14 April, 2023
Resolving Irritable Bowel Syndrome (IBS)
Resolving IBS Webinar Transcript
[00:00:00] Hi everyone. Thank you everyone from for joining us tonight.
[00:00:04] I'll go through my part of the presentation first, and then Jet will go through her section. And then at the end we'll have time for questions as well.
[00:00:14] Tonight's presentation is about IBS, so Irritable brain and the irritable gut. So Jet and I will be going through a few things. Oh, tonight. So the topics that I'll be covering is what is IBS? So what is irritable bowel syndrome, how to diagnose. Irritable bowel syndrome, the four pillars to health that we look at in every consultation, contributing factors to IBS, what are things that can contribute to the cause? The link between the irritable brain and the irritable gut. And then Jet will be covering a low FODMAP diet and the reintroduction phase of a low FODMAP diet.
[00:00:51] So who we are. My name's Carla. I'm an accredited practicing dietician. I've been a senior dietician for quite some time. [00:01:00] There's quite a few areas that I work quite heavily in and that is predominantly gut health. I do pediatric dietetics as well.
[00:01:09] Jet and I have both done the low FODMAP course, so we both work in gut health as well. Jet does a lot of eating disorders also, so between both of us we cover quite a few areas. And then we've all obviously got our general clientele of diabetes, high cholesterol, weight management as well.
[00:01:28] So what is IBS? So, Today what I'll be discussing is a bit about IBS. IBS is a common term that's been used over the past decade to refer to a condition called Irritable Bowel Syndrome. So IBS is described to affect the gut and overall digestion regularly. So for some people that may mean certain foods could trigger a gut response [after every meal].
[00:01:51] Others, it could be after every single meal. They might have that fast or slow transit time going through. It can be ongoing and debilitating. Some patients [00:02:00] have changes in bowel motion so they can vary from constipation to diarrhea. Or abdominal discomforts, so bloating, gas, abdominal distension as well.
[00:02:09] So for many people it impacts the quality of life that they have. I've had a lot of patients that have had to change careers, change jobs avoiding social situations in order to manage their symptoms as well. So it is a disorder of the brain and the gut access, which I will be touching on a bit later, which in turn affects its overall communication between the two, and then leads to abdominal symptoms. These are i b s symptoms. Can become quite extensive in these people and especially when you start to experience stress and anxiety, it can heighten those, exper those symptoms as well. So we have found that 15% of the world's population, so one in seven people, are affected by IBS which is a huge number to see.
[00:02:53] Now we know that there are four pillars to health that can affect these symptoms with diet and lifestyle and [00:03:00] stress playing a prominent role. So this is where, as I mentioned, when Jet and I do our consultations, we really focus on these areas.
[00:03:09] So as you can see here there's a few different things that, or a few different conditions that can present similar to IBS.
[00:03:17] So when diagnosing IBS, it needs to be done by your GP, after further investigation. IBS symptoms present similarly to many other gastrointestinal conditions that would require further investigation to make sure it's nothing sinister. So these conditions can include coeliac disease, inflammatory bowel disease, which is Crohn's disease and ulcerative colitis.
[00:03:40] You've also got diverticular disease as well. There's ulcers, there's gastritis, there's SIBO [Small Intestinal Bacterial Overgrowth], lactose intolerance. There's a few different things that can present similarly, So basically a [ gastro] scope and blood tests are usually done or are recommended to be done by your GP. And then from there they would refer you [00:04:00] on to a gastroenterologist as well.
[00:04:02] So the goal is to rule out any, any other conditions that are key is the key to identifying IBS. And then that's when the appropriate treatment can be put in place for everyone.
Four Pillars of Health
[00:04:18] So, as I mentioned before, there are four pillars to health that Jet and I really look at when we are consulting a patient. Not only do we look at diet, we look at exercise, mental health, and sleep. When completing a consultation and gathering the information from a patient, it's important to gather as much information as possible about the person's diet and lifestyle.
