Get off the toilet!
As an IBS nutritionist I work with people who are ready to address their bloating, excessive gas and spending too long sitting on their toilet.
If you’re exhausted by researching the best diet for IBS, or trying to work out which gut health tip to try next, then you’re in the right place.
IBS is a disorder of the gut-brain connection but this doesn’t mean it’s all in your head!
Typical IBS symptoms are constipation, bloating, abdominal pain, diarrhoea and excessive flatulence. All my clients have some combination of these.
Irritable Bowel Syndrome is a very complex condition, and as you’ve probably already realised there is no universal treatment pathway for everyone.
This means there is no medical cure for IBS, so management of the symptoms are down to diet, and lifestyle practices.
The most common different types of IBS are
- diarrhoea predominant,
- constipation predominant, or
- a mixed presentation of alternating bowel movement types.
Who is at risk for IBS?
Women are much more likely to have IBS, in fact around twice as likely! It’s thought this is linked to how menstrual hormones affect digestion but there may also be other factors.
IBS is often associated with mental health conditions such as depression or anxiety due to the link between the gut and the brain. This can affect motility, the speed of food through the gut, as well as hypersensitivity.
If you’ve had previous trauma or a difficult childhood you could be more at risk for digestive conditions such as IBS. You might also find you’re more likely to experience that dodgy tummy your parent also has because IBS does tend to run in the family! This could be genetic or linked family mental health, or family eating habits that get passed down.
People with eating disorders are also more likely to experience IBS. If you are currently, or have previously verly restricted your food intake, or frequently binged you could be at risk of IBS. Even if you eat a ‘normal’ amount of food if you’re only eating a very smaall range of the same foods you could develop IBS, due to lack of essential nutrient, issues with gut motility, or a lack of beneficial gut bacteria.
Common symptoms of IBS
The most common symptoms in IBS are bloating, diarrhoea or frequent loose stools, chronic constipation and abdominal pain.
We use something called the Rome IV Criteria to diagnose IBS. This is specific, and includes:
Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
What causes IBS?
IBS is typically multi-factorial, meaning it’s not a single cause, and most people I work with have a few things that could be driving their symptoms.
- Post infectious IBS – A type of IBS I see frequently is post-infectious IBS. This is the onset of IBS symptoms after an incident of food poisoning. It can be up to around 18 months to 2 years later that the IBS starts, but typically around 3-6 months after the incident.
- IBS can be also caused by food intolerance, such as lactose intolerance, although this is less common than you think.
- Stress – whilst we can’t say stress ’causes’ IBS, it can definitely worsen symptoms. A key factor in your digestive health is your emotional and mental state. You’ve probably already heard about the important role of the gut-brain connection. I see high levels of chronic stress or anxiety causing all kinds of digestive issues including bloating, constipation and diarrhoea. This doesn’t mean it’s all in someone’s head, far from it! It follows that the support you need includes support to calm your nervous system as well as looking at food and eating habits.
- Hypersensitivity – it’s common for people with IBS to have visceral sensitivity. Hypersensitivity of the lining of your gut means your nervous system picks up on a normal amount of gas or distension, and relays this as heightened pain or sensitivity.
- Imbalances of gut bacteria can be a trigger for IBS symptoms. An overgrowth of bacteria can lead to fermentation of your food, and causing gas, bloating and diarrhoea. This can be changed through diet and lifestyle. Working on changing your gut bacteria can take a long time, and requires changes in eating habits, potentially adding to the gut bacteria, or reducing an overgrowth. Small Intestine bacterial overgrowth (SIBO) is one condition which causes IBS like symptoms.
Frequently asked questions about IBS
What's it like to live with IBS?
Irritable Bowel Syndrome can be anything from mild to severe, and it can severely negatively impact your life.
Many people with IBS find they are very tired. This could be down to lack of essential nutrients through a restricted diet, or down to the worry of what to eat next. There is also an overlap between mental health conditions like anxiety or depression which can also cause fatigue.
The worry about what to eat next takes up a lot of the headspace in my clients. It’s difficult to maintain social engagements when so much socialising revolves around meals out or drinks, and these can cause your symptoms to flare up. Some of my IBS clients worry about leaving the house in case they have an accident.
Depending on your personality type a noisy digestion and smelly gas can be excruciatingly embarrassing. This can cause people to withdraw in relationships, or avoid staying over night with a partner.
IBS isn’t just a bit of bloating, it can really affect the quality of your life.
