What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) has recently been reclassified as a disorder of the gut-brain-interaction. It is a condition which is accompanied by a range of gut symptoms, where no organic or structural cause has been found. These symptoms include recurrent abdominal pain, accompanied by altered gut habits.

IBS is usually categorised into subgroups, which is based on your bowel habits:

• IBS-D (Diarrhoea predominant)

• IBS-C (Constipation predominant)

• IBS-M (Mixed bowel habits)

• IBS-U (Unclassified)

This is very common condition, currently affecting 1 in 5 adults.

Symptoms

Symptoms and severity vary from one person to the next.

• Altered bowel habits (straining, urgency, incomplete evacuation, excess mucus)

• Bloating or abdominal distention

• Cramps

• Increased flatulence

• Heartburn

• Reflux

• Fatigue/lethargy

• Backache

• Bladder symptoms

• Anxiety/stress

Causes

The cause of irritable bowel syndrome is currently unknown, and can be different for each person. Some have their symptoms start suddenly, whereas others can get progressively worse over time.

There have been recent studies to suggest that the traditional western diet and highly processed foods could play a part however. This is because ultra-processed foods are on the rise, and so is IBS. Additionally, some research has reported that those with worse IBS, tend to have a higher intakes of lesser quality foods in their diet (ultra-processed foods).

There have been some established links that are thought to increase your likelihood of developing IBS:

• Genetics

• Microbiome changes (bacteria in the gut)

• Gastro infections

• Increased gut sensitivity (visceral hypersensitivity)

• Female hormones

• Anxiety and stress

Diagnosis

Irritable bowel syndrome (IBS) diagnosis is usually considered if someone had abdominal pain or discomfort related to opening your bowels or altered bowel habits.

IBS is diagnosed by the exclusion of other conditions such as coeliac disease and inflammatory bowel disease (IBD). This is because other gastro conditions have very similar symptoms to IBS, however the treatment is very different. So, it’s important to get a confirmed IBS diagnosis.

Coeliac tests are usually done through blood tests. It is essential that your diet prior to the test contains adequate gluten (2-4 slices of gluten containing bread for 4-6 weeks).

• The coeliac test will check your ‘Tissue transglutaminase (TTG)’ and ‘Total IgA’.

Inflammatory bowel disease tests (for ulcerative colitis and Crohn’s disease) are usually done firstly through blood and stool tests.

• The blood test will be looking for inflammatory markers in the blood. If these are raised, this indicted the need for further testing.

• The stool test will be looking at the ‘faecal calprotectin’ levels. Again, if this is above a certain level it will indicate the need for further testing.

Symptoms that are not related to IBS include:

• Rectal bleeding

• Unintentional weight loss

If you have a family history of bowel or ovarian cancer, this needs to be considered. Furthermore, if you’re over the age of 60 and have looser stools or altered bowels for more than 6 weeks; this needs to be further investigated.

Dietary management of IBS

There are several dietary and lifestyle modifications that have been shown to help improve symptoms. Irritable bowel syndrome (IBS) is a chronic condition where symptoms can fluctuate. Especially in women, where hormones fluctuations will directly affect their gut symptoms.

Therefore, there is not necessarily a cure or solution, however there are strategies that make it more manageable and give the IBS sufferer an element of control.

The low FODMAP diet

The FODMAP diet is a well-known approach for IBS suffers. However, this is an option we tend to explore last. This is because the diet itself is very restrictive. It includes 6-8 weeks on a very restrictive diet, then an additional 6-10 weeks reintroducing each individual food and finding out what a persons individual triggers are. It is also only effective in 70% of people.

Less restrictive dietary modifications have been found to be similarly effective, and non-dietary approaches have additionally been shown to be as effective as the FODMAP diet, such as yoga or hypnotherapy.

Additionally, the restrictive element to the low FODMAP diet can worsen anxiety, which we know in turn can worsen IBS symptoms. Therefore, we would explore other dietary changes first.

‘First Line’ Dietary Modifications

Here are some common changes shown to be effective for IBS management

• Try to establish a regular eating pattern: Often when IBS people are experiencing symptoms, they tend to skip meals to try and help their symptoms. However, this can often worsen the issue.

• Limit caffeine intake to 1-2 drinks per day & focus on un-caffeinated fluids

• Reduce intake of fatty foods, spicy foods & alcohol: Fatty and spicy foods have been shown to trigger IBS symptoms, try limiting how often you eat these foods and see if it makes a difference. Equally, alcohol is a gut irritant, so keep this within healthy guidelines of 14 units/week

• Avoid Sweeteners: Specifically, sorbitol, mannitol, xylitol. This tends to be found in chewing gum, sugar free sweets and fruit squash (the drink).

• Consider gradually increasing your fibre intake: This one’s a tricky one, as each IBS sufferer is different. Therefore, you may have to work with a dietitian to find out exactly which fibres work for you. Evidence is showing however that a lack of plant based fibrous foods may be worsening our IBS and gut health. So, I would encourage making sure you’re getting the right fibre in your diet.

• Spread fruit throughout the day: Some people struggle with too much fruit at once, therefore it could be helpful to keep to a palm sized portion each time and spread these throughout the day.

Non-dietary approaches

• Regular Exercise: Whatever exercise works for you, it could be walking, yoga or cycling. There has been a lot of evidence around yoga for our gut health. Additionally, sometimes high intensity exercise could worsen symptoms. So find what works for you.

• Sleep: An important link has been found between sleep and gut health, so make sure you’re getting enough sleep.

• Meditation or mindfulness: Taking time to relax can really help our gut-brain connection, and in turn help our gut symptoms.

• Gut focused hypnotherapy: A growing area that again works on the stress in our life and restoring that gut-brain connection

Takeaway message

Irritable bowel disease is a challenging condition. For some it can be frustrating to find there is no organic cause to your gastro symptoms. Additionally, when it comes to treatment, unfortunately it’s not one size fits all.

It’s important to work with a dietitian who is experienced in the area and can look at numerous options to help manage your symptoms.

If you’re suffering with this condition and need help. Book now with myself and we can go through your clinical history, any test you have had and your symptoms. We can work together to reduce your IBS symptoms, and food freedom. It will also give you the skills and confidence needed to manage your symptoms in the future.