IBS – Living in Harmony with a Warring Gut

The abbreviation IBS – Irritable Bowel Syndrome, spelt with wooden letter tiles.

1 in 5 people suffers from IBS (Irritable Bowel Syndrome) at some point in their lives.  Often first occurring between the ages of 20 and 30, bouts of IBS come and go.  A lifelong problem, the severity of the impact on sufferers’ day-to-day living varies.  Women are believed to be more commonly affected – though what proportion of the male population fails to seek medical advice for digestive complaints is unknown (notorious doctor avoiders, men’s refusal to visit the GP is not a sexist statement, but rather simple and widely accepted fact).

IBS is a chronic digestive issue that exhibits various signs and symptoms, or ‘flare-ups’, but the most frequently occurring are:

  • Stomach cramps and bloating;
  • Interchangeable diarrhoea and constipation;
  • Feeling further bowel movement is needed but unable to go;
  • Excessive flatulence;
  • Tiredness and generally low energy;
  • Backache;
  • A frequent need to urinate.

Although not an autoimmune disorder, the actual cause of IBS remains elusive.  However, some key dietary factors are thought to exacerbate the symptoms:

  • Alcohol and caffeine;
  • Fizzy drinks;
  • Processed foods.

Some people find they are intolerant of dairy as well and may find it beneficial to switch from a vegetarian to a vegan diet.  Regarding fizzy drinks, in an effort to consume more probiotics, other sufferers find a fizzy kombucha can actually help their ‘battle’ against this persistent digestive affliction, given its gut-friendly properties supporting the microbiome (as defined by Joshua Lederburg and reported on last issue). 

In addition to a fresh and healthy, unprocessed diet – wherein most meals are cooked from scratch so as to avoid unnecessary preservatives and other added chemicals in readymade meals (not to mention the excessive sodium content) – frequent exercise seems to be of help in management of IBS symptoms as well.

What is thought to be a clear causal factor in the development of IBS is stress – perhaps a reason why the common age for first symptoms is the beginning/early years of the working life (20-30 years of age).  To this end, techniques for achieving relaxation of both the mind and body, such as yoga and meditation, are very important in keeping recurrent episodic flare-ups at bay (and many yoga poses are specifically designed for aiding the peristaltic movement of the intestines in digestion, particularly twists).

Care should be taken in keeping an eye on symptoms, as many are similar to warning signs for more serious conditions, such as Crohn’s disease, coeliac disease, IBD (Inflammatory Bowel Disease, which is autoimmune), diverticular disorder, and even bowel cancer.  If you experience any of the following, you should see your GP straight away:

  • Sudden unexplained weight-loss;
  • Blood in stools or general bleeding from the anus;
  • A hard lump or swelling in the stomach area that is noticeable to the touch;
  • Shortness of breath, heart palpitations, and pale skin.

As Hippocrates declared back in 375 BC, “Let food by thy medicine”.  Each flare-up is a battle, but with careful observation of what causes your IBS to return (business travel or late nights doing overtime to finish a report), a personalized management plan of diet and exercise could very well help win the digestive war.

A Low-FODMAPs Diet: The IBS Management Plan

FODMAPs are fermentable carbohydrates which trigger digestive issues in people who have a sensitive gut.  More than 30 studies have shown that adherence to a low-FODMAPs diet for between 3 and 8 weeks – strictly reducing consumption of the culprit foods – lessens symptoms in IBS sufferers by up to 70%. 

With 80% of those who battle IBS exhibiting bloating, reducing any excessive fermentation is key to lessening gassiness.  The reason for these foods being an added cause of aggravation in IBS sufferers is that they are prebiotic foods – that which fuels probiotics within our microbiome.  If you are not an IBS sufferer, you do not want to be cutting these foods out of your diet.  Similarly, those with IBS themselves should gradually reintroduce these foods as they are key to bacterial balance within the gut in the long-term.

Essentially then, the low-FODMAPs diet works on a twofold premise of (1) Restriction and (2) Reintroduction.  The second stage is the crucial part, as foods are reintroduced one at a time in order to see whether they cause a gastrointestinal issue.  Each food is given a 3-day period of observation.  A separate third stage (Personalization) is the common-sense approach of eating those specific FODMAP foods which your stomach can tolerate and very sparingly consuming those which cause an IBS flare-up.

Find the balance that works best for you.  A happy gut means a happy you.

Coeliac Disease and Riding the Free-From Wave

A quarter of people diagnosed as suffering from IBS actually have Coeliac disease. 

Coeliac Awareness Week in May (running from the 13th to the 19th of the month) rightfully sees the spotlight shone on this autoimmune disease, with only 30% of sufferers thought to have been diagnosed.  A dangerous statistic, come simply from a lack of understanding and too softly spoken the informative voice.  Notably, approximately three times as many women as men are diagnosed: guys, it really is time to overcome the GP fear!

1% of the British population lives with Coeliac disease.  It is neither an allergy nor an intolerance: it is a genetic mutation of the HLA-DQ genes, responsible for the development of the immune system.  More common than once thought, Coeliac disease is autoimmune in nature; it is where the lining of the small intestine becomes inflamed in reaction to the protein gluten: the body quite literally begins to attack its own tissue in an immune response.  This inflammation means essential nutrients from other foods cannot be absorbed, which in turn may lead to multiple health complications. 

