A Guide To IBS: From Symptoms To Treatment
Ami Sheward, nutritional therapist, says…
There Are Different Types
“Irritable bowel syndrome (IBS) is a gastrointestinal tract disorder characterised by muscular spasm and inflammation in the large colon, stomach pain (recurrent and often severe), as well as a pattern of alternating diarrhoea and constipation with no obvious cause. There are three types of IBS, and they are categorised based on the type of bowel movement problems that occur. If you have IBS with constipation (IBS-C), your stools tend to be lumpy and hard; if you have IBS with diarrhoea (IBS-D), your stool tends to be loose and watery; and if you have IBS with mixed bowel habits (IBS-M), you have both hard and loose stools on the same day and can even occur within the same bowel movement.”
Getting Diagnosed Is Complicated
“There’s no definitive test to diagnose IBS. Your doctor will start by ruling out alternative problems, such as coeliac disease, and then to be diagnosed with IBS, you’ll need to have had abdominal pain and discomfort for at least one day per week over the course of three consecutive months and connected with at least two of the following factors: pain and discomfort related to defecation, an altered frequency of going to the loo; or a persistent change in stool consistency. Your doctor may also recommend tests to screen for infection or difficulties with your intestine’s ability to absorb nutrients from meals – these may include a colonoscopy (which examines the full length of your colon) or an upper endoscopy (this is often recommended if coeliac disease is suspected). Your doctor may also carry out a stool test if you have persistent diarrhoea and a breath test, which can determine if you have bacterial overgrowth in your small intestine. Finally, your GP may also carry out a lactose intolerance test. Lactase is a digestive enzyme that helps you digest the sugar in dairy products, and if you don’t generate lactose, you may experience symptoms similar to IBS, such as stomach pain, gas and diarrhoea.”
Anxiety May Play A Role
“IBS and emotions go hand in hand. Studies suggest certain feelings and situations can make IBS symptoms worse, or even trigger an attack. Low mood and IBS are also closely related. Although neither condition is known to cause the other, IBS symptoms can often cause low mood, and vice versa. Furthermore, IBS rates are higher in people with anxiety and panic disorders. If you’re struggling with stress, your doctor may suggest counselling or cognitive behavioural therapy (CBT), all of which can ease IBS symptoms.”
Fibre Is Worth A Thought
“Increasing your intake of dietary fibre from plants is an essential step in treating IBS-related constipation. When it comes to fibre, it’s vital to eat both soluble and insoluble fibre. Soluble fibre, which is found in cereals, fruits, beans and avocados, will soften your stools and make them easier to pass, while insoluble fibre, found in wholegrains, bran, nuts, seeds and vegetables, gives the stools volume, making them easier to pass. If you are increasing your fibre intake, always do so slowly as it may initially trigger increased bloating and gas. It’s possible that you’ll have to make a few adjustments before you get the balance right, and you may find that insoluble fibre doesn’t relieve symptoms as effectively as soluble fibre.”
Medication Can Also Help
“While lifestyle changes are crucial, medication can also help relieve symptoms and may be prescribed by your doctor for a limited period of time. Laxatives, for example, can help to ease constipation, while peppermint oil is a natural antispasmodic that can help calm bowel muscles. Low-dose antidepressants can also prevent too many signals being sent by the nerves supplying your bowel, but these should never be taken as a first line of defence.”
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Camilla Gray, nutritional therapist at Optibac Probiotics, says…
There Are Various Underlying Causes
“It’s not known what causes IBS, but it’s likely to be a variety of different factors. High stress levels definitely play a role, but it could also be down to an imbalance in your gut bacteria, which in itself can be brought on by different factors. One example is post-bacterial infection, which you are more likely to develop as you age, but it’s unlikely you will develop IBS for the first time once you are over the age of 50. Having said that, oestrogen therapy, either before or after the menopause, is a risk factor for IBS. For some, genetics play a role. Relatives of an individual with IBS are two to three times more likely to have IBS, with both genders affected. Although IBS appears to run in families, some studies suggest that there are individuals with sporadic or non-familial IBS, too.”
