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Irritable Bowel Syndrome

Irritable Bowel Syndrome or IBS can be recognised by one or more of the following symptoms:

– abdominal (gut) pain and discomfort
– wind (burping or flatulence)
– abdominal distension (bloating)
– altered bowel habits (ranging from diarrhoea to constipation, or alternating between the two).

Some of the factors contributing to IBS can be foods, stress, altered digestive bacteria, medications and caffeine. If you suspect that you have IBS, speak to your doctor about your symptoms (don’t worry, they have heard it all before!).

Irritable Bowel Syndrome is one the most common disorders of the gut and affects the health and well-being millions of people around the world every day. One in seven adults suffers from the debilitating symptoms. IBS is more commonly diagnosed amongst women than men, and IBS is usually diagnosed between the ages of 30 and 50 years. Why don’t we hear more about IBS, when it is more common than diabetes, heart disease or cancer? Well, who wants to tell everyone about their bowels, right?

Anyone can suffer the symptoms of IBS to some degree. Think about it, don’t we all get gassy after eating baked beans or get a bit bloated after too much bread? This is because all humans don’t fully digest fructans and galacto-oligosaccharides (GOS), but people with IBS are more sensitive to them, resulting in symptoms. Some sugars (fructose and lactose) and sorbitol draw extra fluid into the gut, causing diarrhoea and abdominal pain in people who have more sensitive digestive systems.

There are two types of IBS – diarrhoea type and constipation type. Some unfortunate people have both! It is possible to suffer from both constipation and diarrhoea in quick succession because their causes are different. The feelings associated with diarrhoea could include gut pain, cramping, urgent need to use the toilet, lack of control over the bowels or even lack of sensation that bowels are opening. Alternately, people with IBS may feel constipation symptoms including extreme pressure, pain and bloating in the abdominal/gut area. People with IBS tend to have highly sensitive gut nerve endings, meaning they are extremely sensitive to any extra gas or fluids in the gut. If their brain ‘listens’ and over-reacts to the messages sent to it from the nerves of the gut, people with IBS might feel as though they have a balloon pumped up in their gut.

IBS can be tricky to diagnose because it relates to the functioning of the digestive system, not gut structure. IBS cannot be diagnosed via blood tests or exploratory investigations. The first ever image of an “irritable bowel” was published recently and can be seen here. Often people with gastro-intestinal symptoms will have had some investigations to see if there is anything structurally causing their gut symptoms, and if these are all clear, then the symptoms and absence of any other condition result in a diagnosis of IBS. Breath tests can be used to find out if lactose, fructose, sorbitol and mannitol malabsorption might be triggering IBS symptoms. This can be done by a pathology service or using a home testing kit.

Lifestyle and life events that might cause unhelpful changes to gut bacteria include:

– Stress wiping out good bacteria
– Poor dietary habits – particularly low fibre intake
– Cutting out “carbs” – reduces “food” for bacteria
– Antibiotics wiping out both good and bad bacteria.

Other lifestyle factors that contribute to IBS are things that increase “visceral hypersensitivity”. Your gut and brain are linked together by the gut nervous system. This means that anything happening in your brain (stress) can impact on your gut and anything happening in your gut can impact on your brain (usually in the form of pain). So, emotional stress, anxiety, chronic pain and lack of physical activity could all contribute to IBS. If we can “dull down” the signals between the gut and brain, your IBS symptoms may reduce.

IBS does tend to run in families. Whether this is because IBS is hereditary or the causes of IBS are hereditary is less clear. For example, there is evidence that anxiety is hereditary and anxiety is closely linked to IBS, so it is hard to determine whether the IBS itself is hereditary. Anecdotal evidence does suggest a hereditary relationship; as many IBS sufferers who embrace a FODMAP approach then go on to recommend it to both older and younger generations of family members who suffer similar symptoms.

Here are some interesting but painful facts about Irritable Bowel Syndrome:

– 10% of General Practice (GP) doctors’ visits relate to IBS
– Between 20% and 50% of Gastroenterologist visits relate to IBS
– IBS is the 2nd most common cause of work absenteeism
– People with IBS have 50% higher medical costs than the general population
– IBS sufferers rate their quality of life as poorly as those people suffering Chronic Kidney Disease
– The usual age of diagnosis of IBS is between 30 and 50 years (although many have symptoms for a long time before diagnosis)
– IBS is diagnosed more often amongst women than men. However, this may relate to men not presenting to doctors for bowel and wind related conditions rather than a difference in IBS rates!

