Irritable Bowel Syndrome (IBS) – everything you need to know including 10 tips to help you get it under control
What is IBS?
IBS (Irritable Bowel Syndrome) is the most commonly diagnosed condition by gastroenterologists worldwide with a prevalence of 10-15%. IBS is often given as a diagnosis when other conditions of the gastrointestinal tract – Inflammatory Bowel Disease (IBD), Coeliac Disease and bowel cancer - have been ruled out, but symptoms have been going on for a long time and persist (at least 6 months). Whilst there is no question that the symptoms exist, there is some argument as to whether ‘IBS’ as a condition exists as there are often identifiable and treatable causes of the associated symptoms. These are discussed below.
Although they are two different conditions, you can have IBD and IBS at the same time – research has shown that, even in remission, people with IBD can experience ongoing digestive symptoms, despite low calprotectin readings, so something else is going on, and this is often put down to ‘IBS’.
How is IBS diagnosed?
If you suspect you have IBS and you go to the doctor with symptoms of abdominal pain, bloating or change in bowel habits (more constipated or more loose poos!), and you have bloating, your symptoms are made worse by eating or you have mucus when going to the loo, a doctor will usually run some basic tests to rule out anything else. This might include a blood test (full blood count, CRP (C-reactive protein to look for inflammation in your body) and antibody testing for coeliac disease) and in some cases a stool test (poop in a pot!). If these all come back fine but you are still experiencing problems, you may be diagnosed with IBS.
What happens next?
Your GP may suggest some general diet or lifestyle changes or in some cases suggest some medication to help with your symptoms like anti-spasmodic’s (to help relieve cramping), antidepressants used for pain, loperamide (Imodium) or alosetron (Lotronex) for reducing diarrhoea, and soluble fibre for constipation predominant or mixed IBS. However, many people continue to experience ongoing problems because the underlying causes of the digestive symptoms are still present and not being addressed.
Just because you have been diagnosed with IBS does not mean this has to be a life sentence. These treatments can be really helpful in relieving some symptoms but they don’t solve what’s causing the symptoms in the first place. Digestive symptoms usually have root causes, and can be due to any of a number of different factors, including:
Dysbiosis (imbalance of the microbes in the intestines)
SIBO (Small Intestinal Bacterial Overgrowth - an abnormally high number and/or type of bacteria in the small bowel)
Parasitic infection
Insufficiency of digestive enzymes (exocrine pancreatic insufficiency) (IBS-D)
Low grade inflammation
Bile acid malabsorption
Food intolerance’s (e.g. Lactose intolerance or non-coeliac gluten sensitivity (NCGS))
Vitamin D deficiency
Poor diet
Stress
Sleep disruption
Physical inactivity
Its only when we investigate these symptoms further that we are able to identify what triggers them, then work to tackle them and quality of life can dramatically improve.
The steps taken to reduce symptoms will depend on the driving forces behind them. This is where working with a nutritionist or dietician who specialises in gut health and IBS can help you to work out what is causing your symptoms then how to tackle these areas to improve symptoms.
To get you started here are my 10 simple tips to help your IBS:
Keep a food & symptom diary - Even if just for a short time this can be a helpful tool to track any patterns with the food we eat and our symptoms. What can also be extremely helpful is to also note down other factors including lifestyle factors (stress, sleep, menstrual cycle, etc.) that might be contributing to our symptoms then we can see if we notice any patterns. It doesn't have to be extensive, even just quick notes in your phone will do.
Do not exclude food groups or follow restrictive diets without first consulting a registered nutrition professional - There is so much information out there at the moment on different diets that claim to 'cure' IBS type symptoms but please do not embark on any kind of restrictive eating pattern without seeking proper advice first as to whether it is right for you. Firstly, excluding food groups without proper guidance could lead to nutrient deficiencies, and secondly, following a diet like the Low FODMAP diet for a long period of time, without proper supervision around reintroduction of foods, can actually have negative impacts on the diversity of microbes (reduced bifidobacterium species) and gut health in the long term.
Take a look at your eating patterns - Eating big meals may not suit some of us who have IBS or digestive symptoms. Taking a look at our eaten patterns and adjusting them may help - i.e. if you are someone who only eats one or two big meals a day, eating smaller meals more regularly may help reduce bloating and symptoms. On the other hand, if you are someone who is constantly grazing, try eating 3 proper balanced meals and have a break between each one to give your digestive system a rest.
