How many people are affected by IBS?
Around a third of people in the UK suffer some of the symptoms associated with IBS and for 1 in 10 people the symptoms are so bad they go to see a doctor.
Once your doctor has ruled out any serious medical condition he may send you to a registered dietitian for help in sorting out what you should or should not eat.
Keeping a food and symptom diary, which lists what you eat, drink and any symptoms can be used to pin point any foods that could be causing you a problem.
What are the symptoms?
The main symptoms of IBS can vary from mild to severe and include some of the following:
- Abdominal pain and spasm
- Diarrhoea – loose or ribbon-like motions
- Constipation – solid, rabbit pellet-like motions
- Alternating diarrhoea and constipation
- Abdominal bloating
- Rumbling, flatulence and wind
- Sense of incomplete emptying of bowels
- Urgency to open bowels
And sometimes nausea, tiredness, belching and vomiting.
Note – indigestion or feeling full or bloated in your stomach after eating is not usually IBS. IBS symptoms are usually lower in the abdomen.
IBS – is it food?
There is no one dietary cause of IBS symptoms. Just as the symptoms vary from person to person, so can any dietary causes. IBS type symptoms may be aggravated by a low intake of fluid, a low intake of dietary fibre, a poor diet in general, erratic eating habits, long gaps between meals and by smoking or drinking large amounts of alcohol or coffee on an empty stomach. Sometimes it can be caused by intolerance to one or more foods. There is no simple test to see what, if any, foods are involved. The only reliable method of diagnosis is to undertake a supervised exclusion and re-introduction diet whilst keeping a detailed food and symptom diary. This should be done only with the help of a doctor.
What are the most common causes of bloating?
Many people believe that bloating is caused by irritable bowel syndrome or as a result of suffering from wheat intolerance. However the main causes of bloating were linked to hormone fluctuations (32%), over-eating/ irregular meal patterns (28%) and stress related indigestion (27%). Many people feel bloated at lunch or in the evening, especially after a heavy meal. Recent weight gain also adds to discomfort after eating. Irregular meals, skipping meals and drinking a lot (especially fizzy drinks) at meal times can really aggravate that bloated feeling. The answer is to try and spread your food and drinks more evenly over the day.
Small regular meals and snacks are the best option. Some people find the bloating is worse after eating too much fruit, spicy food and fizzy carbonated drinks – all of which can cause gas and bloating. Cut down on these foods to stop the bloating. Being constipated can cause bloating and general discomfort in the abdomen. Constipation is usually linked to a lack of fluid and dietary fibre and can be greatly helped by drinking at least 8 -10 cups or glasses of non-alcoholic drinks a day and eating more fibre containing food including wholemeal bread and breakfast cereals. Some people find that eating certain foods like banana make them feel ‘bunged up’. This is usually specific to an individual so foods should not be excluded without a firm basis. Being open minded is the key.
How do I find out if I have IBS?
Once your doctor has ruled out any serious medical condition he may send you to a registered dietitian for help in sorting out what you should or should not eat. Keeping a food and symptom diary, which lists what you eat, drink and any symptoms can be used to pin point any foods that could be causing you a problem. The dietitian may then suggest you change what you eat for a trial period. This is the basis of an exclusion and reintroduction diet. It may also include:
- Simply drinking more fluid and eating more fibre containing foods to see if treating constipation reduces the IBS type symptoms.
- Changing the timing and size of your meals.
- A pro-biotic yoghurt or drink, especially if you have been taking antibiotics or had gastroenteritis.
If food intolerance is suspected an exclusion diet will be suggested – in 3 stages:
- Exclusion stage – when you avoid the suspect food for 2-3 weeks, continuing to keep a food diary
- Re-introduction or ‘testing’ stage – when you add back the avoided foods – one at a time – in gradually increasing amounts one at a time until you reach normal serving sizes usually over 3 days. If symptoms return, then you should continue to exclude that food from your diet. If no reaction is noted, then add the food back into your diet.
Please note we do not suggest testing any food thought to have triggered a serious allergic reaction.
- Maintenance stage – continue avoiding foods known to cause a reaction, but making sure your diet is nutritionally adequate. The dietitian will recommend the best way to manage the restricted diet to ensure it is nutritious, varied and tasty. They will also provide product information and recipes. Avoided foods should be re-tested from time to time, as quite often with IBS, foods that were a problem can be eaten with no symptoms after a few months
Who can you trust?
It is well known that ‘tests’ carried out in health food shops, bought off the internet or carried out by some unqualified health practitioners or nonregistered nutritionists are not reliable and frequently lead to incorrect results. This leads to people following unnecessarily strict diets. Even more worrying is that such tests and diets can delay the diagnosis and treatment of the true diagnosis.
Independent sources such as the British Dietetic Association and the Food Standards Agency advise consumers not to self diagnose but to go and see their GP who will also refer to a specialist clinic if required. A GP survey found that 90% of GPs agree that women are putting their health at real risk by eliminating foods without any medical consultation and that questionable and potentially harmful advice by unregistered nutritionists and other ‘health gurus’ is often to blame.