Once diagnosed (after a blood test and biopsy), gluten must categorically be avoided from the diet for life.  It can take up to 2 years for the digestive system to heal itself completely.

Coeliac disease can occur at any age, but the most common beginnings are between 8 and 12 months old and between the ages of 40 to 60.  For infants, it is recommended gluten is not introduced before 6 months (the usual weaning age), and then only while still breastfeeding (for added immune support).  Those most ‘prone’ to developing Coeliac disease are sufferers of Type-I diabetes, ulcerative colitis, and autoimmune thyroid disease, as well as those with Down’s and Turner syndromes.  There is also thought to be a 10% chance of it being genetically inherited (while identical twins have a 75% chance if the other is diagnosed). 

The symptoms of coeliac disease are similar to those for IBS (diarrhoea, bloating, stomach cramps, etc.), but the risks from inappropriate diet (i.e. continuing to eat gluten) are far higher.  There are further signs (such as frequent mouth ulcers, skin rashes, oedema, and anaemia) which serve to give additional clues to something being amiss, and yet too many people still believe it to be IBS.  In children, growth is often significantly slower than peers’ and puberty may be delayed.

If untreated, osteoporosis is the biggest concern regarding resultant health conditions (due to malabsorption of nutrients), as well as infertility, neuropathy, gluten ataxia, and – more rarely – bowel cancer and intestinal lymphoma.

Gluten is found in the cereals wheat, rye, and barley.  Seems simple enough, right?  Wrong.  Those three cereals are so expansively used in the food industry that if you’re trying to avoid gluten, you have to carefully consider what you buy, especially when it comes to convenience foods: what pasta you’re choosing, which pizza, biscuits, what cake you can make (and also eat), breakfast cereal options, ready-meal ones, even sauces and – deep breath – that weekend beer.  You probably believe bread is out forevermore by now: think again.

The gluten-free industry was estimated to be worth £588 million back in 2017 by Kantar Worldpanel.  This rose exponentially the following year.  It is currently thought that much free-from produce is consumed not by actual allergy sufferers or those with specific diseases (like Coeliac) which require elimination of key ingredients from their diet, but rather by people looking for a healthier way of eating.  To this end, gluten-free bread is very much ‘in’.

Like dairy-free cheeses, gluten-free bread has had its detractors, but – like anything – once you get used to the taste and texture, and don’t try to compare it with the original, then it really is quite alright; not to mention practical, too!  And as for that beer – indulgence is not a thing of the past; fear not!  With small changes, much more easily done since the advent of Free-From products, shopping for a Coeliac-specific diet is no more troublesome than, say, shopping as a vegan.  Read the labels carefully and all will be well.  Anything is possible if you set your mind to it.

Oats should be fine for most people with Coeliac disease.  However, if the oats have been contaminated with other grains in the packaging process, there is a risk of a flare-up of symptoms if consumed.  Unfortunately, some Coeliac sufferers are also sensitive to the protein avenin in oats (similar to gluten).  In such cases, oats and their related products will have to be removed from the diet.

For further advice, consult your doctor.  Coeliac UK also offers further guidance and information sheets.

The Lowdown on Legumes

Though you might think we’re telling a rather big white lie: legumes are fruits.  There, we said it.  Legumes are fruits when fresh and when they’re dried… They become pulses.  Still with us?

Beans and peas, chickpeas and lentils, soybeans and peanuts, and even alfalfa – they’re all legumes.  Yet, what sorts their digestibility each from each – the ability of some people to eat one kind and other people’s inability to go anywhere near any of them at all – is the balance of fibre and protein within each type, and whether one suffers from pre-existent digestive health issues.  Nevertheless, if you’re vegan, legumes are a crucial part of your diet.

Furthermore, the ‘Blue Zones’ of the world (those with the largest proportion of centenarians as reported by Dan Buettner National Geographic) are those whose inhabitants are for the most part vegetarian and who consume a large quantity of legumes (Okinawa in Japan; Italy’s Sardinia; Nicoya in Costa Rica; Greece’s Icaria; as well as California’s Loma Linda Seventh-Day Adventists).  Setting aside any criticism of Buettner’s notion by those who sought birth certificates for all those centenarians… Many people avoid legumes because of tummy trouble, including the rather anti-social side effect of flatulence. 

On paper, beans in particular are almost perfect as a food: affordable, adaptable, containing everything you need from protein to iron to vitamins and minerals…  Don’t sit down with an entire bowl and then complain about the effects!  Yet, the answer also lay in the preparation/cooking method. 

Adequately rinsing, then soaking dried beans in cold water, and then rinsing them well again before cooking removes a large amount of the digestively irritating carbohydrate, raffinose.  In addition to this process, when cooking the beans, be sure to add either a couple of pinches of cumin, or 1 bay leaf, or a 1-inch piece of dried kombu to the pot.

Nonetheless, if you find you still experience discomfort after eating beans, then perhaps eat only the most easily digested type: adzuki, borlotti, black-eyed beans, lentils, and mung beans.  Avoid butter beans and cannellini beans.

Start small and think long-term and, who knows?  Perhaps those Blue Zones will adapt to include Great Britain…

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