‘My GP told me I have IBS, is this a serious disease?’ This question is asked over and over again by individuals experiencing digestive problems such as bloating, cramping and inconsistent bowel movements. There are, fortunately, a lot of nutrition tips available on how to control IBS.
So before we dive into the many factors on how to control IBS, let’s grasp an understanding of what this ‘syndrome’ actually is. Irritable bowel syndrome, often referred to as IBS, is not actually a disease. IBS is simply a term used to describe a collection of digestive symptoms present without a diagnosed disease. In essence, IBS can be considered to be a symptomatic mystery with various possible causes. If you have diarrhoea, cramping or blood in your stools, your GP will most likely refer you to a gastroenterologist who can check your gut lining using endoscopy (a camera on a long flexible tube) to look for abnormal growths, inflammation and ulcers; they may also run tests for conditions such as coeliac disease and H.Pylori bacterial infection. If all results prove negative, then you will most likely be diagnosed with IBS – no obvious state of disease, although digestive symptoms present.
It can often be frustrating to know that you have no clear cause for your unpleasant symptoms, which may be causing significant misery with painful cramps and diarrhoea. On a positive note, if you have been screened for other conditions, thankfully you don’t have something which could be far more serious in the long term. You can now concentrate your efforts on learning how to control IBS.
IBS (irritable bowel syndrome), not IBD (Inflammatory bowel disease)
IBS must not be confused with IBD. These terms are often incorrectly used interchangeably; they are, however, very different and it is valuable to be aware of both and the differences between them. IBD includes inflammatory diseases such as Crohn’s disease and ulcerative colitis. Both conditions are the result of an overactive immune response, resulting in damage to the lining of the intestines, allowing toxins and bacteria to seep through the intestinal wall and into the bloodstream, which further accelerates the inflammatory process. Diverticulosis coli is another common IBD involving development of mucosal folds and inflammation of the colon.
Both ulcerative colitis and Crohn’s disease can result in abdominal pain and cramping due to inflammation and ulceration, which may also result in thickened and scarred walls of the bowels, diarrhoea, and in some individuals nausea, reduced appetite and vomiting.
The big bloat
Bloating and feeling like you are 5 months pregnant – when you are not – is one of the most common complaints with someone suffering with IBS. So what causes bloating? Even if you eat a particularly large meal, your gut should not be sticking out to the extreme; there is plenty of space in your digestive system for food to sit. Also, the stomach is actually quite high up, partially underneath the ribs, so bloating immediately after a large meal is not simply due to large volumes of food taking up space. Bloating is usually a result of excess gases accumulating in your large intestines, lower down in your abdomen.
Narrowing down what causes your bloating
Gas production can occur for many different reasons, so to tackle your bloating problem and to understand how to control IBS in general, you first need to identify the problem at hand. Consider the following points in the following order, one at a time:
1. How do you eat? Are you chewing your food properly or do you guzzle it down? It may seem like an obvious statement, but so many of us eat on the go, when in a rush or when very hungry. Chewing our food to a pulp until no lumps are left, allowing saliva to start the digestion process, can give your digestive system a substantial break. Remember, our intestines don’t have teeth!
2. Are your digestive enzymes functioning? If you have chewed your food properly and you are still suffering from bloating, next on the list is to ensure that your pancreas is producing adequate levels of digestive enzymes. A great simple test to check for this is to try a digestive enzyme supplement containing the enzymes amylase (to digest carbohydrates), protease (to digest proteins) and lipase (to digest fats). If your bloating disappears when taking a digestive enzyme, then you know that your pancreas isn’t producing good levels. A wide-spectrum digestive enzyme supplement will also include other digestive enzymes such as lactase (to digest natural sugars in milk).
3. Do you have healthy gut flora? If you are still experiencing problems, another very common cause for bloating is an imbalance of bacteria in the gut. Pathogenic ‘bad’ bacteria may be taking over in your intestines, feeding off your food and expelling gases as their waste products. To simply test if a bacterial imbalance may be the case, try taking a high dose probiotic supplement (at least 10 billion bacteria per day). Symptoms may not disappear as probiotics will not necessarily get rid of an infection, but if bacteria are to blame, probiotics ‘good bacteria’ may help to ease your symptoms slightly. Probiotics are very effective at reducing symptoms of bloating in people with IBS (1), suggesting bacterial infections are a common cause or aggravator of IBS.
4. Do you have excess yeast or parasites? If probiotics seemed to reduce your symptoms, you may wish to do a digestive stool analysis to find out exactly what kinds of bacteria may be causing a problem. A stool analysis will also identify other types of infections such as yeast and parasites, which can produce a significant amount of gases in the gut. A diagnostic test is also a quick and easy way to identify digestive enzyme production, levels of inflammation and undigested food in the stool.