FODMAP

FODMAP is an acronym to explain the carbohydrate (various types of sugars) part of foods that are not well absorbed in the small intestine and pass through to the large intestine.
Fermentable
Fermentable means bacteria in the lower part of the digestive system break down undigested carbohydrate to produce gases (hydrogen, methane and carbon dioxide). These gases contribute to the pain and smell of resulting wind that can be associated with IBS.
Oligo-saccharides
“O” as in “Oh my goodness”, was that me? We all know that baked beans give people wind, but this is much more severe in those with IBS. This Includes:
– Fructo-oligosaccharides (FOS) found in; wheat, rye, onions and garlic
– Galacto-oligosaccharides (GOS) found in ; kidney beans, lentils, baked beans, chick peas and other legumes/pulses.
Di-saccharides
Lactose is the “double sugar” in; milk, soft cheese, yoghurts that can be broken down by bacteria, enzymes or fermentation. This does not happen too well in some people, and can affect others temporarily after illness.
Mono-saccharides
Fructose (in excess of glucose) found in honey, apples, high fructose corn syrups, fruit juices, dried fruits, sweet wines.
And
Polyols
Sugar polyols (eg. sorbitol, mannitol) found in some fruit and vegetables and used as artificial sweeteners.

IBS FAQ

A low FODMAP diet is the proven dietary approach to managing IBS. You take FODMAP containing foods out of your diet TEMPORARILY to relieve your IBS symptoms, before gradually re-introducing these foods until you achieve a good balance between diet variety and symptom relief.

There are a wide variety of foods from every food group that you can choose to replace FODMAP containing foods. The grain foods staples will be rice, corn, quinoa and some oat based foods. Low FODMAP fruits include banana, strawberries, rockmelon and oranges. Lots of vegetables have a low FODMAP content, including potato, beans, capsicum, carrot and tomatoes. In the dairy food group, lactose free varieties of milk and yoghurt are recommended, along with hard cheeses. Most meats are suitable, except those that contain onion or garlic seasonings. There is plenty to choose from, it’s only temporary and most people find that the benefits from symptom relief far outweigh the dietary limitations. Each of the Gut Feelings programs gives specific advice about what foods to include, and which to avoid.

The low FODMAP diet has an overall success rate of about 80% for people with IBS. The other 20% often have additional health issues, or medication requirements that make it more difficult to achieve complete symptom relief. So, the odds are fairly good, and certainly make the low FODMAP diet worth a try for people suffering IBS symptoms. The success rate for people who have completed the Gut Feelings programs is approximately 90%, largely because they have been guided through each step of the process in precise detail.

Yes and no. Yes, it is the same in that we start by avoiding the same high FODMAP foods, and no in that the food choices that people make while on the low FODMAP diet could be completely different. Individual responses to the low FODMAP diet might also differ depending on how severe the IBS is and whether they suffered constipation type IBS or diarrhoea type IBS.

No, we would not wish that on you! Gut symptoms amongst people who have tested negative for coeliac disease were previously considered to be “gluten intolerance”. This was because these people seemed to respond well to a gluten free diet. We now know that what was considered to be intolerance to the protein component of wheat (gluten) was actually a reaction to the carbohydrates (fructans) in wheat (and many other foods) that resist normal digestion.

gluten

To start with we ask you to go as low as you can go! The lower in FODMAPs your diet is, the sooner you will get relief from IBS symptoms. It is equally important to expand your food range again until you find a balance between food variety and symptom relief – what we call your “FODMAP threshold” which we cover in the 3rd and final program.

The first stage is called the Low FODMAP Fortnight, which includes just two weeks of eating low FODMAP foods. For those with severe IBS it might take a bit longer for symptoms to settle, but for most people two weeks is plenty. IBS symptoms occur in response to the foods moving through the digestive system at the time, so taking FODMAPs out of the diet should reduce these symptoms within days, not weeks or months. Improving overall gut health can take a bit longer, but most people are willing to tackle that once they are symptom free.

