One of the issues with irritable bowel syndrome (IBS), is that we need experienced and patient doctors to help diagnose the problem properly. This in part is because symptoms can vary from one person to another and may be worse for some people than others. It can, in other words, be a bit of a moving feast, meaning it takes patience and care to pin a diagnosis down.
Given that around one in five adults are affected by IBS, it is however definitely worth preserving if you feel you may be affected, not least because with effort and a long-term approach, you can work with your body to find things that can genuinely help ease symptoms.
1. Do I have IBS?
If you have been living with discomfort in your gut; have experienced bloating, or a change in bowel habits over the last six months, then you need to ask your doctor for an assessment for irritable bowel syndrome. An experienced doctor will know to then ask a set of important questions, which will start with asking if your abdominal pain or discomfort is relieved by passing stools or if it is associated with a change in bowel habit.
If you answer ‘yes’ to either of these questions, then they should go on ask four further questions. If you answer 'yes' to two of these, then your doctor will diagnose IBS. The four extra questions are i) Have you noticed that your stool passage has altered – in other words, have you had to strain more than usual, have you noticed an increased urgency in needing to dash to the loo or have you been unable to evacuate your stools properly? ii) Have you noticed abdominal bloating, your stomach distending or felt tension or hardness around your stomach? iii) Are any of these symptoms made worse by eating? iv) Have you noticed any mucus while passing stools?
2. I feel tired and nausea, are these also symptoms of IBS?
Yes, along with backache and bladder symptoms, feeling tired and nauseous can support a diagnosis of IBS.
3. Could my gut symptoms be something other than IBS?
Again, the answer is yes. If you have noticed that you have lost weight unintentionally, have signs of blood in your stool, know of other people in your family who have had bowel or ovarian cancer or if you are over 60, and have noticed that you are passing stools more frequently and persistently for more than six weeks, then you need to see a doctor right away to rule out any other, serious causes of gut symptoms, which need fast medical treatment.
4. What general diet tips can I follow, if my doctor diagnoses IBS?
There are some general tips that we can all follow if diagnosed with IBS. The British Dietetic Association advise everyone with IBS to eat three regular meals a day and to try not to skip meals or eat late at night. They advise too, to limit alcohol to no more than two units a day with at least two alcohol free days a week and to stick with not more than two mugs or three cups of caffeine-containing drinks daily.
In addition, everyone with IBS is advised to stick with still drinks, aiming for at least eight cups a day. Replacing processed foods with meals and snacks that use fresh ingredients is recommended as well as swapping fatty foods to plainer versions. For example, chips or roast potatoes to boiled or baked potatoes. Cakes and biscuits for oatcakes and rice cakes. Garlic bread for plain, hot bread.
In addition, weighting your 'five a day' of vegetables and fruit to three of the former and two of the latter is also advised.
When it comes to complementary helpers, a large review of many studies over five decades looking at more than 800 people with IBS, reveals that peppermint oil helps to significantly improve abdominal pain and overall symptoms. This makes it very well worth trying in your daily routine.
Studies have also revealed that taking standardised extracts of St John’s Wort (Hypericum perforatum) have helped to improve bowel symptoms scores while reducing the overall ‘interference’ that IBS brings to people’s life; possibly by helping to relieve low mood, which is often associated with chronic gut discomfort.
Extracts of globe artichoke meanwhile have been shown to calm IBS symptoms significantly, helping particularly to shift bowel patterns in people experiencing alternating constipation and diarrhoea towards more ‘normal’ bowel habits.
5. What can I do if I experience bloating and wind?
In both cases, it is important to eat slowly, avoid carbonated drinks and chomping on chewing gum to help to reduce the amount of air we swallow. Some foods like Brussels sprouts, cauliflower and swede can lead to gas production, so leave out any that you know have this effect on you.
It is also important to avoid sugar free sweets containing sweeteners like sorbitol and mannitol because these naturally sweet carbohydrates avoid digestion in our small intestine and make it down into our gut, where they provide a food source for gas-producing bacteria.
Adding oats and linseed to your diet may also help to quell issues with bloating and wind as can including peppermint oil.
6. I regularly suffer constipation with my IBS, what should I eat?
More wholegrains, vegetables and pulses can all help, if you introduce them gradually and make sure that you drink plenty of water, to help to soften stools and make them easier to pass.
Including supplements containing linseeds or having a tablespoon of brown or golden linseeds, which can be ground or whole may also help but again, make sure that you drink plenty of fluids, around a cupful of water with each tablespoon of linseeds.
Research reveals that including slippery elm (Ulmus rubra), extracts may be help to increase in bowel movements and reduce abdominal pain, bloating and straining.
7. My problem is that I experience diarrhoea often with IBS, are there any diet tips for me?
Diarrhoea leads to loss of fluids and so these must be replaced by taking the ‘drink regularly’ advice seriously. You may well need more than the ‘eight’ cups a day advice, especially in hot weather and if you are exercising.
Although general healthy eating advice is always encouraging more wholegrains and fibre-rich foods, this is one time when doing the opposite and swapping wholegrain bread, pasta, and rice for white versions, could be a good idea. And as with people who suffer with bloating, avoiding sugar-free sweets, gums and drinks that contain sweeteners like sorbitol, mannitol and xylitol is important. All of these can have a laxative effect, which is the last thing you need.
There is some research that suggests aloe vera may help people who experience diarrhoea with their IBS and trying it for a month, can be worth a go. Research also reveals that supplementing with a preparation containing slippery elm may help to reduce bloating and abdominal pain and general symptoms in people with diarrhoea prominent IBS, while including psyllium within a supplement routine may also help, by helping to bulk the stools.
8. I’ve heard of the Low FODMAP diet, should I try it?
The name of this diet comes from the 'f' of the word ‘fermentable’ and then the first letters of a group of carbohydrates, which are poorly absorbed in our small intestine and make it down into our gut, where they can be fermented, producing hydrogen and methane gases. These gases may trigger IBS symptoms by altering the lining of the gut and sparking bloating and loose stools.
Cutting FODMAP containing foods out, may therefore be worth trying but following the FODMAP diet is a process and needs to be done in three stages. The first is to eliminate the Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols for several weeks. The second phase involves another two weeks of reintroducing FODMAPs gradually, so that you can identify if they trigger symptoms.
The final two weeks is to continue including the FODMAPs that you were able tolerate but leaving out those that triggered symptoms. Help from a registered dietitian with specialised experience in this area is important to ensure your overall diet remains healthy and nutritious.
9. Should I go gluten free?
There is a little, limited evidence that suggests cutting out gluten can be helpful to some people with IBS, irrespective of whether they also have Coeliac Disease (for which removal of gluten is essential) but experts do not feel confident enough to recommend ‘going gluten free’ as a first-line approach. With so many other more proven dietary changes to try, going gluten free is one to put on the backburner.
10. Is it a good idea to try probiotics?
The consensus is that probiotics (‘good bacteria’), either in supplement form or added to foods such as yoghurts and kerfir style drinks, may be helpful but that you need to give them around four weeks before deciding whether they are having an effect. It is important to opt for a brand of food or supplement that has proven the probiotic bacteria it contains; both survives digestion and is able to then thrive in the gut.
Registered Nutritionist AFN
PG Dip Dietetics,
Associateship King's College (AKC)