Diagnosis. There is no definitive blood test or imaging procedure to diagnose IBS. Instead, your health care provider will likely diagnose the condition based on your description of the type and frequency of your symptoms. The cause of IBS isn’t known, but it’s believed to be a biological malfunctioning of the intestinal tract, possibly due to a miscommunication between the brain and the gut. There don’t appear to be any serious long-term complications from IBS, however, the diarrhea and/or constipation, which are common, can cause hemorrhoids or aggravate existing ones.

Dietary Treatment. Once your healthcare provider has diagnosed you as having IBS, the first line of treatment is typically a change in your diet. Amy Bragagnini MS, RD, CSO, spokesperson for the Academy of Nutrition and Dietetics counsels patients with IBS and she says, “Many of my patients have a wide variety of symptoms, and they often feel confused about what foods to eat.” It’s no wonder, since IBS varies among patients, and there is no single diet prescription that will work for everyone.

A typical dietary plan for IBS calls for sticking to a regular meal pattern; reducing insoluble fiber, such as whole wheat cereals; increasing soluble fiber, such as that found in oats; and reducing alcohol, caffeine, and spicy foods. Regular exercise and drinking a lot of fluids to prevent dehydration, which hardens stools, are also recommended. A gluten-free diet may help reduce symptoms for some people, but it’s a major and often expensive dietary change. If you’ve been diagnosed with IBS, a gluten-free diet might be worth a try, but other dietary changes or supplements might be tried first.

A recent review and analysis of several studies concluded that a FODMAP diet was better than other dietary treatments for relieving symptoms. A FODMAP diet is one that is low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols—all types of carbohydrates that can cause an increase in gas and liquid in the intestinal tract. Following a FODMAP diet means eliminating several foods, including dairy-based milk, yogurt and ice cream; wheat-based cereals, bread and crackers; beans and lentils; artichokes, asparagus, onions, and garlic for two to six weeks and then gradually reintroducing each food to see if the offending food can be identified. There are several sources for lists of foods that are to be eliminated and those that are allowed, but the Mt. Sinai Health System provides comprehensive lists. https://www.mountsinai.org/health-library/selfcare-instructions/low-fodmap-diet.  As many as 86 percent of IBS patients who follow a FODMAP diet experience an improvement in symptoms, according to Johns Hopkins Medical Center.

Dietitian Bragagnini says that she keeps in mind that people who follow restricted diets, such as the FODMAP diet, long term may be at risk for nutrient deficiencies such as vitamin B₆, folic acid, thiamin, niacin, iron, and riboflavin. “It’s necessary to have their healthcare provider monitor them for deficiencies and supplement as needed.”

Psyllium fiber, found in over-the-counter products and supplements, like Metamucil, is often recommended as a safe and effective treatment. The American College of Gastroenterology has suggested that probiotics may help symptoms, but there are dozens, if not hundreds of probiotic products available and the exact probiotic bacterium or combination of bacteria that effectively relieve IBS symptoms has not been identified.

A study published earlier this year in The Lancet Gastroenterology & Hepatology found in a four-week study, which compared medications for IBS and different diets, that a combination of a traditional diet for IBS combined with a FODMAP diet was the most effective treatment for symptoms.

Medications. The American College of Gastroenterology recently published the organization’s recommendations for the treatment of IBS. Among the prescription medications that may be effective for the short-term treatment of symptoms, are Linaclotide (Linzess®), Plecanatide (Trulance®), and Lubiprostone (Amitiza®). But, like all prescription drugs, they come with side effects and should not be taken indefinitely.

Bottom Line. Because of the wide range of symptoms of IBS and the variety of foods that can trigger symptoms, individualization of a diet plan provided by a registered dietitian is the best approach for developing an effective dietary plan that fits within your food preferences and your budget.

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Plant-Based Certification. The term “plant-based” is often interpreted to mean “vegan,” but some products labeled as “plant-based,” may actually contain animal-based ingredients. Certification programs for plant-based foods through the Plant Based Foods Association (PBFA) and the Vegetarian Society review the manufacturing process and verify that the food contains no animal ingredients. However, it’s a fee-based certification program and not all companies are willing to pay for certification for each food they sell. The U.S.-based PBFA states that products with any amount of animal-derived ingredients are not eligible for Certified Plant Based labeling, including eggs and honey. Plant-based foods made from whole grains, nuts, seeds, legumes, vegetables, fruits, fungi, and algae are eligible for certification, but whole plant foods will not carry the label, though they’re clearly “plant-based.”

