What is Irritable Bowel Syndrome (IBS)? 
 
If the term IBS conjures up feelings of pain, bloating and anxiety as you search to identify those ‘trigger foods’ then you’re not alone. About one in five people in the UK will experience IBS at some time in their life and about two thirds of the people affected are women. It can leave sufferers feeling frustrated and feeling totally lost. So what is IBS and how well are we managing this extremely debilitating condition? 
 
IBS is a common condition that affects how the gut moves and functions. Symptoms include pain, bloating and altered bowel habit. I like to think of it as a gut that becomes extra sensitive. Symptoms vary from person to person and it can be incredibly disabling with its unpredictability affecting work, life and confidence. 

What causes IBS? 

IBS used to be referred to as a ‘functional gut disorder’ meaning symptoms aren’t linked to any structural abnormalities or underlying disease. But IBS is now viewed as a disorder of what’s called the ‘gut-brain-microbiota axis’. In essence a disorder of the communication between the gut, brain and our very important gut microbes. 

How do the gut and brain talk to each other? 

If you’ve ever felt butterflies in your stomach what you’ve actually noticed is your gut talking . The gut’s ability to talk is so powerful it’s now referred to as our second brain, linking our moods, our digestion and our overall health. The vagus nerve is the nerve connecting our gut and brain a bit like a communication superhighway. The brain communicates with the gut just as much as the gut communicates with the brain and it’s beautifully multilingual, picking up all sorts of ‘languages’ including inflammation from immune cells and serotonin from the endocrine system as well as signals from our environments, our personalities, our thoughts, stresses, modern lifestyles and our guts. I like to think of it a bit like google translate

Who's at risk of IBS? 

It’s estimated IBS affects 1 in 10 people globally and is more common in women. The science also shows a four times greater risk of onset of symptoms if you’ve suffered a gut infection in the previous year. There appears to be a genetic element and trauma, stress, anxiety and depression can also play a part and although genes are implicated it doesn’t mean you are destined to suffer. Instead I like to think of it as a combination of genes and environment. Genes are a bit like a loaded gun and the environment (hormones, stress, sleep, the foods we eat etc. ) the trigger. 

How is IBS diagnosed? 

There’s no test for IBS. Diagnosis tends to be made following elimination of other conditions like inflammatory bowel disease and coeliac disease. IBS is more a label to describe a set of symptoms where no other structural or autoimmune issues are found. 
 
A healthy gut microbiota feeds our gut lining to help maintain healthy barrier helps make helpful nutrients and helps fight invading pathogens. All these functions help our immune system. But how do we make sure we have the right types of gut bugs? 

How do most people manage IBS? 

The short answer is poorly. Because IBS isn't treated particularly well in the community, many gastroenterologists are seeing re-referrals of patients desperately trying to find ways to manage the symptoms of the condition. Sufferers are often frustrated and struggling. They can end up spending a fortune trying one quick fix after another. Many people also eliminate foods they’ve identified as trigger foods surviving on bland and poor quality foods. This can lead to food anxiety, poor diets only serving to agrevate symptoms. 

What are the treatment options for IBS? 

Diet and lifestyle changes, psychotherapy and medications to tackle the symptoms. 
 
Dietary changes 
 
Roughly 9 in 10 people feel their symptoms worsen after meals so dietary changes are often the starting point. Manipulating how, when and what we eat has revolutionised management of IBS. While diet can be effective in treating the symptoms it doesn’t necessarily target the underlying cause so if diet is the only thing change that’s made when ‘trigger’ foods are reintroduced symptoms can often reappear. 
 
The first line approach is something we can all do at home by looking for triggers such as alcohol, caffeine, foods containing sweeteners, not drinking enough water, fruit, spice, fat and fibre. But it’s not just what we eat, it’s when and how we eat that matters because this directly affects the ‘leakiness’ of the gut, the way the gut moves, inflammatory levels and hormone levels. Keeping a food diary is a brilliant way to identify patterns. 
 
The second line approach is introduced when IBS symptoms are more difficult to control. The low-FODMAP diet was developed by a team at Monash University in Melbourne. There’s a lot of evidence to support this approach with success in roughly 70% of people who try it, however this approach has been poorly managed in practice in the UK. It is NOT a long-term diet and should never be interpreted as such. Use of the low-FODMAP approach should always be overseen by a dietician or trained nutrition professional. 
 
Probiotic use is currently being studied as a treatment in IBS but findings are inconsistent. I do belive the future of IBS management will involve gut microbiota screening and a more personalised approach. 
 
Lifestyle changes 
 
Tackling stress and incorporating good lifestyle habits like better sleep, relaxation and regular exercise have been shown to be incredibly helpful. Many studies have found yoga and mindfulness practices improve IBS symptoms, maybe because they help reduce stress which in turn helps regulate the gut-brain axis. Exercise is also helpful but bear in mind high intensity exercise is associated with increases in gut symptoms. Diaphragmatic breathing also appears to be highly beneficial. It works by stimulating the parasympathetic nervous system and is currently an area of significant amounts of research. 
 
Medications for symptoms 
 
Prescription and over the counter medications tackle a range of symptoms from bloating, to cramps to diarrhoea or constipation. Low dose antidepressant mediaction may be useful to help manage pain. 
 
Gut focused psychotherapy and hypnotherapy 
 
Gut directed cognitive behavioural therapy (CBT) has repeatedly been shown to improve symptoms and improve quality of life. Gut directed hypnotherapy has also been shown to be an effective approach in managing IBS symptoms. 

How can you help yourself? 

Firstly, get yourself checked out by a doctor to make sure it is IBS. Secondly avoid third party advice or internet searches for help. There’s a preoccupation with trying to find ‘trigger foods’ because diet appears to be the easiest thing to control but as a consequence we are seeing worrying amounts of food and food group removal from diets which can make an already poor situation worse.each day. Thirdly, avoid processed foods. 
 
Understanding your own IBS is really important because we are all so incredibly unique. If you are a sufferer or suspect you have IBS, try to identify the patterns of your condition and look at lifestyle factors as well as foods. If you need support, find a dietician or nutritional health professional highly skilled in dealing with IBS. If you like to read, take a look at Megan Rossi’s fabulous book called ‘Eat Yourself Healthy’. It’s a great, easy to digest step by step guide and has all you need to know. 
 
References 
 
1. Forsythe, P., Bienenstock, J. & Kunze, W. A. Vagal pathways for microbiome-brain-gut axis communication. Adv. Exp. Med. Biol. 817, 115–133 (2014). 
 
2. Dimidi, E., Rossi, M. & Whelan, K. Irritable bowel syndrome and diet: Where are we in 2018? Current Opinion in Clinical Nutrition and Metabolic Care vol. 20 456–463 (2017). 
 
3. Grundmann, O. & Yoon, S. L. Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J. Gastroenterol. 20, 346–362 (2014). 
 
4. Healing Irritable Bowel Syndrome with Diaphragmatic Breathing – Resource Center. https://bio-medical.com/resources/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/. 
Tagged as: Gut health
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