April is IBS awareness month, so it is a perfect time to discuss this important condition and offer my tips for how to improve your symptoms. IBS is the most common disorder of the digestive system, affecting an estimated 10-20% of the population. Women are more commonly affected than men and symptoms can be exacerbated by hormonal fluctuations. The usual age for patients to seek advice is between 20 and 40 years but it can affect people of any age.
Symptoms of IBS include abdominal pain, abnormal bowel habits (constipation, diarrhoea or alternating between the two), bowel urgency, bloating, excess wind, nausea, and indigestion. It is often associated with other symptoms outside of the GI tract such as fatigue, bladder symptoms, headaches, depression, sleep disturbance, brain fog and back pain. Overall, these symptoms can be very restrictive and have a significant negative impact on both physical and mental health Quality of Life.
IBS is a medical syndrome, a term used for a set of symptoms that occur together. When given a diagnosis of IBS patients are often left wondering what the underlying cause is, and how best to treat their condition. Possible causes and contributary factors include diet, food sensitivities, gut microbiome imbalances e.g., Small Intestinal Bacterial Overgrowth (SIBO), leaky gut, stress, an underlying medical condition e.g. hypothyroidism or Coeliac disease, medications and heightened sensitivity to the sensations within the gut (termed visceral hypersensitivity). In fact, IBS is now more appropriately termed a disorder of the gut-brain interaction (DGBI) – a term which recognises the complex interplay between our gut, it’s microbiome, and our nervous system, immune system and brain.
If you have symptoms of IBS, it is important to discuss this with your GP, especially if there is a family history of a gut disorder or you are over 40 with new onset of symptoms. Your GP will often do some blood or stool tests to exclude other underlying conditions and then give a diagnosis of IBS. You may be prescribed medications (e.g. peppermint oil or mebeverine) or advised about diet (e.g. to avoid certain triggers or to look into the “low FODMAP diet”). Given the current pressures on NHS General Practice you may not have much time with your GP, and you may be left with ongoing symptoms and unanswered questions. This is where taking a holistic approach, really looking at root causes, considering further testing and having time to discuss what interventions will be most helpful for you, can be invaluable. It is always best to have a personalised approach from a one-to-one consultation but if this is not possible, or while you are awaiting your appointment, you may find some of the following tips helpful:
There is good evidence that following a Low FODMAP diet for up to six weeks, before gradually re-introducing these foods, can be beneficial. FODMAPS are non-digestible carbohydrates which can be fermented by the bacteria within our gut. This can cause bloating and diarrhoea. Reducing FODMAPS for a short time gives the gut time to settle. Then by gradually re-introducing these foods you can find particular triggers and may choose to avoid these long-term. It is not a good idea to follow a strict low FODMAP diet for a long period as they are important to feed your “good bugs”. You can see more about this approach here https://www.monashfodmap.com/about-fodmap-and-ibs/ and to get the most out of it I would recommend that you consult with a Nutritional Therapist, Dietician or Doctor for support with this diet.
A more simple dietary approach is to keep a food and symptom diary and avoid triggers that you identify, and I would always recommend reducing sugar, processed foods, alcohol and caffeine to help your symptoms.
Stress, anxiety and depression can have a huge impact on your gut, and vice versa. There is good evidence that Hypnotherapy is beneficial for IBS, perhaps through modulation of the stress response and via the gut-brain axis. You can access my recording here https://thenaturalpractice.podbean.com/e/hypnotherapyhealing/ which takes you through a simple relaxation and healing approach. Listening to this regularly, practicing meditation, breathwork or any other approach that for you reduces stress and activates your relaxation response will often help to improve symptoms. The effects are modulated not only by the effects on your visceral sensitivity and central nervous system but also by changes to your microbiome which occur when you alter the balance away from stress.
Finding the right sort of exercise or physical activity for you can really help balance your digestion. Regular aerobic exercise helps to promote gut motility if you have been suffering from constipation. If you have issues with diarrhoea, then more gentle approaches such as yoga and T’ai Chi can often be helpful to calm the excess contractions in the gut.
If you suffer with constipation, you can try adding in prunes, homemade apple puree (including skins), kiwi fruit (they contain an enzyme which can help with motility) and chia seeds (contain loads of soluble fibre – soak 1tbsp in water or plant milk then take with each meal).
If you suffer more with diarrhoea, then choose lower FODMAP foods and consider using a homemade bone broth one cup three times daily. Bone broth (made by stewing bones from organic meat with vegetables for a long, slow cook) has been used for centuries to help heal the gut and contains nutrients that can support gut healing.
In order to improve the microbial balance of the gut gradually introducing fermented foods (e.g., live yogurt, kefir, kombucha, sauerkraut, tempeh and kimchi) can be beneficial. Start low and go slow when introducing these foods and make sure you choose non-pasteurised and preferably organic versions (or to make your own see here https://www.bbcgoodfood.com/howto/guide/beginners-guide-fermented-foods)
I hope these approaches help you with your IBS symptoms. If, however, you are still suffering, or if you are interested to get to the root cause through an in-depth consultation and personalsied approach, then please speak to our reception team about an Integrative Medicine or Nutritional Therapy appointment. IBS is often multi-factorial and having support, appropriate testing (e.g., of the gut microbiome) and an individualised dietary, supplement and lifestyle plan can be transformative. If you feel your symptoms are mainly stress related and Hypnotherapy would help, or you have been advised to seek Hypnotherapy by your Gastroenterologist, you can also book for this directly via reception.