Do you suffer from IBS?

Irritable bowel syndrome (IBS) is a chronic and debilitating condition that affects up to 23% of the population, particularly women. At a recent meeting of the Association for dietetics in South Africa (Adsa) in Pretoria, registered dietician Mari Pronk presented a very informative lecture on the subject of "Irritable Bowel Symdrome in Adults".

During the open discussion that followed, other dieticians mentioned that they had noticed an increase of patients presenting with IBS, something that I too have become aware of in recent years.

The Problem Disorder

IBS can with justification be called a "Problem Disorder" because it disrupts the lives of so many individuals, the symptoms can range from mild flatulence to severe abdominal pain and excessive bloating to the extent that patients are regarded as "pregnant" by their family and friends, and there is no specific test available that can pinpoint what causes IBS.

Added to these complicating features, IBS also tends to manifest in three different types:

• IBS with Constipation
• IBS with Diarrhoea
• IBS with Mixed Symptoms

Possible causes

Ms Pronk (2013), listed a whole host of potential contributing factors, namely:

• hypersensitivity of the digestive tract
• low-grade inflammation of the mucous membranes lining the gut
• changes in the normal tempo of bowel movements or gut motility
• preceding infections of the gastrointestinal tract (GIT) and/or treatment with antibiotics
• inability to handle gas (wind) in the GIT
• abnormal fermentation of foods in the digestive tract
• abnormal gut muscle reactions after eating

In addition, the following trigger factors are well known:

• stress, anxiety, a hectic lifestyle - all the factors modern humans have to contend with all the time (Pronk, 2013)

Treatment

It is important to remember that the treatment of IBS must be based on an individualised programme. Each IBS patient has a unique set of circumstances in his or her life that may predispose him or her to develop IBS.

Ms Pronk (2013), reported that an evaluation of 30 studies showed that dietary management of IBS should include one or more of the following components, depending on the individual patient’s symptoms and response:

• Initial clinical assessment of the patient’s specific symptoms and reactions to foods, particularly to lactose, and dietary fibre or so-called non-starch polysaccharides (NSP).
• Advanced interventions such as elimination diets to identify which foods a specific patient is reacting to (see below).
• Provision of a diet to the specific patient that avoids the offending foods, but is still fully balanced so that by eliminating foods such as milk and dairy, the patient does not develop deficiencies (i.e. calcium deficiency leading to osteoporosis).

What is of particular interest is that food allergies which probably 98% of patients tend to hold responsible for their IBS symptoms, are not regarded as a major cause of IBS. On the other hand, food intolerances to a wide spectrum of foods are of major importance in IBS aetiology.

The role of the dietician

Ms Pronk (2013), once again emphasised how important it is for IBS patients to consult a registered dietitian to assist them with the above mentioned assessments, elimination diets and treatment diets that avoid trigger foods but do not precipitate deficiencies.

To consult a registered dietitian, visit the Association for Dietetics in SA Website at: www.adsa.org.za and click on "Find a Dietitian" to find a dietitian in your area. You can also phone ADSA at: (011) 061-5000 during office hours for contact information of local dietitians.

Please do not embark upon your own ‘elimination’ diet as you may end up suffering from additional problems, besides IBS!

Fodmap and IBS

Researchers at the Monash University in Melbourne coined the acronym "Fodmap" for a variety of carbohydrate-containing foods that have been linked to IBS. (Fodmap stands for: Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols)

In 1999, Dr Sue Shepherd at Monash University designed the low-fodmap diet which has been accepted as an effective diet therapy for IBS (Monash, 2013). The fact that 75% of IBS patients show improvements in their symptoms on the low-fodmap diet, makes it particularly valuable to IBS sufferers worldwide.

The offending foods

Most members of the public will not be acquainted with the terminology used in the acronym, so it may be useful to list some examples of oligosaccharides, disaccharides, monosaccharides and polyols, but please keep in mind that it is essential to consult a registered dietitian to have your IBS assessed so that the dietitian can help you can identify which fodmap foods you react to.

1) Oligosaccharides, which include Fructans and Galacto-Oligosaccharides:

• Fructans or long-chain fructose polymers are found in artichokes, asparagus, beetroot, chicory, garlic (when consumed in large quantities), leek, onion, wheat, rye, inulin (a fructo-oligosaccharide that is used as a so-called ‘Prebiotic’ in many health foods and neutraceuticals)
• Galacto-Oligosaccharides are found in legumes such as dry cooked or canned beans, baked beans, lentils and chickpeas.

2) Disaccharides (carbohydrates or sugars that consist of two monosaccharide sugars, examples include lactose (milk sugar) which is made up of the monosaccharides glucose and galactose)

• Lactose is found in milk and all foods that contain milk such as ice cream, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, soft cheese (e.g. ricotta, cottage cheese, cream cheese, mascarpone, etc)

3) Monosaccharides (carbohydrates or sugars that contain only one sugar molecule such as fructose and glucose)

• Fructose which is found in honey, apples, mango, pears, watermelon, fruit juice, diabetic so-called ‘sugar-free’ products, high-fructose corn syrup, and any foods or confectionary made with fructose

4) Polyols

• Apples, apricots, avocado, cherries, lychee, nectarines, pears, plums, prunes and mushrooms
• Sugar alcohols which are used as so-called ‘dietary sweeteners’ for diabetic and slimming products, include sorbitol, mannitol, xylitol, maltitol and isomalt.

These poorly absorbed carbohydrates tend to cause abnormal fermentation in the lower part of the small intestine and the colon, which produces large quantities of gas, that in turn is held responsible for causing IBS symptoms, such as abdominal pain, bloating, distention, diarrhoea and constipation alternating with diarrhoea.

More to come

Next week I hope to attend another symposium which will feature a presentation on the Fodmap Diet by Prof Joanne L. Slavin, who is an eminent professor in the Department of Food Science and Nutrition at the University of Minnesota. I promise to report back on her talk about the low Fodmap Diet and hopefully this new approach at last represents a light at the end of the dark IBS tunnel.
 
(References: Monash (2013). The Monash University Low FODMAP Diet. http://med.monash.edu.au/cecs/gastro/fodmap/;  Pronk M (2013). Irritable Bowel Syndrome In Adults. Paper presented at the ADSA Pretoria Branch Breakfast Seminar: Irritable Bowel Syndrome & Ethics. Pretoria, 19 March 2013.)