There’s a Rumbling in my Tummy


    On the 15 May 2012, the British Dietetic Association issued new evidence-based guidelines for the dietary management of IBS (Irritable Bowel Syndrome) in adults which I found most interesting. So I thought that as we come into summer and a lot of our eating habits change to accommodate the hotter weather, longer daytime hours and the never-ending flood of family and friends coming to “visit” us for the silly season, this might be an ideal opportunity to chat about some of the points raised by this new study.

    So firstly, what is IBS?
    Irritable bowel syndrome (IBS) is a common functional disorder of the intestinal tract (i.e. there is a problem with the function but not the structure of the organ. Up to 1 in 5 people in the UK develops IBS at some stage in their life, and an estimated 20-50% of gastroenterology referrals relate to this symptom complex. It can affect anyone at any age, but it commonly first develops in young adults and teenagers, and is twice as common in women as in men. Osler first coined the term mucous colitis in 1892 when he wrote of a disorder of mucorrhea (mucous diarrhoea) and abdominal colic with a high incidence in patients with coincident psychopathology. Since that time, the syndrome has been called by various  terms, including spastic colon, irritable colon, and nervous colon.
    Some people have occasional mild symptoms, while others have unpleasant symptoms for long periods of time. But in actual fact, many people fall somewhere in between, with flare-ups of symptoms from time to time. Doctors generally group people with IBS into one of three categories:

    • Those with abdominal pain or discomfort, and the other symptoms are mainly bloating and constipation.
    • Those with abdominal pain or discomfort, and the other symptoms are mainly urgency to get to the toilet, and diarrhoea.
    • Those who alternate between constipation and diarrhoea.

    However, in practice, many people will not fall neatly into any one category, and considerable overlap occurs.
    IBS has generally been considered a disease diagnosed by exclusion, and although several tests are still necessary to make the final and accurate diagnosis, a  consensus panel created the Rome III criteria for the clinical diagnosis of irritable bowel syndrome which  require that patients have had  recurrent abdominal pain or discomfort at least 3 days per month during the previous 3 months that is associated with 2 or more of the following:

    • Relieved by defecation
    • Onset associated with a change in stool frequency
    • Onset associated with a change in stool form or appearance

    So what causes IBS?
    Well… doctors don’t actually know! A lot of research is still going on into IBS causes and so far we do know that IBS sufferers have an abnormal intestinal transit profile with either increased or decreased (at times) colonic motility, due to hyper-reactive muscles mainly in the colon. Neuro-hormonal mechanisms such as serotonin ( which is normally associated with brain function), can also play a role in the functioning of the digestive system, this is why stress plays such an important part in IBS flare-ups. It’s also possible that people with IBS have an essential bacterial imbalance in the intestine, and some even relate the onset of the disorder to an acute episode of Gastroenteritis.

    And what can we do about it?
    In many cases, simple changes in your diet and lifestyle can provide relief from IBS. Although your body may not respond immediately to these changes, your goal is to just persevere and finally find those long-term, not temporary, solutions:

    • Incorporate fiber into your diet, but avoid wheat bran (especially if gluten intolerance is suspected), rather try ground linseeds
    • Avoid problem foods: the most common culprits are foods which contain caffeine or its products, high sugar foods and gas producing foods such as beans, cabbage, cauliflower and broccoli
    • Avoid swallowing air, such as when chewing gum or drinking through straws, especially fizzy drinks.
    • Eat smaller meals
    • Drink plenty of fluids
    • Get regular exercise
    • Take care with dairy products: lactose intolerance is common and if suspected a 2-week trial of lactose –free diet is a positive diagnostic point
    • Reduce intake of fermentable carbohydrates, which often helps with bloating and pain. These include foods containing large amounts of Lactose, Fructose, Fructans, and Polyols

    Final advice….
    Since the symptoms of IBS are so wide-ranging , here is just a short list of warning signs that what you think is just your IBS playing up again is in fact something else:

    • Difficulty in swallowing or sensation that food gets stuck.
    • Indigestion-type pain that regularily wakes you up at night.
    • Abdominal bloating that does not get better overnight.
    • Significant and unexplained weight loss.
    • Bleeding from the back passage.
    • Chronic, painless diarrhoea.
    • Recurrent fevers and constant pain

    If you do experience any of the above, you now have no excuse, just call your doctor!

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