April is IBS Awareness Month

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April is IBS Awareness Month

April marks IBS – or Irritable Bowel Syndrome – Awareness Month. So here I’d like to look at the things that can go wrong in our gut that lead to IBS.

IBS is a diagnosis of exclusion, meaning that when conditions such as Inflammatory Bowel Disease (Crohn and Ulcerative Colitis), gastritis, and colon cancer have been ruled out a doctor will often diagnose IBS. The symptoms can be wide ranging, from bloating, gas, constipation, diarrhoea, abdominal pain and reflux, through to more systemic symptoms like joint pain, skin issues, brain fog and fatigue.

There are four broad areas of the gut where things can go wrong, and we’ll look at each in turn.

1.Digestion and Absorption

When we think of the function of the gut, the process of digestion and absorption is generally the first thing that comes to mind. It doesn’t matter how good our diet is if we’re not properly digesting and absorbing our food. Problems with this issue often comes down to our digestive system not producing sufficient enzymes to properly break down the food we eat. This could be due to a lack of nutrients, but also, we may not be preparing our body to eat; are we eating on the go, in a stressed environment? Cooking meals from scratch – whilst not always possible – starts to prepares us for digestion by releasing digestive enzymes.

Signs your digestion and absorption could be compromised include:

  • Indigestion and/or nausea after eating
  • Pale stools that float
  • Diarrhoea

What can you do to support digestion and absorption?

  • Reduce stress and don’t eat in a stressed state; be mindful of meal quantity and timing – not too close to bedtime.
  • Consider eating more soluble fibre
  • Moderate fat intake – healthy fats from avocado, extra virgin olive oil, fish in moderation
  • Consume foods to increase bile, like eggs, soya, liver, scallops, tuna, turkey, chicken, seeds, salmon, seaweed
  • Reduce fluid intake right before and during meals, this can dilute stomach acid.

2.Integrity and Immunity

Here I’m referring to the integrity of the gut lining, which is a vital interface between the external environment – in this case the food we eat – and our internal environment. The intestinal lining needs to be permeable enough to allow digested particles through into the bloodstream but not so permeable that bacteria and undigested particles can slip through.

Your gut integrity may be compromised if you:

  • React to some food with a rash, headache, diarrhoea, palpitations
  • Feel discomfort when eating certain foods – cereals, gluten, dairy
  • Have difficulty maintaining weight
  • Have a history of recurrent NSAID use (non-steroidal anti-inflammatories) e.g. ibuprofen or naproxen

All these symptoms can be signs the gut lining is compromised. To support and help repair the lining we can:

  • Reduce aggravating foods – consider an elimination diet e.g. Paleo, low FODMAP
  • Stress reduction and sleep routine
  • Consider meal quantity, and timing
  • Focus on real foods; vegetables and fruit. Reduce processed foods, sugar, artificial sweeteners and alcohol, caffeine (sorry!)
  • Supplement with L-glutamine, vitamin A, C, E, zinc, probiotics.

3.Imbalanced gut bacteria

The balance of the bacterial community in our gut has wide-ranging effects throughout the body, from helping digestion and immunity to influencing mood and cognition. However, this community is delicate and can be knocked out of balance by a range of things, including:

  • Antibiotics
  • Chronic stress
  • Highly processed diet / low fibre diet
  • Food poisoning
  • PPIs / Low stomach acid

Your gut bacterial community may be imbalanced or ‘dysbiotic’ if you suffer with the following:

  • Bloating
  • Gas
  • Abdominal pain
  • Loose stools / diarrhoea

To support and rebalance the microbiome we want to take a methodical, stepwise approach.

  1. Follow an elimination diet for 4-6 weeks, this could be a Paleo diet, a low FODMAP diet, a Mediterranean diet – anything that moves you away from a standard overly processed diet. Removing foods that commonly cause reactivity reduces the fuel for inflammatory bacteria.
  2. Reintroduce foods one at a time and see what you react to
  3. Once your improvements plateau you can introduce a clinical grade probiotic for 2-3 months and continue to broaden your diet as your symptoms allow.
  4. You could also use a herbal antimicrobial if you’re still having issues at this stage.

4.Motility

This refers to the speed at which food moves through the gut, which determines the frequency and consistency of bowel movements. Issues around motility can manifest as loose stools / diarrhoea or constipation (not having a daily bowel movement), or a fluctuation between the two. Bloating and/or gas can also be the result of a sluggish bowel.

This can also have a social and emotional element where anxiety and our busy lives can contribute to tension in the gut and decrease the likelihood to passing a bowel movement.

What can we do to improve the consistency and regularity of bowel movements?

  • Reduce snacking, allow at least 3-4 hours between meals.
  • Routine is key and meal timing
  • Stress reduction
  • Hydration, along with increasing soluble fibre, like oats, apples, rice, quinoa.
  • Prebiotics supplements, which will contain inulin, FOS and/or GOS
  • Herbal teas with digestion supporting properties like, ginger, peppermint, fennel and camomile.
  • Probiotics (live bacteria)
  • Prokinetic supplements

Conclusion

IBS is an umbrella term that covers various symptoms. Fortunately, there are several tools we can use to positively impact outcomes, from diet and stress reduction techniques to supplements and awareness of meal timing. Where to start will depend on the root cause of your symptoms. If you’d like help to dig down and uncover the unique cause of your gut distress feel free to book a discovery call with me, James Dunham, a qualified Nutritionist based in Market Harborough and Oakham. Online consultations are also available.

Photo by Sean S on Unsplash

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