[00:04:40] I really spend the first session going through every aspect of the person's life, because I really need to get a full picture. So when we look at diet, we look at meal timings and choices as well as what they are consuming. So what is the first thing you would eat or drink when you wake up in the morning? What's the last thing you would eat or drink when you go to bed [00:05:00] at night? I go through portion sizes, snacks, what their likes and dislikes are as well.
[00:05:07] Under diet, I also go through behavior. So this is also covered here because behavior plays a big role. So for example, the speed at which food is consumed play a role. Do you chew your food? Do you eat it really fast? Are you always in a rush When you are eating your food, are you distracted? So these are all things that I cover. And chewing your food, that's a big.
[00:05:28] Then when we look at mental health, I always ask my patients, what their stress levels are like, you know, what's sort of going on in their life at the minute and what they would rate their current stress at.
[00:05:38] So stress, anxiety, stressful moments around food, like especially when you are eating food and you're feeling stressed, that can affect food digestion and open up that brain and gut axis which can create symptoms. So we want the environment to be calm. We want the eating environment to be relaxed. At the table, not in front of the tv, not in front of [00:06:00] any devices, your phone, your laptop. Stepping away from your desk if you can, to have lunch, for example. They're just some examples of what I look at.
[00:06:08] Then with exercise, exercise is a big one. It's great for mental health. We know that with just all areas of health, not just people that have IBS. It helps with energy levels, achieving ideal body weight as well as it increases your serotonin levels, which puts you in a good mood and a healthy, clear mindset as well. So that's something else that we look at.
[00:06:28] And then lastly, the other thing that we tend to touch base on is sleep. So poor sleep can lead to feeling tired for the rest of the day, which in turn can lead to poor food choices as the day goes on. The body can crave sweet, caffeinated products. It can crave salty, fast foods, which can increase symptoms and reduce nutrient consumption. It can really affect your IBS symptoms as.
[00:06:56] So the contributors to IBS, you know, a lot of people think it's [00:07:00] just diet. I have so many patients that come in to see me and say, I need to change my diet because my gut is not feeling right. But there's so many other areas, as I just mentioned.
[00:07:08] With IBS, as I said, other things could be the pace of eating. Whether you're a fast or a slow eater, do you chew your food? Are you mindfully eating or are you just eating mindlessly and not really paying attention of how much you're eating or if you're chewing or what you've actually had. And yeah, if you're distracted by technology or other areas in the house.
[00:07:28] So additional food sensitivities can also play a role, such as food chemicals, which we won't be touching on tonight. But that is another area that we tend to look at when patients come in with presenting symptoms. So, for example, there's food chemicals called amines and salicylates that are found in ripe fruit or veg, aged meats, aged cheeses. They can also present similar symptoms to IBS as well.
[00:07:47]So, and finally, the ever expanding research topic on the brain and gut axis. So is there a link between an irritable brain [00:08:00] and an irritable gut? Well, the answer is yes. There definitely is a link.
[00:08:09] So in regards to the brain and gut axis, it has been strongly researched. There has been emerging research to show the link between the brain and gut axis.
[00:08:19] So the brain in turn tells the gut how sensitive it needs to feel and how fast or slow it needs to move. So when the gut has gas, for example, like if you've consumed a food and you start to get gas in the gut, it stretches the large intestine and activates the gut nerves. These nerves become hypersensitive in those that have IBS so then basically they start to overcommunicate these signalings of, okay, oh my gosh, the gut is feeling, you know, I'm feeling a little bit stretched. I'm feeling a little bit sore. So then these signals start to overcommunicate[00:09:00] and they overcommunicate that information back to the brain. Then these messages can become scrambled along the way, and then, The whole body really starts to you know, in short, really freak out about what's going on.
[00:09:12] So all these messages are going up and down, up and down, saying, oh my gosh, my gut is feeling sore. Oh my gosh, I'm feeling really bloated. I'm feeling really gassy. I'm feeling, you know, really distended and the brain's saying, yep. Okay. I'm noticing that. We need to really fix this situation. And then that's when you know the bowel motions can happen when you might have a really fast bowel motion or a really fast transit time with bowels, especially if the stress and anxiety levels really start to heat up, the nerves continue to overcommunicate and then these signals can create a fight- flight response.
