The number of people who have Irritable Bowel Syndrome (IBS) is remarkably high.
Nutritionist therapist Petronella Ravenshear estimates about 1 in 5 people have it. It's a common condition of the digestive system than can cause bouts of stomach cramps, bloating, diarrhoea and constipation.
Having stomach problems doesn't necessarily mean you have IBS, but Petronella advises that if you've had symptoms for six months or more, then it may be IBS.
We spoke to one of the leading gastroenterologists Professor Ingvar Bjarnason to ask for his advice on what to look out for.
What are the most common symptoms of someone who has IBS?
IBS accounts for around 40% of all referrals to gastroenterologists. Abdominal pain is the most common symptom as well as change in frequency of bowel movements, alternating from constipation to diarrhoea. Flatulence and in particular bloating are also common symptoms.
Are there specific foods that set off IBS or is it specific to the person?
Certain foods or food intolerances can set off or exacerbate symptoms of IBS such as coffee, wheat, pulses, alcohol, cereals, spicy food, certain fruits and vegetables and dairy products to name a few and these are specific to the person. So it really is a case of trying to identify what triggers IBS for you.
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How it affects you: If you like to cut calories by adding artificial sweetener rather than real sugar to your coffee, you may be affecting your digestion and increasing inflammation in your body. “In general, sweeteners which are partially digested (sugar alcohols) have the biggest impact on the GI system and can lead to bloat, gas, and diarrhea,” according nutritionist and dietitian Erin Palinski-Wade. What you can do: Experiment with the multitude of artificial sweeteners that are on the market and determine which affects you the least, suggests Palinski-Wade, who recommends using natural sweeteners, such as agave nectar. “This is not calorie-free, but because it is sweeter than sugar, less is needed, helping to reduce carbohydrates and calories,” says Palinski-Wade.
How it affects you: Your sweet tooth may affect more than just your waistline. Caffeine contained in chocolate may trigger heartburn and IBS symptoms in people prone to digestive disorders. What’s more, like coffee, chocolate is also a diuretic, which can result in loose stool or diarrhea. What you can do: If you need to satisfy that craving, choose dark chocolate. “It contains polyphenols that can slow GI function and increase water absorption to prevent diarrhea,” says Palinski-Wade. “Cocoa, which is found in higher amounts in dark chocolate than milk chocolate, is also a good source of fiber, which promotes healthy digestion.”
How they affect you: Beyond upping the risk of Type 2 diabetes and heart disease and leading to weight gain, refined carbohydrates, like white bread, soda, and potato chips, move quickly through the digestive tract and can result in bloating, cramping, and other GI issues. What you can do: If you can’t totally cut out processed foods from your diet, eat them in combination with foods that digest slowly, like lean protein – think chicken breast without the skin – and healthy fat – like an avocado or natural peanut butter, says Palinski-Wade. On top of that, keep portions in check, so those refined carbs don’t outweigh the good food you’re combining them with.
How it affects you: Whether we’re talking hot curry or spicy Buffalo chicken wings, foods that give your taste buds a run for their money can also trigger heartburn, particularly if you eat them close to bedtime. What you can do: "Cooling foods, specifically dairy, can help to calm the burn associated with spicy food in some people," says Palinski-Wade. "Since milk itself can be hard to digest, reach instead for Greek yogurt or Daisy Brand cottage cheese, which contain GI-friendly probiotics to aid digestion while cooling the burn felt from heavy spices."
How they affect you: Conventional wisdom says that reaching for nature’s bounty in the produce aisle is the best way to stay healthy. And while fresh produce should always be included in a healthy diet, digesting raw fruit and vegetables can be difficult for people with sensitive GI systems. Raw produce has high amounts of insoluble fiber, which move quickly through the intestinal tract and can result in loose stool, diarrhea, gas and bloating. What you can do: Cook your veggies and, whenever possible, your fruit. “Cooking helps to break down some fiber in produce, allowing it to be digested more easily, limiting gas and bloating that can occur when eating raw produce,” says Palinski-Wade.
How they affect you: Food high in saturated fat, like steak (certain cuts, like rib-eye, are fattier than others), French fries, and ice cream, is difficult for the body to digest and can make you feel uncomfortably full and increase the chances of acid reflux, according to Palinski-Wade. If you already suffer from heartburn, fatty food can make it even worse by relaxing the valve that seals off the stomach from the sphincter. The loose valve can cause stomach acid to rise into the esophagus and result in a really unpleasant case of heartburn, says Karen Ansel, nutritionist and dietitian. What you can do: If you’re jonesing for a steak, burger, or other high-fat meal tonight, remember not to combine it with alcohol, which can further irritate your GI tract, says Palinski-Wade. Whenever possible, cook meals in plant-based fats, such as olive oil, which is easier to break down than saturated fat, like butter.