What to eat when you have IBS
There are different approaches to the best IBS diet, and it might be different for everyone. A common diet that has been tried and tested for IBS is the low FODMAP diet. This diet restricts fermentable carbohydrates for a few weeks and then carefully reintroduces them to identify triggers. FODMAP is an acronym standing for:
Read a Beginners guide to the low FODMAP diet to read about how to get started.
What are the treatment options for IBS?
Depending on the type of symptoms you have with your IBS will dictate possible options for diet, supplements, lifestyle, or medication use.
Diet changes can include
- the low FODMAP diet – most helpful for IBS diarrhoea predominant or IBS Mixed type.
- low histamine diet – often helpful for reflux, abdominal pain and allergic symptoms such as itchy skin, hives, rhinitis or sneezing and wheezing
- low sulphur diet – if very smelly odorous gas, joint pains along side loose stools, and bloating.
- increasing your fibre content – especially for people with constipation
Lifestyle changes include getting enough sleep, regular exercise, managing stress, finding some joy back in your life. Medication could include laxatives, drugs to firm up your bowel movements, antispasmodics for cramps and gas as well as other things your doctor could recommend.
Supplements include vitamins and minerals essential for gut health, probiotics, anti-microbial herbs, prebiotics or support for the immune system.
Is IBS affected by your menstrual cycle?
Many women find their menstrual cycle changes their digestion. It can be normal to feel a little more constipated before your period, and then experience looser stools as the bleeding kick in.
Women with IBS tend to have more painful periods, and it’s been shown rectal sensitivity increases around your period as well.
You may also find during the perimenopause phase when your hormones are fluctuation that digestive symptoms can increase. This might all feel very unfair as you’re already struggling with bad digestion, painful periods and bloating, but you can get relief from both together when you identify your digestive triggers, and eat in a way that suits your body.
You can read more about IBS and Periods in my longer blog post.
How to get an IBS diagnosis
There isn’t a clear medical test for IBS, and so it can take a while to get a diagnosis from a doctor. If you suspect you might have IBS it’s important you visit a doctor so they can confirm this.
There are lots of more serious conditions, such as colon cancer, inflammatory bowel disease or coeliac disease that have similar symptoms to IBS, so you don’t want to miss your doctor ruling these out first. IBS is sometimes called a diagnosis of exclusion, because we have to rule out other conditions before it’s confirmed you’ve got irritable bowel syndrome.
Typical tests your doctor might run depend on your symptoms, they could include:
- Blood test – looking for inflammation markers such as CRP, or ESR
- Stool test – looking for a bacterial or parasite infection, or traces of blood in the stool which could indicate a more serious condition
- Endoscopy – looking at the health of your upper digestive system with a small camera
- Colonoscopy – looking at the health of your colon with a small camera
- Feeling your stomach – physical examination can check for lumps, adhesions and your pain
- Scans – CT or MRI scans to look inside your body and check for adhesions, tumours or blockages.
Once you have an IBS diagnosis, there is no automatic treatment path as with some medical diagnoses, but there is lots of help in terms of diet and lifestyle, as well as some medication to ease symptoms.
How to calm an IBS flare up
Calming an IBS flare is normally a mix of diet and lifestyle actions. It can take a few days, or a few hours, but some of the things I recommend include
- gentle movement like walking, to shift trapped gas
- Wearing a loose fitting waistband because tight clothes can make cramps and pain worse
- warmth such as a hot water bottle or a warm bath to sooth
- eating a lower FODMAP diet for a few days to remove fermentable carbs
- going easy on yourself, take time to recover
You can read more about how to calm an IBS flare in my blog post.
How I can help you as an IBS Nutritionist
I work with people who have IBS, SIBO, or unexplained bloating, constipation, gas or loose stools. As part of my signature programme the Gut Reset I will
- Assess your digestive symptoms, but also look at mood, skin health, sleep, weight, muscle / joint pain and other relevant symptoms
- Support you to find a diet that relieves the bloating, pains and gas
- Arrange for additional testing at home (if necessary, e.g. stool test or SIBO breath test) and help you understand the results
- Define a supplement plan for the 3 month Gut Reset programme and afterwards.
- Help you implement the dietary changes with recipe ideas and meal plans, as well as understanding nutrition better so you can create your own meal plans.
- Support you to eat a wider diet variety, reintroducing your eliminated foods again
- Support you with regular calls so you really understand what to focus on each week.
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