It is IBS awareness month and if you haven't come across this 3-letter acronym, it stands for ‘irritable bowel syndrome’ and affects about 15% of the world’s population. Bloating, gas, irregular bowel movements, abdominal pain and urgency to use the loo are some common symptoms many sufferers go through. Some people with IBS complain of constipation, others have diarrhoea and some experience both.
IBS is a gut disorder of the gut-brain axis (formerly known as a functional gut disorders). The rename of these group of conditions has been welcomed given the stigma around functional disorders where they have been perceived as being less serious and legitimate than an organic disease.
The causes are multifactorial and include dysbiosis, stress, intolerance to compounds in foods called FODMAPs as well as experiencing a gut-infection (also called post-infectious IBS).
Diagnosing IBS is not as straightforward as you might think given that there are no biochemical or physiological abnormalities. For this reason, the diagnosis is symptom-based and the most widely used diagnostic tool is based on the Rome IV criteria. Getting a diagnosis of IBS will also involve a work up that includes both blood and stool tests to rule out other conditions such as coeliac disease and inflammatory bowel disease as symptoms can overlap.
The most common method for IBS symptom control is by managing diet, lifestyle and stress levels. In severe cases, medical treatment and counselling may be required.
The typical dietary modification for IBS symptom management is the shift towards reducing Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs), which of course, has its pros and cons. We have covered the aspects of this approach in numerous instagram posts, so we will talk about a much simpler principle here that may help you manage your symptoms without the eliminations.
A study published in 2022 aimed to examine the relationship between meal regularity and IBS in an adult population to investigate previous inconclusive research findings implying that the irregular meal patterns and meal-skipping may be related to worsening of symptoms.
Indeed, participants following a regular meal pattern had reduced odds of IBS, IBS-Mixed and syndrome severity. Meal regularity was also linked to reduced IBS prevalence in women, and in normal-weight individuals. More prospective studies are needed to affirm these associations. However, meal regularity has other benefits too, and generally considering it would do no harm.
So what exactly is meal regularity?
The “5 meals per day” gold standard as presented by social platforms and even some nutritionists is a “one-size fits all” mentality, which we do not condone. However, consuming 5 meals per day could suit some individuals, keeping in mind that there are other balanced options between that and eating a huge meal once a day.
It is hard to exactly define what meal regularity is as even public health guidelines advise eating "regular" meals without defining “regular.” Lacking a standardised definition, makes such a guideline too generalised and hard to follow. Agreeing that such advice could impact IBS prevalence and severity, insight into what meal regularity means is necessary before advising this subgroup of people to eat regularly!
A study conducted in 2020, constructed a meaning for “regular” meals congruent with dietary quality. It is quite odd that timing of food intake, fundamental to human health and disease, has had limited scientific analysis. Of course the meaning of the term “regular meals” remains under scrutiny, but at least the aforementioned study offered a practical, temporally based suggestion aligned with dietary quality.
Mealtime regularity was defined according to the day-to-day consistency of eating occasions for breakfast, lunch and dinner, thus reflecting a circadian rhythm of intake in alignment with cellular circadian rhythms.
The definition of mealtime regularity most in tune with dietary quality and lower BMI denotes always being consistent with eating each meal within an hour of the same time each day, with an option for one day’s lunch or dinner to differ by as much as 2 hours as long as the other day differences are an hour or less. This definition represents a novel approach to defining “regular meals” and has the potential for informing future dietary recommendations.
Based on this definition of regular meals, IBS patients could benefit from eating nutritious food at similar times every day. A higher BMI was associated with lower mealtime regularity in previous research. With that said, it could be speculated that the lower BMI associated with regular meals, rather than meal regularity per se, might be responsible for milder IBS symptoms. However, research on IBS and meal regularity also revealed a lower prevalence in IBS in individuals with a normal BMI following a regular meal pattern.
To sum it up, scheduling your meals regularly and sticking to that schedule may benefit your overall health and improve your symptoms.
If you suffer from IBS, your medical team should include a GP, gastroenterologist, counselor or therapist and most importantly, a gut-health specialist dietitian or registered nutritionist. You can join our 1:1 Beat the Bloat program today that address the 4-pillar approach to conquering IBS.