Remission of irritable bowel syndrome with lifestyle medicine.

Irritable bowel syndrome (IBS) is a chronic symptom complex diagnosed by the ROME-IV criteria with a global incidence of 7-18%. Pharmacological treatment is largely symptomatic, relying on laxatives and neuromodulators. Previous studies have linked IBS to individual factors such as stress, poor sleep, lack of dietary discipline and physical activity. However, data on remission through a comprehensive lifestyle medicine approach remains limited. This intervention included 12 week period of structured sleep routine. It included compliance with a nocturnal sleep schedule from 10-11 pm (bedtime) to 7 am, reading before bedtime, limiting screen time and caffeine consumption especially in late evening. The intervention at the level of stress management involved counseling by a psychiatrist and a nutritionist and mindfulness-meditation. The intervention at the level of physical activity included tracking steps for at least 45 minutes per day using a diary. Personal weekly zoom meetings were conducted for each participant by research team members to ensure thorough understanding of compliance diary. This was in addition to consultation with a nutritionist and a psychiatrist. Compliance was monitored and tailored guidance was provided. To assess comprehension, participants were asked to summarize the instructions provided during the sessions. They were subsequently able to explain the contents and structure of their compliance diaries in a clearly and consistently manner. These efforts ensured a standardized lifestyle management over 12 weeks period. Dietary management included self-documented adherence to a low FODMAP diet after providing them with a list of high versus low FODMAP diet. Participants demonstrated notable improvements in sleep quality, a decrease in stress levels, physical activity, and adherence to a low FODMAP diet which was significantly associated with remission of symptoms. A limitation of the study was small sample size (n=6) as patients became increasingly difficult to follow up with due to multiple dropouts (attrition) during the study. These constraints reduced the power and generalizability of the results. Larger and long-term studies are needed to confirm these findings.