Help: I think I have IBS…

What is IBS?

Irritable bowel syndrome (IBS) is more common than you might think, with a global prevalence of 9.2% (1) - that’s almost one in every ten people! IBS is described as a functional bowel disorder because it is diagnosed based on symptoms after other causes (organic diseases, e.g. coeliac disease) are ruled out by your doctor.

Symptoms of IBS can be embarrassing and difficult to talk about! But you are not alone. The most common symptoms of IBS include:

-       Fluctuating abdominal pain

-       Bloating

-       Excessive passage of wind

-       Distension

-       Altered bowel habit (diarrhoea, constipation, or a combination of both)

Not very nice huh? But for many people this is their daily reality. IBS can affect one’s quality of life, including mental health, and ability to work, and lead to greater medical costs year after year (1).  

It is important that you have a diagnosis of IBS made by a medical doctor as the diagnosis can be quite challenging because symptoms can change over time and mimic other disorders.

And now for the good news – once you have a diagnosis of IBS there are dietary and lifestyle modifications that can help reduce symptoms!

Let’s start by taking a look at the triggers for IBS:

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Dietary management of IBS

The first step in managing your IBS is to start with modifying the general triggers above, such as limiting intake of fatty and spicy foods, alcohol, caffeine and carbonated beverages. Check to see that you are having regular meals of an even size evenly distributed throughout the day. Evaluate what your stress levels are like and whether you can reduce them, as stress can play a role too. Once you have addressed these, consideration of more specific dietary modification might be useful.

IBS does not necessarily equate to an unhealthy gut, although it may feel that way. In IBS, it’s the nervous system and the communication between the brain and gut, that causes symptoms.

Symptoms such as bloating and abdominal discomfort arising from fermentation for example is a normal process, and is actually a sign that the food you are eating is providing fuel and nourishment to your gut microbiota. As a result a small amount of bloating and wind is actually quite ok and healthy. However, if your bloating and other IBS symptoms are excessive and impacting on your quality of life, and you have tried addressing the above general triggers, you may like to attempt the low-FODMAP diet to see if it reduces the severity of your gut symptoms. Research shows that at least 70% of individuals with IBS feel better on a low-FODMAP diet (2).

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The low-FODMAP diet

The low-FODMAP diet is a therapeutic diet for IBS and should only be carried out under the guidance of an experienced Specialist Dietitian. Although there is a lot of information available on the internet, it is not always accurate and never individualised to you. A Specialist Dietitian will complete a dietary assessment based on what you usually eat, identify the main sources of FODMAPs in your diet and provide you with suitable substitutions for the initial ‘Elimination Phase’. This will ensure you are on the least restrictive diet to enable symptom control and overall nutritional adequacy.

Research shows that at least 70% of individuals with IBS feel better on a low-FODMAP diet (2).

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At the end of ‘Elimination Phase’ when symptoms are relieved, the Specialist Dietitian will guide you through the ‘Challenge Phase’ to establish which FODMAPs were triggering your symptoms and at what doses. Together you will be able to interpret your results and move into the ‘Adapted Diet Phase’ whereby you can gradually reintroduce FODMAPs that were not problematic for you. This will enable you to move forward with the most liberal diet possible for symptom control in the long run and avoid unnecessary restrictions.

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References:

1.     Oka, P., Parr, H., Barberio, B., Black, C.J., Savarino, E.V. & Ford, A.C. 2020, "Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis", The lancet Gastroenterology & hepatology, vol. 5, no. 10, pp. 908-917.

2.     Halmos, E.P., Power, V.A., Shepherd, S.J., Gibson, P.R. & Muir, J.G. 2014, "A diet low in FODMAPs reduces symptoms of irritable bowel syndrome", Gastroenterology, vol. 146, no. 1, pp. 67-75. e5.

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