Irritable Bowel Syndrome (IBS) – what you need to know

The reality is this is a real problem for a lot of people. Historically (and maybe still) Irritable Bowel Syndrome (IBS) is the phrase left echoing in your ears when a whole barrage of tests have concluded nothing in particular. Relieved on the one hand that there isn’t chronic inflammation or a tumour in your bowel but on the other hand faced with the reality that you’ve still got to get through the day with unpredictable bowel habits, a stomach prone to inflation and most probably a whole heap of pain or discomfort that you’re supposed to just deal with.

As dietitians too historically we’ve had a heavy heart when seeing those words on a referral. So desperate to help but not quite having the solution to hand.

The gut is the most complex organ we have. Food digestion is the same in every gut – that’s what all the tests are for – to clarify that your gut still looks like the text book and if you have any of these symptoms, it’s advisable to get some basic tests done to rule out any underlying causes. In an IBS gut when it interacts with foods eaten, it goes a bit do-lally – here we have a functional bowel disorder which is the fancy term for IBS.

There have always been plausible explanations for why in some individuals too high an intake of caffeine, alcohol, spicy food or fatty food for example, causes unpleasant gut symptoms. If these are the culprits a relatively straight forward remedy is to remove or control them in the diet.

But for many more sufferers the reason for symptoms has remained a mystery and the research fellows have continued their quest to further understand food-gut interactions. This lead to the discovery of fodmaps…

Fodmaps is the collective term for short chain carbohydrates, which are the broken down components of certain foods – we can’t digest them so they make their way on into the large bowel (colon) where they represent the weekly Sainsbury’s shop for our trillions of bacteria. Our large bowel deals with all the ‘leftovers of life’ – for anything up to 16 hours! The bacteria, perfectly at home there, are as unique to us as our finger prints so it not surprising they may have more power than we first thought.

The feeding frenzy is the same for everyone but for those with a sensitive bowel wall, pain and bloating are experienced. This is partly due to water being drawn in earlier up in the bowel which then expands pressing on the nerves and secondly due to the excessive gas produced by the bacteria feeding. The acronym stands for Fermentable Oligosaccharides, disaccharides, monosaccharides and polyols. You see now why we shorten it!

The speed with which food moves through the gut also differs and this can also cause altered bowel habits in IBS, for example diarrhoea, constipation or a combination!

Now let’s throw in another curve ball, stress or anxiety in all its shapes and forms.

Being told your symptoms are in your head or that your stress levels are causing your symptoms is largely unhelpful and frustrating to hear but the brain-gut axis is a powerful highway and it goes both ways.

Nerves in the gut can become highly sensitive when stress signals from the brain are being fired all the time. Stress felt in the head, plays out in the gut and when the gut is irritated, its connection to the brain can make life really unpleasant in terms of the pain and discomfort you then register.

These pathways become learnt so even after stress has passed, it may still have an influence on how your gut behaves. It is also believed stress influences our bacterial buddies – killing off the good guys and encouraging the bad guys to thrive. This is another way in which the effects of stress can linger for longer than you’d imagine.

So we can’t ignore the influence of our brain and its potential to create over-zealous signalling in response to its own stressors and clearly this needs a more holistic treatment approach. For many though, dealing with the food culprits causing the problems in the bowel, can help to ease symptoms.

And so to the nitty gritty, if you ignore the rest of this blog remember this bit:

  • Fodmaps are found in a broad range of foods from bread to onions; apples to yogurts. You may wrongly be thinking other food components are the culprit e.g. gluten. Unpicking the science and tailoring it to you is what usually gets results, not blanket food avoidance of major food groups with a lack of nutritious alternatives.
  • Please, please do not get fobbed off by your GP telling you to look on the internet – a A4 sheet is not the same as a dietetic consultation
    – it’s a complicated sometimes over whelming diet which needs to be tailored – use us that’s why we’re here. Fodmap content of foods will also vary from country to country.
  • You do not need to remain on a low fodmap diet for life – the structured reintroduction programme allows you to identify your personal threshold of tolerance – and with that power to control your symptoms. If you don’t do this bit, it can stay harder than it needs to be for longer. Again, don’t go it alone. Seek advice.
  • Fodmaps can be thought of as the bricks in this ‘treatment house’ we’re building so if your foundations consist of terrible dietary habits – wolfing food down at speed, high fat, high caffeine, lots of spice all washed down with too much alcohol then you’d be wise to address these and your lifestyle first!
  • Alongside dietary changes, consider strategies to manage your emotional well-being too.

The future

You will be able to get to know your bacteria as well as your hair. What is our unique bacterial finger print and most importantly what impact is it having on our health? If we can identify it, we can manipulate it!

People with IBS have been shown to have lower levels of Bifidobacteria – these are the good guys so that’s quite an interesting find. We do not yet know which came first – did the IBS cause the lower levels of bifido or did the lack of them lead to IBS. We also don’t know if supplementing would make a difference.

Hence why this blog is probably part one…

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