What Is IBS, Do I Have It & Why Is It So Hard to Overcome?

April is Irritable Bowel Syndrome (IBS) Awareness month, but how much do you actually know about what IBS really means? Let’s dig deep into IBS, its signs, symptoms and whether you may have it. If you ever found yourself wondering if you have IBS - you are not alone. It often goes unchecked by so many people for years as they become used to dealing with their symptoms or cutting out whole food groups which they think cause their symptoms. Estimates range from between 1 in 10 to 1 in 3 people have experienced IBS symptoms in the UK… So let’s look at it more closely! 

What is IBS? 

Irritable Bowel Syndrome (IBS) is an umbrella term for a whole host of gastrointestinal symptoms that can affect you anywhere in the GI tract from the stomach to large intestine. 

Symptoms of IBS

• Pain and cramping
• Diarrhoea
• Constipation or urgency to go
• Alternating diarrhoea and constipation
• Blood or mucus in the stool
• Gas (especially if it's foul smelling)
• Bloating - often extreme
• Difficulty digesting fatty foods
• Reacting to certain foods
• Reflux
• Indigestion
  

Lesser Known Symptoms of IBS

Since the gut directly impacts many other bodily systems, IBS can cause a range of non-gut-related symptoms that often go unnoticed or are mistaken for other issues:

• Fatigue and difficulty sleeping
• Anxiety and depression
• Skin issues including acne and rosacea
• Achy joints and bones
• Brain fog and poor concentration
• Hormonal imbalances - heavy, painful periods, mood swings
• Hair loss
• Brittle nails and dry skin
  
  

Diagnosis typically involves ruling out other conditions through medical history, symptom assessment, and ideally stool testing. In my clinic we use the most thorough diagnostic, functional medicine stool tests available using PCR technology which assess everything from your good and bad bacteria, to the way you breakdown protein, fats and carbs, your digestive enzyme capacity as well as looking at parasites, yeasts and any inflammation in the gut. They really are the gold standard test to help create a treatment plan for your IBS and unfortunately a regular GP stool test will not give you the breadth of information required to do this. We also use breath tests to measure gasses produced from overgrowth of bacteria in the small intestine which can be causing you to bloat or have foul smelling gas and stools. This all may sound unpleasant, but a stool and breath test reveals so much about a client’s health and provides a clear cut reason as to what is triggering their IBS.

Factors Affecting IBS & Why is it so Hard to Overcome? 

Living with IBS can be a daily struggle, and many people wonder why it seems so hard to manage. Here are a few reasons: 

1. Complex Triggers: IBS does not always have a single cause; sometimes, multiple factors can trigger symptoms. Dietary habits, stress, hormonal changes, food poisoning, parasitic infections and antibiotic use are the most common. This complexity makes it challenging for individuals to identify one single trigger.
   
   
2. Individual Variability: Every person’s experience with IBS is unique. What works as a management strategy for one person might not work for another. This is why testing is so important. It’s not simply a case of removing commonly assumed IBS trigger foods such as gluten or dairy - you need to know what has caused your individual gut to react, which could be long term medications causing leaky gut or bacterial imbalance to a travel bug causing a parasitic infection.
   
   
3. Psychological Factors: Stress and anxiety have been linked to IBS symptoms. The gut -brain connection means that mental health has a direct impact on gastrointestinal function. This interplay can make it difficult to ‘cure’ IBS as the sufferer's mental wellbeing needs to be considered and addressed in order to allow the gut to heal. Stress can cause the gut to become inflamed and create dysbiosis of bacteria.
   
   
4. Embarrassment: IBS can have social implications, affecting work, relationships, and overall quality of life, and you know what, I get it - sometimes talking about poo with a stranger is embarrassing! I've found many clients have left it years before they seek help as they found it such a difficult subject to talk about.
   
   
5. Eating healthy can make it worse: Ever heard of SIBO? That’s okay, many people haven’t. 80% of IBS symptoms are caused by SIBO - Small Intestinal Bacterial Overgrowth. This is where bacteria have gotten into the small intestine, where they shouldn't be. When food arrives here, the bacteria eat it and give off their toxins and create gases which lead to almost instant bloating, urgency, foul smelling stools and a mixture of constipation and/or diarrhea. These bacteria love high FODMAP foods (FODMAP stands for different types of carbohydrates) which are commonly found in a lot of the healthy fruits, vegetables and legumes you think you should be eating - onions, garlic, broccoli, cauliflower, avocado, aubergine, apples, pears, peaches, lentils, chickpeas, beans. If these foods resonate as triggers for you, then you may have SIBO.
   

How to Manage IBS

The most important step in healing your IBS is through testing. People often ask me if they should get a food intolerance test, but in my professional opinion, this is not always needed, especially at the start anyway. It's much more important to understand your microbiome, digestive capability, stomach acid levels and regularity of bowel movements before we consider an intolerance test. These tests can be useful if you have a raised Secretory IgA marker in your stool test (an antibody created in your gut in response to intolerances and infection) but this is something you would address after a stool test.

Long term IBS 

If you have suffered with IBS for any longer than 3 months consecutively then I would suggest you see professional advice for testing sooner rather than later. Your practitioner may also consider a blood test to see if you are suffering with any nutrient deficiencies as long term IBS can mean you have a reduced ability to digest and absorb nutrients. This may lead to fatigue, slow wound healing, poor sleep, mood disorders, hormonal imbalance or skin issues.

Once we have a clear understanding of what is going on inside through testing, most nutritionists follow what is called the 4 R’s Protocol:

• Remove phase: Remove anything causing the gut to react: pathogens, parasites, bacterial overgrowth, food intolerances, toxins, stress. If you have SIBO, this is where the Low FODMAP diet would be started.
• Replace phase: Replace much needed digestive aids such as enzymes, stomach acid, bile support and prebiotics.
• Repair phase: Repair the gut lining with the right vitamins, minerals and nutrients to support a healthy mucus membrane and reduce inflammation and 'leaky gut'
  Reinoculate phase: Reinoculate with the necessary pre and probiotics to support a healthy gut microbiome.
• Reinoculate phase: Reinoculate with the necessary pre and probiotics to support a healthy gut microbiome.

FODMAP Diet for IBS: 

A Low FODMAP diet is a short term restrictive diet that is not to be followed for more than 8 weeks at a time, otherwise you risk becoming nutrient deficient. Coupled with a targeted antimicrobial protocol to kill off bacterial overgrowth, low FODMAP helps to starve off the bacteria which are causing your symptoms such as bloating, smelly gas and loose stools (or constipation). Once you are guided through a reintroduction phase (which can last weeks to months), you should be able to go back to eating most foods.

Gut Brain Axis and IBS 

Lastly, because the gut and brain are intrinsically linked, taking care of our minds is just as important, so alongside diet, I would always recommend gentle lifestyle changes. These include ways to help with alleviating stress or relaxation techniques, ensuring regular exercise that benefits the gut is incorporated and reducing alcohol, smoking and other lifestyle choices that are incredibly inflammatory for the body. 

IBS Support 

So this month, if you suspect that you have IBS or are struggling with some of the above symptoms, remember that you’re not alone, and help is available! Please reach out to someone as you 100% do not have to live life uncomfortable or embarrassed about your gut health. You can also reach out to either myself or one of my team members who are gut health and IBS/SIBO experts!