Tuesday, 10 June 2014

Feeling Irritable?


Cramping, abdominal bloating and pain, diarrhea, gas, and sometimes constipation - irritable bowel syndrome is no fun, no fun, and no fun. But wait…this story improves. There are some solid non-drug ways to reduce symptoms and eliminate flare-ups.

IBS often starts when people are quite young as early as their 20's and 30's and is more common in women and people who have a family history of IBS (Mayo).  We don't know what causes IBS but we do know that it is a functional problem with the bowel. The muscles in the bowel that contract to move food are either moving too fast or too slow and causing digestive problems. More recent research also suggests that people with IBS have low levels of serotonin - a neurotransmitter that works in our brain and in our bowels (Mayo). And we know that people with IBS tend to have an imbalance of bowel bacteria. The gut is missing the right balance of bacteria to properly break down food (Mayo). 

Even though we aren't sure what causes IBS there are some well known symptom triggers. Some people react to certain foods (caffeine, carbonated beverages, certain vegetables or wheat). Other people get symptoms with stress. Some people get symptoms with hormonal changes (e.g. menstrual cycles in women) (Mayo)

Irritable bowel syndrome (IBS) is what we call a "diagnosis of exclusion". In other words we make sure that we have ruled out all the other possibilities before we diagnose someone with IBS. Unlike most other bowel pathologies IBS cannot be seen on a bowel scope or an X-ray or in blood work results. So we make sure a person doesn't have anything else going on and make an IBS diagnosis based on history and physical exam.

Irritable bowel syndrome (IBS) should not be confused in any way with inflammatory bowel disease (IBD) (Crohn's disease or colitis), celiac disease, or colorectal cancer. These are separate and unique diseases and although some of the symptoms are similar to IBS these diseases are managed and treated in very different ways.

IBS can range from very mild and occasional symptoms to frequent or extremely painful symptoms that are functionally limiting. If not controlled severe IBS can cause people to miss work or school or cause disability. Being tied to your home and your bathroom is no laughing matter. But the good news is that for many people IBS can be prevented with food changes and lifestyle modifications. For easier reading I've divided the food versus non-food strategies below.

