By Imogen Wolsey RD MSc
I think every runner must have had it; that moment, mid-run, when you just have to go. Immediately. Doesn’t matter where, don’t care how, just needs to happen absolutely asap and my god does that bush look perfect…
As un-glamourous as it is, this is something that runners in general (myself included) have accepted as part of their sport and, as a result, are pretty open about discussing bowel habits. However, it’s certainly not the easiest of subjects for the majority of people which makes it extremely concerning that approximately 1 in 5 of us are having to suffer the curse of irritable bowel syndrome in silence, or somewhat in shame. Hopefully, this brief overview of the condition will help to clarify the basics and give some helpful tips to the many IBS warriors out there in need of some support.
Definition and Diagnosis
So firstly let’s start with the basics. Irritable bowel syndrome (IBS) is known as a ‘functional disorder’, meaning there is an issue with the way the bowel functions despite normal looking cells in the colon and no underlying structural abnormalities. Depending on which symptoms are present IBS can be subdivided into the following;
- IBS-C Tendency towards constipation
- IBS-D Tendency towards diarrhoea
- IBS-U Interchanging constipation and diarrhoea
Regardless of which category a person falls into they may also experience wind, bloating, acid reflux and cramping among a whole variety of other symptoms.
In order to make a diagnosis of IBS, doctors must first rule out any ‘red flags’ via a series of blood tests/stool samples to make sure there is no chance of other conditions such as Crohn’s disease, ulcerative colitis or coeliac disease. Following this, and in accordance with guidelines from the National Institution of Clinical Excellence (NICE), a diagnosis of IBS can be given if there is at least 6-month history of abdominal pain, bloating, changing bowel habits with associated relief from defecation and if symptoms are triggered by eating.
Causes and Bacterial Links
Much to the frustration of everyone affected, a specific underlying cause of IBS cannot actually be confirmed due to its multifactorial nature- as it is a condition affected by a combination of dietary, lifestyle and emotional factors which are different for everyone. So this means that your bowel could be working like clockwork on a lazy Sunday but go haywire again when a stressful working week commences, despite eating the same things…. not ideal.
Following this, on top of unpredictable emotions, funky foods and potentially challenging lifestyle choices, there is another factor to consider that has been proven to predispose a person to IBS; alterations to our trusty microbes. This may be as a result of abnormal interactions with bacteria in the gut from antibiotic use or episodes of gastroenteritis (aka one hell of a tummy bug). If such occurrences have taken place and severe gastrointestinal symptoms are being experienced, there could also be a chance of what’s known as small intestinal bacterial overgrowth (SIBO), which is essentially when unwanted bacteria are present in places they shouldn’t be and may require some drug-specific treatment.
Although antibiotics may be necessary in treating severe cases of SIBO, they’re aren’t favourable in cases of more textbook IBS as they can leave our microbiome rather worse for wear; a bit like the uninvited guests at a house party who make the night for a select number of people but are also responsible for all the broken glasses in the morning. Instead, there is a different kind of ‘fairy godmother pill’ that can come to the rescue for many a tummy-troubled Cinderella… We are, of course, talking probiotics. Given their safety profile in providing a variety of beneficial bacteria, and the evidence to show improved GI symptoms after short-term use, they are a hugely attractive means of rebalancing an out-of-whack gut. There is some controversy over the best types available as these days there is so much choice, but reliable bets would definitely be VSL3, Optibac or Symprove formula (a particularly good one for those of us who just can’t say no to a shot).
Following this, it must be said that probiotics should ideally be consumed in everyday food choices as a long-term means of maintaining a happy gut. Dietary alterations are usually the first port of call for IBS sufferers, with first line advice from the NHS including the following;
-Eat three regular meals a day
-Limit alcohol intake to no more than two units per day
-Reduce intake of caffeine-containing drinks and fizzy drinks
-Cut down on rich fatty foods
-Cook from fresh ingredients as much as possible
-Take time to chew and digest food in a relaxed environment rather than rushing/on-the-go
However, if these general guidelines do not help there is always the more extreme approach, the name of which is likely to send shudders down the spine of those who are familiar…. The Fodmap Diet. That’s Fermentable, Oligo-, Di-, Mono-saccharides, And Polyols. Essentially an elimination diet that involves eating a narrowed range of fruits/vegetables/grains whilst symptoms calm down, before reintroducing the FODMAP foods at different stages to try and identify IBS triggers. This method is scientifically proven to be successful in reducing symptoms, yet also seem to cause a lot of anxiety over food choices and makes socialising god damn hard! It must be noted that the complete FODMAP-free diet should only be followed for the suggested 6-8 weeks and embracing the reintroduction of foods is important for the sake of broadening dietary choices and giving your microbiome the variety it needs to thrive.
Additional treatment tips include certain medications such as buscopan, which can help to relax the gut, and peppermint oil which aids and soothes digestion. Re-evaluating lifestyle choices may also be needed in order to give your tum a little extra R-E-S-P-E-C-T…like allowing yourself an extra half an hour in the morning to get into a good poo-tine or taking a walk outside on your lunch break and getting a good dose of that old-fashioned medicine known as fresh air.
Take Home Message
IBS is HARD. It’s a bloody tough thing to live with and can make every day feel like a total battle. But there is always a way… it will be individual and it will be down to figuring out personal coping mechanisms for when things flare up… but it doesn’t have to be lonely. Visiting a GP and getting referred to a registered dietitian, or visiting a freelance privately (www.freelancedietitians.org), is a starting point that will give the best medical support towards recovery. Then in addition to the medical professionals, there is a whole army of IBS warriors out there willing to share stories and give advice- and with new science coming to light all the time (especially in terms of gut health!) the answers might just be closer than they seem.
The Gut Stuff Tackles IBS (Round 2)
We hate that 1 in 5 of us, at some point in our lives, suffer from IBS and aren’t able to easily enjoy nights out and dinners with friends. So we thought we’d create a night where you can learn, eat and meet people in a relaxed, fun environment on the 15th of November from 6:30 – 10:00 PM at Candid Arts Trust (3 Torrens St, London EC1V 1NQ – Nearest tube station is Angel).
Powered by Symprove we’ll have an expert panel of doctors, scientists, nutritionists, and dieticians and real-life stories from brave IBS warriors bringing you information to help tackle your IBS.
Things kick off at 6.30pm and the £30 pp ticket gets you:
• 1 Welcome Cocktail
• A selection of Canapes and Organic Wine
• A Panel discussion and Q and A
• A goodie bag full of resources and tools
Please note this is an 18+ event. Identification may be required.