Category Archives: IBS

Vitamin D & IBS

Vitamin D: a better life for IBS sufferers?

Vitamin D improves quality of life for IBS sufferers

April is IBS Awareness Month, a campaign aiming at improving diagnosis and treatment of IBS, and heightening awareness of both the condition and its affect on sufferers.

IBS impacts severely on quality of life, with patients commonly suffering with pain, discomfort and social embarrassment. Previous studies have found that IBS patients demonstrate significantly higher levels of anxiety and depression than healthy individuals (1). Research in this area is desperately needed, as IBS affects as many as 1 in 5 of us, and many people struggle to manage the condition.

The relationship between IBS and mood disorders is a complex one. Stress, anxiety and depression can cause digestive issues because the nervous system and the digestive system are linked. In addition, IBS symptoms can cause anxiety and stress for sufferers.

Fortunately, some recent promising research has revealed that vitamin D supplementation may improve the quality of life of IBS sufferers (2). This pilot study will hopefully lead to further research in this area.

The Study

The recent study, published in the British Medical Journal, was a double-blind, randomised trial. It compared the effects of a placebo, vitamin D, and a combination of vitamin D and probiotics on IBS patients.

Each patient was randomly assigned to receive a placebo, a vitamin D supplement, or a vitamin D and probiotic supplement. Over the course of 12 weeks, each patient completed several health questionnaires to monitor symptoms and quality of life.

The study found that 82% of the IBS patients were deficient in vitamin D. As expected, at the end of 12 weeks, the final results showed that those who had supplemented vitamin D had improved blood levels of vitamin D. In addition, the results also showed a strong link between vitamin D status and quality of life. Those who had supplemented vitamin D felt that their IBS symptoms had less influence on wellbeing compared to their vitamin D deficient counterparts.

Those supplementing vitamin D also showed improvement in all IBS symptoms as their vitamin D levels improved, although the study was too small to draw a firm conclusion about this. Lead researcher Dr Bernard Corfe stated that these results nevertheless “justify a larger and more definitive clinical trial.”

More research is needed to clarify the link between vitamin D and IBS. The gut is home to millions of vitamin D receptors, and vitamin D helps to protect the gut lining, preventing ‘leaky gut’, and it also reduces levels of inflammation in the digestive tract. Its role in the immune system means that vitamin D is also believed to be helpful in protecting against digestive infections and overgrowths.

Dr Corfe added: “Our data provides a potential new insight into the condition and more importantly, a new way to try to manage it.”

The study certainly suggests that those with IBS should ensure that they have adequate levels of vitamin D, especially if they are suffering with stress and anxiety. “It was clear from our findings that many people with IBS should have their vitamin D levels tested” says Dr Corfe, “and the data suggests that they may benefit from supplementation with vitamin D.”

References
1. Hyun Sun Cho et al (2011) Anxiety, Depression and Quality of Life in Patients with Irritable Bowel Syndrome. Gut Liver. 5(1): 29–36
2. Tazzyman S et al (2015) Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial. BMJ Open Gastro 2:e000052.

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April is IBS Awareness Month

IBS Awareness Month, observed every April, is an annual campaign aimed at increasing awareness and understanding of irritable bowel syndrome.

IBS is a functional gut disorder, which means that the bowel simply does not work as it should. Around 10% of the population suffers with this disorder, and sufferers can experience a number of intermittent symptoms including diarrhoea, constipation, gas, bloating and lower abdominal pain. While the condition is not thought to damage the bowel, it has a significant impact on quality of life (1).

Before IBS is diagnosed by your doctor it is important that he or she rules out other digestive conditions such as Crohn’s or Ulcerative Colitis which are inflammatory bowel diseases.

For many, treatments such as anti-spasmodics offered by the GP have limited success. Sufferers can be left feeling helpless, and do not always have the information they need to manage the condition.

IBS: Four Steps to Digestive Health

1. Optimise digestion

Chewing food thoroughly and eating in a slow and relaxed manner can help improve the first stage of digestion by increasing levels of digestive enzymes and helping them to work more effectively. Plant enzyme formulas, such as papaya enzymes in Caricol, may also be helpful in optimising digestion, and have been found to improve symptoms of IBS (2).

2. Restore gut bacteria

Many studies have drawn attention to a link between IBS and overgrowth of pathogenic bacteria in the gut. Probiotic formulas can help to crowd out these problem bacteria, improving digestion, decreasing inflammatory response and restoring proper balance in the digestive tract. Strains of Lactobacillus and Bifidobacter look particularly promising as natural agents aimed at improving symptoms of IBS (3,4).

