I haven’t posted on here in such a long time & I’m truly sorry. Exams & general life responsibilities, like having to earn money to live, have just took over my life. I am back though & I am going to share some information with you regarding IBS and it’s dietary management.
I recently had to write an essay for my masters degree on the dietary management on IBS so whilst its at the front of my mind & i have numerous practice essay’s written out about it, I thought I may as well share this with you. IBS can be a seriously debilitating syndrome with it effecting 15% of the population. It is one of the most common gastrointestinal disorders, with symptoms including abdominal bloating, abdominal pain and changes in bowel habits. IBS is also often associated with anxiety. To make this clear, anxiety has previously been thought to be the main cause of IBS, however research is beginning to highlight that this is not the case for the majority of people affected. There are people however who can benefit from psychological techniques to manage their IBS such as cognitive behavioural therapy or hypnosis. This kind of management tends to be a last resort when all other options are exhausted.
If you suspect you have IBS, it is so important that you go to your GP clinic to get checked out and have a proper diagnosis confirmed. Causes of IBS are multifactorial in nature and proper checks need to be done to make sure there is nothing else causing your problems. Your GP will usually run routine blood tests to rule out inflammation within the bowel and possible coeliac diagnosis. They can also make sure noting more serious is going on especially if you present with ‘red flag’ symptoms. Once all that is ruled out your GP will probably discuss general lifestyle changes with you. These can include drinking more fluids. You should aim for approximately 2 litres of fluid per day to keep well hydrated to allow all your bodily processes working as they should.
They may also discuss your fibre intake with you. Fibre intake is such a personal thing to each individual and many people will react to an increase in fibre intake compared to those who find it beneficial. Little evidence has been shown for an increase in fibre intake vs controls within clinical trails. Fibre supplements also provide little benefit. Wheat bran has been shown to worsen symptoms through increased fermentation within the bowel, causing nasty side effects such as bloating and gas. Psyllium husk supplements have been shown to have beneficial effects in some individuals and are favoured over insoluble fibre sources.
Food intolerance has also shown to be component for IBS. An intolerance to food is NOT the same as an allergy. An intolerance takes a few hours to days to evolve and symptoms will differ in severity for each individual. It also takes larger quantities of the food in question to create a response. IBS has also been shown to occur after a gastrointestinal virus or a large intake of antibiotics, therefore possibly having a causation factor of altered gut bacteria. Interestingly, atopic skin conditions are largely seen present in association with those who have IBS. Probiotic supplementation have been shown to have positive effects in studies but larger studies are still required. The idea is that the ‘good’ gut bacteria are reduced compared to the ‘bad’ bacteria in your gut. Examples of ‘good’ gut bacteria are Lactobacillus and bifidobacterium ( so hard to pronounce and to learn to spell!! ). These ‘good’ bacteria help assist transit time and motility within the gut and produce fatty acids as by products. They also play a huge part in the immune system, which is largely found within the gut.
IBS management from dietary change can include elimination of foods called ‘FODMAP’s’. This MUST be done with guidance of a qualified professional and is only meant for a short term option to find food culprits. FODMAP’s stand for fermentable oligosaccerides, monosaccharides and polyols. The idea is basically that these carbohydrates create fermentation within the gut by not being fully absorbed within the small intestine. Examples of FODMAP’s include wheat (fructans), lactose, fructose and sorbitol (polyols). Lactose is found in milk products and some people may have trouble hydrolysing and digesting certain amounts of this sugar, same goes with fructose however this is found in fruit products such as dates, mango (basically all the delicious fruits that are normally good for you), it is also found in products which contain high fructose corn syrup and many fizzy drinks beverages. The fructose when digested in a healthy person does not need breaking down and should be rapidly taken up into the small intestine. It can be co transported with glucose. 1 in 3 adults with IBS have trouble up taking loads higher than 25-50g of fructose and it will travel through to the large intestine where it will cause a whole load of trouble including luminal distention and fermentation.
The way to reduce these effects is to cut down on these sugars daily. Then you can gradually introduce them after a two week period to see how your body reacts. One study showed that 74% of IBS patients had improvement in symptoms with this kind of diet. Again please seek advice from a qualified health professional if you are experiencing these symptoms, this is only for knowledge and information, not to be used as a guide for self treatment. Small intestinal bacterial overgrowth is also a condition which is gaining more light. This condition is normally recognised with a hydrogen breath test and is normally associated with a longer duration of symptoms, which may mean that it occurs due to having IBS for a a longer period of time, not that it is necessarily a cause itself. Treatment for this condition has also been shown to have benefits, but much more research is required.
Food intolerance elimination again should be done under supervision to make sure you are getting essential nutrients and a healthy balanced diet. Gluten has gained a lot of attention in regards to being a big culprit of food intolerance and this differs again on an individual basis. Gluten sensitivity is NOT the same as coeliac disease. Within coeliac disease the smallest particle of gluten protein can cause an autoimmune reaction and cause devastating symptoms in the small intestine of an individual. Saying this a food intolerance should not be taken lightly either, especially if its causing debilitating symptoms. Non – coeliac gluten sensitivity is a new area of research and there is currently minimal evidence. Some studies have however shown that a gluten containing diet can reduce the amount of bowel movements daily and increase permeability of the bowel but much more high quality evidence is required in this area.
NICE (national institute for clinical excellence) guidelines suggest lifestyle adjustments, physical activity, relaxation, medication and diet are all possible treatment options and each one has benefits in their own rights. They also suggest taking time eating, watching fizzy drink/alcohol intake and cutting down of processed foods as to aiding with symptom control. These guidelines should be adopted and considered for a balanced healthy lifestyle IBS or no IBS.
I hope you found this useful & hopefully helpful to those in need. If you have any questions just give me a message and i’ll be sure to get back to you.