[00:09:49] With treatment the main thing, like Jet will be elaborating on this today, but the main thing with treatment isn't just diet and eating as we mentioned before. It is [00:10:00] psychology, so the psychological aspect of it. So this is where a lot of patients can go and get gut hypnotherapy because of the brain and gut connection. There is a guided meditation, so it just depends on whether we see that there's a link between that in people.
[00:10:16] Medications also can help depending on the person. So there's different fiber supplements you can take. There's probiotics, there's prescribed laxatives as well.
[00:10:25] And then lifestyle lifestyle's a big one. So taking a step back from a fast place, stressful life, being organized, planning out your meals, eating, having good behaviors, and then referring back to the four pillars of health. They're all areas that we look at in treating IBS.
[00:10:39] So I'll pass you on to Jet now, who will actually look at the diet side of things with IBS.
[00:10:56] All right, so I'm gonna quickly go through what FODMAPs are [00:11:00] before we go into the dietary approach. So FODMAPs are carbs that are not completely digested or absorbed in intestines. There are six types of FODMAPs and they can be found in different foods.
[00:11:12] When FODMAPs reach to small intestine, they move slowly attracting water. They pass into the large intestine, they're fermented by the gut bacteria producing gas as a result. Now the extra gas and water stretches your gut like a balloon. And because people with IBS, they generally have a more sensitive gut that stretching off the gut can really cause symptoms like bloating, tummy pain, and extra time spent in the toilet.
[00:11:41] And that leads us to the low FODMAP diet. Now this is a short term, three phase diet that acts as a temporary relief for people with IBS, and as Carla has mentioned previously, is important to note that the diet is not the first line of approach. We'll need to do a really detailed [00:12:00] examination if to determine if you're a good candidate for the diet. Especially if there's a full low FODMAP diet. Sometimes we might modify it to remove some restrictions, but a standard, full, low FODMAP diet can be really restrictive, and we do not wanna put anyone through this unless they absolutely need to.
[00:12:21] So this is an overview of a full low FODMAP diet. You can see phase one is what we call the elimination phase, where we would swap out all high FODMAP foods with a low FODMAP food to allow your gut to reset in a way, as is, it's currently reacting to pretty much everything.
[00:12:39] So it might take about two to six weeks. We normally do about four weeks. Just to give you gut enough time without stressing yourself out too much because like I said, it can be quite restrictive.
[00:12:49] Phase two is what we call every reintroduction phase where we would bring back all the fruits that we have been avoiding and challenging each FODMAP systematically. [00:13:00] Note that this is not challenging every food that we've avoided, but to challenge the exact FODMAP that we have been avoiding. So like I said, there are six of them.
[00:13:08] And then stage three, we aim to resume a certain level of normal eating. They'll still help to control your symptoms. So it will be a personalization process. It will be different for everyone. So it is really important to work with us and really go through what's happening because everyone's intolerance might be different. Everyone's reaction to the diet might be different as well.
[00:13:33] So as we mentioned, phase one would be the elimination phase where we would sort out the high FODMAP foods such as apples, such as wheat containing products, avocado is a big one. Garlic and onion, again, another big one. We'll sort those with some low FODMAP alternatives. For example, we might swap a high FODMAP fruit, like apples and cherries, for example, with oranges, pineapple, and [00:14:00] blueberries as they might be a bit more gentle in their gut and less likely to react.
[00:14:05] What we normally do is that we also assist with meal planning by providing a low FODMAP recipe. We'll also assist with label reading to identify some sneaky high FODMAP ingredients in packaged foods.
[00:14:18] It is also important for us to watch out for other foods and drinks that can irritate our gut, such as coffee, black tea, alcohol, and carbonated drinks. Carbonated drinks are actually quite a big one. A lot of people do experience a lot of gassiness, bloating things like that with the carbonated drinks.