Lack of Labeling Regulations. Lack of regulation leaves the labeling up to manufacturers and supermarkets to define what constitutes “plant-based.” Some supermarket chains label shelves or individual products as “Plant Based,” but this is open to interpretation. A plant-based diet, for example, doesn’t mean that no animal products are included. It generally means that plant foods take center stage in the diet and animal products are a minor component. The same could be said for non-certified foods labeled “Plant-Based,” as the product may contain mostly plant-based ingredients, but it’s no guarantee that it contains no animal products at all.

Bottom Line. Official organizations, including the FDA, are discussing the development of a standard definition for “Plant-Based” food, but no legal definition currently exists. The way to guarantee that the food you’re buying is free of animal products is to look for foods certified as “vegan” or those that carry the PBFA certification seal.

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Defining Deserts and Swamps. Food deserts are areas or neighborhoods that have limited access to healthy food choices and may be solely dependent on convenience stores or fast-food restaurants, where going hungry and not having enough to eat may be residents’ biggest concerns. A food swamp, on the other hand, is an area or neighborhood that has access to healthy foods, but these options are outnumbered by much less expensive food outlets with few or no healthy options. Poor diet quality, rather than going hungry, is the primary concern. For someone on a tight budget, the choices are clear, but less expensive often translates to less healthy. Some researchers have used the term “food mirage” to describe areas where healthy food choices are readily available, but out of reach financially for a significant portion of the population that lives there.

Experts have suggested that part of the problem is that supermarket chains offering healthy food choices may lack a vested interest to remain in low-income areas, where residents’ budgets don’t allow for the purchase of high-priced fresh fruits and vegetables and may shut down if most people in the area opt for less expensive food outlets, further restricting healthy food choices available to them.

Health Risks. “Both food deserts and food swamps pose health risks,” says Whitney Linsenmeyer, PhD, RD, LD, spokesperson for the Academy of Nutrition and Dietetics and assistant professor of nutrition at Saint Louis University. Studies have found that living in food swamps or food deserts is associated with increased rates of obesity, stroke (especially in older people), and some types of cancer. One study found that the death rate from cancers overall was 77 percent greater in counties with high food-swamp scores, meaning areas where fast-food outlets far outnumbered supermarkets and other fresh food options. The death rate from obesity-related cancers (breast, colorectal, endometrial, esophageal, gallbladder, stomach, liver, kidney, pancreas, ovaries, and thyroid) was 59 percent greater in counties with high food-desert scores, areas where few health food options were available. Another study in the International Journal of Environmental Research and Public Health found that food swamps better predicted obesity than food deserts. Researchers have even found that pregnant women living in areas identified as being food deserts were more likely to develop gestational diabetes, a type of diabetes that is diagnosed for the first time during pregnancy and that can have a negative effect on the health of both mother and baby. One study even found that living in a food desert had a negative effect on patients’ recovery after surgery for colorectal cancer.

While diet is often cited as a major “modifiable risk factor” for preventing diseases, like cardiovascular disease and cancer, if healthy foods are not available, or are not financially feasible, choosing healthy foods may be not be a realistic option.

Bottom Line. Short of moving to an area where healthy food choices are affordable and abundant, education is key. If you live in a food desert or a food swamp, it’s important to learn about realistic healthy, affordable food choices. If you’re able to identify healthier choices, Linsenmeyer recommends stocking up as far as your pantry space and budget allows. While fast food restaurants and corner markets typically offer far more unhealthy options than healthy ones, most do offer one or two healthier choices, such as canned beans, baked potatoes, grilled chicken breasts, veggies, sandwiches, yogurt parfaits, and kids’ meals for smaller portion sizes. Bottled water or unsweetened drinks cost the same as sugary sodas. At fast food outlets, if you opt for the typical menu items, forgo extras like double meat, cheese, or bacon on your burger.

