Irritable bowel syndrome has symptoms such as stomach pain, diarrhea and gas. gettyimagesbank

Jessie Wong, a gut health expert and registered dietitian who specializes in Irritable Bowel Syndrome / Courtesy of Jessie Wong

Imagine waking up one day to a relentless discomfort in your gut, a turmoil that disrupts your daily life severely without any warning. This invisible adversary, known as irritable bowel syndrome (IBS), haunts 10 percent to 15 percent of the global population with its unpredictable symptoms of stomach pain, diarrhea and gas.

Even celebrities such as “Spider-Man” actress Kirsten Dunst and supermodel Tyra Banks, who is known for following strict diet and workout routines, have faced the challenges of IBS, which is known to have no cure, with many being told simply to "live with it."

Jessie Wong, a Hong Kong-born, Seattle-based dietitian, knows this all too well as both she and her husband suffered with IBS for more than a decade.

Wong's husband was studying for a doctoral degree in the United States when he experienced symptoms and saw a university doctor who told him: “It's just IBS and you have to learn to live with it.”

His case was not typical as he received an early diagnosis of the disease. One study showed that it takes on average more than six years from the onset of symptoms, seeing doctors and undergoing tests to reach a definitive diagnosis of IBS.

Wong also started battling IBS when she was pregnant with her second child in 2016. She experienced constipation, cramps and lower abdominal bloating. “There was no guidance as to what to do,” she said.

This lack of guidance spurred Wong on a path from accounting to dietetics, driven by a desire to impact health and well-being positively. By the time Wong started experiencing discomfort from IBS, she had already transitioned into a career as a dietitian.

“I studied business and finance in college, did my master's in accounting and worked for one of the big four accounting firms. But it wasn't a good fit,” she said.

Motivated by her long-standing interest in healthcare and a commitment to fostering positive impact on well-being, Wong went back to school for another five years to study dietetics.

During that time, a gastroenterologist recommended the couple follow a low-FODMAP diet.

FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols,” short-chain carbohydrates that are difficult to digest, and found in various vegetables, fruit, dairy milk and wheat.

After passing through the small intestine, the poorly absorbed sugars from these foods enter the colon, where they are fermented by bacteria, releasing gas that distends the bowels, causing gas buildup, bloating and pain.

Lactose, a sugar found in dairy products, fructose, a sugar found in many plant-based foods, and polyols, sugar alcohols found in certain fruit, vegetables and sugar-free sweeteners, cause water retention in the bowel, leading to loose stools and diarrhea.

Wong later trained in the FODMAP diet at Monash University in Australia, where it was developed, and realized it was only a temporary solution to managing their symptoms.

Determined to find a more comprehensive approach, the gut-health dietitian outlined a three-step strategy to combat IBS on her popular social media channels, including her website ibsfreedom.org and her Instagram account with nearly 47,000 followers.

The first step she recommends is to identify your food triggers.

“The goal is to eliminate and reintroduce FODMAP groups to see what level of tolerance you have for each group. Then you can personalize the diet afterwards,” she said.

Wong's Instagram account has several resources for IBS sufferers who want to test the low fodmap diet. Captured from Instagram

There are four types of IBS — IBS-constipation, IBS-diarrhea, IBS-mixed bowel type and IBS-unclassified. The exact cause of IBS is unknown, but there are several factors, such as dehydration, deficient fiber intake, lack of sleep and high stress levels, that trigger symptoms, according to Wong.

Next is learning how to optimize your gut microbiome for better gut function and health.

“One thing that really helps is staying hydrated … drinking one to two glasses of water when you get up,” she said.

“What I really encourage is to eat more … vegetables and fruit at each meal. If you're getting two to three different kinds of vegetables per meal for lunch and dinner, then you are likely to meet your fiber goal (25-35 grams of dietary fiber intake per day) and that really helps improve your gut motility,” she said, referring to the movement of food through the body from the mouth to the throat, esophagus, stomach, small and large intestines and out of the body.

Then, it's about enhancing your gut-brain connection and making lifestyle changes.

“Improving sleep, reducing stress and finding the right exercise are foundational things that can help improve your gut motility and manage diarrhea and constipation,” she said.

She recommends deep diaphragmatic breathing, which “stimulates the vagus nerve, which connects our brain and our gut, and that, in turn, activates the parasympathetic nervous system. It calms your body when you're experiencing cramps.”

The biggest mistake people tend to make when they have IBS, Wong said, is trying dietary supplements.

When they take probiotics for bacterial imbalances in the gut, sometimes “they turn from having constipation to diarrhea soon afterward, and that can be very devastating,” she said.

For Wong, the key to managing her IBS was addressing chronic constipation.

“Increasing water and fiber intake, managing my stress and getting enough sleep [made things] … a lot easier,” she said. Her husband took a similar approach to help curb his symptoms.

According to Wong, there was an increase in IBS cases during and after the pandemic. Many people stayed at home more and exercised less, which can make constipation worse and cause more IBS symptoms.

Since the end of the pandemic, there has also been an increase in autoimmune diseases, including celiac disease, in which your immune system attacks your tissues when you eat gluten — a protein found in certain cereal grains — and non-celiac gluten sensitivity, she said.

IBS is not an immune disorder and has little connection with the immune system, but several autoimmune disorders, including lupus, can cause similar symptoms.

Treatment options for IBS have evolved significantly over time, she said. Today there are medications to try depending on which type of IBS a patient has.

“Stress is a big factor in causing IBS and cognitive behavioral therapy is extremely helpful for that. Also, research on gut-directed hypnotherapy carried out by Monash University has shown that it has the same efficacy as the low-FODMAP diet in early trials,” she said.

“It encourages a state of focused attention and deep relaxation with image and verbal meditation.”