Prebiotic foods, such as asparagus, garlic, leeks and bananas can also be helpful as a regular addition to the diet. Prebiotics feed the friendly bacteria in your gut helping it to proliferate.

3. Repair and protect

April is IBS awareness month
April is IBS Awareness Month

While IBS is not classed as an inflammatory condition. However, recent research published in the journal Gastroenterology has actually found ‘mini-inflammations’ in the gut mucosa of IBS patients. This inflammation is thought to upset the sensitive balance of the bowel and cause hypersensitity of the enteric nervous system leading to IBS symptoms. Lead researcher Prof. Schemann explains: “The irritated mucosa releases increased amounts of neuroactive substances such as serotonin, histamine and protease. This cocktail produced by the body could be the real cause of the unpleasant IBS complaints.”

Natural measures to help repair and protect the gut lining, such as supplementing glutamine or omega-3 oils could help reduce this localised inflammation, improving IBS symptoms.

4. Identify trigger foods

While food choices are not the cause of IBS, they can certainly trigger symptoms. Trigger foods can vary from person to person, but common culprits include wheat, fatty of fried foods, milk and coffee. Keeping a diary of your diet and symptoms can help to identify trigger foods. Eliminating possible trigger foods from your diet should be done in a safe and healthy way, and guidance from a nutritional therapist can be helpful for those who need support with this.

The management of IBS requires a personalised approach, as what works for your neighbour may not be the best option for you. It is important to persevere in order to find the right approach. Hopefully international campaigns such as IBS Awareness Month should encourage sufferers to find the information and help they need to manage the condition effectively.

References

1. Amouretti M et al (2006)  Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol.  Feb;30(2):241-6.

2. Muss et al (2012) Papaya preparation (Caricol®) in digestive disorders. Biogenic Amines Vol. 26, issue 1 (2012), pp. 1–17.

3. Clarke G et al (2012) Review article: probiotics for the treatment of irritable bowel syndrome – focus on lactic acid bacteria. Alimentary Pharmacology & Therapeutics 35:4. pp. 403–413.

4. Technische Universitaet Muenchen (2010, August 20). Proof that a gut-wrenching complaint — irritable bowel syndrome — is not in your head. ScienceDaily. Retrieved March 29, 2013, from http://www.sciencedaily.com­/releases/2010/08/100819141950.htm.

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Probiotics – What are they and do you need them?

Probiotics, or ‘friendly bacteria’, are live microorganisms, which when consumed in adequate amounts, are thought to confer health benefits on the human body. Taking a daily probiotic supplement could not only help with your digestion, but could also spark off other feel-good factors, such as good skin health, immunity and wellbeing.

Digestion
Probiotics are key to the digestive system. They help the body to produce digestive enzymes (such as lactase) which breakdown certain food substances (in this case, lactose, found in dairy products.) This is why topping up your levels of probiotics on a daily basis can help with food intolerances.

Probiotics support the digestive system, and various research has shown that these microorganisms can help to encourage bowel regularity, and discourage digestive disorders or conditions such as diarrhoea (1,2), bloating (3) , or constipation(4,5).

High Quality Probiotic
A High Quality Probiotic such as OptiBac For Daily Wellbeing EXTRA Strength can help line the gut wall with good bacteria to fend off pathogens.

Immunity
Probiotics are thought to support the immune system thanks to the ‘barrier effect’. A high quality probiotic is tested for its ability to bind to cells on the gut wall lining. When you supplement with plenty of probiotics they begin to coat your gut wall, taking up space on this lining. This means that when pathogens (harmful microorganisms) enter the body, they reach the gut and have fewer points on the gut wall upon which they can adhere. It’s effectively a competition for space, between the good guys and the bad! The more good guys (probiotics) you have lining your gut wall, the fewer bad guys (pathogens) you should have in turn. This is known as the barrier effect; taking a daily probiotic can support this process.

Probiotics also improve the absorption of vitamins and minerals into the bloodstream. After all there’s no use taking lots of vitamins if your body is not absorbing them. This improved vitamin uptake provides essential support for the immune system, and what’s more, means that a probiotic nicely complements any other daily supplements you may take.