How it affects you: This energy hero can quickly become your GI tract’s worst enemy. In fact, nearly 40 million people in the United States refrain from drinking coffee – or as much coffee as they would like – due to stomach irritation, according to the American Chemical Society. Coffee doesn’t just wake up our mind, it also stimulates acid production in the stomach, which can cause inflammation and result in heartburn and GERD. What’s more, caffeine acts like a diuretic, which can cause dehydration and, ultimately, constipation. What you can do: Limit caffeinated coffee to one cup, says Palinski-Wade. “If that’s not possible, limit to one caffeinated cup every two hours to allow your body time to process the caffeine.” It’s important not to drink coffee on an empty stomach, which can increase indigestion, notes Palinski-Wade. She recommends adding something that’s easily digestible – like a banana or bran cereal at breakfast – to reduce symptoms.
How they affect you: Even if you have the best intentions, many healthful fruits and vegetables, like oranges, lemons, grapefruit, and tomatoes, may increase your risk for acid reflux and GERD due to their acidity. What you can do: Removing acidic foods from your diet is the best way to reduce your risk for heartburn. However, if you still want to eat these fruits and vegetables every once and awhile, don’t do it on an empty stomach, which can increase irritation and inflammation.
Are there any set questions people should ask themselves or maybe keep a food diary?
Keeping a food diary is useful as diet can aggravate IBS. It’s not surprising as people lead such busy lives and often resort to convenience foods or eat on the fly and don’t take enough time to sit and eat meals properly.
Of course, there are other factors that may trigger IBS too such as shock, bereavement, or balancing lifestyle. In this case, it’s useful to jot down or note when symptoms arise if anything significant happens, or making a note of activities over a typical week. Seeing a ‘typical’ week in this context quickly identifies whether a patient is trying to juggle too much and may be over-stressing themselves.
PETRONELLA'S IBS TIPS AND FACTS
Is it genetic?
In IBS the genes are important but it is the way the genes are expressed. If someone is eating lot of wheat and dairy they may have problems.
Why may that be?
We’ve changed our diet in the last 10,000 years – for instance now we have grains and dairy - but our genes haven’t changed that much to be able to digest them properly. For instance things like cereal became popular because after the second world war, it was a cheap food source. Then people came into schools and said 'you must have calcium for strong bones' but our bodies haven't evolved much and we lived for thousands of years before the advent of dairy farming.
Do you have to be extra careful about what you eat?
Fatty foods can make things worse - especially fast food. Fruit can be painful and bloating and again, our ancestors didn't have a wide variety of fruit - they'd come across one bush, one variety and eat that. We are also the only animals that have special foods for breakfast. I say, eat what you fancy. It doesn't have to be cereal - it isn't good for you. Gluten is latin for glue because it has such a sticky characteristic. Milk protein is also sticky and when combined together, it ends up becoming this sticky mass.
Fermented foods and yogurt are good for people with IBS, Petronella says
What is Symprove? We've heard that it's really good for IBS and you oversaw the clinical trials.
Symprove is a live liquid formulation with multiple strains of live bacteria which survive the varying pH conditions in the digestive tract. Taken on a fasting stomach before breakfast, the bacteria pass through the stomach without setting off the digestive process thereby giving the live bacteria a much greater chance of reaching the more distal gut unharmed.
Some people don't know whether to take IBS seriously - what are the more acute cases?
A gastrointestinal condition, IBS affects between 10% to 20% of the population and twice as many women as men. Whilst not life-threatening, IBS can be very distressing and disabling and impacts significantly on quality of life. Some people can end up being hospitalised due to acute abdominal pain. Patients with diarrhoea symptoms are often house-bound for weeks on end, or only venture as far as the local shop for fear of having an accident.
As a result, they may suffer depression due to isolation and because their quality of life has been so severely affected. IBS is also associated with numerous problematic extra-intestinal symptoms such as fibromyalgia, period problems, sexual dysfunction, etc.
Is there enough research being done into IBS at the moment?
There is plenty of research being done into IBS; however, we have to question whether enough trials are independently-led and being run to full clinical standards. When we designed the probiotic IBS trial using Symprove at King’s College Hospital, this was one of the first to address the efficacy of a probiotic using robust standards equivalent to a drug trial.
The results showed a significant reduction in symptom severity for IBS, over and above what was seen with placebo, and of equal importance, a biologically meaningful outcome.
You've worked in gastrointestinal research for over 25 years - what changes have you noticed in people's diets, for better or for worse?
People’s diets have changed significantly in the last couple of decades for many reasons. Food is produced and manufactured differently, with addition of preservatives and binding agents and we’re still not sure how much of an effect this may have on people long-term. Many people snack or eat convenience foods on the fly and these may not always provide the right balance or contain the freshest ingredients.
On the other hand, the internet provides a rich source of information and inspiration when it comes to food, and with the upsurge in blogging, some of these sites are providing engaging ways to encourage people to cook from scratch and try different foods and recipes.
However there is also much misinformation on the internet, so a sensible informed approach is required. We’ve also seen a big drive in supermarkets and some food companies towards reducing salt and fat content with key messages being conveyed to consumers in campaigns, as well as a huge amount of choice when it comes to food so plenty of options when it comes to healthy eating.