Food Strategies for IBS: 
  1. Remove Trigger Foods: If you know that you get a flare-up of symptoms after you eat a particular food - stop eating that food! Sounds simple right? But many people don't take this easy  step. People find it overwhelming to consider a life without soda pop, onions or coffee. But if you have an identified pattern of IBS with these foods then consider taking it out of the equation. Your body is telling you it doesn't want what's currently on the menu.  
  2. Remove FODMAPs:  FODMAPs are a group of small carbohydrates found in common foods. They are poorly absorbed in the small intestine so they move through to the colon and draw water into the bowel (bingo! diarrhea) and are rapidly fermented (yep…gas).  FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. They include foods such as asparagus, avocado, wheat and dairy products. Researchers estimate that 75% of IBS suffered can reduce their symptoms by removing FODMAPs from their diet (CDHF).  To read more click  FODMAPs (CDHF) or FODMAPs (Stanford U)
  3. Consider removing dairy & wheat from your diet: dairy and wheat products contain large proteins that are tough on the bowel. They are also FODMAPs (see above). Many of the patients with IBS that I meet have tried removing these products from their diet with fabulous results. Some will try to add some dairy or wheat back in later on to see how they do with it. Truthfully most stay off both because they have much better control of symptoms when they do. 
  4. Avoid artificial sweeteners: these can cause significant bowel distress particularly sorbitol. Artificial sweeteners can be hidden in processed and packaged foods - but we shouldn't be eating those anyway right?
  5. Avoid processed, low fibre, nutrient deficient food: fast food, junk, and processed food has little to no nutrients and fibre. In general it offers empty calories and lots of sugar, trans fats, and chemicals that the IBS bowel just doesn't need (in fact no body should eat it!). I think of processed food as a sort of cement that gets into the bowel and just sits there. Remember that some seemingly healthy grocery store foods like crackers and cereals fit very comfortably into this category and should be avoided. Don't be fooled by sneaky marketing. 
  6. Drink Water: Am I stating the obvious again? You'd be surprised how many people don't do it. The bowel needs water just as much as the other body parts. A minimum of 8 glasses per day (8oz) more with activity or if you work outdoors. And no - juice, pop and coffee do not count as water. Some clinicians recommend drinking your water between meals not with them (HealthLinkBC).
  7. Eat Fibre: It sounds counter-intuitive. Why would someone eat fibre if they have diarrhea? But in fact fibre binds fluid in the bowel and allows stool to be more formed. It also keeps everything moving so prevents constipation as well. Every person has to play with this and figure out which sources of fibre work the best for them to prevent symptoms rather than make them worse. If you are just starting to add fibre to your diet start low and increase gradually and always drink your water (see above) to reduce gas. Fibre in food is preferable to pills and supplements because food has so many other nutrients. But every person's body is different and you have to use what works for you. Finally, know the difference between soluble and insoluble fibre….and choose soluble sources (Patient.co.uk, HealthLinkBC). 
    • Soluble fibre includes oats, psyllium, nuts & seeds, some fruit & vegetables & pectins. For a list of soluble fibre foods click here
    • Insoluble fibre includes corn, bran, wheat bran & some fruit & vegetables. Avoid bran in particular. For a list of insoluble fibre foods click here
  8. Eat small frequent meals: The bowel is happier with 5 smaller meals rather than 2 or 3 large ones. Meals don't have to be massive. Snacks can be a handful of nuts or some veggies. 
  9. Consider peppermint: peppermint is a natural antispasmodic. Evidence for it's use in IBS is divided but if consumed in natural sources (peppermint oil) it's not likely to be harmful. Remember that chewing gum adds air to the bowel and causes bloating so should be avoided (Mayo, CDHF). 
  10. Consider probiotics: again probiotics can repatriate the bowel with healthy bacteria needed for the digestion of food. So that means plain yogourt (not the sweetened flavoured kind) if your body tolerates dairy products. If not some people benefit from a supplement. 
Non-Food Strategies for IBS:
  1. Mitigate Stress: Yes it can be done. Again IBS may be your bodies way of telling you it's not happy with your current stress level. Listen to it. Assess what (or who) is contributing lots of stress to your life and remove or reduce it. If you are not able to change your stressors consider changing how you manage stress. Yoga, walking, and meditation have all been shown to be successful ways of improving people's daily experience. 
  2. Exercise: exercise stimulates bowel motility and helps the muscle to contract properly. It also mitigates stress and boosts serotonin levels. You don't have to run a marathon. Just get out and walk every day. 
  3. Get Sleep: a sufficient amount of sleep is directly connected to bowel health as well as stress. Adults should average 8 hours of sleep per night (click here to read Sleeping Yourself Healthy ). 


If your feeling overwhelmed by the food recommendations don't panic. In fact the IBS diet makes many recommendations that everyone should follow - like water, exercise, sleep, fibre and avoiding processed food. Beginning with a whole foods diet is a good place to start. Then check the FODMAP list and begin removing things and replacing them with recommended foods. You may wish to keep food diaries for a while so you can really identify patterns. Once IBS symptoms are under control you can experiment with what might be added back in.

Thanks for reading Getting Healthy With NP Sam. Comments welcome - click the pencil icon below. 


Resources & References:
Irritable Bowel Syndrome (Mayo Clinic)
Irritable Bowel Syndrome (Patient.co.uk)
Healthy Eating Guidelines for People with Irritable Bowel Syndrome (HealthLinkBC)
Irritable Bowel Syndrome (Canadian Digestive Health Foundation, CDHF)
Understanding FODMAPs (Canadian Digestive Health Foundation, CDHF-2)
The Low FODMAP Diet (Stanford Hospital)
Food Sources of Soluble Fibre (Dietitians of Canada)
Insoluble Fibre Foods (Help for IBS)

1 comment:

Anonymous said...

I suffered from this for years. Every afternoon after lunch, terrible pains in my stomach. The real cure was retirement so I guess it was stress. Still happens occasionally but very rarely.