While they’re not an option for everyone, a backyard garden or establishing a community garden can offer greater access to healthy food. Linsenmeyer says, “If you have a little patch of yard, or even a windowsill with good light, you may be able to grow some of your own fresh food at home, relying less on what the neighborhood grocer has (or doesn’t have) to offer.”

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If you thought yes, you’d be wrong.

It may be shocking, but it’s true. The situation has even been described as a sort of Wild West of supplements. If the label on a supplement says that it is “FDA Approved,” it is not. Proving the safety and efficacy of vitamins, minerals, herbs, amino acids, probiotics, and compounds such as caffeine in supplements, is the responsibility of the supplement manufacturer. In fact, the FDA doesn’t even have to be notified when a dietary supplement is introduced to the market and it doesn’t have the authority to approve dietary supplements or approve their labels before they are available for sale. Neither are there laws or regulations that limit the serving size of dietary supplements or the amount of an ingredient that can be in a serving of a supplement. The exception to the no-FDA-oversight rule is if a dietary supplement contains a dietary ingredient that is not currently present in the food supply.

Dietary Supplement Regulations. The Federal Food, Drug, and Cosmetic Act from 1994 required that supplements have a Nutrition Fact label and a listing of all dietary ingredients under “Other Ingredient.” The Act defined a supplement as “a product intended for ingestion that, among other requirements, contains a dietary ingredient intended to supplement the diet.” The term “dietary ingredient” includes vitamins and minerals, herbs and other botanicals, amino acids, enzymes, probiotics, or extracts of any kind. However, says Debbie Petitpain, MBA, MS, RDN, spokesperson for the Academy of Nutrition and Dietetics, “Data repeatedly shows that the supplement label can misrepresent what’s truly in a product.” Some may even contain unlabeled prescription drugs. However, ConsumerLab.com regularly analyzes and evaluates dietary supplements and reports if they contain the ingredient and in the amount stated on the label.

While The FDA does periodically inspect dietary supplement manufacturing facilities and reviews product labels and websites to make sure that they don’t make claims that the product can treat, diagnose, cure, or prevent disease, which would reclassify a supplement as a drug and would require rigorous review, as the FDA carries out for all drugs. If no such claim is made, dietary supplements are not held to the same rigorous standards as prescription drugs. Dietary supplements can make what are called structure/function claims. A calcium supplement, for example, can state “Calcium helps build strong bones,” but it can’t say that the supplement “Reduces the risk of osteoporosis.”

After-the-Fact Regulation. The FDA does monitor reports of adverse effects of dietary supplements filed by health professionals and consumers, such as itching, nausea/vomiting, or shortness of breath, filed by consumers and health care professionals. If a complaint or adverse event is reported, the FDA will work with the company to make the supplements safe to prevent future events, ask the company to voluntarily recall the product, or take action to remove a dangerous product from the market.

However, Petitpain cautions, “Some adverse effects may go unnoticed because they are difficult to assess. We see this a lot with food safety issues as well. For example, a person with a headache or stomach ache may not attribute the problem to a supplement.” That’s why it’s important that you let your healthcare provider know of any over-the-counter supplements you are taking. Your healthcare professional may know of possible harmful interactions of specific dietary supplements with prescription medications you might be taking. There is a system in place for reporting adverse effects, but Petitpain adds, “Consumers are often unaware of the reporting system and how to use it.”

To report a suspected adverse effect from taking a dietary supplement, you can contact the FDA by either going to the Safety Reporting Portal at www.safetyreporting.hhs.gov or by contacting your local FDA Consumer Complaint Coordinator via www.fda.gov/safety/report-problem-fda/consumer-complaint-coordinators. Also, check the FDA’s website for safety alerts. You may not be the first to experience adverse effects from taking a specific dietary supplement.

Bottom Line. Dietitian Petitpain recommends talking to your healthcare provider before you take dietary supplements, especially if you are currently taking prescription medications. Try to choose a reputable supplement brand with third-party certification for quality. ConsumerLab.com is an excellent source for information about what dietary supplements can and can’t do, what they actually contain, and whether they contain the amounts stated on the label.

