Irritable Bowel Syndrome (IBS) and Nutrition
IBS is a common condition affecting 10-15% of the population, the main symptoms being:
- Abdominal discomfort and pain, relieved by the passing of wind or stool
- Altered bowel habit (constipation or diarrhoea or fluctuation between the two)
It is a highly frustrating condition and there seems to be no obvious damage to the bowels which is noted in conditions such as Inflammatory Bowel Disease or Colitis. The latest research suggests that malfunction of the nerves of the gut wall is a dominant factor, and that these nerves communicate with the brain and vice versa.
Treatment of IBS is often unsuccessful. Changes to diet may help. Controlling the amount of dietary fibre consumed can influence symptoms; for example too much fibre can aggravate abdominal pain and bloating, while too little can contribute to chronic constipation. See food sheet attached explaining the importance of fibre and the differences between soluble and insoluble fibre.
Stress and IBS. In response to a possible (or real) threat the body releases adrenaline and cortisol which shut down digestion as blood is diverted away from the stomach and skin towards the heart and muscles. Digestive secretions are severely reduced since digestive activity is not necessary in an emergency. After the initial alarm phase is over the body goes through a temporary recovery phase. But constant stress will not allow for recovery and may have a deleterious impact on your digestive system. An overgrowth of the wrong gut bacteria may result which will affect digestion of carbohydrates for instance and a reduction of stomach acid secretions may affect the digestion of proteins. A nutritional therapist will assess any deficiencies and address with dietary manipulation and/or supplements such as digestive enzymes, hydrochloric acid and probiotics (bowel bacteria). Research suggests that taking a good quality probiotic significantly reduces symptoms of IBS compared to a placebo.
Dairy intolerance and IBS. Many people lack the enzyme lactase that breaks down the milk sugar lactose. Symptoms of dairy intolerance are excess gas, bloating, diarrhoea, cramps, and abdominal rumblings and flatulence. Consider removing milk from the diet for a short period and then reintroduce and see if symptoms reoccur. Yoghurt is helpful in reducing the symptoms of lactose intolerance. Consume “live” yoghurt only that contains bacteria such lactobacillus bulgaricus and streptococcus thermophilus that produce significant quantities of their own lactase enzyme. Consider a probiotic supplement.
Quick guide nutritional management of gastro-intestinal tract disturbance (based on NICE guidelines 2008)
- Have regular meals and take time to eat
- Avoid missing meals or leaving long gaps between eating
- Drink at least 8 cups of fluid per day, especially water or non-caffeinated drinks such as herbal teas. (Peppermint tea is excellent as is lemon and ginger tea)
- Restrict caffeinated drinks to 3 cups per day
- Restrict intake of alcohol
- Consider limiting intake of high-fibre food (whole grain bread and rice or cereals high in bran)
- Limit fruit to three portions per day – and only eat safe fruits that agree with you (One portion = 80g)
- Avoid sorbitol and any slimming and diabetic products
- Eat oat-based breakfast cereal or porridge and add 1 tablespoon of linseeds per day
Other important general nutritional considerations:
- Try to eat when relaxed and chew food thoroughly
- Avoid all known food triggers
- Optimise stomach acid production, specialist help will be needed
- If possible eat a range of fruits and vegetables in order to optimise intake of beneficial phytochemicals, such as allicin in garlic which has anti-bacterial activity
- Consider digestive enzyme deficiencies such as lactase
- Reduce wheat as it is a glycoprotein (a sticky protein) that physically flattens the villi of the digestive tract and may prevent absorption of nutrients
- Consider the stress response and how you act in stressful circumstances
- Seek expert nutritional advice
Anna Pugh, Nutritional Therapist