Susan Hughes interviews Siobhan about Irritable Bowel Syndrome. Siobhan talks about the difference between IBS and inflammatory bowel disease. She describes various symptoms, diagnosing IBS and how to manage it. She refers to and explains the FODMAP diet.

Below you will find the transcription while the video is to follow in a forthcoming blog.

Hi Siobhan, thanks for joining me today. I want to ask you about Irritable Bowel Syndrome. This is a term I’ve heard a lot. Is it common?

It is common and most GPs will see it every week in their practice.

Before we continue I’m going to clarify between IBS and Inflammatory bowel. Inflammatory bowel is an auto immune condition that often requires medication.

IBS is a diagnosis the we come to after we rule out other possibilities such as inflammatory bowel.

So yes it’s very common. Most people have some form of it - constipation or diarrhoea or a mixture of the both with abdominal cramps and bloating. They would be the main symptoms.

And what causes IBS?

We don’t know exactly what causes it but generally stress or a change to the microbiome. The  microbiome is the bacteria that lives in bowel our and carries a lot of our genetic material.

And infection, if you were on holidays and you picked up a gut bacteria, you might say afterwards ‘my gut has never really recovered’.

Can it be cured or at least managed?

It can certainly be well managed where you only get infrequent bouts. For a small percentage of people it is long standing and it can be difficult to manage those symptoms. In my experience I see a lot of people with IBS who are dealing with stress. Stress makes it difficult to get on top of IBS symptoms.

If you are stressed about other problems that your body might be having that haven’t been picked up with tests, this can exacerbate the symptoms and can cause your bowel to not settle back into its innate pattern. This brain-gut axis has a big impact.

Is it hard to diagnose IBS?

I wouldn’t say it’s hard to diagnose. I spend a lot of time with the patient at the beginning to make things as clear as possible: I tell them we’re going to run tests to check the blood count, do a stool test to make sure there isn’t inflammation. If those test come back normal then you can then rule out something like bowel cancer (for older patients) and inflammatory bowel (for younger patients) and then it’s likely that IBS can be diagnosed.

Do you believe that more people suffer from IBS now as opposed to 200 years ago?

I’d love to know! I’d love to have been a family doctor 200 years go! We know that it definitely existed, this dysfunctional bowel. We don’t know for sure because we don’t have any studies, but I imagine it is more common now. We are more sedentary, our diet is so narrow and we don’t eat enough vegetables or those ancient grains, we have more stress, there’s more pollution, what’s in the water we drink… all kinds of stuff impacts the micro biome.

The micro biomes of people change according to where they live too, so for example take someone who’s lived in New York City all their life and compare to someone who’s lived in rurally all their life, their micro biomes will be very different, the latter’s will be more diverse. Micro biomes change from city to city and country to country, it’s incredible. There’s a lot going on in our guts.

That’s fascinating, that the gut is so sensitive and it evolves according to its environment.

So Siobhan, have you any quick tips to deal with an upset stomach?

If it’s just an upset stomach, for example if you’ve eaten something very greasy or if you have bit of food poisoning then I would suggest just eating healthily, lots of water, rest the gut. The gut is good at repairing itself.

If it’s chronic constipation then you need to eat lots of fibre, psyllium husk or laxatives to keep the bowel moving. Also exercise regularly if possible.

If it’s both constipation and diarrhoea your symptoms are debilitating, severe bloating etc. then you need to look into something like the FODMAP diet. People who have chronic IBS are happy to try this diet even though it is very specific and regimented because they are determined to get their lives back and get more control over their IBS.

I saw someone who had a very stressful time in hospital and for the first time in their lives developed an irritable bowel. They sought expert advice from a dietician to do the Fodmap diet and they were able to figure out what worked and exactly what to eliminate.

The FODMAP Diet

So what is the Fodmap diet?

When people say “FODMAP diet,” they usually mean a diet low in FODMAP which are certain sugars that may cause intestinal distress. Here is a list of characteristics and sources of common FODMAPs. I got this from UpToDate, a website of medical research that most doctors refer to as a reliable source of current information.

F for Fermentable

O for Oligosaccharides

Compounds in this category: Fructans, galacto-oligosaccharides

Foods that contain these compounds: Wheat, barley, rye, onion, leek, white part of spring onion, garlic, shallots, artichokes, beetroot, fennel, peas, chicory, pistachio, cashews, legumes, lentils, and chickpeas

D for Disaccharides

Compounds in this category: lactose

Foods that contain these compounds: Milk, custard, ice cream, and yogurt

M for Monosaccharides

Compounds in this category: "Free fructose" (fructose in excess of glucose)

Foods that contain these compounds: Apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey, high-fructose corn syrup

And

P for Polyols

Compounds in this category: Sorbitol, mannitol, maltitol, and xylitol

Foods that contain these compounds: Apples, pears, apricots, cherries, nectarines, peaches, plums, watermelon, mushrooms, cauliflower, artificially sweetened chewing gum and confectionery


How does the low FODMAP diet work?

The following information was taken from the Monash University website where the Fodmap diet was developed (https://www.monashfodmap.com/about-fodmap-and-ibs/)

Developed by Monash University researchers, the Low FODMAP Diet limits foods that have been shown to aggravate the gut and cause Irritable Bowel Syndrome (IBS) symptoms like intestinal bloating, gas and pain. These foods are high in a group of sugars called FODMAPs.

The Monash University Low FODMAP Diet™ is best followed under the supervision of a qualified dietitian or healthcare professional who is experienced in this specialized area. The diet begins with a 2-6 week period of high restriction and then transitions to a more relaxed diet where certain foods are gradually re-introduced. Despite including the word “diet”, a low FODMAP approach to eating is not intended as a weight loss plan.

So when I meet someone who is ‘Gluten-free’ is that because they have had quite debilitating IBS and have discovered by process of elimination that gluten is what is causing them problems?

Yes, so if you are suffering from IBS then, as long as you keep a balanced diet, it’s good to try cutting out gluten or milk for example and see if that helps. You need to be careful that you get your calcium, for example, from other sources.

The last 10-20 years there’s been a big movement towards gluten-free foods, more to do with the fact that we can’t process the gluten, genetically we were not exposed to it for a long enough time to make us able to process it.

In the US people are much more aware if they are lactose intolerant or gluten sensitive. I think we’re too cool over here to embrace it to the same extent. There’s lots of people who are lactose intolerant but they don’t realise it. It’s not until they try other milks eg. Oat milk that they might see their gut settle. You have to try these things.

This all gives me a lot more respect for people who have cut out foods from their diet. It’s no joke.

Yes. It’s interesting the power of the mind where your brain so wants to eat that slice of toast with butter and yet you know it drives your stomach crazy. For example if you are gluten free and you eat even a tiny bit of gluten it can be so damaging to your intestine, the reaction lasts for weeks and weeks. So you have to be very disciplined.

Thanks so much Siobhan. That was so interesting and I hope it informs people about IBS.