Skin health
Probiotics are also thought to help support healthy skin, as often acne or spots are caused by bad bacteria, or toxins in the body. Supporting your gut with friendly bacteria means that the body will digest foods more efficiently (producing fewer toxins in the first place) and what’s more, probiotics help to displace toxins or bad bacteria in the gut (through various mechanisms, including the barrier effect mentioned above.) Probiotics have even been shown to help with atopic allergies such as eczema (6). Supporting your gut health from the inside should hopefully see you benefiting on the outside too.

Frequency of Use
Some specific probiotics can be effectively taken as a ‘one-off’ treatment, for example Saccharomyces boulardii to support gut health in those suffering from diarrhoea. However if you’re taking probiotics for general support to your digestion, immunity, energy & skin, best to take them every day for at least a few months; giving your gut time to top up its friendly bacteria levels. Many people safely and happily take probiotics on an ongoing basis for years.

 

References:

1. McFarland, L.V. & Bernasconi, P. (1993) Saccharomyces boulardii: A Review of an Innovative Biotherapeutic Agent. Microbial Ecology in Health and Disease; Vol. 6 pp. 157-171.
2. Hochter, W. et al (1990) Saccharomyces boulardii in acute adult diarrhea. Efficacy and tolerance of treatment. Munchener Medizinische Wochenschrift; Vol. 132 (12) pp. 188-192
3. Paineau, D. (2007) Regular consumption of short-chain fructo-oligosachharides improves digestive comfort with minor functional bowel disorders. Br. J. Nutr. Aug 13:1-8 [Epub ahead of print]
4. Matsumoto, M. et al. (2001) Effect of Yoghurt with Bifidobacterium lactis Bb-12® in Improving Fecal Microflora and Defecation of Healthy Volunteers. Journal of Intestinal Microbiology; 14(2): pp. 97-102
5. Pitkala, K.H et al. (2007) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. Journal of Nutritional Health and Aging; 11(4): pp.305-311.
6. Isolauri, E., et al., Probiotics in the management of atopic eczema. Clin Exp Allergy, 2000. 30(11): p. 1604-10.

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IBS Awareness

April is IBS Awareness Month. This calendar event is aimed at heightening awareness of the causes and symptoms of IBS, and the treatment options available. It also encourages sufferers to talk about their condition and take positive steps to manage their symptoms.

Painful tummy
IBS can cause symptoms such as gas, bloating, constipation and / or diarrhoea

The exact cause is unknown, but attacks can be triggered by stress and dietary factors. Typical symptoms of IBS or Irritable Bowel Syndrome include abdominal pain, a sense of urgency (having to rush to the toilet), bloating and gas, and diarrhoea or constipation.

Might you have IBS?

Learn your ABC for IBS! The National Institute for Clinical Excellence (NICE) advises that anyone experiencing the following symptoms for 6 months or longer should be assessed for IBS:

  • Abdominal pain or discomfort
  • Bloating
  • Change in bowel habit

Common myths and misconceptions

There are many misconceptions about IBS, perhaps because many people find IBS difficult or embarrassing to talk about. A clear understanding of IBS can help sufferers to manage the condition more effectively.

1. MYTH: IBS is “all in the head”

FACT: For many years, doctors believed IBS was a psychological condition, only existing in the patient’s head. This misconception is damaging for patients who require practical help to manage IBS. Fortunately physicians now have a better understanding of the condition and can offer practical approaches to relieve symptoms.

2. MYTH: IBS is not a serious condition

FACT: IBS is not life-threatening, and it is not an inflammatory disease like Crohn’s or Ulcerative Colitis. However, IBS can significantly impact a person’s quality of life and ability to function on a day-to-day basis. These are serious concerns and should be treated as such by your GP.

3. MYTH: IBS is related to lactose intolerance

FACT: IBS and lactose intolerance are not linked, although their symptoms are very similar. Some people suffer with both IBS and lactose intolerance. If your symptoms are relieved by cutting out lactose, or by taking lactase supplements, then it is possible you have lactose intolerance rather than IBS.

4. MYTH: Increasing your fibre intake will help IBS

FACT: Although fibre is an important part of a healthy diet, certain types of fibre can actually trigger IBS symptoms. In IBS, the rough edges of insoluble fibre can irritate the digestive tract, causing abdominal pain and cramps. Swapping foods high in insoluble fibre, such as bran flakes, for foods high in soothing soluble fibre, such as oats, can help to manage painful symptoms.