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A: Cellulose gum is a common ingredient in both food products, such as salad dressings, sauces, yogurts, and ice cream, and in pharmaceuticals, such as tablets and liquid medications. It’s an effective thickening agent, stabilizer, and an emulsifier. It has no calories or nutritional value and is used in very small quantities in processed foods. The gum comes from plant cell walls, often from wood pulp or cotton. The Food and Drug Administration and the Environmental Working Group, a nonprofit, nonpartisan organization that evaluates the safety of foods, among other things, have recognized cellulose gum as a safe ingredient in foods, pharmaceuticals, and even cosmetics. While cellulose gum is generally considered safe, some research has suggested that a diet that contains a lot of processed foods, with cellulose gum as an ingredient, could upset the balance of good to bad bacteria in the intestinal tract and cause bloating, gas, and diarrhea. Also, people with irritable bowel syndrome (IBS) may be more sensitive to the additive. 

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A: Yes, several studies have linked high-fiber diets to a reduced risk of developing cardiovascular disease (CVD). Current fiber recommendations are for women to consume 25 grams/day and for men to consume 38 grams/day. However, surveys show that a meager five to nine percent of Americans meet those fiber recommendations. Fiber is found in plant foods—fruits, vegetables, nuts, seeds, beans, lentils, and cereal grains. Not only is eating more fiber important for reducing CVD risk, the type of fiber in your diet may be important as well. A 2022 study published in the Journal of the American Medical Association found that while a high total fiber intake was linked to less inflammation and a reduced risk of developing CVD, the strongest link for prevention was found with the intake of cereal fibers, such as oats, barley, rye, and wheat. While the study included only people over the age of 65, the researchers suggested that the findings are likely to hold for younger people as well.

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The Procedure. FMT is typically done by a gastroenterologist. Preparation for FMT is similar to that for a colonoscopy, and the procedure requires anesthesia, so it is done in the hospital or at a surgery center.

According to Sahil Khanna, MBBS, MS, FACG, AGAF, professor of medicine, gastroenterology, and hepatology at the Mayo Clinic in Rochester, Minnesota, while antibiotics have long been the first-line treatment for C. difficile infections, they also destroy the “good” bacteria in the gut. Khanna says, “FMT has about a 90 percent success rate for these infections.”

There are “stool banks” that operate like blood banks. Stool donors are carefully screened, and must undergo blood and stool tests that check for infections or drugs that could be transferred. Khanna says that most insurance policies cover conventional FMT, including Medicare.

Last year, the Food and Drug Administration approved a capsule (brand name, VOWST) for FMT. Four capsules of VOWST a day are taken orally for three days. While the 12 capsules can cost thousands of dollars, even with most insurance policies, there is a Zero Co-Pay Savings program through Nestlé and Seres Therapeutics, if you have commercial health insurance.

New FMT Guidelines. Earlier this year, the American Gastroenterological Association released practice guidelines for gastroenterologists practicing FMT. While the Association recommends FMT for recurrent C. difficile infections, the Association did not recommend FMT for other gastrointestinal issues.

Bottom Line. While the idea of “rewilding” the gut might seem unappealing, it can mean an end to suffering for those with chronic C. difficile infections. Research is underway for the application of FMT to treat many other conditions. Most of the studies are in the initial trial stage, but, says Khanna, “There is a lot of excitement in this field.” 

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A: While the theory that what you eat can affect your risk of developing or worsening acne has been alternatively promoted and downplayed over the years, the conclusion of recent studies would indicate that there is indeed a connection, though the effect may vary among individuals.

Increased Risk. The most studied diet connection is the Glycemic Index (GI). High-GI foods are rapidly digested and absorbed, leading to high blood sugar levels. Diets that provide a lot of high-GI foods have been linked to acne, both its development and severity. Several studies have examined the link between milk consumption and acne, and have found a connection. However, most studies have been observational, not clinical. Of all the theories about diet and acne, probably the most pervasive, yet the one with the least amount of evidence, is for chocolate.

Decreased Risk. A recent review in the Journal of the American Journal of Clinical Dermatology cited research suggesting that diets rich in omega-3 fatty acids improved acne in some patients. And while probiotics are promising, little research has been done to date.

