• The Coeliac Nutritionist

Irritable Bowel Syndrome (IBS) - An Overview

A lot of you may have heard of IBS, but what exactly is it?

IBS is a functional gastrointestinal disorder. What that means is, there is no actual mechanical issue in the gut, but there are still gastrointestinal symptoms like bloating, cramping, excess wind, constipation, diarrhoea and general discomfort. IBS has a significant disease burden, can be very uncomfortable to live with and research has shown can affect quality of life and increase absenteeism from school or work.

IBS affects around 12% of the global population and around 1 in 5 people in the UK.

If you already have a gut disorder e.g. Coeliac Disease, you can still have IBS alongside this.

What causes it?

The exact cause of IBS isn’t fully known. Some suggested factors includes:

- Food passing through your gut too quickly or too slowly (gut motility)

- Disturbed gut microbiome (balance of good and bad gut bacteria)

- Leaky gut

- Gut immune function

- Approximately 1 in ten patients with  (IBS) believe their IBS began with an infectious illness.

- Oversensitive nerves in your gut

- Stress (brain-gut interactions)

- Family history

Due to more research, chronic, low-grade inflammation has now been linked to the disease. This has only come to light recently with advances in testing technology. Previously, in most patients with IBS, routine examinations did not reveal significant gut abnormalities.

So how is it diagnosed?

There's no specific test for IBS, so usually what your GP will do is firstly rule out other gut disorders with similar symptoms such as Coeliac Disease or Inflammatory Bowel Disease like Crohns Disease. They may also check a stool sample for infection. What is also usual is a GP will determine the predominant symptom i.e. IBS with diarrhoea, IBS with constipation or mixed IBS - as this can play an important role in the selection of diagnostic tests and treatments.

How is it treated?

A common misconception is that IBS symptoms solely stem from the foods you are eating and many patients are quick to solely put the blame on perceived irritants or allergens such as gluten or dairy. But whilst diet plays a role, other lifestyle elements are of equal if not more importance in management of the condition. Management is optimised by an individual and holistic approach that embraces ALL elements of the patients life. Various dietary, lifestyle, medical and behavioural interventions have all proven effective in clinical trials.

IBS and Diet

Diet is one way people try to manage IBS symptoms but it should not be the only way. A logical approach is to avoid the foods that trigger symptoms. The low FODMAP diet is now commonly used by Dieticians and Nutritionists to treat or manage IBS symptoms which was developed in Australia. and has shown promising results. In fact one study found that 76% of IBS patients following the diet reported improvement with their symptoms. FODMAPs are a collection of poorly absorbed simple and complex sugars that are found in a variety of fruits and vegetables, pulses and also in lactose and sweeteners They can create bloating, gas and discomfort particularly in the small intestine and increase fluid in the bowel. The main culprits are foods such as cabbage, broccoli, cauliflower, brussel sprouts, beans, onions and dried fruit. The diet specifically involves reducing high FODMAP food for four to eight weeks and then re-introducing them using a specific protocol. Participants then follow a FODMAP modified diet, particular to their circumstances. This diet is thought to work in around 3/4s of patients. This diet should always be done with the help of a professional in this area, as major foods are being cut or restricted.

Other dietary advice recommended is to increase how much soluble fibre you eat – good foods include oats, pulses, carrots, peeled potatoes and linseeds. Drink plenty of water - especially if constipated as it will help to make your stools softer and avoid products containing sorbitol the sweetener as this is an irritant. Fizzy carbonated drinks can tend to cause bloating and coffee, tea and many energy drinks contain caffeine, which may stimulate colonic spasms. Alcohol can irritate the gut and may cause diarrhoea. I would recommend not drinking more than two units per day and have at least two days a week off.  

IBS and Probiotics

I regularly get asked about probiotics in IBS management. Some research suggests an increase in healthy bacteria may help to reduce stomach bloating, cramping and stool frequency, for those with a diagnosis of IBS. However I would recommend discussing probiotic use in detail with a qualified Dietician or Nutritionist. Probiotics should never be used in place of a healthy balanced diet and I would always recommend attempting dietary and lifestyle changes first before considering probiotics as your main form of management of the disease. Furthermore the success of probiotics is heavily dependant on choosing the correct strain of bacteria. If you are not clued up on this you may end up taking the incorrect strain for your exact symptoms.

The website is a useful website to decide which probiotic is best for your particular symptoms. It is a little complicated so do ask a Dietician or Registered Nutritionist for advice if you need to.

Do also remember you can find probiotics naturally in a number of foods. For example, eating cultured dairy products and fermented foods can help. Look out for yoghurts, kefir, pickles and sauerkraut.

IBS and Stress

There is strong evidence that IBS is a stress-sensitive disorder. Therefore, the treatment of IBS should pay much attention to managing stress. Traditionally in the past medical interventions such as laxatives or peppermint capsules have been used however they do not necessarily give permanent relief and so non-medical approaches are now getting more and more attention. Stress has been shown to increase movement of stools and sensation in the colon to a greater degree in IBS patients compared to healthy individuals. There is a complex interaction between the brain and the gut known as the Gut-Brain Axis which has been linked to anxiety and depression. Working alongside a health professional and trying different stress-busting techniques may help ease your IBS symptoms. Techniques include Mindfulness, deep breathing exercises, meditation and practising gratitude. The most recent study this year lead by Bruce Naliboff at UCLA’s David Geffen School of Medicine followed 68

IBS patients through an eight-week mindfulness-based stress reduction class. More than 70% of participants in the study reported a reduction in the severity of their IBS symptoms following the training, and benefits continued three months after its conclusion. The mental health charities all have great resources on these techniques.

In some cases if symptoms are so severe, or other interventions are not working, following discussion a GP may prescribe an anti-depressant or a referral to cognitive behavioural therapy.

Hopefully this was a useful overview for IBS and its management. If you have any concerns about gastrointestinal symptoms which are not normal for you do seek medical advice.

Thanks for reading,

The Coeliac Nutritionist NI

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