5. MYTH: IBS cannot be diagnosed

FACT: There is an established protocol that GPs can use to diagnose IBS. By assessing symptoms and ruling out other digestive disorders such as inflammatory bowel disease and celiac disease, your doctor can accurately diagnose IBS.

6. MYTH: There are no good treatment options for IBS

FACT: There are several prescription drugs, over-the-counter medications and nutritional supplements that can relieve symptoms for sufferers. Different approaches can work for different people, and it is sometimes necessary to experiment to find what works best for you. Some over the counter medications can actually make symptoms worse if they are used excessively. Dietary and lifestyle changes can make a world of difference. For example, the FODMAP diet has proved helpful to many. Probiotics (especially strains such as Bifidobacterium Infantis), peppermint oil, and soluble fibre supplements such as psyllium husk all represent effective natural approaches to troublesome symptoms.

If you have been diagnosed with IBS then a nutritional therapist can advise you on dietary management and helpful supplements. If you suspect you may have IBS then you should initially speak to your GP. After all, one of the most important messages of IBS Awareness Month is that nobody should have to suffer in silence.

Written by Nadia Mason, BSc MBANT NTCC CNHC

References

National Institute for Health and Clinical Excellence (NICE) Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care. Feb 2008.

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An introduction to Coeliac Disease

Coeliac disease (CD) is a common autoimmune disorder where the body attacks itself.  It occurs as a consequence of gluten intolerance and affects approximately 1% of the population. Gluten is found in all food and non-food products that are made from wheat, barley and rye. Oats contain some lower levels of gluten but the levels are not always problematic for Coeliac sufferers, however as oats are often processed in the same factories as wheat, barley and rye they should be eaten with caution.

When these products are consumed, the disease activates chronic small intestine inflammation and erosion of the intestinal villi which can lead to nutrient malabsorption and potentially deficiencies, with iron and folic acid deficiency being the more common deficiencies. Although it is usually thought to be solely a gastrointestinal disorder, many will be surprised to know it is in fact a systemic disorder affecting the whole body. Gluten ingestion can trigger inflammation in several other areas of the body, manifesting itself in many ways and consequently it can be extremely distressing for the individual, severely affecting quality of life. For example it can cause skin disorders such as psoriasis and eczema, fatigue, and also more serious conditions such as type I diabetes, heart and/or liver disease, anaemia, epilepsy, osteoporosis amongst others. Sufferers may feel like their symptoms are unrelated to those typically associated with an intolerance such as abdominal pain, bloating, diarrhoea etc which means that Coeliac disease often goes undiagnosed for years. It is however becoming more widely recognised and acknowledged by the Medical Profession and diagnosis is improving.

Bread and Wheat are foods that Coeliac Disease sufferers should avoid
Bread and Wheat are some foods that Coeliac Disease sufferers should avoid due to their gluten content (3.)

A gluten free diet is currently the only method of treatment as there is no approved medication, however gluten is extremely difficult to avoid completely as cereal use in food products is widespread and it is often hidden in many products unexpectedly e.g. in cosmetics. It is now possible to get gluten free oats along with better and more tasty gluten free breads and other grains, so CD sufferers should look out for these options.

Prolonged exposure to gluten in Coeliac sufferers can result in mortality, therefore in addition to attempting to remove gluten, other therapeutic methods should be considered. It has been acknowledged that the gut balance (microbiota) is vital for keeping a healthy state and reductions in beneficial bacteria can cause imbalances and potentially contribute to diseases such as Coeliac disease. One study published in 2010 by Journal of Leukocyte Biology investigated the effects of the probiotic Bifidobacteria on the immune triggers of Coeliac disease. They found that the inclusion of this beneficial probiotic improved the gut state, immune reaction and disease outcome for those with CD. In addition to probiotics and a gluten free diet, anti-inflammatory nutrients such as fatty acids will also help to reduce the inflammation across the body. Taking supplements such as glutamine and arginine can help to repair the intestinal damage to allow the villi in the small intestine to grow back and begin to absorb the nutrients again (2).

These nutrients are not only beneficial for those suffering with Coeliac disease and can benefit everyone, as they allow the body to be in a balanced state and reduce inflammation which can also be a cause of many conditions including IBS. If you think you may have Coeliac Disease or would like to be tested for it, you should contact your Health Practitioner or a local BANT or Nutrition Society registered Nutritionist.

