Do you arrive at a dinner party, start to have a good time, relax, and then cringe at the sight of the main course? Do you spend your lunches checking over the menu for food you can eat without a problem? Do you feel embarrassed that you have excessive gas? Do you feel you look pregnant or swollen in your stomach? Do you always need to be close to a bathroom and dread traveling anywhere? Unfortunately, these are stories I have heard weekly at Nordic Clinic and for all of my career in medicine, health and performance.  

Maybe you can take some comfort in the fact that you are not alone, with figures indicating anywhere from around 10-15% of the European population suffering from this disorder. Also, IBS is not cheap. It costs our healthcare systems approximately 1000 to 2100 EUR per patient per annum in the EU, driven mostly by ER/hospital visits. (7) These figures are not including costs to the patient directly or businesses, who also lose out with sick days and people underperforming on the job due to the symptoms. 

Most likely if you have had an IBS diagnosis by your doctor, then you have also been told there is nothing to do. This is totally incorrect, there is a LOT you can do. IBS is not serious, but let’s face it – it is very annoying and frustrating and impacts quality of life for so many. 

If you have been lucky enough to not have IBS, I better explain. IBS is a chronic disorder involving the gastrointestinal tract, primarily the colon, or large intestine, which is the last section of your digestive system. People with IBS experience many different symptoms including gas, bloating, abdominal pain, nausea, diarrhea, and constipation. Unfortunately, the exact cause of IBS is not known and may differ depending on the presentation (diarrhea vs constipation). I am sure you have most likely had diarrhea at some point. Now, imagine having that most days, also with constipation and bloating. Not so much fun right?

Having spent a large part of my career helping resolve and manage chronic IBS cases, it is clear that different strategies are required, because, simply put, there are different causes. This is what makes it hard to treat, as our standard medical systems are not built well to deal with different causes. They thrive with acute problems with one cause, not so much with chronic multiple possible cause problems. Figure 1 below is a great example, outlining different causes of IBS.   

Figure 1: Brown BI. Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not. Gastrointestinal Disorders. 2019; 1(3):314-340. https://doi.org/10.3390/gidisord1030027

I know IBS all too well, after picking up post-infectious IBS early in my hospital career, whilst on holiday I should add. None of my doctor colleagues could help. I was just told I would have to live with it, which I did not want to accept. I spent a lot of time reading research, testing and implementing lifestyle changes. Finally, I got to a point where I was able to get to a long-term solution that did not involve continuous food elimination or constant medication and/or supplement use.   

As there are several factors that contribute to IBS – from nutritional factors and function imbalances, to lifestyle and environmental factors – we have to go through a process of detective work to understand is it one of those, or a combination? My experience is it is rarely one cause, so you likely need to change multiple factors. People with IBS experience periodic flares of symptoms and addressing these factors helps control flares. You must:

• Address underlying conditions – Some treatable underlying disorders may cause IBS symptoms, including 
  • pancreatic insufficiency (where the pancreas does not effectively produce enzymes needed to break down foods), 
  • bile acid malabsorption (bile acids help to break down fats from your diet), 
  • SIBO (Small Intestinal Bacterial Overgrowth, where bacteria live at too high levels in the wrong part of the digestive system), 
  • carbohydrate malabsorption (carbohydrates are not absorbed normally), and 
  • microscopic colitis (minor inflammation in the colon). (2)
• Manage stress – Functions in the gut are regulated by our autonomic nervous system, which regulates our stress response. The autonomic nervous system is a kind of background system in our body that keeps us breathing etc without the conscious part of our brain. Chronic stress impairs digestion and motility and contributes to flares in IBS. (1)
• Build healthy circadian habits – Circadian rhythms play an important role in regulating all automatic processes in the body via the autonomic nervous system. Creating habits that synchronise your feeding cycle to the day/night cycle improves gut function and lowers stress. (3)
• Correct metabolic dysfunction – Metabolic syndrome is a cluster of symptoms that include high BMI (Body Mass Index), hypertension (high blood pressure), hyperglycemia (high blood sugar), and hyperlipidemia (high levels of fats in your blood). People with metabolic syndrome have a 2x increased risk for IBS. (4)
• Exercise – Exercise can be a useful strategy to improve IBS symptoms provided it’s at an appropriate intensity and volume to the individual. (5)
• Personalize your diet – Certain foods can trigger an IBS flare in people, but specific foods vary by the individual. A recent paper found that an IgG-guided elimination-rotation diet outperformed low FODMAP diet for IBS. (6)

Bloating, gas and pain, or whatever your symptoms, addressing each of these factors is key to managing IBS. In my next blog I will go into some of these areas in greater detail and what you can do about them to help. 

If you are interested in how we approach IBS at Nordic Clinic, you can read more here.

At Nordic Clinic we have also launched an IBS programme developed for clients with an IBS diagnosis or symptoms. The focus is on identifying and addressing the client’s individual underlying causes of the IBS symptoms. You can read more about the programme here (Note! The information is in Swedish).

This article was originally published as a guest editor post at foodpharmacy.se

By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.

Published: 22/06/2021

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202343/

2. https://gut.bmj.com/content/70/Suppl_1/A217.2.abstract

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147411/

4. https://www.researchgate.net/publication/268154630_Irritable_Bowel_Syndrome_Is_Positively_Related_to_Metabolic_Syndrome_A_Population-Based_Cross-Sectional_Study

5. https://onlinelibrary.wiley.com/doi/abs/10.1111/nmo.13461

6. https://assets.researchsquare.com/files/rs-145873/v1_stamped.pdf

7.    https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-019-0985-1