Irritable Bowel Syndrome (IBS) is exceptionally common. It has been for many years, however only recently have people felt comfortable discussing their symptoms.
“A lady doesn’t discuss these matters!” Margaret told me. As a lovely 88 year old lady, she grew up being told that talking about bowel motions was taboo. Margaret continued, “I’m not sure about the younger generation, they talk about it all the time. My grandson is always describing his in such colourful ways.”
With a gentle explanation of the need and that it would assist me in helping her feel better, Margaret slowly checked around to make sure her husband Bart wasn’t listening. “I fart like a trouper, but only when Bart leaves the room” Margaret whispered. So with that, it allowed us to begin identifying the causes and help her avoid the constant and excessive gas.
Margaret discussed with me that she had experienced this for over 25 years and she wished she was “like the young folk” who could comfortably discuss their issues more openly. As it would’ve made her a lot more comfortable earlier.
Margaret is not alone. A huge percentage of the population are living in discomfort. From bloating, excessive flatulence, constipation or diarrhoea, nausea or stomach cramping/pain are all symptoms experienced from IBS. If you are one of them, it is time to speak up and get help. As there is no reason to live with such disturbances to your daily life, or to live in such discomfort. There is no shame, with some estimating as much as 25% of the population have some form of IBS.
So what are the triggers and how do we treat it and help people like Margaret? The most common trigger is food in the form of a food intolerance, but stress can also play a role in gut disturbances.
The gut – brain axis is very strongly linked, so stress can impact on your gut, it can also make symptoms worse. It is easy to say stress less, but implementing it isn’t so easy. I have found mindfulness very successful in helping better manage stress and stressful situations. Also involvement from a psychologist as a sounding board.
Dietitians have for years modified fibre intake, consumption of fats, spicy food, caffeine, probiotics to name a few to try and help relieve gut symptoms. However the most successful method is to implement a low FODMAP diet. FODMAPs is an abbreviation for a collection of sugar alcohols and short chain carbohydrates that can be poorly absorbed (malabsorbed) in the small intestine by some people.
In brief, one (or more of these foods) when poorly absorbed in the small intestine arrive in the large intestine when they shouldn’t have. As such, the bacteria ferments the carbohydrate or sugar alcohol and it can produce the range of symptoms often seen. The complicated part is that many people malabsorb different FODMAPs without experiencing any gut symptoms. 40% of people malabsorbing fructose and they don’t get any symptoms, all humans malabsorb fructans and galactans and not everyone gets symptoms either. So your symptoms really are the guiding factor.
To diagnose if it is a food intolerance you have a few options.
- You can do a pathology lab based breath test
- Follow a strict FODMAP diet
- Follow a selective FODMAP restriction based off a food and symptom diary.
My preference is option 2 or 3 as you need to follow some form of a FODMAP restrictive diet anyway for a breath test, so it just saves you some money. It also covers all FODMAPs, whereas the breath test can only cover some of the FODMAPs.
A food and symptom diary is simple to do at home. You write what you eat through the day and you record any symptoms such as bloating, gas, cramping and bowel motions all with the time of the day they occur. Ideally it is done for a week so that a dietitian can look over a better representation of what you eat normally. From this we can identify which FODMAPs, if any, you are intolerant to. The other method is to follow a strict FODMAP diet for between 2-8 weeks once symptom free, the length depends on your dietitian as many have varying opinions.
The outcome is knowledge of what you are intolerant to, a clear direction of what foods you can eat instead and a much more enjoyable and symptom free life. It doesn’t matter how old you are, as Margaret can attest to, you can still help improve your quality of life by better discussing your gut health and taking action.