Irritable Bowel Syndrome
Do you think you have Irritable Bowel Syndrome (IBS)?
If you regularly suffer from abdominal pain, bloating, constipation, or diarrhea then you may have IBS. The good news is, you are not alone! IBS affects about 11% of the population. And it affects women more so than men. Luckily, IBS is not known to affect your health in the long-term, however, if left untreated IBS can affect your enjoyment of life, productivity at work, ability to socialise and can leave you feeling embarrassed, frustrated and anxious. I am here to let you know that you do not have to go on feeling this way.
What causes IBS?
There is not one sole cause of IBS and there is still a lot about this condition that is not yet fully understood. What we do know is that IBS can be caused by the following:
Breakdown of the protective layer lining the intestines
Alterations in the gut flora, following a bout of gastroenteritis for example
Changes to the way your intestines shift food through your system
Hypersensitive nerves in your intestines
Changes to the way your brain perceives and interprets information from the body
Low grade inflammation
Immune system activation
How do you diagnose IBS?
One of the most frustrating aspects to IBS is that there is no test to adequately diagnose the condition. Typically, your Doctor will run a range of tests that may include a blood test, stool sample, a colonoscopy, and/or an endoscopy to rule out other potential causes for your symptoms. Once your Doctor is convinced that you do not have another gut condition, such as coeliac disease, Crohn’s disease, or ulcerative colitis, you can end up with a diagnosis of IBS.
Be careful: You may see IBS diagnosis tests advertised by alternative health practitioners. These can be costly and unfortunately lack clinical validity. They include; faecal microbiota testing, faecal short-chain fatty acids testing, IgG food intolerance testing, salivary IgA, intestinal permeability testing and hydrogen breath tests.
You have an IBS diagnosis, what next?
You have several options to get on top of your IBS symptoms.
An Accredited Practicing Dietitian can advise you on the diet therapies, lifestyle changes and supplements that can improve your symptoms and put you in control of your IBS. They can also make recommendations to your doctor on medications and discuss with you whether psychological therapies may be of benefit.
The FODMAP diet
The low FODMAP diet is well researched and helps 50-80% of people like you achieve satisfactory relief from IBS symptoms. This is why it is usually the first diet therapy people choose to trial for their IBS.
FODMAP is an acronym which stands for Fermentable Oligo- Di- Mono-saccharides And Polyols. FODMAPs are small carbohydrates that are either poorly absorbed or not absorbed at all in the small intestine. As a consequence they drag water into the intestine leading to diarrhea. Due to the fact that they are not completely absorbed they continue on into the large intestine where they are rapidly fermented by bacteria generating gases causing bloating, pain, discomfort, and wind.
FODMAPs are found in a wide range of foods including fruit, vegetables, breads, cereals, grains, nuts, seeds, dairy products, processed foods and beverages.
A FODMAP diet has 3 phases, the major goal of which is for you to achieve optimal enjoyment of life by balancing good symptom control and expansion of the diet.
Step 1: Low FODMAP Diet
Aim: to identify FODMAP sensitive individuals and induce symptom relief.
How: High FODMAP foods are eliminated based your symptoms and situation. It is important to substitute high FODMAP foods with suitable replacements so that you are maintaining a nutritionally balanced diet. This phase of the diet is relatively short, anywhere from 2-6 weeks.
Step 2: FODMAP challenges
Aim: to identify your sensitivities to the individual FODMAP subgroups (excess fructose, lactose, GOS, fructans, mannitol and/or sorbitol).
How: If Step 1 resulted in symptom improvement for you, then you would progress to Step 2 (if not, refer to ‘I have tried the low FODMAP diet and my IBS symptoms continued, what do I do?’ below). In this Step, you systematically challenge each FODMAP subgroup by eating a food high in only that FODMAP subgroup in a structured way recommended by your Accredited Practising Dietitian. Your reactions to the challenges determines the length of time you will need to complete this step. It is usually anywhere from 6-8 weeks.
Note: tolerance to FODMAP subgroups can change over time so Step 2 can be repeated at various intervals.
Step 3: FODMAP Personalisation
Aim: to liberalise your dietary restrictions and establish a ‘personalised’ FODMAP diet for the long-term.
How: Now that you know which FODMAP subgroups cause your IBS symptoms, you can work with your Accredited Practising Dietitian to add in tolerated FODMAPs while maintaining satisfactory symptom relief.
I have tried the low FODMAP diet and my IBS symptoms continued, what do I do?
Firstly, well done for taking action to get in control of your IBS symptoms. It is estimated that 20-50% of people with IBS do not find satisfactory relief from the low FODMAP diet. Thankfully, this is not the end of the road. There are several other diet therapies and diet strategies that can improve IBS symptoms under the guidance of an IBS Specialist Dietitian.
RPAH Elimination Diet
Natural and artificial food chemicals can aggravate nerve endings causing a whole host of symptoms including migraines, rashes, asthma and IBS.
Sucrase-isomaltase deficiency or Disaccharidase deficiency
Both of these conditions affect your ability to digest sugars. Sucrase-isomaltase deficiency occurs from birth and disaccharidase deficiency can be acquired from damage to the lining of the small intestine. Both of these conditions can lead to IBS symptoms.
Gut irritants and lifestyle changes
Don’t be fooled by the simple title, avoiding gut irritants and making changes to meal size, and frequency of meals can have significant positive effects on IBS symptoms. A recent study by Swedish researchers concluded that these changes may be just as effective as the low FODMAP diet for IBS.
Fibre is the indigestible parts of plant foods, such as vegetables, fruits, grains, beans and legumes and can also be taken in the form of a fibre supplement. Fibre is usually categorized as soluble or insoluble but we now know that fibre varies in terms of how quickly and where it ferments in the bowel. Getting enough of the right types of fibre is essential for maintaining healthy gut flora. Manipulating the balance of fibres in your diet can improve IBS symptoms by changing the consistency of stool form, the frequency of bowel motions and modify gas and bloating.
IBS is common and affects women most of all
The Low FODMAP diet is one of the most well researched and effective ways to manage IBS
If you do not get relief from your IBS after following the low FODMAP diet, do not despair! There are many other dietary strategies that can offer you the relief that you are after. An Accredited Practising Dietitian specialising in IBS can help you get the symptom relief you are after.
Sascha has developed her specialisation in managing IBS and gut health over the past 8 years. She is an Accredited Practising Dietitian and a Monash Certified FODMAP Dietitian. Her experience in the IBS space has ranged from leading the Functional Gut Disorder clinics at London Bridge Hospital, to being the Gastrointestinal and Colorectal Dietitian at St John of God Hospital in Perth, and currently assisting with the Noisy Guts research project, the brainchild of Nobel Laureate Professor Barry Marshall, which aims to develop a non-invasive diagnostic tool for IBS at the University of Western Australia.
Sascha’s goal is to empower women affected by IBS with the right knowledge to put them in control of their symptoms to feel their best and get the most out of life.
Sascha is an Accredited Practising Dietitian specialising in IBS & FODMAPs