5. Are foods triggering your bloating? For an immediate reduction in bloating, consider temporarily cutting out the common culprits including gluten, beans and lentils. If your digestive system is healthy, you should be able to digest these foods reasonably well without too much bloating. If these foods exacerbate your bloating, consider excluding these foods until you find out the true cause of your bloating. We often consider foods to avoid with IBS as one of the most influential factors in how to control IBS but, as you have now seen, this is actually only a relatively small part of the overall picture.
Inconsistent bowel movements
Constipation can be a chronic condition for some individuals, and when combined with intermittent bouts of diarrhoea, this is a clear sign that something is out of balance.
If you only suffer from constipation, this is not on its own strictly considered to be a symptom of IBS. If you consistently experience slow digestive transit time, consider adding soluble fibre to your diet to take more water through. Soluble fibre is water absorbing and forms a soft gel-like consistency in the gut to help take waste through easily. Fruits, vegetables, flaxseeds and oats are all great sources of soluble fibre.
If your constipation alternates with bouts of diarrhoea, i.e. typical symptoms of IBS, you may need to take a different approach. Adding fibre alone is not necessarily going to relieve your symptoms, but keeping your fibre intake at regular quantities each day is something to consider to begin with.
Inconsistent bowel movement can be a result of weak muscle contractions in the intestines. Causes could be due to abnormalities in the muscle or possibly a side effect of medication. This may result in higher levels of bacteria collecting in the small intestine, leading to bloating, pain and possibly diarrhoea due to infection. Disorganised strong contractions may also cause a similar problem, in which it is possible that food may be pushed in the wrong direction.
Other well known causes of diarrhoea include infections, most likely bacterial infections. If you have experienced diarrhoea after travelling to a foreign country or after eating food such as undercooked meat or fish, you may want to have a digestive stool analysis to identify infections or to eliminate this possibility. If you frequently seem to pick up infections when travelling, strengthening your immune system with optimum nutrition may prevent an infection taking hold.
Pain and sensitivity
If your IBS symptoms also include a burning sensation when eating certain foods or significant pain very shortly after eating a meal, consider the integrity of your stomach and gut lining. Possible damage and inflammation to your digestive system can result in over-sensitive cells, which may become inflamed and painful when exposed to certain foods. Consider these aggravating foods to avoid with IBS such as spicy foods, strong foods such as garlic, and alcohol. If you imagine the stinging reaction of a certain food on an open wound, this reflects the pain associated with eating certain foods or drinks.
If the mucosal cells covering your intestines have become damaged, this is often referred to as a ‘leaky gut’, because damaged cells may allow food particles and bacteria to pass through the gut lining. One of the main problems with undigested food particles passing the gut barrier is that it can initiate an immune response (2), often developing into food intolerances. This may explain why a huge majority of individuals with IBS also have positive results for food intolerances.
If you experience pain, burning or diarrhoea, one of the main aggravating foods to avoid with IBS is gluten. Gluten is a protein found in grains like wheat, barley and rye, and considerably influences bowel function. Gluten has been shown to increase bowel movements in those prone to IBS, it also increases gut permeability and raises inflammation. (3) Foods to avoid with IBS also include chillies and other strong foods including ginger, garlic and raw onions, as they may also cause direct aggravation on mucosa. Alcohol also commonly makes the situation worse (4), and can even result in diarrhoea for some individuals.
In order to heal your gut, concentrate on anti-inflammatory foods including oily fish and easy to digest vegetables. Try not to simply concentrate on foods to avoid with IBS; also pay special attention to healthy foods to include which have shown how to control IBS. If you don’t have oily fish frequently i.e. 2-3 times per week, you may want to consider taking a high dose omega-3 EPA concentrated fish oil supplement such as Pharmepa RESTORE for its strong anti-inflammatory effects. Other supplements such as glutamine (5), liquorice and aloe vera are also very soothing on the gut lining and can help to speed up the healing process.
(1) Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, et al. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J Clin Gastroenterol 2011 Jul;45(6):518-25.
(2) Suzuki T. Regulation of intestinal epithelial permeability by tight junctions. Cell Mol Life Sci 2013 Feb;70(4):631-59.
(3) Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O’Neill J, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013 May;144(5):903-11.
(4) Elamin E, Jonkers D, Juuti-Uusitalo K, van IS, Troost F, Duimel H, et al. Effects of ethanol and acetaldehyde on tight junction integrity: in vitro study in a three dimensional intestinal epithelial cell culture model. PLoS One 2012;7(4):e35008.
(5) Rapin JR, Wiernsperger N. Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine. Clinics (Sao Paulo) 2010 Jun;65(6):635-43.