First published in the Inside Tract® newsletter issue 207 – 2018


Which is better for Treating IBS?

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder. It affects 13-20% of Canadians, causing symptoms that include abdominal pain, bloating, and constipation and/or diarrhea. Treatment for IBS is complex, because we aren’t quite sure what causes IBS, so most patients require a combination of various lifestyle and diet changes, along with supplement or medication therapy.

One prospective 2017 study from Germany set out to analyze the effectiveness of two common IBS treatments: yoga and a low-FODMAP diet.1 The low-FODMAP diet involves removing certain types of carbohydrates from the diet. These include fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which might contribute to symptoms in IBS. The study consisted of 59 patients with IBS, who the researchers randomly assigned to either yoga classes or nutrition counselling for managing a low-FODMAP diet.

A hatha yoga instructor gave the individuals in the yoga group lessons twice per week for 12 weeks. These sessions were approximately 75 minutes long, and designed specifically to be helpful for those with digestive symptoms. In addition to these classes, the subjects received a written manual and three half-hour instructional videos so that they could practice at home between classes. The researchers encouraged them to practice daily.

Those in the low-FODMAP group received four 60-90-minute nutritional counselling sessions, including two group lessons and two private sessions with a nutritionist for each individual. The researchers also provided the participants with plenty of resources to take home, including a pamphlet with detailed instructions on how to eat a low-FODMAP diet, some easy low-FODMAP recipes, and a list of foods that are not low-FODMAP, and suggestions for replacing these foods. After the first 12 weeks, the researchers instructed the participants to test their tolerance of various FODMAPs, by testing one type of food per week for 2-3 days to see if symptoms worsened. The subjects completed a 6-day food diary before the study, along with another 6-day food diary on the last week of the 12-week elimination phase. Nutritionists used these diaries to analyze and score how well they adhered to the low-FODMAP diet.

The researchers used a scale known as the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) to measure the participants baseline IBS severity and measure again after the study period, to see if there were any improvements. The IBS-SSS measures five symptoms of IBS:

  1. abdominal pain intensity
  2. abdominal pain frequency
  3. abdominal distension/bloating
  4. dissatisfaction of bowel habits
  5. interference on life in general from symptoms

Patients rate each of these items out of 100 – with higher numbers representing more severe disease – and add them together for a total maximum score of 500. Individuals who score less than 75 are considered in remission if they previously had a higher score, because this is considered a normal score for people who do not have IBS. A decrease in an individual’s score of 50+ points indicates a clinically relevant improvement.

In this study, the patients in the yoga group started with an average score of 263.02, and after the study period their average score had dropped down to 196.86. In the low-FODMAP group, the average starting score was 259.73, but by the end of the study it was at 163.55. While the low-FODMAP diet saw a greater score drop, the difference between the two groups isn’t statistically significant. According to the study authors, this shows that both interventions result in a similar reduction in IBS severity.

While these treatments can be effective, it is important to ensure you are doing them correctly to avoid harm, such as an injury from incorrect form in a yoga pose or a nutritional deficiency from a poorly-conducted low-FODMAP diet. If you are interested in trying either of these treatments, please contact your health care team.

1. Schumann D et al. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2018;47(2):203-211.