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A: That depends. The terminology for these drinks can be confusing. There are “no-alcohol,” “alcohol-free,” zero-proof,” “low-alcohol,” “light,” and “reduced alcohol” drinks. For example, “non-alcoholic” drinks can contain up to 0.5% alcohol. “Alcohol-free” drinks, however, must contain no detectable level of alcohol. If you’re overseas, these definitions may be different. Being aware of these differences can be critical for recovering alcoholics. Also, be aware that taste varies considerably and may be disappointing if you expect it to taste exactly like the real thing. It’s like expecting diet sodas to taste exactly like sodas that contain sugar.

The market for these beverages is expected to reach more than $2 billion by 2031. You can choose from non-alcoholic beer and wine, zero-proof bourbon and liqueurs, or mocktails in a can or at a bar. Several are calorie-free, but some contain a lot of sugar, raising calorie counts to as much as 85 calories per 6-ounce drink. Some contain botanicals, antioxidants, even CBD, but labels may simply say “botanical blend” or “natural flavors,” so it’s not always possible to know an exact ingredient breakdown.

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Fat Distribution. Fat cells play important roles, not just in fat storage, but in regulating immune function and in the production of hormones. There are specific patterns of fat distribution in the body that typically indicate a higher or lower risk of health issues. For instance, fat accumulated under the skin, also referred to as subcutaneous fat, which makes up about 80 to 90 percent of fat tissue, is not associated with an increased risk of disease. However, fat that accumulates in the liver, heart, pancreas, and skeletal muscle, referred to as visceral fat, which makes up anywhere from six to 20 percent of body fat, is linked to an increased risk for type 2 diabetes, cardiovascular disease, and high blood pressure. People with more visceral fat around their abdomen, sometimes called an “apple shape” tend to be at greater risk for high blood pressure and cardiovascular disease. An apple shape is more common among men than women. Women tend to accumulate fat below the waist, in the hips and thighs, which generally carries a lower risk for cardiovascular disease as well as the other conditions that are associated with an apple shape.

According to Emma Laing, PhD, RDN, national spokesperson for the Academy of Nutrition and Dietetics and director of dietetics at the University of Georgia, “Research studying the effects of visceral adipose tissue on health have thus far also discovered links to dementia, asthma, stroke, and breast and colorectal cancer.”

Fat distribution is affected by sex hormones—especially estrogen and testosterone—but it is also greatly affected by age. With age, fat tissue is altered in amount, composition, degree of inflammation, hormone production, and metabolic activity, and there is a clear shift from subcutaneous fat to visceral fat. Accumulation of abdominal visceral fat in women generally begins to occur in women who are premenopausal, and the health risks of visceral fat appear to be stronger in women than in men. Research has also found that whether fat accumulates above or below the waist is highly dependent on genetics. Parents are likely to pass on their pattern of fat accumulation to their children, but studies also suggest that damage to DNA that occurs over a lifetime can also play a role in where body fat is stored. Obesity itself may be important in determining where fat is stored in the body.

Types of Fat. Where fat accumulates in the body is not the only factor that determines your health risk. The type of fat is also a factor. The body stores 3 types of fat: White fat, which makes up most of the body’s fat, stores energy and produces hormones. Brown fat burns energy and produces heat in cold weather. People who have more brown fat tend to be healthier, but there is no known way to increase the amount of brown fat in your body. Beige fat serves a dual purpose. It stores fat, but under extreme conditions can act like brown fat. Beige and brown fat activity decreases with age, body mass index, and elevated blood levels of fats and glucose.

Measuring Fat. There is currently no method that is available outside of research settings to accurately measure where fat is stored or what types of fat are present. BMI, which is often used to assess obesity, doesn’t account for either. A tool called a skinfold caliper can be used to measure skinfold thickness, so that a rough prediction of the total amount of body fat can be calculated, but the calculation only measures subcutaneous fat and is based on the assumption that fat is equally distributed throughout the body.

The Bottom Line. A variety of factors determine how much and where fat is stored on your body, many of which are out of your control. But, says Liang, “Eating a varied and nutritionally balanced diet, being physically active, and managing stress can improve health regardless of fat tissue distribution.”

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