[00:14:38] It is also important that we don't stay in this phase for too long. We normally don't do it for more than six weeks because it can affect your long-term gut health.
[00:14:48] These high FODMAP foods are actually really high in pre and probiotics. They're really high in fiber. So like I said, really good for long-term gut health and because it has a really [00:15:00] restrictive nature, so we don't wanna put anyone through that stress.
[00:15:07] Once we have experienced adequate symptom improvement in phase one, we'll start to challenge a single FODMAP item that is high in one of the six types of FODMAPs. Just using mango as an example here. So mango is a fruit that, a fruit that's high in excess fructose. I am just assuming that everyone has one mango in the setting.
[00:15:27] So day one you can see that we'll be challenging a quarter of a mango. So that would normally be a quarter of our usual serve. Day two, we'll challenge half of a mango. And then day three, if we're still feeling okay. We'll do one mango or whatever your usual serve is. Day four, day five, day six, we'll return to a low FODMAP diet, which is what we call the washout period.
[00:15:52] So the washout period is there because some people don't get an immediate reaction to the challenge. Foods say if you [00:16:00] actually have an intolerance to access fructose, some people might not react on day one, day two, or day three. They might react on day four, day five, or day six. So it is important for us to give, to allow for that window for your gut to respond to it, to determine if there is an actual intolerance to the food or the front map.
[00:16:19] We'll repeat this whole process until all six FODMAPs have been challenged, and then that's when we'll move on to phase three, the personalisation phase.
[00:16:32] All right, so after the reintroduction phase, you should be able to determine and understand what you can tolerate and how much. In phase three, we'll be assessing the quality and quantity of various foods.
There are three elements to this phase: 1. minimising the restrictions - so that you can eat a variety of foods; 2. interpreting symptoms; and 3. what to do for non-responders.
- 1 in 7 people are affected by IBS
- Diagnosis involves ruling out any other medical issues first. Seeing your GP is a great starting point!
- Look at the 4 pillars to health during a consultation and overall to assist in proper management: diet, sleep, mental health and exercise.
- There are many contributing factors to IBS and a strong link between an Irritable Brain and the Irritable Gut.
- Treatment can include diet and behaviour, gut hypnotherapy, medication and lifestyle factors.
- Treatment includes a low FODMAP Diet which is a short-term, three-phased diet that is tailored by your Accredited Practising Dietitian.
About the Author
Carla Battaglia - Senior Accredited Practicing Dietitian & Accredited Nutritionist
Accredited Practicing Dietitian Carla specialises in gut health. She's passionate about eating food to enrich our lives and health. She regularly helps with gut disorders, women's health and chronic diseases like diabetes and heart disease. She's completed post graduate studies in the FODMAP diet for IBS and has many years experience working with gastroenterologists.
Jet Yee Ho - Accredited Practicing Dietitian / Nutritionist
Similar articles you'll enjoy:
- Halmos, E.P., et al., A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014. 146(1): p. 67-75 e5
- Mayer, E.A. and K. Tillisch, The brain-gut axis in abdominal pain syndromes. AnnuRev Med, 2011. 62: p. 381-96.
- Maagaard, L., et al., Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol, 2016. 22(15): p. 4009-19.
- Peters, S.L., et al., Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2016. 44(5): p. 447-59
- Staudacher, H.M., et al., Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr, 2012. 142(8): p. 1510-8.
- Lovdahl J., et al., Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome. Aliment Pharmacol Ther. 2022 Jun; 55(12): 1501–1511.
- Irritable Bowel Syndrome (IBS), 'https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs', victorian government 2021.
- Image 1: https://www.fodmapformula.com/tag/irritable-bowel-syndrome/, accessed 30th March 2023.
- Image 2: https://www.istockphoto.com/vector/connection-of-cute-healthy-happy-brain-and-intestine-gut-relation-health-of-human-gm1317404542-404843783, accessed 30th March 2023.
- Webinar: Gut Health Symposium, February 2023, organised by Dietitian Connection.