The FODMAP Diet Could Help
“The FODMAP diet appears to offer some people relief from IBS symptoms. It stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are types of carbohydrates the body struggles to digest, and they may be responsible for the abdominal pain and bloating associated with IBS. The FODMAP diet, however, can be very confusing and complicated, so always discuss with a dietitian before starting. The diet should also not be followed for more than one month as many FODMAP-rich foods are great for feeding your good bacteria.”
Meditation Is Worth A Try
“The link between the gut and the brain (aka the gut-brain axis) has been extensively researched. There is a big nerve, called the vagus nerve, which links the brain and the gut, so if we aren’t happy, then neither is our tummy and vice versa. Taking up a meditation practice is not only good for helping to deal with stress and anxiety, but it has shown to improve pain and bloating scores in up to 57% of participants with IBS in one study.”
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Kim Plaza, nutritional advisor at Bio-Kult, says…
An Elimination Diet Could Be The Answer
“Elimination diets are often popular with IBS patients, especially given that between 70% and 89% of people with IBS report exacerbation of symptoms with specific foods. If you are interested in trying an elimination diet, always do so with a nutritional practitioner – they will most likely recommend eliminating fermentable foods, gluten or chemicals and additives (such as histamines, glutamates and caffeine). Most elimination diets have two phases – the elimination phase, which can last from three to eight weeks, and the reintroduction phase. When reintroducing foods, you’ll need to do so slowly, and it can be helpful to keep a diary and track symptoms. As you complete the reintroduction phase, you should end up with a list of foods to restrict, eat occasionally or consume in smaller amounts.”
Eating Slowly Can Help
“If you eat in a hurry and on-the-go, this can exacerbate IBS symptoms. It’s important to remember that digestion starts in the brain – think about how you salivate when you anticipate a meal or smell delicious food. This is known as the cephalic phase, and it’s during this phase that the body releases digestive juices and enzymes ready to break down the carbs, fat and protein in your meal. If you eat in a rush or when stressed, your body doesn’t have a chance to release these enzymes, meaning you may struggle to digest food properly. This can lead to increased gas and bloating as well as constipation and loose stools.”
Cooking From Scratch Counts
“IBS patients often report an increase in symptoms when consuming additives and sugars, particularly mannitol, high-fructose corn syrup and monosodium glutamate. It’s believed these additives alter the gut microbiome and trigger inflammation. It can therefore help to cook food from scratch at home – this will mean you naturally use less additives and you’ll also stimulate the cephalic phase, which can aid digestion.”
Caffeine Requires Care
“If you’re one of the many who relies on caffeine from coffee, tea, green tea and cola to get a kickstart during the day, it could be worth scaling back your habits. Whilst antioxidants in good quality coffee and tea can offer some benefits to the gut (increasing beneficial bacteria levels), too much caffeine has a stimulant effect, triggering the fight or flight response and the release of stress hormones. This is likely to have a negative impact on IBS symptoms and many sufferers (especially those who suffer with IBS-D) may see an improvement in symptoms if they reduce their tea and coffee intake.”
It Could Be Worth Taking Probiotics
“Looking after your gut health is helpful, whether you suspect you have IBS nor not, as a healthy microbiome supports good gut and immune defences, as well influences mood via the gut-brain axis. Consider taking live bacteria in the form of a supplement – Bio-Kult Advanced was used in a large-scale trial, in which 34% of patients suffering with IBS-D were symptom-free at the end of the four-month trial.”
Tweaking Your Workouts Might Make A Difference
“High intensity exercise may aggravate IBS symptoms, whereas mild-to-moderate exercise may improve some symptoms (especially those with IBS-C). Physical activity may help symptoms by encouraging peristalsis, which is the natural muscular propulsion of contents through the digestive tract. This may help to relax the bowel and ease symptoms. Additionally, taking part in some form of physical activity, whether it be a gentle swim or walking, can be helpful for our mental health and may potentially reduce stress and anxiety levels.”
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For more information visit AmiShewardNutrition.com, OptibacProbiotics.com and Bio-Kult.com.
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