Written by Lauren Foster

(1) G. De Palma,* J. Cinova,† R. Stepankova,† L. Tuckova,† and Y. Sanz Pivotal Advance: Bifidobacteria and Gram-negative bacteria differentially influence immune responses in the proinflammatory milieu of celiac disease. Journal of Leukocyte Biology, vol. 87 no. 5 765-778.

(2) Sukhotnik, I., Slijper, N., Pollak, Y., Chemodanov, E., Shaoul, R., Coran, A.G., Mogilner, J.G. (2011) Parenteral omega-3 fatty acids (Omegaven) modulate intestinal recovery after intestinal ischemia-reperfusion in a rat model. Journal of Pediatric Surgery, Vol. 46, Issue 7, Pg. 1353-1360.

(3.) Image courtesy of Grant Cochrane

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A new way to manage Irritable Bowel Syndrome (IBS)?

A new way to manage Irritable Bowel Syndrome (IBS) is quickly gaining support amongst the medical community, and many IBS sufferers are seeing positive results.

Dr Susan Shepherd, an Australian dietician and researcher, led a presentation on the low-FODMAPs diet last month at the American College of Gastroenterology conference in Washington.

A low FODMAPs diet has been shown to help those with IBS
A low FODMAPs diet has been shown to help those with Irritable Bowel Syndrome (IBS)

The theory is that people with IBS have difficulty digesting certain types of carbohydrate, leading to symptoms such as gas, bloating, abdominal pain, constipation or diarrhoea.

Small studies in the UK and Australia have shown that the diet reduced symptoms in around 75% of IBS sufferers, which makes it a more successful approach than many other dietary or medical interventions. In a controlled study published some weeks ago in the Journal of Human Nutrition and Dietetics, the low-FODMAP diet improved IBS symptoms in more than 80% of the adults tested (1).

FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides and Polyols. These are a group of short-chain carbohydrates and sugar alcohols present in food. They comprise fructose, lactose, fructans, galactans and polyols.

Certain foods are particularly high in FODMAPs. These include milk and unripened cheeses, which are rich sources of lactose, and wheat and rye which are high in fructans. Sources of galactans and polyols include legumes, some fruits, and sweeteners such as sorbitol and xylitol.

FODMAPS have a number of characteristics which can make them troublesome for those with IBS and other digestive problems.

  • They are poorly absorbed in the small intestine.
  • They tend to draw liquid into the gut, affecting movement in the gut.
  • They are quickly fermented by bacteria in the gut, producing gas and bloating.

The low-FODMAPs diet recommends eliminating all suspect foods for 6-8 weeks, and then gradually reintroducing these foods in order to identify which ones are causing digestive problems.

As the low-FODMAPs diet is rather restrictive, it is advised that those with IBS should only follow the diet under the guidance of a qualified health practitioner.

There are some potential drawbacks to the low-FODMAPs diet, which can be overcome with a little careful planning. For example, those restricting FODMAP foods should be sure to include other sources of fibre in their diet. Fibre is an important nutrient for bowel health, and this can be provided by grains such as quinoa and rice, as well as well-tolerated fruits and vegetables.

The FODMAP diet also excludes many ‘prebiotic’ foods, which help to feed good bacteria in the gut. Good bacteria help to produce vitamins, support the immune system and prevent the growth of harmful bacteria. It may therefore be helpful to include probiotic supplements or probiotic foods in order to help boost levels of good bacteria in the gut.

Written by Nadia Mason, BSc MBANT NTCC CNHC

References

1. Staudacher HM et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. Journal of Human Nutrition and Dietetics. October 2011. 24(5):487-495

2. Image courtesy of Ambro

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bodykind do some detective work on food intolerance

Do you have a health issue getting you down that Doctor’s just can’t seem to help with?  Do you not feel quite as well as you should?  According to Allergy UK as many as 45% of people in the UK suffer from a food intolerance (1), many of which lead to varying symptoms that while not life threatening, can make all aspects of life uncomfortable, painful or just down right miserable. Symptoms of food intolerance are varied and can have a serious effect on the quality of your day to day life.  From abdominal pains to eczema, fatigue and Irritable Bowel Syndrome, food intolerance can lead many to unhappiness.  But it is a common area that can be difficult to get help for from many in the medical profession.(2)

Do you have a food intolerance?
According to Allergy UK as many as 45% of people in the UK suffer from a food intolerance