No, it is better not to be on a very low FODMAP diet for any longer than you need to be. If you don’t have a very high “threshold” for FODMAPs, then there are other approaches that are investigated in the Gut Feelings programs to help increase that tolerance for FODMAPs. A long term low FODMAP diet will not contribute to digestive health, because FODMAPs are actually prebiotics, so they are helpful to gut health.

The best possible outcomes will be achieved by addressing diet as well as physical and mental health. The non dietary approaches to IBS relate to numbing the “visceral hypersensitivity”. This means that anything happening in your brain (stress) can impact on your gut and anything happening in your gut can impact on your brain (usually in the form of pain). If we can “dull down” the signals between the gut and brain, your IBS symptoms may reduce. The lifestyle factors we recommend not only help your chances of achieving better gut health, but are healthy lifestyle habits for your overall health and wellbeing.

IBS FAQ

The ‘FODMAP Friendly’ labelling symbols are really helpful in the initial stages of following a low FODMAP diet so you feel “safe” about your food choices. Some of these food products are also really useful for when you are travelling or eating away from home, or if your cooking skills are limited! There is not a full range of food group choices to select from yet, so you won’t be able to buy everything you need with ‘FODMAP Friendly’ symbols.

IBS FAQ

The Gut Feelings programs will get you to where you want to go. Our resources include an eating out guide, shopping guide and a whole range of other handy tools to help you stay on the low FODMAP track, wherever you are. Using the low FODMAP smartphone app and buying grocery items that have the ‘FODMAP Friendly’ symbol are especially useful when you are eating away from your own home.

It depends. There are some tricks that we share with you in the Gut Feelings programs that will minimize the risk of symptoms when you are eating food prepared by others. The easiest way to describe a low FODMAP diet to someone preparing foods for you (even though it is not technically true) is “gluten free PLUS no onion, garlic or maybe dairy”. Most of the other FODMAPs can be identified and kept to a minimum.

The main reasons for getting symptoms when eating out include larger than normal portions, garlic, onions, wheat and the added irritation to the gut caused by alcohol. The Gut Feelings programs include a comprehensive eating out guide for every type of food and situation you could think of.

Your Bowels

There is no definite “normal” frequency of bowel movements. It’s “normal” to go once or twice a day, but not unusual to go more. It is fine to open your bowels every other day, and or as infrequently as once or twice a week. As long as you feel comfortable, and don’t need to give your bowel habits too much thought or consideration.

It is normal for food to take about three days from the time it is eaten to when it comes out the other end, usually as a brown coloured stool. If the stool is greenish, it might have moved through the system faster. If a stool is black, it may be because of a medication you are taking, but this should be checked by your doctor.

It is normal to pass wind a few hours after you eat baked beans, especially if you eat a lot in one sitting, or have not eaten them for a while! However, some people experience discomfort and bloating after eating foods such as bread, garlic and onions. This is not “normal” and is typical of IBS. These foods may cause abdominal pain in a gut that is “hypersensitive” to the additional pressure created by such gases. This would also put you on the IBS end of the spectrum. Pain, bloating and wind tend to be associated with gas production and constipation.

Certain foods (e.g. prunes) can soften bowel motions by drawing fluid into the gut. This is normal and useful for alleviating constipation. However, some people find that eating certain FODMAP foods causes diarrhoea because way too much fluid is drawn into the bowel. That is not normal, and can be one of the most frustrating issues for IBS sufferers.

You start by taking out the foods that could be getting “fermented” by gut bacteria, which results in gases that expand, bloating the tummy. Then, you gradually re-introduce these foods in a certain way, while also working on other issues such as stress, gut bacteria and lifestyle. Eventually you reach what we call the threshold level, where you remain free from symptoms, with a varied diet as possible.

GLOSSARY

Gut

Gastrointestinal or digestive system, mainly below the stomach in the small intestine and large intestine.

Burp

Gas that comes back out of mouth (also called belching).

Wind

A more polite or subtle word for gas that comes out the other end (also known as gas, fart, ponky, pop-off).

Probiotic

Means promoting life and for us that means healthy bacteria in the digestive system.

Prebiotic

Food for healthy bacteria, usually resists normal digestion until it gets munched up by health bacteria, preferably in the large intestine.