IBS - Irritable Bowel Syndrome

IBS

The gut is a highly sensitive area and is easily disturbed and upset.  When it is not happy with it's inhabitants and transient foods it reacts causing symptoms such as constipation and/or diarrhoea, abdominal bloating, fermentation and gas. These symptoms are indicators that food is not being adequately digested in the stomach and the small intestine whereby  proteins have not been sufficiently broken down for absorption in the colon.  Furthermore these symptoms are indicative of irritation of the gut wall and discontent microflora in the gut reacting to by products of dietary metabolism. There is no single cause or cure for this very uncomfortable syndrome.  Food and by-products of digestion are the most frequent visitors passing through the digestive tract.  So it is the most obvious place to begin investigating what disruptive impact they are having on the workings of the gut.  Trying to identify the culprits is often like looking for a needle in a haystack.  Statistics show that IBS is far more prevalent in women than men.

Chew on it

Teeth were given to us so that we can break down food by chewing.  Digestion is a complicated process which begins in the mouth, particularly carbohydrate digestion.   The first crucial stage of digestion is chewing.  Chewing allows the food to mix with digestive enzymes, these are little chemical helpers which help  to break down foods into absorbable nutrients.  Protein is digested in the stomach with the aid of stomach acid and digestive enzymes which the body produces.  Digestive enzymes can also be obtained from foods such as raw cabbage, apples, fennel, rocket, papaya, bananas, pineapple, and many other foods.  Some people have a lack of, or reduction of digestive enzymes resulting in food not being properly broken down.  This maybe due to stress, the ageing process, low stomach acid or simply poor diet or eating too much too quickly.  Inefficient digestion in the stomach causes problems further down the line.  Increasing raw plant foods will increase digestive enzymes to help with this process.

Who's the host

Approximately 4lbs of bacteria reside in the gut.  Many of these guys have been on the planet long before we arrived.  Most of them are permanent residents of the digestive system and as such are continually interacting with gut cells.  They have many functions in the gut and are crucial to the digestive process.  The digestive system is a long tube which resides outside of the main body.  Along the lining of the gut wall lives 80% of the immune system.  It acts as a patrol between the gut and the body.  It is highly tuned and works by preventing unwanted bacteria, viruses and nasty proteins from entering the body.  It can become overly sensitive to certain proteins resulting in food intolerances.  Such intolerances can cause IBS type symptoms and when they are removed from the diet, symptoms do improve. 

Fodmaps

The low Fodmap diet was developed in Australia.  Fodmaps is an acronym that stands for; Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.  This is a group of short-chain carbohydrates (sugars) which in some people are  poorly absorbed in the digestive system.  Malabsorption of these carbohydrates leads to water retention, fermentation, trapped wind, pain and diarrhoea.  Included in this group is lactose, fructose, polyols and fructans.  The advice is to remove all foods containing these carbohydrates.  The list is very long. Many people try to remove all of these foods out of their diet but personally, I find it far too restrictive and unnecessary.  While it is advised to remove all of the foods on the list for a period of time and reintroduce them slowly while monitoring symptoms.  It is very hard to implement and is not always easy to know which food is causing the problem.  I tend to work with the individual with an elimination diet and a food diary to identify the culpurits.  Trying to identify the offending foods takes time but it is key to eliminating the symptoms.  This area of personalised nutrition is the most effective way to treat IBS.

Wheat and gluten

Coeliac disease is an autoimmune disorder. Gluten is a protein present in wheat, rye, oats and barley.  This protein does not agree with some people.  It interacts with the immune system in the gut causing inflammation and damage to the gut wall.  Coeliac's have no choice but to remove all gluten from their diet.  Being gluten free appears to help some people with IBS. Apart from the fact that wheat contains fructans known to irritate some gut,  this was poorly understood until recent research identified another group of proteins in wheat called ATI's Amalyse Trypsin Inhibitors.  These wheat proteins can cause inflammation in the gut and irritation.  Those who respond well to a wheat free and gluten free diet are known as non-coeliac gluten intolerant.  Replacing wheat and gluten with gluten-free foods may not be the answer as gluten free foods contain high levels of sugars, emulsifiers, additives and starches which are simple sugars and can negatively impact the gut.  Instead opt for gluten free oats, quinoa, buckwheat, brown and white rice and millet.  These are whole-foods and provide better nourishment.

 Probiotics

I see many people with IBS.  They often arrive with a bag full of supplements.  Chief amongst these pills and potions is the bottle of probiotics.  Probiotics are live organisms that live in the gut.  There are thousands of probiotic species in the intestines.  Each person has his/her ownfamily of microflora that is unique to them.  Resident lactobacilli and bifido bacterium are probably the most known and researched.  These are the good guys that support digestion and immunity in sufficient numbers.  Taking a probiotic pill does not guarantee that the live organism will get to the gut alive and be compatible with it's surroundings and be effective.  It's a long journey from the mouth and en-route the PH of the digestive system differs at each stage.  The best chance to increase lactobacillus and bifido in the gut is to eat natural yogurt which contains live bacteria.  Similarly fermented foods such as keifir, kimchi, miso and sauerkraut all contain live bacteria which may help. 

Too much of a good thing

You’ve probably heard that eating more fiber is a good thing, but there’s more than one type of dietary fiber There are two types of fibre found in plant foods called soluble and insoluble. They are both needed to support digestion, absorption and facilitate elimination.  Soluble fibre absorbs water in the gut and forms a glue like substance.  It tends to act in a more gentle manner and causes less trouble. Insoluble fibre which is often referred to as “roughage.” is more difficult to deal with.  It’s the tough matter found in pulses, beans, whole grains, fruits and vegetables (specifically in the vegetable stalks, skins of pulses, fruit, and seeds). It doesn't dissolve in water. The main inhabitants of the gut, the microflora love to dine on fibre particularly insoluble. They assist digestion  by breaking fibre down further.  This process causes fermentation, gas and wind which can exacerbate IBS symptoms.  Fibre is a double edge sword as it adds bulk to waste in the digestive system, which helps to prevent constipation.  If you are prone to constipation increasing fibre will really help.  If diarrhoea is an issue you will need to reduce it particularly in insoluble form.

Sugars

The enzyme sucrase-isomaltase is essential for the digestion of carbohydrates in the human intestine. Genetic variation of the enzyme could, according to a recent study by the Karolinska Institute in Stockholm, be a possible cause of irritable bowel syndrome and would explain why some patients feel better when they eat low a carbohydrate diet.  The human body produces this enzyme in the small intestine and to a lesser extent in the colon. It is responsible for breaking down polysaccharides which are chains of sugars. The loss of enzyme activity of  sucrase-isomaltase coincides with poor carbohydrate digestion in the gut and is now thought to be responsible for abdominal discomfort and malabsorption.   Sugars are known to stimulate the bowel and have a laxative effect.  Aim to avoid all sugar sweetened drinks, juices, biscuits, dried fruit, sweets and cakes.  Just because honey is a natural product doesn't mean it is agreeable with everyone.  Honey, Agave syrup, date syrup and maple syrup work in the same way as table sugar.

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