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Irritable Bowel Syndrome - what exactly is it?

In the UK, approximately 2 in 10 people suffer from digestive concerns and many of us can relate to having some sort of digestive discomfort and can’t quite put our finger on what can be causing it. Symptoms can include bloating, heartburn, pain, loose stools or even constipation. You might have been to the doctor who likely ran some tests or prescribed laxatives or anti-cramp medication but in truth finding the cause of a digestive concern can be very difficult. Even if you are diagnosed as having Irritable Bowel Syndrome (IBS), it just means a collection of symptoms according to government guidelines [1].


So, we asked Daniel O’Shaughnessy, the Naked Nutritionist, to tell us more…



As a nutritionist, I view digestion as one of the most important systems in the human body. Digestion is so important in how we use and absorb the nutrients in food, and studies have shown how digestive health is linked to the immune system, mood and mental health, skin health and cancer [2].


Whilst it’s important to seek medical advice for a digestive concern, the functional holistic approach to digestive disorders looks to find out the cause of the issue and there may be many causes, including:


Food Sensitivities

Your body can be sensitive to foods you’re eating. This is very different to food allergies, such as a nut allergy or celiac disease, or intolerances such as lactose intolerance - when you lack the enzyme to break down the sugar lactose in milk. The main culprits for food sensitivities are gluten (the general name for proteins found in the grains wheat, barley, spelt, rye and barley), dairy, eggs and soy. You can consume one food and react to it 7 days later so it’s very hard to isolate and know if it’s a problem and doesn’t necessarily always correlate with digestive health issues.


Food sensitivity testing is quite complex, expensive and there are validity concerns so the gold standard is to consider an elimination diet of foods that you think are causing an issue for three weeks. It’s best to do this with a nutrition practitioner as they can advise you on the reintroduction of the food and challenge testing.


Low stomach acid (Hypochlorhydria)

When your stomach acid is low, it can mean key minerals and protein aren’t absorbed properly and also leave the body vulnerable to harmful bacterias. Low stomach acid can be caused by ageing, zinc deficiency, stress, high sugar diet, not chewing properly, chronic illness, infections, allergies and medications The main symptoms of low stomach acid are gas and bloating after meals but can also be heartburn, constipation, acid reflux, weak nails, hair loss.

If you suspect you have low stomach acid then you can consider the following:

  • Chew your food thoroughly. Try closing your eyes when you eat and see how much slower you chew. This is the first thing you should do when trying to improve your digestive health.

  • Cook your own food. The digestion starts in the kitchen when preparing your meal.

  • Try ½ tsp of apple cider vinegar in a little water before meals, swish and swallow (be mindful that this may not be suitable for everyone and can interact with some medications so check with a nutrition professional).

  • Increase zinc-rich foods such as asparagus, beans, lamb, oysters, poultry, scallops, pumpkin seeds, prawns and spinach. Zinc is needed to make stomach acid.

  • Manage stress.

  • Increase fermented foods in the diet such as sauerkraut, kimchi, miso, kefir and natural yoghurt.


An issue digesting fats or low levels of pancreatic enzymes

Your pancreas may not be working as it should be to produce the enzymes to break down food. In addition, your liver could be under stress because of factors such as environmental toxins (these include alcohol and drugs, both prescription/over the counter and recreational), hormone imbalances or inflammation. Additionally, bile flow can be an issue that assists in the breakdown of fats during digestion and carries away waste. This can result in your inability to tolerate fatty food and even the formation of fatty gallstones.


Constipation

Most of the time this is caused by low levels of fibre in the diet but can also be due to other reasons such as dehydration, an overgrowth of bacteria in the small intestine or underactive thyroid. If you are suffering from constipation then try to increase the amount of fibre in your diet with fruit, vegetables and wholegrains and see if it solves the issue. However, there are some digestive conditions where fibre may be making the problem worse. Usually, this is when the gut is inflamed or when there is an overgrowth of bacteria in the gut.


Inflammatory Bowel Disease (IBD)

If your digestive symptoms are ongoing, there is a history of IBD in the family and blood in your stool then it should be a priority that you visit your doctor to rule out conditions such as Ulcerative Colitis and Crohn’s Disease. If the gut is inflamed then you need to work out why and get the appropriate medical care, testing as well as support this with the correct diet and lifestyle interventions.


Bacterial imbalance

The overuse of antibiotics and diets which are high in sugar and low in fibre means that degree of “dysbiosis” or put basically, not enough beneficial bacteria balance in the gut. It can be a cause of digestive issues but also can be seen with bad breath, a coated tongue and even fungal nails. To help this, you should aim to include a diet rich in colourful fruit and vegetables as well as increasing fermented foods.


Infections

Helicobacter Pylori, Small Intestine Bacterial Overgrowth (SIBO), parasites and yeasts can all play a role in digestive problems, even if you don’t have any noticeable symptoms. A stool test can help you pick up active infections so you can do something about them. Removal regimes include the use of antibiotics and/or herbal antimicrobials and a restrictive diet such as a Specific Carbohydrate Diet or a low FODMAP (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) diet, where certain fermentable carbohydrates are removed. It's incredibly important to work with a professional if you suspect an infection in your gut.


Stress

This can wreak havoc on your physiology. The result can lead to any of the above issues. Consider stress reduction strategies such as going for a walk, yoga, meditation, eating healthy and some time away from your phone. Head over to our Copingwell section for more tips on reducing stress.



Leaky gut

Otherwise known as intestinal permeability. This occurs when the intestines which normally control what enters the bloodstream become leaky allowing undigested food, toxins and bacteria to enter the bloodstream. This can be caused by poor diet, high alcohol intake, coeliac disease, poor gut health, inflammation, nutritional deficiencies, non-steroidal anti-inflammatory drugs (NSAIDs) and stress. There is debate in the medical community as to whether leaky gut exists but now there is a fair amount of scientific evidence showing that it does and may be linked to autoimmune disease [3].


 

Final thoughts: You may be reading this and still not sure about your digestive concern as your symptoms relate to quite a number of the possible causes above. If this is the case and you have been suffering for a long time then it’s worth considering a stool test to understand what exactly is going on in the gut. A test is not essential but allows you to be more targeted with nutrition interventions. Remember to speak to your GP too.


Daniel


Daniel O'Shaughnessy

The Naked Nutritionist

Award-winning BANT Registered Nutritionist

Certified Functional Medicine Practitioner


A note from Beingwell: If your organisation would like Daniel to deliver a workshop, or want to find out more about the many ways he can help your employees to eat better, pop us an email hello@beingwellgroup.com. Find out more about Daniel here.




References:

  1. Irritable bowel syndrome in adults: diagnosis and management (2008). National Institute for Health and Care Excellence.

  2. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis (2018). Frontiers in Microbiology.

  3. Alterations in intestinal permeability (2006). British Medical Journal.


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