IBS – The Low Down
April is IBS awareness month, so I’m giving you a low down on the common syndrome many people suffer from.
What is IBS?
Irritable Bowel Syndrome (IBS) is one of many different functional gut disorders – meaning that the gut may appear normal on scans when in fact the issue is with the gut function. IBS symptoms are experienced by 10-20% of the UK population.
According to the Rome IV criteria, IBS is diagnosed if you have experienced abdominal pain, at least 1 day a week for the last 3-6 months, with two or more of the following:
- Related to stools (e.g. pain relief following excretion)
- A change in stool frequency
- A change in stool form and consistency
There are different types of IBS, mainly IBS C (constipation), IBS D (diarrhoea), IBS M (mix of constipation and diarrhoea).
Symptoms can overlap massively with other more serious diseases such as coeliac disease, small intestinal bacterial overgrowth (SIBO) and inflammatory bowel disease (IBD). It is best to visit your GP first to rule out these more serious conditions. It’s also important that you don’t diagnose yourself based on what you read on the internet. As IBS is a syndrome it can’t necessarily be cured, but it can be managed.
Other common symptoms:
- Stomach cramps or pain
- Mucus in your stools
- Lack of energy
- Constipation, diarrhoea or alternating between the two
- Muscle/joint pains
It is reported that two thirds of IBS sufferers are female. This may be due to women being more likely to seek help about their problems, but female hormones may play a role in how sensitive one’s gut is.
What are the effects?
IBS can impact all aspects of life and one study showed IBS sufferers1:
- Visit the GP more frequently
- Use more diagnostic tests
- Take more medications
- Have more sick days from work
- Have lower work productivity
- Are hospitalised
…more than those without IBS. These impacts are often due to investigating the cause of IBS, and the results of living with the pain/invocative of the syndrome.
Causes of IBS
There is no one direct cause for IBS, mainly due to individual differences, but also because IBS is often experienced due to an underlying condition or reason. One study showed that 94% of IBS cases were due to abnormal biomarkers on test results which required further investigation.2
IBS is often associated with the following:
- Gut infections (common post foreign travelling)
- Chronic inflammation of the gut
- Trauma, whether this is mental and/or physical
- Chronic stress (due to the gut-brain axis – see an article on it here)
- Small intestinal bacteria overgrowth (SIBO) – where bacteria accumulate in larger than normal numbers in the small intestine
- Vitamin D deficiency
- Chronic stress/anxiety/depression
Trying to undercover the underlying cause for your IBS symptoms is vital. Below are some interventions/techniques which may alleviate symptoms or improve gut health.
Chewing and mindful eating – breathing in for 4 seconds and out for 6 seconds can be an effective deep breathing tool. This helps the body recruit the parasympathetic nervous system, which is needed for proper digestion. Try doing this for a few minutes before and after meals.
Manage or reduce stress – we know there is a direct connection between the gut and the brain; through the vagus nerve. The brain is constantly being informed of changes that occur in the gut, and vice versa. For this reason, experiencing acute or chronic stress may cause some IBS and digestive symptoms. Finding ways to manage or reduce stress can be effective. Most importantly, find what works for you. Gentle walks, regular baths, meditation, yoga, reading a book, talking to a friend can all be effective stress relieving tools.
Try to identify food intolerances – the gold standard way to do this is to exclude the food/food you suspect for about 4 weeks, then reintroduce it alone and see if you notice any symptoms or patters. It’s important not to do this without guidance from a registered nutritionist, nutritional therapist or dietitian. Excluding food groups without professional guidance can put you at risk of deficiency or worsening your symptoms if foods are not reintroduced.
Low FODMAP diet – This is the most common dietary strategy used to help the management of IBS although it really isn’t for everyone, should never be done as a first port of call and shouldn’t be done alone. It can serve as a symptom reliever, rather than a cure and should not be followed long term.
Fibre – Fibre resists human digestion; therefore, its main job is to feed the microbes in the lower intestine (colon) so they can produce all kinds of substrates than are vital for our gut and overall health. Including sources of fibre in your diet such as vegetables, fruits, legumes, nuts, seeds and wholegrains is important. 30g daily is the aim in the long term.
Probiotics – probiotics are live beneficial bacteria which can reach the large intestine (colon) and are beneficial to the human host. Research shows than supplementing with probiotics can relieve pain and improve IBS symptoms, but not all probiotics are the same and benefits may be specific to certain strains. In some cases, where SIBO may be present, probiotics may even exacerbate symptoms by adding fuel to the fire.
Correcting Vitamin D deficiency – low vitamin D levels are present across all age groups in the UK. Correcting vitamin D deficiencies may should improvement in IBS symptoms3. Get your vitamin D levels tested with your GP to be sure.
The bottom line
IBS can be a common set of symptoms experienced by 10-20% of the UK population. There is often an underlying cause for symptoms, so the root cause should be investigated before interventions are trialled. Please consult for GP, nutritionist/nutritional therapist or dietitian.
*** This blog post is not intended or implied to be a substitute for seeking professional medical advice, diagnosis or treatment. Information provided here is general and is not intended to treat, diagnose, prevent or cure any diseases or conditions. Please contact your GP or private health consultant if you have any personal health concerns, or consult a registered nutritional therapist for personalised dietary and lifestyle advice and guidance.
- Spiegel, B.M., 2009. The burden of IBS: looking at metrics. Current gastroenterology reports, 11(4), pp.265-269.
- Emmanuel, A., Landis, D., Peucker, M. and Hungin, A.P.S., 2016. Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome. Frontline gastroenterology, 7(4), pp.275-282.
- Abbasnezhad, A., Amani, R., Hajiani, E., Alavinejad, P., Cheraghian, B. and Ghadiri, A., 2016. Effect of vitamin D on gastrointestinal symptoms and health‐related quality of life in irritable bowel syndrome patients: a randomized double‐blind clinical trial. Neurogastroenterology & Motility, 28(10), pp.1533-1544.