What is IBS?

IBS (Irritable Bowel Syndrome) is thought to affect 10-20% of people within the UK and is characterised by the presence of either abdominal discomfort or pain which can also be accompanied by a change in bowel habit.

It is important to work with your GP or healthcare specialist towards a diagnosis of IBS and to make sure that there are no other underlying conditions. Once other conditions have been ruled out IBS can be split into 3 different types depending on the dominating symptom. IBS-D (Diarrhoea), IBS-C (constipation) and IBS-M (mixed).

There is no single clear reason as to the cause of IBS but it is common after a bout of food poisoning or gastroenteritis and there are several other factors that can increase or provoke symptoms such as stress, poor diet, not enough exercise and some medications (antibiotics, some anti depressants and medicines made with sorbitol).

What You Can Do to Help?

The treatment of IBS should ideally be based on IBS subtype (D, C or M); for example the low FODMAP diet has been shown to be beneficial for those with IBS-D, and psyllium husk has a positive effect for those with IBS-C but it can be very individual and dependent on your symptoms and current gut health / personal gut microbiome!

After receiving a diagnosis from your doctor and more serious conditions ruled out, you can work with a Nutritional Therapist or other health care specialist to tailor your diet. We would work out which foods exacerbate your symptoms and include those that may improve and reduce your specific symptoms.

Improving Gut Health

Improving overall gut health is a good focus and asking your Nutritional Therapist to arrange a comprehensive Stool Test is very useful for anyone with digestive problems. I tend to use functional tests such as the GI Effects or GI Map stool tests or the GI Ecologix test. These tests look at bacterial balance, health markers as well as digestive function and dysbiosis. They can tell you which types of bacteria you have, both beneficial and potentially harmful ones as well as whether there are any fungi or pathogens present. These tests also tend to look at inflammatory markers which is useful when distinguishing betwen IBS or more serious conditions as well as identify whether treatment has been effective or not.

Prebiotics

Prebiotics are non-digestible fermentable carbohydrates, usually fibre, which may have beneficial effects, especially as they are known to encourage the growth of beneficial gut bacteria. Including prebiotic plant fibres in particular, is important for long lasting digestive health. You ideally want to try and establish a balance between beneficial and non-beneficial bacteria. Some studies have shown that getting the correct balance of beneficial bacteria may reduce bloating, improve mood, lower inflammation and reduce depression.

However, many prebiotic foods may make IBS symptoms worse, so it is important to work with your healthcare specialist to find a way to include them in your diet. Initially you may not include them, as you work on improving gut and reducing symptoms, but then it would be important to very slowly add them back into the diet, in tolerated amounts, as part of your ongoing IBS management as well as for overal gut health.

Common prebiotic foods include:

Asparagus

Bananas

Chicory

Dandelion Greens

Fruit especially berries

Garlic and onions

Legumes

Jerusalem artichokes

Probiotics

Using both probiotic foods and probiotics supplements can be a useful way to top up your beneficial gut bacteria. It is thought that this is a transient process, so they don’t stay within our gut, but pass through. Whilst they are passing through though, we can benefit from the natural processes that occur whilst they take up temporary residence (potentially 12 days). Bacteria are able to produce nutrients that we can benefit from, nutrients such as B vitamins, vitamin K and vitamin A.

Probiotic foods, often fermented or cultured foods, are ones that contain beneficial bacteria and include:

Cottage cheese

Yoghurt (greek / natural)

Sauerkraut

Tofu

Miso

Temph

Kombucha

Kefir

Probiotics Supplements

These are another way of introducing beneficial bacteria into our gut. It is thought that probiotic supplements are thought to improve IBS symptoms and pain through the manipulation of the gut microbiota.

It is important to use well-researched probiotics, always look for a batch number and an expiry date on the box and if possible purchase from a health professional.

Some studies have suggested that certain strains, species or combinations of probiotics may be beneficial for IBS symptoms and abdominal pain for example Lactobacillus species has been shown to significantly reduced abdominal pain and flatulence while urgency and other general symptoms were alleviated by Bifidobacterium. It has also been observed that there has been significant normalization in the consistency of stool when using both probiotic species.

There are several studies that have shown that both single strain and multi strain probiotics significantly improve IBS symptoms but that the beneficial effects were more distinct in those studies that were using multi-strain supplements. It’s never as simple as just buying a probiotic off the shelf, however and other symptoms, conditions should also be considered, for exaple if your diarrhoea is chronic you may prefer a specific strain initially such as Saccharomyces boulardii but if you happen to be lactose intolerant you may need a dairy free probiotic. The bigger picture of your health needs to be considered but there is definitely relevance in monitoring and investigating the microbiome in patients with IBS.

Lifestyle Factors

As a Nutritional Therapist I would also look at improving other lifestyle factors, if necessary. This could include adding stress management techniques, looking at the best exercise for you, plus checking your sleep and eating habits.

As we are currently in isolation, it can be difficult to stick to nutrition plans and the added stress or boredom may drive people to comfort eating. Setting yourself a daily plan, an activity schedule, attending courses and including daily exercise will all be very important. Uncertainty and change can be very stressful on top of the usual work and family stress. Incorporating daily stress management techniques is essential. This could include, gentle exercise such as Pilates or yoga, breathing techniques, mindfulness, meditation, walking in nature, reading a book, aromatherapy or enjoy a warm bath are just some ideas. You will need to try a few and find one that resonates, one that allows you to calm down and tap into your parasympathetic nervous system.

Simple Food Swaps You Can Do Now!

Changing sugary snacks for fresh brightly coloured whole foods would be essential. Raspberries and blueberries are fantastic fruits which are low fodmap and low sugar. They are also anti-inflammatory and a great source of plant fibre to feed your beneficial bacteria. Berries are still accessible at the moment in both fresh and frozen forms so it would be an easy addition to your weekly shopping list and a great swop for processed sugary snacks.

Switching sugary or diet soda drinks for non carbonated drinks would also be beneficial. Caffeine, sweeteners, and carbonated water can all lead up to IBS flare-ups so avoiding these and switching for filtered water, herbal teas including green tea or probiotic drinks such as kombucha or kefir can have beneficial effects.

Get in Touch

Do get in touch if you would like more information on this topic or if you would like help with your own IBS symptoms. We can work together to create a plan that is right for you, your lifestyle and your symptoms. Click the button below.

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References

A. C. de Albuquerque, M., De Moreno de LeBlanc, A., Joseph LeBlanc, J. and Bedani Salvio, R., 2020. Lactid Acid Bacteria. Milton: CRC Press LLC.

Agnello, M., Carroll, L., Imam, N., Pino, R., Palmer, C., Varas, I., Greene, C., Hitschfeld, M., Gupta, S., Almonacid, D. and Hoaglin, M., 2020. Gut microbiome composition and risk factors in a large cross-sectional IBS cohort. BMJ Open Gastroenterology, 7(1), p.e000345.

Asha, M. and Khalil, S., 2020. Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Sultan Qaboos University Medical Journal [SQUMJ], 20(1), p.13.

Bailey, C., 2016. The Gut Health Diet Plan. Nourish.

Dale, H., Rasmussen, S., Asiller, Ö. and Lied, G., 2019. Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), p.2048.

LIPSKI., E., 2018. DIGESTIVE WELLNESS, 5/E. 5th ed. [S.l.]: MCGRAW-HILL.

Martoni, C., Srivastava, S. and Leyer, G., 2020. Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial. Nutrients, 12(2), p.363.

Pizzorno, J., Murray, M. and Joiner-Bey, H., 2016. The Clinician's Handbook Of Natural Medicine. 3rd ed. Elsevier.