Irritable Bowel Syndrome

Nutrition and Irritable Bowel Syndrome

Unlike other bowel conditions which have specific tests for a diagnosis,  IBS is more elusive. Indeed irritable bowel syndrome does not cause easily detectable abnormalities in the digestive system. As a result everyone can be affected differently and with varying severity.

In fact the exact cause of IBS is unknown. The symptoms of irritable bowel syndrome are similar to many other conditions. Therefore before making any dietary changes,  it is a good idea to consult your GP as well as a nutritional therapist to rule-out Inflammatory Bowel Disease or other bowel conditions.

So the most important step to take is to identify and share your symptoms clearly with your GP or your nutritional therapist.

Common dietary triggers for IBS include: drinking either fizzy or caffeinated drinks, alcoholic drinks, many types of processed snacks, and fatty foods. So reducing the intake of these, or other discernible triggers, is a sensible starting point for alleviating symptoms.

Equally high‑fibre food (like wholemeal flour and breads, cereals high in bran, and whole grains like brown rice can be triggers. A nutritionist can review your fibre intake and make recommendations to adjust your intake with you, whilst monitoring the effects.

A professional nutritional therapist will work with you to understand what triggers your symptoms. They will also carry out assessment and give guidance on any possible positive lifestyle changes that you can make.

Dietary changes often help to relieve symptoms of irritable bowel syndrome, and some sufferers will need to add probiotic supplements as a regular part of their diet.

What happens when you get an IBS diagnosis?

When an individual is diagnosed with IBS, the GP may refer them to a dietician or other healthcare professional, who may recommend a special elimination diet called the FODMAPS diet. This diet seems to work by altering the inflammation in the gut often found with IBS, which is caused by altered gut microbiome. FODMAPs are fermentable, short-chain carbohydrates which for some sensitive individuals, become fermented in the colon because the small intestine cannot complete absorption of these foods. (this may be because the individual has SIBO (see SIBO section)). In other words, when foods containing FODMAPs are fermented in the colon, gas, pain, bloating, diarrhoea and/or constipation, and other gut sensitivities, may result.

Occasionally, the GP service may suggest that an OTC generic probiotic could be tried. Probiotics are beneficial bacteria that can have various health benefits when taken. There is some good evidence that selected key strains of probiotics may be helpful for individuals with IBS, but the GP may not be able to recommend these specific probiotics as few have been officially included in NICE guidelines.

Patients with irritable bowel syndrome are often prescribed medication for their symptoms by healthcare professionals. Pharmacological treatments are prescribed based on specific IBS symptoms. For IBS-C, laxatives are used, such as lactulose or Movicol, to name a few. Unfortunately, common side effects from laxatives are abdominal pain, diarrhoea, nausea, and distention. For IBS-D, loperamide (brand name Imodium) is usually the first medication prescribed. For bloating and gas symptoms of IBS, an antispasmodic is used (Buscopan), which helps relax the muscles. Typical side effects for antispasmodics include nausea, vomiting, altered taste, dry mouth, blurred vision, dysphagia, palpitations, and urinary hesitancy and retention. If there are psychological diagnoses, the first-line medication is typically a selective serotonin reuptake inhibitor (SSRI). SSRIs are proposed to change an individual’s threshold of pain for IBS symptoms; however, it is not known how they treat depression or anxiety for an IBS patient specifically. The second line of pharmacological treatment includes tricyclic antidepressants, which have the potential for more negative side effects than SSRIs.

How does IBS clinics use functional medicine to resolve IBS?

Functional Medicine differs from the standard conventional or allopathic medicine model in that it determines how and why illness occurs and restores health by addressing the root causes of disease for each individual.

The Functional Medicine model is a highly individual, patient-centred, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalised treatment plans that lead to improved patient outcomes. By addressing root cause, rather than symptoms, it is possible to identify the complex nature of disease. It is often found that a health condition has a variety of different causes and, likewise, one cause may result in many different conditions. As a result, Functional Medicine treatment targets the specific manifestations of disease in each individual.

Special functional tests may be recommended to uncover the underlying causes for an individual’s IBS. Comprehensive stool tests are one such test commonly used to assess digestive and metabolic gut function, identify gut infections and bacterial imbalances or overgrowth. The vast majority of IBS clinics patients will be recommended to test for SIBO as this is a common contributing factor to IBS. Between 60-73% of our patient demographic will have SIBO as a single contributing factor, but often accompanied by other factors. Food intolerance testing can also be helpful to identify problem foods which may be contributing to IBS and there is some good research to support this in IBS sufferers.