Celiac disease is a common condition which can have similar symptoms to IBS. Discussion with a medical practitioner is important in diagnosing IBS.
The most common ways to treat IBS include dietary modification, behavioral therapy and medications. There has been recent research which suggests that certain foods can worsen symptoms of IBS. The FODMAP diet has been studied at Box Hill Hospital by Dr Gibson's team. The theory is that the sugars in certain foods are poorly absorbed by people with IBS.
These sugars are fermented by bacteria in the colon and lead to symptoms of bloating, abdominal pain, diarrhea and constipation. These rapidly fermentable, short-chain carbohydrates (FODMAPs) are commonly found in wheat, onions and many fruit and vegetables.
IBS is diagnosed by clinical symptoms. When there are certain features which are not typical of IBS, further testing may be required. This may include bloods tests, endoscopy or colonoscopy. Breath testing may be useful to confirm short-chain carbohydrate malabsorption and can help tailor dietary advice. Consultation with a dietician who is expert in IBS is often very useful. Remember that the foods listed in FODMAP are generally healthy foods, however abdominal symptoms may worsen when many of these foods are consumed in combination.
Some of the foods which are most likely to worsen symptoms of IBS include wheat, onions, honey and fruit. Wheat is now part of the staple diet of many people, and just reducing wheat alone can significantly improve IBS. Wheat based products tend to only be a problem when wheat is the main ingredient, such as with bread, pasta, noodles, pastries, cakes and biscuits.
Wheat can be tolerated in small quantities, such as breadcrumbs or when used as a thickener for gravy. It is important to distinguish IBS from Coeliac disease. People with Coeliac disease may have similar symptoms to IBS, however should be on a strict lifelong gluten free diet, and should not have even a small amount of gluten (wheat, rye and barley). Wheat will damage the intestine in coeliac disease and should not be consumed at all. Wheat does not cause any damage to the intestines in IBS and can be consumed in small amounts if tolerated.
Onions are another major problem for people with IBS, and should not be consumed at all if possible. One simple option includes cooking with onion cut into large strips to flavour the food, however removed prior to eating. Honey and fructose sugars found in fruits such as apples, peaches and pears can also worsen bloating and should be consumed in moderation. Many people with IBS have co-existing lactose deficency and may need to reduce dairy intake. Spicy foods, alcohol and caffeine are common causes of IBS symptoms and should be reduced.
Fibre intake can also be difficult to manage in people with IBS. Although high fibre intake is commonly recommended for general health benefits, fibre can worsen symptoms of abdominal pain and bloating. A moderate dietary fibre intake and low dose fibre supplement such as Normafibe 1 level tsp can be daily taken with one glass of water. Normafibe is an insouble fibre and causes less bloating than other fibre supplements and does not contain stimulant laxatives. It is safe to take on a long term basis and will not damage the colon.
SUMMARY:
1. The most important message is to consult with a doctor and dietician. It is important to make sure that your symptoms are due to IBS, and that diseases such as Coeliac disesae and Inflammatory Bowel Disease have been excluded.
2. Pay attention to what foods seem to trigger symptoms for you. Keeping a food journal is often useful. Remember that it can take several days for food to be digested and pass into the large intestine, so you may not develop symptoms immediately after eating certain foods. Also keep a note of other lifestyle events which seem to worsen IBS. Stress levels, anxiety and depression are commonly associated with IBS.
3. Use FODMAP diet as a guide to see which foods may be worsening your symptoms. Wheat, onions, honey and fruit are common trigger foods. Consider a 4-8 week trial and then slowly start re-introducing food groups and watch what difference this makes. Consultation with a dietician during this time can be really useful.
4. Continue to consult a doctor to help manage this disease. Some doctors are more knowledgeable about IBS, and choosing a good doctor is vital. Sometimes you may be referred to see a gastroenterologist, who can give specialist advice and help to exclude other diseases which may be causing symptoms.
Medications can play a role for more disabling disease, however this should ne discussed with your health care provider.
5. Develop mastery over IBS. Read and learn as much as possible about IBS. Try out different strategies, in particular looking at nutrition. Developing control over symptoms of IBS is a powerful way to help beat this distressing disease.