There is a stark difference between food allergy, and food intolerance. Food allergy sparks a rapid response in the body’s immune system to a particular food.  The immune system mistakes a food for an ‘invader’ which often results in a rapid allergic reaction, commonly associated with nut and seafood allergies.(3) Food intolerance on the other hand can lead to many less serious reactions but uncomfortable symptoms that manifest themselves through skin conditions, digestive problems, aches and pains and much more.(4)

There are numerous foods that can spark intolerances including dairy, meat, fruit, fish, gluten, wheat and even vegetables.  But how can you find out just what it is that’s upsetting you.  You could try eliminating certain foods from your diet to see if this has a positive effect on your symptoms but this can be a long drawn out process (and must be done under the supervision of a qualified Nutritionist). There are a number of products on the market today however that offer home tests for a variety of different food intolerances and the Food Detective is one of the most popular.

Food Detective
Food Detective is the world's first self test for food intolerance

Simple, safe, reliable and fast the Food Detective is the world’s first self test for food intolerance.  No more waiting days for results, the Food Detective tests your reaction to 59 common foods through a finger prick blood sample and gives you results in about 40 minutes. The test identifies foods causing IgG antibody production which may be involved in various conditions such as IBS, eczema, and arthritis. The test gives you the ability to easily identify the type of foods that may be affecting your health and eliminate them from your diet giving you the peace of mind to eat the right things and improving your lifestyle.

It is important to note however that changes to diet should only be made after consultation with a qualified nutritionist.  Symptoms of intolerances and allergy can be eased with nutritional and dietary help.  “Some general advice would be to boost the immune system via a diet rich in a variety of vegetables and fruits which provide vitamins and bioflavonoids.  In addition to this omega 3 fatty acids from oily fish e.g. salmon, trout, mackerel and sardines (at least two portions per week) are really helpful to the immune system and also to reduce inflammation in the body.”(5)

 

Written by Mike Pye

1.  http://www.allergyuk.org/

2.  http://www.foodintoleranceawareness.org/isitfi.htm

3.  http://www.foodintoleranceawareness.org/isitfi.htm

4. http://www.foodintoleranceawareness.org/symptoms.htm

5.  Ani Kowal, Food Allergy and Intolerance Week, bodykind Blog, January 27th 2010.

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‘Friendly’ bacteria for the treatment of IBS symptoms

April is International IBS (irritable bowel syndrome) awareness month.  IBS describes a combination of symptoms including constipation, diarrhoea, abdominal pain/discomfort, nausea and vomiting, feelings of fullness, gas and bloating.  Sufferers often feel embarrassed by the condition which generally develops in individuals between the ages of 20 and 30 and affects around 20% of the population.  IBS also appears to be more common in women than men. There is no single remedy for irritable bowel syndrome, individuals find that their symptoms are provoked by a variety of different foods and situations, with stress and other emotional issues being common triggers.

International Irritable Bowel Syndrome (IBS) Awareness Month is organised by the International Foundation for Functional Gastrointestinal Disorders (IFFGD). IBS is common with worldwide prevalence estimated at 9% to 23%. Although the condition is associated with heavy economic and social burdens, many people remain undiagnosed and unaware that their symptoms indicate a medically recognised disorder.  For more information about IBS and the IFFGD please visit the IFFGD website there you will find information on the symptoms of IBS, available treatments, special IBS diets and more.

Lepicol - Healthy Bowels Formula - 350g Powder
Products like Lepicol contain Psyllium Husks, Prebiotics and Probiotic Cultures including Lactobacilli and Bifidobacterium bifidum which can support IBS symptoms

The causes of this uncomfortable condition are unclear and complex.  However, an imbalance in intestinal bacteria is frequently implicated.  Often IBS develops after a bout of gasteroenteritis or repeat courses of antibiotics (which kill off the vast majority of intestinal bacteria).  The bacteria in the digestive system of individuals suffering from IBS seems to be different to healthy people with fewer ‘beneficial/friendly’ bacteria such as Bifidobacteria and Lactobacilli being present in those with IBS.

Growing evidence suggests that probiotics (as well as prebiotics and synbiotics), supplemental beneficial bacteria, seem helpful in managing IBS.  Probiotics may help by reducing the level of inflammatory chemicals (cytokines), implicated in IBS.  Imbalances in gut bacteria can lead to chronic low-level inflammation in the intestines and the measurable presence of inflammatory markers in the bloodstream.   However, there are complications with the scientific studies that have taken place to date as it seems that the type of bacterial probiotic supplement used may be responsible for the degree of improvement noted in IBS sufferers.  Supplements containing Bifidobacteria seem to be especially effective.

