nutrition

The ins and outs of irritable bowel syndrome

Stephanie Karl, Clinical Nutritionist, Emirates Integra Medical and Surgical Centre, explores the condition

By Stephanie Karl
00:00 February 5, 2018
IBS omega-3

Efficient movement of food through the digestive tract is vital to good health and comfort. When food gets stuck somewhere in the process, it can begin to ferment, rot, or even turn into more problematic obstructions. At the very least, inefficient digestion prevents the proper assimilation and absorption of nutrients, leading to insufficiencies. 

Irritable bowel syndrome (IBS) symptoms vary from person to person and tend to come and go with lifestyle changes and stress. The term IBS is used to describe a digestive disorder characterised by a group of common symptoms, including abdominal pain and discomfort, gas and bloating plus changes in bowel habits. IBS is technically diagnosed when digestive symptoms have been experienced for at least three to six months and the duration of symptoms is an important distinguishing factor. It tends to appear more among women, especially under the age of 50. 

Patients come to me with undiagnosed gut issues and frustration. A natural treatment plan is more appealing than resorting to a long-term dependency on anti-spasmotic drugs.

Holistic approach

Patients come to me with undiagnosed gut issues and frustration. A natural treatment plan is more appealing than resorting to a long term dependency on anti-spasmotic drugs, antacids and antibiotics. My approach is not to dampen down the symptoms but to seek the underlying cause. This requires knowing what foods are causing some concern, what microbial life is activated and the enzyme and acid balance necessary for food breakdown. Dietary and lifestyle changes along with short-term gastro-intestinal support are the prescription. 

This may require testing from a three-day stool collection, a hydrogen breath test for rogue bacteria and measuring the IgG antibody response of protein foods with a food intolerance test. It is important to make an informed start to treatment as IBS caused by insufficient digestive support doesn’t necessarily require antibiotics and antifungals are only used when bacteria migrates either up from the colon or down from the stomach into the small intestine (SIBO).

Common IBS symptoms

  1. Changes in normal bowel movements, including constipation or incomplete stool movement, diarrhea or both
  2. Changes in the appearance of stools and passing undigested food particles 
  3. Bloating, gas and burping
  4. Abdominal pains, trapped gas, and cramps 
  5. Nausea, heartburn or acid reflux
  6. Loss of appetite or always feeling full
  7. Feeling relief from symptoms after going to the bathroom normally for several days in a row.

IBD

Inflammatory bowel disease (IBD) is a rarer condition even though it shares similar symptoms. It is a severe and sometimes life-threatening inflammatory gastro-intestinal disorder and includes Crohn’s and Ulcerative Colitis. Nutritional involvement is to help improve digestion, avoid deficiencies and identify and replace foods that are very poorly tolerated and inflammatory.

Symptoms of IBD depend on where the disease occurs in the bowel and its severity but commonly include:

  1. Abdominal pain and tenderness (often on the right side of the lower abdomen)
  2. Chronic diarrhoea (sometimes which is bloody)
  3. Unintentional weight-loss
  4. Fever
  5. Feeling of a mass or fullness in the lower, right abdomen
  6. Other symptoms of IBS 

Treating IBS differs between each person. For some, reactions to various foods can trigger symptoms especially true when it comes to carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). These sugars are poorly broken down in the stomach when the stomach acid is low and enzyme activity gets lazy and easily become fermented to cause gas and bloating. Constipation and diarrhoea are usually present, causing mixed reactions to fibre consumption. SIBO is a common driver of upper tract gas and bloating, burping and bad breath. It is tested for by a hydrogen breath test with a specific carbohydrate challenge solution to identify if a bacteria has taken up residence in the small bowel to cause these symptoms. If present, a targeted antibiotic is required as well as longer term rehealing herbs and oils to re-establish intestinal health and stop the bacteria coming back.

While there is not one specific cause of IBS that applies to everyone, common factors contributing to IBS include:

  1. Food sensitivities and allergies, especially to things like dairy, gluten and other FODMAP foods, which contain certain carbohydrates
  2. Chronic stress 
  3. Having family members who also have IBS
  4. Travelling
  5. Changes in sleep routine 
  6. Hormonal imbalances 

Managing it

Getting help to manage IBS symptoms, require identification of the underlying cause to be able to build the best treatment plan and support for you. 

IgG food intolerance testing is a highly requested test highlighting the antibody response to protein foods that are poorly broken down, absorbed and treated by the immune system as foreign. 

If many foods come up, increased intestinal permeability or Leaky Gut is indicated as they cross the intestinal lining. It is not usually the food that is the issue but insufficient digestive support to break food into absorbable components, causing damage and a burden in the gut.

In the absence of testing, an elimination diet can be followed whereby you take foods out for a time and slowly add them in to gauge a tolerance. They tend to be genetically modified grains and pea, dairy and egg white. If you experience an improvement, you can introduce the foods one at a time over weeks to test a response.