Irritable Bowel Syndrome

ibs

What is IBS?

Irritable Bowel Syndrome (IBS) is a common condition which affects the digestive system. It is a long-term condition with varying degrees of severity depending on person to person. Most people have flare-ups of symptoms which can last a few days. The symptoms may then improve but not go completely. The main triggers include certain foods and stress.

Symptoms

The most common symptoms include:

  • Abdominal pain and cramping
  • Diarrhoea or constipation (or sometimes alternating between the two)
  • Bloating and distended stomach
  • Excessive wind (flatulence)
  • Occasionally needing to urgently go to the toilet
  • Feeling that you have not fully emptied your bowels
  • Passing mucus from your bottom

In addition to these symptoms, people with IBS may experience some of the following:

  • Lack of energy (lethargy)
  • Feeling sick
  • Backache
  • Bladder problems (i.e. feeling an urgent need to urinate or waking up at night to urinate)
  • Pain during sex (dyspareunia)
  • Incontinence

Causes

The exact cause of IBS is currently unknown. Some experts have suggested the following causes:

  • Problems with digestion – It is thought that the natural process of moving food through the digestive system by squeezing and relaxing the muscles in a rhythmic way is altered in IBS sufferers, causing food to either move through the digestive system too quickly (resulting in diarrhoea) or too slowly (resulting in constipation).
  • Increased gut sensitivity – Some experts believe that people with IBS may be oversensitive to the digestive nerve signals. For example, mild indigestion may be barely noticeable to a non-IBS sufferer but will present itself as distressing abdominal pain in IBS sufferers.
  • Psychological factors – There is evidence to suggest that psychological factors play a role in IBS. This does not mean that it is “all in the mind”. The symptoms are very real. Emotional states such as anxiety and stress can trigger chemical changes that can interfere with the normal workings of the digestive system. Some sufferers feel that their symptoms worsen when they are under stress.
  • Food triggers – Certain foods and drinks can trigger the symptoms of IBS. Examples include alcohol, fried/fatty food, fizzy drinks, etc. but not everyone with IBS has the same reactions to the same foods.

Diagnosing IBS

There are no specific test for IBS as it does not cause any detectable abnormalities in the digestive system. In most cases, a diagnosis will be made depending on the symptoms the patient presents. A diagnosis may also be made once other conditions such as coeliac disease and inflammatory bowel disease (IBD) have been ruled out. To rule these out, the GP may order blood tests and other tests such as an endoscopy.

Treatment

IBS can often be managed by changing your diet and lifestyle. The main dietary tips offered to IBS sufferers are:

  • Try eating smaller meals throughout the day (i.e. 5 or 6 small meals) rather than large meals (i.e. 3 large meals)
  • Don’t rush your food
  • If you have diarrhoea, try to cut down on insoluble fibre (i.e. wholegrain bread, nuts, seeds, bran, etc.)
  • If you have constipation, try to increase soluble fibre (i.e. oats, barley, rye, fruit such as bananas and apples, golden linseeds, root vegetables such as carrots and potatoes, etc.)
  • Certain teas may have a calming effect on symptoms of IBS, i.e. peppermint tea may help with cramping and spasms while ginger tea may help nausea
  • Drink plenty of fluid throughout the day i.e. water and herbal teas
  • Restrict tea and coffee to a maximum of three a day
  • Reduce the amount of alcohol and fizzy drinks you drink
  • Some sweeteners such as sorbitol can trigger IBS symptoms. Avoid this sweetener. They are often found in some chewing gums, drinks, diabetic products and slimming products
  • Limit fresh fruit to three portions a day
  • If you suspect certain foods are your triggers, do an elimination diet where you completely eliminate those foods for 4 weeks then re-introduce them (one at a time if you’ve eliminated more than one food) to see if your symptoms have returned. If they return then eliminate that food again.
  • Low FODMAP Diet: FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. They are types of carbohydrates which are not easily broken down and absorbed by the gut. Because of this, they start to ferment in the gut quite quickly. The gases which are released during this process can cause bloating. Doctors or Dieticians sometimes recommend a Low FODMAP Diet to IBS sufferers. It involves restricting the intake of foods considered High FODMAP which include some vegetables, fruit, animal milks, wheat products and beans. This diet can be quite restrictive and may not work for everyone but some individuals may find relief of their symptoms

Many people find that regular exercise can help relieve their IBS symptoms. You should aim to do a combination of cardio (3-5 days a week for 20-90 minutes), strength/resistance training (2-3 days per week for 20-60 minutes), core stability training (no set guidelines) and flexibility training/stretching (2-3 days per week with each stretch being held for 15-60 seconds).