 

Some definitions:

A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance.  Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.

A prebiotic is a food that stimulates the growth of the beneficial bacteria already present in the colon.  Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available.  Natural prebiotics can be found in asparagus, onion, chicory and garlic.

Synbiotics are a mixture of probiotics and prebiotics.

Recent reviews of evidence (1,2,3,4) for the usefulness of probiotics in the treatment and alleviation of symptoms of IBS all seem to concluded that there are good quality medical trials to back up their usefulness.  The review papers also suggest that there is a solid link between alterations in the bacterial composition of the gastrointestinal tract (gut) and IBS.  The problems that are flagged up is that there are so many different probiotics available of varying quality.  Not all probiotics are the same and further studies are needed to discover what the best strains/types of bacteria are.

One review paper published this year (3) looked at the randomised controlled trials available for the use of probiotics in IBS.  19 trials in 1650 patients with IBS were identified. Trial quality was generally good.  When the data was collaborated it was found that probiotics were statistically significantly better than placebo in treating IBS.  The authors conclude that “probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain”.  A study published last year (4) found that the most solid evidence for the use of probiotics in IBS was with Bifidobacterium infantis (specifically B. infantis 35624).  This probiotic showed repeated efficacy, with improvements noted in bloating, pain or discomfort, and bowel habit.   Other probiotics may prove beneficial in the future, but well designed studies are needed to clarify effectiveness.

If you are suffering with IBS it may well be worth trying a Bifidobacterium probiotic supplement.  Keep the supplement in the refrigerator and take the dose away from hot food, since heat can kill the beneficial bacteria.  It is also worth looking for a probiotic that also contains FOS (a prebiotic) since this may help the bacteria to establish in the gut and may also have a positive effect in itself.

In addition to the IFFGD  website mentioned above please visit  the Gut Trust the national charity for people with Irritable Bowel Syndrome in the United Kingdom.

The Gut Trust say  “We support people like you, who are coping day to day with IBS; a condition that is misunderstood, often stigmatised and which can chronically affect your everyday life.  We support people with Irritable Bowel Syndrome in several ways. For our members, we offer a telephone helpline staffed by medical and nursing specialists and on-line medical advice and consultation, factsheets on all aspects of IBS, online support, can’t wait cards and travel cards to facilitate access to toilets at home and abroad, a quarterly magazine, and an interactive and frequently updated website that includes our unique fully comprehensive Self Management Programme to help you live life to the full with IBS

 

References

(1) Parkes GC et al.  2010.  Treating irritable bowel syndrome with probiotics: the evidence. Proc Nutr Soc. 2010 Mar 18:1-8. [Epub ahead of print]
(2) Ghoshal UC et al.  2010.  Bugs and irritable bowel syndrome: The good, the bad and the ugly. J Gastroenterol Hepatol. 2010 Feb;25(2):244-51.
(3) Moayyedi P et al.  2010.  The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010 Mar;59(3):325-32.
(4) Brenner DM et al.  2009.  The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 104(4):1033-49; quiz 1050.

Written by Ani Kowal

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Exercise seems to be helpful for some sufferers of IBS

This month, April, is Irritable Bowel Syndrome (IBS) awareness month.  A campaign organised by the  International Foundation for Functional Gastrointestinal Disorders (IFFGD).

IBS is a common worldwide problem and I have previously written extensively about the condition and how nutrition, diet and supplements may be useful in reducing symptoms.

There is no single remedy for IBS.  Individuals find that their symptoms are provoked by a variety of different foods and situations, with stress and other emotional issues being common triggers.

Exercise can be helpful for IBS
Exercise such as walking and running can be helpful for IBS Sufferers

A fairly recent study (1) published in the International Journal of Sports Medicine has found that regular exercise may be useful for some people suffering with IBS, especially those individuals who experience constipation as a major symptom of their IBS.

The researchers involved in this study (1) examined the effects of a twelve week exercise programme upon 56 patients in the UK with clinically confirmed irritable bowel syndrome.  The participants of this study were split into two groups.  A control group who were assigned to ‘usual care’, or an exercise group.  The exercise programme consisted of two 40 minute one-on-one exercise consultations which were specifically designed to provide exercise skills, knowledge, confidence and motivation.  The goal of the exercise consultations was to encourage 30 minutes of moderate intensity exercise on 5 days a week.

