As a clinical nutritionist I have seen many clients over the years who have been medically diagnosed with IBS or irritable bowel syndrome. They have usually been in discomfort for some time – months, years or even decades, and have seen doctors, gastroenterologists and even psychologists who have not managed to pinpoint the issue so the umbrella term of ‘Irritable Bowel Syndrome (IBS)’ provides an answer. Here is a full definition of IBS and how is diagnosed.
By the time a person gets to me they may have lost hope that they can get better and believe that these symptoms are part of a syndrome that they are probably just going to have to live with. I am happy to inform that that is not the case. IBS support is a major part of my clinical practice.
A systematic approach is required to each client I see with IBS to work out what part of their diet, lifestyle, physiology, stress response, genetics etc is causing their discomfort. When I see clients with IBS it is guaranteed that no two are the same. What’s causing one person’s symptoms will not be causing them in the next person.
So, I have a client in front of me who is reacting to many foods commonly found in the diet, they are bloating after meals and have periods of diarrhoea and/or constipation that are either around all of the time or come and go on a periodic basis. It’s time to take a full client history.
CAUSES OF IRRITABLE BOWEL SYNDROME
The first area I explore is the client’s diet.
- Are they eating lots of refined, high sugar foods and unhealthy fats (pathogenic gut bacteria love junk food)?
- Do they have adequate fibre in their diet and do they tolerate fibre well?
- Are they drinking enough water (very important in constipation)?
- Are they eating too much protein (can be very hard for the gut to process a high protein diet especially if some of the digestive enzymes are lacking)?
- Are they eating foods that they know they will react to? It’s amazing how many people will tell me that certain foods will cause them serious discomfort but they keep eating them – get them out of your diet!
- Are they eating enough fruit and vegetables?
- Are they drinking alcohol in excess?
An unhealthy diet can be the root cause and a major escalator of IBS.
When I have a good understanding of the client’s diet, I go way back to the beginning, to when the client was born. Here’s some of the factors I am looking for:
- Were they born naturally or via caesarean? Babies born naturally are inoculated with beneficial bacteria from their mother’s vagina and babies born via caesarean are inoculated with bacteria from the mother’s skin. This means that their gut bacteria will not be off to a good start.
- Were they breast or bottle fed? Breast fed babies get another good blast of beneficial bacteria. Bottle fed babies don’t get the same probiotic effect. So, if I have a client who was caesarean born and bottle fed I know that their microbiome did not get off to a good start.
- Did they have tonsillitis, multiple ear infections, acne or any conditions that would have required lengthy or multiple doses of antibiotics as a child, teenager or adult? Multiple doses of or long-term antibiotics can have a very detrimental effect on a child’s developing or adult’s established gut bacteria, and some beneficial bacteria can even be wiped out.
- Did they have any point in their life where their gut hasn’t been right since? This could be a trip to somewhere, but quite often it’s a surgery or a stressful event in their life. The trip might suggest the presence of or the aftermath of a parasite. The surgery suggests antibiotic overload. When you have surgery you are usually given an antibiotic at the time (I’ve had surgeries where I wasn’t told that I was given an antibiotic and was only informed when I asked) and given an antibiotic to take afterwards. I’m not criticising this process – if there’s any time an antibiotic should be given, I think a surgery should warrant it! However, we have to realise how this affects the patient’s microbiome and provide the necessary counteracting treatment, such as probiotics, at the same time. The stressful event suggests that the effect of the stress on the gut has lead to some ongoing issues. Stress actually slows the gut down as the body deals with the stressor. There is a big nerve called the vagus nerve that hooks our gut up to our brain. This is why doctors are running with the anti-depressants for IBS treatment. However, researchers are now linking the state of the gut microbiome to our moods, feelings and reactions. Working on improving the gut microbiome may have a huge impact on mental health and our ability to handle stress. I would prefer to work on that first before turning to medications that may have an adverse effect on our gut and the composition of the microbiome. Many of the side effects of anti-depressants are gastrointestinal in nature.
- What is their family history? Did their parents or grandparents have gut health issues? This might suggest a genetic condition such as coeliac or even the same food intolerances. For example, if your mum or dad was unable to handle lactose (the sugar found in dairy products) then it is more likely that you may have the same trait.
I then take a full medical history.
- Do they have any autoimmune disease, or have they had any serious chronic diseases over their lifetime?
- Do they experience fungal infections on their body or do they have a history of thrush (both of which is suggestive of a yeast overgrowth in the bowel)?
Every piece of information I gather from a client can help me get to the bottom of their discomfort.
Then I ask lots of questions about the gut.
- How often do they pass a stool? What colour is it? What does it look like (I use the Bristol Stool chart for this delight!)?
- Are they fully evacuated when they’re done?
- Do they bloat before or after food? If so, when?
- What types of food cause extra discomfort or are they reacting to everything?
- Do they digest fat well?
- Do they digest protein well?
- What happens if they eat fish and chips or another form of junk food?
- Do they get bad hangovers?
- Do they get excess wind or burping?
- What time of day is their discomfort the worst?
- What makes their symptoms better?
The more information the better.
IRRITABLE BOWEL SYNDROME TREATMENT
Once all of the information has been gathered, the client and I decide on the best way forward. I have a wide array of testing available to get to the bottom of the issues including a comprehensive digestive stool analysis, parasitology, food allergy and intolerance testing, microbiome mapping and genetic testing to list a few. It really depends on the client’s budget and the symptoms we are dealing with. I will only recommend expensive testing if I think it is absolutely necessary.
Then comes treatment. I mentioned earlier in this article that each client’s prescription for IBS will be completely different. I may ask the client to remove some foods from their diet or add extra foods in. It is always way easier to make a decision regarding the foods that are in or out once a client has completed a food allergy and intolerance test – it’s creates a much more specific treatment plan. I may prescribe some supplements such as beneficial yeasts, probiotics, prebiotics, stomach acid and enzymes or gut healing powders. I may prescribe further testing. I may prescribe stress management techniques. It depends on who I have in front of me.
Then comes regular follow-ups. This is very important as it helps me to assess how well a client is doing on a specific treatment plan. If they are doing very well then we know we are heading down the right road and we keep going until all of the symptoms are gone. Even with a good result I usually tweak the treatment plan a little to make it even better. If they are not doing so well then we change the plan until we get the results we want. Sometimes it takes 2 or 3 visits to really nail the specific treatment plan that is going to work the best for the client. However, I do not give up until my client is 100% better. This may mean excluding reactive foods for a lifetime but often as not foods can be added back into the diet at a later date.
You may notice that I mentioned gut bacteria many times during this article. There may be other issues going on with the gut (low/high stomach acid, lack of digestive enzymes, parasites etc.) but with IBS you always work on manipulating the gut bacteria to a better mix. There is a constant battle in our gut between good bacteria and bad bacteria, and all it takes is a hit of antibiotics or a stomach bug picked up on holiday to allow the bad bugs to take control. My job is to help the good bacteria fight back. I use supplements to help this along, but a wide, diverse plant-based diet is the key to keeping the good stuff happy. Working on the microbiome can make a massive difference to a client’s health and it’s relatively easy to do.
So that’s my take on IBS. I actually really enjoy helping clients with IBS. You can make a massive difference in a very short time. Please don’t suffer in silence – help is out there if you seek it out. You can be 100% well in no time.