We've all heard about IBS (irritable bowel syndrome), or spastic colon as it's also commonly referred to. You may even have diagnosed yourself with IBS when at some point you started noticing a lot of bloatedness, cramping or diarrhoea after you've eaten certain foods. Perhaps you've been persuaded by media articles to go gluten - or lactose-free to alleviate the symptoms.
But are you sure it's really IBS? And why does it feel like almost half the world is suffering from it? As a dietetics student I also started asking myself these questions and got introduced to some great scientific literature on the topic, which you can go and have a look at if you want some more detail. Experienced registered dietician (and a guest lecturer at the Stellenbosch University), Dianne Ivison from Panorama Dietitans, also granted me some of her valuable time to explain the syndrome, it's causes and it's symptoms a bit better.
Why the IBS boom?
According to Dianne, research indicates that up to 20% of the adult population struggle with IBS. So my next question was, why now? Why in the past decade have we seen such a huge influx of people struggling with IBS? Dianne says that it might just seem like there are more people, but there might just be an increase in diagnoses because people are more conscious of their bodies.
"And stress plays a huge role," she says.
"Almost 90% of your body's serotonin [a neurotransmitter related to mood-regulation] is made in your gut, not in your brain. So if you stress, you're going to have a brain gut problem," she explains. So in very oversimplified terms, stress causes your gut to be unhappy and overly sensitive.
And we should keep in mind that stress often leads to bad lifestyle choices that add to the problem. "People don't sleep enough, don't eat properly and don't get enough fibre. All this aggravates symptoms of IBS," says Diane.
There's also evidence that susceptibility can be hereditary, so if you have a family history of someone with gut problems, you probably have a bigger chance of developing IBS. "Also people that tend to suffer from depression or anxiety are more susceptible," says Dianne.
Probiotics are basically live-micro organisms that can improve the microbial balance in the gut and thereby have beneficial effects for you, their host.
How to diagnose
So now we're closer to understanding what the underlying cause is, but how do we diagnose it?
"It's important not to self-diagnose," Dianne warns. She says that because there are many gut related diseases, such as inflammatory bowel disease, Crohn's disease and cancer that may present with similar symptoms, it's important to go see a doctor or a specialist to do a colonoscopy to rule out any other more serious disorders. There are also certain diagnostic tools, for example the Rome criteria commonly use in South Africa, whereby doctors or specialists can then confirm IBS once other conditions have been ruled out.
What's the fix?
There are a variety of meds that can then be prescribed to help alleviate symptoms, and although there are literally hundreds of supplements in the pharmacy aisles that promise to cure your IBS, there really only is a few that has been proven to work says Dianne. One of the most common supplements recommended that actually has a real potential to work, is probiotics. Probiotics are basically live-micro organisms that can improve the microbial balance in the gut and thereby have beneficial effects for you, their host.
"Probiotics are generally regarded as safe to use," says Dianne. She however suggests you ask your pharmacists, dietician or doctor to help you choose the right one (a multi-strain variety with live cultures) and use if for a month to see if it helps to bring your IBS under control.
Where does your diet come into play?
Though you can't "cure" IBS with your diet as far as scientist know, you can manage the symptoms as the result of a stressed, unhappy gut that is sensitive to certain trigger foods. Dianne believes in keeping a food-diary (where you detail all the ingredients of the food you eat along with symptoms and when they occur) to try and pin-point culprit foods.
Following a low FODMAP-food diet (developed by the Australian Monash University) is another option. The diet works by identifying trigger foods through eliminating foods containing fermentable oligo-di-monosaccharides and polyols, and then reintroducing them into your diet again, but Dianne says she doesn't really use it in her practice. It can be very time-consuming and expensive.
Will a gluten-free diet help? "It's not dangerous to eat gluten-free, there are enough products available, but there's limited research showing that gluten free diets will drastically control symptoms. And by going gluten free you invariably cut out a lot of your fibre sources, so you may struggle from constipation. You'll then need to ensure you get it from other sources such as fruit and vegetables," she explains.
If you feel your symptoms disappearing when you are on holiday or in a relaxed space, just to have it flare up again as soon as they return to a stressful environment, you need to address the underlying problem. Dianne says seeing a psychologist or a life coach might be a good idea to help you cope with stress.
And cutting out milk? "A lot of people are lactose intolerant, meaning they have an inability to digest the milk sugar properly. This is especially common in the African population. So this will worsen symptoms (if you are lactose intolerant)."
Reducing dairy intake could then help with the symptoms, says Dianne, but then it's important to replace calcium with other sources. "Cheese and yogurt are quite low in lactose, but there are also lactose-free versions available."
Once again, it's best to ask your GP to confirm lactose intolerance by doing the necessary tests. Dianne says common trigger foods include fatty foods (think cheese and cream), spicy foods, garlic, onions and coffee, but it really is very individual.
Some myths debunked and action points
I then asked Dianne what she thinks the biggest misconceptions are about IBS. Her answer? That cutting out gluten and lactose is a cure-all. And people should be wary of all the supplements on the shelf. "Don't spend hundreds of rands on supplements that have not been scientifically proven or sound too good to be true."
Also, remember the impact of stress. If you feel your symptoms disappearing when you are on holiday or in a relaxed space, just to have it flare up again as soon as they return to a stressful environment, you need to address the underlying problem. Dianne says seeing a psychologist or a life coach might be a good idea to help you cope with stress.
Here are Dianne's top 3 guidelines for managing your IBS:
1. First of all, make sure it is IBS and get proper diagnoses.
2. See someone to help you adjust lifestyle and food — get in some exercise, look at your fibre intake (in some cases you'll need to increase it and in others you'll need to decrease it, depending on whether you have diarrhoea or constipation), eat regularly, eat slow, chew properly, etc.
3. Keeping a food diary, symptom diary and a bowel movement diary for 2 to 3 weeks helps you get a clearer picture of where and what you need to cut out.
To hear to the full interview with Dianne, listen to the Trust Your Gut podcast on Soundcloud. Trust Your Gut is an experimental project where I speak to experts in the field of health and nutrition to help debunk myths, answer questions on confusing health matters and share research based facts and advice. The aim is to provide you with some tools to make the best health decisions for yourself and your family. Please share it with anyone you think might be interested in the topic.