Some people find stress and anxiety are triggers for their symptoms so reducing stress levels can be very beneficial. Ways to reduce stress include:

  • Meditation
  • Breathing exercises
  • Cognitive Behavioural Therapy (CBT)
  • Counselling
  • Hypnotherapy
  • Colouring books
  • Yoga
  • Exercise such as running, walking or swimming

Probiotics can often be recommended by a doctor or dietician. They contain “beneficial bacteria” that can supposedly improve digestion. They can come in supplement form and can also be found in yoghurts and yoghurt drinks.

Doctors may prescribe certain medications for IBS. These include:

  • Antispasmodics
  • Laxatives
  • Antimotility medicines
  • Low-dose antidepressants

Some complementary therapies may also be useful in the treatment of IBS such as acupuncture and homeopathy.

 

If you suspect you have IBS or have been diagnosed with IBS and feel it is ruling your life, the first step is to go see your GP to start the process of getting to a healthier and happier state.

Water and Hydration

Keeping ourselves hydrated is probably the most important part of our daily lives. We can only survive for a few days without water while we can live for around 8 weeks without food. Our body weight consists of around 65% water. The majority of this is contained within our cells. The remainder is contained in the lymph and circulatory systems and some is used for assisting excretions and secretions.

What does water do?

  • It assists with the absorption, excretion and circulation of nutrients into and out of cells. It also assists with carrying the nutrients in the blood
  • Aids digestion
  • Is a medium for all chemical exchanges
  • Is a solvent for the body’s substances
  • Assists in removing cellular waste
  • It is used for building and repairing the body
  • It is needed for body temperature regulation and distributing heat around the body from areas where it’s produced to cooler sites such as the skin’s surface
  • It lubricates the moving joints and eyes

Fluid depletion

We lose water in the body mainly by urinating, breathing and sweating. Dehydration happens when lost fluid is not replaced. Changes in the fluid balance of as little as 1-2% can result in dehydration which can have negative consequences. A 10% loss of body fluid through dehydration is life threatening.

The effects of chronic dehydration include:

  • Constipation
  • Lethargy
  • Dental disease (dehydration is associated with salivary dysfunction and saliva is essential for maintaining oral health)
  • Headaches
  • Impaired cognitive function
  • Confusion in the elderly – can result in dizziness and fainting and can increase the risk of falls
  • Skin changes – flushed skin, dry skin and loose skin with loss of elasticity
  • Increased risk of urinary tract infection and renal stones

Why do we sweat?

The purpose of sweating is to keep your core temperature at around 37 degrees Celsius. This is why we sweat when we exercise as the heat we generate whilst exercising has to be dissipated in order to maintain this temperature. There are several factors which can determine how much each individual sweats including:

  • The exercise intensity
  • Length of exercise
  • Environmental factors (temperature and humidity)
  • Body size
  • Fitness levels
  • Gender (women tend to sweat less than men)

During a normal 1 hour exercise session, the average person should be expected to lose around 1 litre of fluid.

How much do we need?

The amount of fluid needed for each individual person will depend on various factors such as environmental temperature, humidity, individual metabolism, activity levels and general state of health.

The World Health Organization (WHO) provide general recommendations for the average person:

  • Men (based on a 70kg male) – 2.5 litres a day
  • Woman (based on a 58kg female) – 2.2 litres a day
  • Children – 1 litre a day (for a 10kg child) or 0.75 litres a day (for a 5kg child)

The water requirements can be met through food as well as fluid. Some foods such as fruit and vegetables contain high amounts of water.

Thirst is not the best indicator of fluid status as thirst is a response to dehydration so you are technically dehydrated once you feel thirsty. The best method of measuring your hydration level is through the colour of your urine. As seen in the chart below, your urine should be pale or pale yellow. The darker it is, the more dehydrated you are.

nutrition_guide_hydration_urine_color_chart

If you experience sluggishness, fatigue, loss of appetite, headaches, feeling excessively hot, light-headedness and nausea, start drinking immediately.

You will need to increase your fluid intake if you are ill with sickness or diarrhoea to replace lost fluids and you may need to up the intake the more active you are due to sweating.

