity**: Aim for 30 minutes of moderate activity (e.g., walking, swimming) most days to regulate motility and reduce stress. - **General IBS Diet Advice**: Regular meals; limit caffeine/alcohol/fizzy drinks; reduce resistant starch; limit fresh fruit to ~3 portions/day; consider adding oats/linseeds for bloating. This is simpler to implement and helps some patients. ## 2. Fiber Adjustments - **Increase Soluble Fiber**: Gradually increase to 25-30g/day (e.g., oats, psyllium husk supplements like Metamucil). - **Reduce Insoluble Fiber**: Avoid or limit bran, nuts, and seeds to prevent worsening diarrhea. ## 3. Elimination of Common Triggers - **Avoid or Limit**: Caffeine (coffee, tea), alcohol, fatty foods (fried items, rich sauces), spicy foods, and gas-producing items (beans, broccoli, cabbage, onions, carbonated drinks). Try a 2-week elimination, then reintroduce one at a time. - **Limit High-Fructose and Sweeteners**: High-fructose fruits (apples, pears) and artificial sweeteners ending in "-ol" (e.g., sorbitol in gum, diet sodas), which ferment in the gut and cause gas/bloating. ## 4. Specific Elimination Diets - **Gluten Elimination**: Eliminate gluten (wheat, barley) for 4-6 weeks; use gluten-free grains. Stop wheat-based products strictly. - **Lactose/Dairy Elimination**: Eliminate lactose (dairy) for 4-6 weeks; use lactose-free milk. Stop dairy strictly. - **Low FODMAP Diet**: Follow a FODMAP food list to limit fermentable carbs. - [Low FODMAP Diet Handout](https://files.arizonainternists.com/Stanford-University-Low-FODMAP-Diet-Handout.pdf) ## 5. Supplement Trials - **Probiotics**: Try for at least 4 weeks at standard dose per label while monitoring response. If already on them, try stopping probiotics. - **Peppermint Oil Capsules**: An antispasmodic for pain, bloating, and cramps. Take enteric-coated capsules (180–225 mg three times daily or 0.2-0.4mL, 1-2x daily with meals) for 2–4 weeks, then reassess. - **Antigas**: Simethicone (Gas-X) for bloating/gas - **Antacid:** Omeprazole 20mg for 2 weeks - **Pancreatic Enzymes**: Trial for digestion support if fat malabsorption is suspected. ## 6. Mind-Gut Connection Strategies - **Stress Reduction Techniques**: Daily yoga, meditation, or deep breathing for 10-20 minutes. Use apps for guided sessions. - **Exercise Routine**: As mentioned in basic changes, but emphasize consistency. - **Sleep Optimization**: Ensure 7-9 hours nightly; poor sleep worsens symptoms. - **Gut-Directed Hypnotherapy or CBT**: Use self-guided apps (e.g., Nerva for IBS) for relaxation and symptom control; may involve a small cost. ## 7. Lab Workup - **Basic Blood Tests**: CBC and either CRP or fecal calprotectin to flag inflammatory disease; universal celiac serology (IgA tTG with IgA deficiency reflex) regardless of subtype; thyroid function. - **Stool Studies**: Giardia; consider testing for bile acid diarrhea (e.g., if post-cholecystectomy or nocturnal diarrhea). - **Breath Test**: For Small Intestinal Bacterial Overgrowth (SIBO).