After 12 weeks, as expected, the exercise group had participated in significantly more weekly exercise than the control group and they reported significantly greater declines in symptoms of constipation.  This result is very encouraging since the programme was not highly intensive and represents an achievable level of exercise for most people.

Many individuals who suffer with IBS do not exercise regularly due to the abdominal symptoms they may experience.  However exercise is known to reduce feelings of stress and anxiety as well as bloating and constipation in individuals without diagnosed IBS and is certainly worth a try if you are experiencing any IBS symptoms.  Even a half hour daily walk may prove to be very beneficial, for mood as well as bodily symptoms.  If time is an issue then the walk/exercising can be split into two manageable 15minute sessions.  Any amount of cumulative exercise is better than none for our health.

 

References

(1)Daley AJ et al.  2008.  The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomised controlled trial. Int J Sports Med. 29(9):778-82.

 

Written by Ani Kowal

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Peppermint proves useful in IBS

Peppermint tea is one of my favourite refreshers, so I was interested to read a paper(1) published in the latest issue of the British Medical Journal linking peppermint in the treatment of IBS (irritable bowel syndrome).  Back in August I wrote three lengthy pieces investigating IBS and this paper provides a nice update. 


The key to IBS is to try and find a cause to treat, this is very individual and may be linked to stress, emotions, food intolerances and more.  Any sort of diagnosis needs to be done in conjunction with a health professional.  However, it is always good to have some idea of the natural remedies that can help reduce symptoms.  The research in the British Medical Journal was a review of randomised controlled trials looking into the effect of fibre, antispasmodics (prescribed medication) and peppermint oil in the treatment of IBS.



Fibre
Traditionally, people with irritable bowel syndrome were instructed to increase their daily intake of dietary fibre, because of its potentially beneficial effects on bulking stools and moving them through the intestine more quickly (speeding up intestinal transit time).  However, many individuals with IBS found this advice unhelpful and some people reported that it made the condition worse.  The study looked at types of fibre and their usefulness in IBS treatment.  The investigators found that bran fibre (usually from wheat) had no effect on IBS symptoms.  However, ispaghula fibre, a soluble fibre derived from plaintain, did have a beneficial effect and reduced persistent symptoms of IBS.  The authors of the study indicate that ispaghula may be particularly beneficial to individuals who suffer constipation as one of their major IBS characteristics.



Ispaghula husk is readily available to buy from health-food stores and pharmacies as well as online. 



Antispasmodics
Antispasmodic medications attempt to reduce spasms in the digestive system.  Doctors frequently prescribe these types of medication for IBS symptoms, particularly when an individual is suffering from bloating and pain.  In the study 12 drugs were assessed.  Only 5 of these were shown to bring about a relief for IBS symptoms.  Some of the drugs, which are specifically licensed for use in IBS e.g. mebeverine, dicycloverine and alverine actually seemed to have very little evidence behind them.  The best evidence seemed to be for a drug called hyoscine.  The most common side effects for this type of medication are dry mouth, dizziness, and blurred vision, but none of the trials reported any serious adverse events.



It is not really known why antispasmodics are helpful for IBS sufferers.  The authors of this study note that “The biological rationale for the efficacy of antispasmodics is unclear…..antispasmodics may act by reducing colonic contraction and transit time and therefore pain and stool frequency”.  In light of the evidence discussed in this medical journal I would think that further studies are necessary to investigate the use of these drugs in patients with IBS to see if they really are helpful.


 


Peppermint oil
There were fewer available studies to analyse for the use of peppermint oil.  However, the studies that have taken place with this remedy show consistently positive results for use in IBS patients.  In fact peppermint oil appeared to be the most effective treatment for IBS when assessed via a measure called NNT, or number needed to treat, a measure of the number of individuals that need to be treated for one to get significant benefit.  Peppermint appears to have natural antispasmodic properties and is widely available over the counter in capsule form.  Larger trials of this traditional remedy would be welcome.



The authors conclude their paper by talking about the current guidelines for the management of IBS, they discuss the fact that these guidelines have been set around previous studies that have potential methodological flaws.  In the UK “Antispasmodics are recommended as first line treatment, particularly when pain and bloating are the predominant symptoms, although which of these drugs should be preferred is not stated”(1).  They also suggest that the current clinical guidelines be updated to take into account their findings.



(1) Ford AC et al.  2008.  Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ.  337:a2313


Written by Ani Kowal

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