Different Drinks and Their Effects on Hydration

Many of us rely on drinks other than water such as tea or soft drinks. This is how useful they are in rehydrating our bodies:

  • Tea & Coffee – Approximately 40% of the nation’s fluid intake will come from tea. 80% of UK adults also regularly drink coffee. Both of these drinks have caffeine in them which can have a mild diuretic effect (causes increased output of urine). However, a recent review of the evidence linking caffeine with increased urine production observed that this generally only happens when at least 300mg of caffeine (or 5-6 cups of tea or 4 cups of coffee) is ingested. As a cup of tea is 99.5% water, it can be a useful way of hydrating ourselves as long as we don’t go overboard. However, it is advised that people with high blood pressure and pregnant women should limit their caffeine consumption.
  • Carbonated Soft Drinks – These include drinks such as Coca Cola, Lucozade, Ribena, 7Up, etc. These types of drinks are very high in sugar which add a lot of unwanted calories to our diets and can cause damage to our teeth. Even drinks labelled ‘sugar free’, ‘reduced sugar’ or ‘low sugar’ can still cause damage to our teeth because they have the same acids as the standard carbonated drinks. They are best kept to a minimum.
  • Hypertonic Soft Drinks – Hypertonic describes a drink that has a sugar (glucose) concentration which is higher than the glucose concentration of the blood (this is typically greater than 8g per carbohydrate per 100ml). If the concentration in the drink is higher than that of the blood, the body will have to provide fluids to dilute the drink before absorption can take place. This means that a considerable amount of water is initially removed from the body in order to process the high levels of sugar. This will delay swift fluid replenishment. Soft drinks are also very acidic.
  • Fruit Juices – Pure fruit juices can often have as much sugar as carbonated soft drinks. However, pure fruit juices also contain the same vitamins, minerals and phytochemicals as fresh fruit (although not the fibre or pectins). It is recommended to only have one glass of unsweetened fruit juice a day. They are also hypertonic as the sugar concentration is more than that of the blood. You can dilute fruit juices with water to make it a more effective rehydrating drink.
  • Fruit Juice Drinks – These are different to the pure fruit juices mentioned previously. Unlike ‘pure fruit juices’ and ‘freshly squeezed juice’ which contain 100% fruit juice, fruit juice drinks can contain as little as 5% real fruit juice. The rest is made up of a combination of sugar, water and often flavourings, colourings and sweeteners. These drinks won’t have the same health benefits and the added sugar in them can lead to dental problems. Check the labels to see how much sugar and real fruit juice they contain.
  • Dairy Drinks – Milk, milk-flavoured drinks and yoghurt drinks provide us with calcium which helps to strengthen our bones. Milk also contains 5g of carbohydrates per 100ml. This is similar concentration to that of the blood so the water content is easily absorbed into the body. A glass of milk is 85-90% water. Milk-flavoured drinks and yoghurt drinks may have added sugar so it’s best to check the labels. It is advised for the general population to use semi-skimmed or skimmed milk rather than whole milk as they are lower in fat but still contain the same amount of calcium. For children under five, whole milk should be used although semi-skimmed milk can be used from the age of two as long as the rest of the diet provides adequate amounts of energy.
  • Alcohol – Alcohol can have a dehydrating effect on our bodies because it depresses the production of the anti-diuretic hormone called vasopressin (the hormone which normally acts on the kidneys, concentrating the urine by promoting the re-absorption of water and salt into the body). Other side effects of alcohol consumption include tiredness, attack of free radicals (harmful molecules formed in the liver as it struggles to break down ethanol), headache and loss of co-ordination. Alcohol provides 7kcal per gram so can be a large provider of empty calories in our diets. The Department of Health advises that men should not regularly drink more than 3-4 units of alcohol per day and women should not regularly drink more than 2-3 units of alcohol per day. When drinking alcohol, alternate alcoholic drinks with water to counter-act the dehydrating effects.

The Bottom Line

The best way to keep yourself hydrated is to drink around 6-8 glasses of water a day. This can also include other types of hydrating drinks such as tea (including fruit teas and green tea), coffee (moderately), pure fruit juice and milk. Try to limit any drinks which have added sugar and alcohol to prevent diuretic effects and added calories which can contribute to obesity and health problems. Take a bottle of water with you wherever you go so you can easily top up your water supply.