08 Dec 2022 Article

The one thing that is certain about irritable bowel syndrome (IBS) is that it is not easy to live with. Living a normal social life with an unpredictable gut can be challenging. Much is not clear regarding IBS. For example, it is almost impossible to determine how you contracted IBS. Finding the right treatment is also often a challenge. In this article we will look at what is known about irritable bowel syndrome today, and what steps you can take yourself if you suspect you have IBS.

What is irritable bowel syndrome?

Irritable bowel syndrome is a common so-called “functional gastrointestinal” disorder. A “functional disorder” is a condition in which diagnostic tests do not reveal any abnormalities that explain the disorder.

It is estimated that 11% of the world’s population suffers from this condition. About one third of people with IBS symptoms seek medical advice.

In IBS, there is a matter of dysfunction of the colon. It means it doesn’t function as it should. The symptoms are very different. Typically, patients with IBS complain about abdominal pain and cramping, extreme gas, discomfort, or changes in bowel habits. Patients say that the complaints often worsen after eating. There are three types of IBS: with persistent diarrhoea, with persistent constipation, and a mixed type, in which periods of diarrhoea alternate with periods of constipation. Some people literally suffer from IBS all the time, but for most persons the symptoms come and go. Complaints often worsen during periods of stress.

The exact cause of IBS is still unknown. Today, however, a lot of information about the course of IBS is available, and there are several interventions that help most people manage their condition. As a dietitian, I can confirm that almost everyone who has IBS complaints can find the right dietetic approach.

How is IBS diagnosed?

The diagnosis of IBS is only made if no structural or biochemical explanation has been found for the patient’s complaints. This means that no physiological abnormalities and no abnormalities in the faeces are found during the examination. Complaints must in any case be present for more than six months. In addition, the patient should have clear complaints at least one day a week in the past three months. Furthermore, at least two of the following three complaints must be present:

  • abdominal pain associated with defecation;
  • change in stool frequency: diarrhoea or constipation;
  • the structure of the stool has changed, i.e. it has become too hard or too watery.

The Cause of Irritable Bowel Syndrome

Irritable bowel syndrome and diet are connected, but the connection is not always very straightforward.

The cause of IBS is, as I’ve said, unknown. As a rule, IBS is suspected to be caused by a combination of factors. In any case, there is matter of an intestinal motility disorder and/or hypersensitivity of the intestinal wall.

Genetics may also play a role. IBS often affects several family members.

In addition, an intestinal infection, for example because of food poisoning, can be a reason for the development of IBS.

Stress, smoking and regular alcohol consumption can also cause/worsen IBS.

IBS can also be related or worsened by improper eating. Some people eat too little fiber, and this is actually the cause of their complaints. But for other people, some types of fiber can actually make the symptoms worse. Therefore, the advice of a GP or dietician should always be individual. My personal experience as a dietitian has taught me that with the right tailor-made approach, the chance of success is high.

What can you do if you think you have IBS?

What can you do if you have complaints that resemble IBS, but you do not want to go to the GP / dietician yet? Ask yourself the following questions and adjust your eating and drinking habits as needed:

Do you drink enough water?

Very often, symptoms disappear when a person starts drinking more water. This is especially relevant for people with IBS accompanied by constipation. The general recommendation of the World Health Organization is to drink at least 6 glasses of water (one glass = 250 ml), even if it is not warm outside and you are not thirsty. You can drink warm water if you don’t like it cold. You can also drink tea instead of water.

Do you drink alcohol?

IBS symptoms almost always get worse after alcohol consumption. Therefore, eliminate it from your routine.

Are you getting enough fiber in your diet?

Dietary fiber is complex carbohydrates. They are responsible for the structure of plants, it is thanks to them that fruits and vegetables look a certain way. Take a celery stick for example. See the long wires on it? These are dietary fibers. However, dietary fiber is not always visible to the naked eye.

Dietary fiber can be divided into two main categories: soluble and insoluble. Soluble fibers are tough, soluble in water and can ferment. They are food for the bacteria in our gut. Insoluble fiber leaves our body in the same form as it enters it. It increases stool volume and improves intestinal motility. Both types of fiber should be present in the diet. But soluble fiber is mostly assigned for the treatment of IBS. In particular, psyllium fiber is often prescribed to people suffering from IBS.

The main source of fiber are vegetables. In addition to vegetables, dietary fiber is found in high amounts in legumes, berries, fresh and dried fruits, nuts and seeds. In fact, in all plant products. Foods of animal origin do not contain fiber.

Do you keep a food diary?

Irritable bowel syndrome and diet are directly connected in most cases. However, different people react differently to the same foods. A food diary can help you find out whether your gut reacts to certain foods. The following foods are the most well-known triggers for IBS:

  • Milk

Milk contains the milk sugar lactose. Most adults do not produce enough enzymes to break down lactose. In small amounts, lactose usually does not cause any complaints (for example, hard cheeses contain little lactose), but a glass of milk (= a lot of lactose) can cause cramps, flatulence and diarrhoea.

  • Coffee

Coffee often causes the manifestations of IBS. This is because of the caffeine. Although black and green teas also contain a lot of caffeine, they are usually not considered triggers. This is probably because tea is much less acidic than coffee.

  • Legumes

Legumes is a collective name for beans, peas and lentils. Legumes are super healthy but unfortunately not easy to digest for most people. What you can do to make them more tummy friendly is soak them and rinse them well before use.

  • Fruit

Citrus fruit and most fruit that you consume with a peel (apple, pears, grapes, etc.) can trigger IBS complaints.

  • Vegetables

Well-known triggers in IBS are onion and garlic, bell-peppers and all kinds of cabbages (Chinese cabbage, Brussels sprouts, white cabbage, red cabbage, etc.).

  • Sweeteners

Regular use of polyols can cause diarrhoea. Polyols are a class of sweeteners. Examples of polyols are xylitol, sorbitol, maltitol.

Do you exercise enough?

Physical activity has been shown to have a positive effect on IBS. You don’t necessarily have to go to the gym. A daily walk also counts as exercise. Remember to exercise for at least half an hour every day.

If the above advice is not of much help for your particular situation, I strongly recommend finding a dietitian who specializes in IBS. Under his/her guidance you can try the so-called elimination diet or FODMAP diet or another intervention and find a nutritional strategy that suits you.