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IRRITABLE BOWEL SYNDROME

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IRRITABLE BOWEL

As a clinical nutritionist I have seen many clients over the years who have been medically diagnosed with 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.

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.

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 like India or Bali, but quite often it’s a surgery or a stressful event in their life. The India or Bali 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 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 conditions, or have they had any serious chronic illnesses 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 after food? 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 in Bali 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.

CLIENT REVIEWS

Fiona is one of my all time favourite people. After high schiol, I weighed in at 99kg. At 174cm, I have been overweight by 15-20 kgs for all my adult life. Until, at age 53, I met Fiona. She immediately dianosed my primary problem and by following her dietary coaching, I lost 16 kgs in 5 months. More importantly, I have maintained this for more than a year now. Now, well into the second half of my life, life is good, very good. As I said, Fiona will always be one of my all time favourite people. Thank you Fiona.
John
Fiona ran a course at work and it was fantastic – I learned so much and she tailored the programs to each individual which worked really well. I reached my weight loss and health goals and it really wasn’t too hard and I still have treats!  More importantly, I feel much better in myself for making food changes and continued to see her independently when the course at work finished.
Charlotte Carlish
Indigestion, stomach pain and abdominal cramps, were an every day occurrence for me. I was quite desperate by the time I found Fiona. With the help of some supplements and allergy testing, Fiona Took me on a journey of discovery. Thanks to her professional and kind guidance, I now  know which foods to avoid and which ones will help my gut to stay healthy.  For the very first time in a long time, my tummy now feels quite normal and I no longer suffer any of the above conditions. To say Fiona has change my life may sound rather dramatic but it is completely true and I will be forever grateful to her.
Alison

Feeling Great, Losing Weight!

I have been working with Fiona at Physical Nutrition for about 10 weeks through a corporate program run my employer.  Losing weight and making some real changes to my dietary lifestyle has been a game changer for me.  Through her weekly tutorials, Fiona has taught me about the food I eat, what is best for my body and to gauge how I feel after each meal.  Combined with a sensible exercise routine of walking and cycling, I have managed to drop my weight by 7kgs during this period.  My energy levels are up, I’m feeling fitter and I’m eating much more balanced meals and now know which foods to avoid and which to eat more of!  It’s been a great experience and I would highly recommend Fiona’s program.

Warren
I have recently completed the Physical Nutrition 10kg in 20 weeks program and I couldn’t be more thrilled with the support and guidance Fiona has provided.
The 10 in 20 program not only helped me change my habits by giving me a coach that kept me accountable but also helped to educate me to make better nutrition choices in the future.
Thank you again Fiona & this is just the beginning, I’m not going anywhere ☺️
Paris Doran
Fiona has been working with the City of South Perth over the last year.  She has developed a customised 10 week health coaching and nutrition program with us which the City now offers as part of its suite of health and wellbeing benefits.  All of the participants were overwhelmingly positive about the program.  They rated the program highly on the aspects of Fiona’s professionalism, approachability and knowledge, as well as the results they had achieved.
I would recommend Physical Nutrition to any organisation looking to develop staff benefits.
Gillean Sharp
Physical Nutrition/Fiona Murray has really helped my husband and I to achieve our weight loss and lifestyle goals. Her advice, support and knowledge during the 20 week challenge has set us up to lead a healthier and balanced life style. We thought we had enough food and exercise knowledge before meeting Fiona but she has kept us on track, motivated us and through her group classes has kept us entertained and true to our goals! Thanks Fiona!
Alison Thair
My son is 21 and has been ill for years and part of it was Diet, and we have been to many nutritionalist’s but FIONA MAKES SENSE and TELLS YOU WHY you should be careful what you eat. She changed my sons life so I sent my Daughter who had auto immune issues and she has helped her. It is now my turn so I will keep you updated. Highly recommend her she is also very understanding.
Lisa Mann
I have been with Fiona at Physical Nutrition for several months in relation to skin and gut problems and for weight loss. Fiona is knowledgeable and supportive. I am slowly losing weight and my skin and gut issues are improving. Fiona works in conjunction with my integrative medical practitioner which is a very helpful. First time I have had any positive results, a slow but worthwhile approach.
Lynne Besant

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