Mindful Eating - Remove any distractions whilst eating - put your phone away, close down your computer and focus entirely on the food in front of you. This helps our digestive system to register we are eating and will in turn help to ensure we secrete our digestive enzymes to help break down our food properly so we can absorb all the important nutrients. If we mindlessly eat our meals, not only may we overeat, but we may not be breaking down and digesting our food properly which can lead to undigested food causing problems like gas production and bloating further down our digestive tract. Why not try 1 Mindful Meal to start with - perhaps it will be lunch for you; chose your meal and commit to eating it mindfully with no distractions, notice the different colours, textures and flavours.
Chewing - This might seem like an obvious one but you’d be surprised at how many of us don’t chew our food properly, particularly when we are not eating mindfully. Try chewing each mouthful for 20-30 chews. Although simple, this tip can make a huge difference. Chewing not only mechanically breaks down our food, it also enables some enzymes in our saliva to be mixed with the food to help start breaking it down. Chewing also helps signal the stomach and pancreas that food is coming so they release acid and enzymes respectively to further break down our food so it is ready to enter our small intestine where nutrients are absorbed.
Manage stress - Stress can not only impact our mental health but it can also have a huge impact on our second brain, our gut. I know it is not possible to remove all stress from our lives but it is important we learn to manage stress and give ourselves time to rest and recover if we are having a particularly stressful time. Stress can negatively impact our gut microbes, gut movement, gut secretions and so much more so stress management is very important. Try an app such as Headspace or Calm for guided meditations. Taking a little walk around the block and doing some deep breathing exercises (in for 4 seconds, out for 6 seconds) before we tuck into our meals can help us get out of our fight and flight and into our rest and digest state.
Fibre - We should be having around 30g per day of fibre but on average, in the UK, we only get around 17-18g. We get fibre from foods like wholegrains, fruit, vegetables, nuts, seeds and legumes. Fibre is so important to keep our bowels moving, to feed our gut microbes and its also important for a healthy heart and maintaining a healthy weight. Aiming to have at least 5-7 portions of fruit and vegetables per day (e.g. 5 veg and 2 fruit) can help us to increase our fibre intake. Swapping refined grains (white bread, white pasta etc) for wholegrains can also help, as can adding beans, pulses and lentils to our dishes. It is important we increase fibre slowly rather than going from very little to lots very quickly to avoid unwanted side effects (bloating and flatulence) so try increasing the amount over a few weeks. NB: There are some people who suffer with IBS and digestive problems who find certain foods worsens symptoms, particularly certain types of carbohydrates found in foods like onions and garlic. If this is you it’s important to get proper help and guidance from a qualified nutrition professional. In addition, increasing fibre may not be suitable for some people with IBD who have strictures (narrowing of the bowel).
Try Yoga - Studies have shown the effectiveness of yoga in helping to control IBS and digestive symptoms. Yoga not only helps us move our body but it also helps us breath and calm our minds. If you’re not sure where to start head over to YouTube and have a go at some beginners videos from the comfort of your own home. Sophie Dear Yoga and Yoga by Adrienne are great places to start.
Avoid Tight Clothing - Tight and restrictive clothing around our tummy’s may restrict blood flow and the movement of our digestive tract. People with IBS and tummy troubles may also be more sensitive around the abdominal area so tight clothing may feel uncomfortable and make symptoms worse. So, try avoiding tight jeans/trousers, tights or leggings; wear more loose fitting clothing and see if you notice a difference.
Get help - If you are struggling with your digestive symptoms and IBS, please don't suffer in silence - get help. There is so much we can do to help. Health can never be a one size fits all and what works for one of us may not work for another but seeing someone will help you find the best way forward for you personally. I see so many people who wish they had got help earlier and not lived for years suffering in silence.
If you need help getting to the root cause of your IBS symptoms, I can help. How do you know if this is right for you? Lets chat and find out. We can have a (free) 20 minute no obligation phone call. I’d love to hear about you; your journey, your struggles, your life, and we can chat about the best route forward for you. If that sounds interesting click here so you can find a time that works for you for us to chat.
NB: I see all clients via video call so it doesn’t matter where you live in the UK or the world and we can get started straight away.