Written by Christina Boon NT mANP, mGNC
Irritable bowel syndrome (IBS) affects many people in the Uk. Figures suggested by Bupa(1) predict for every 10 people, there are 2 that are affected by IBS. This figure may be a lot higher.
With Nutritional Therapy not being available to everyone due to cost and availability, I wanted to write the top factors that have helped my clients with easing IBS symptoms.
These symptoms include stomach cramps, bloating, diarrhoea and constipation and general discomfort that impacts wellbeing which tend to come and go and can last for an unpredictable amount of time. Symptoms can start at any time in life usually as teens and can be lifelong for some people.
There are many different causes and as we are all so different there is no one cause so it is about finding the things that will trigger your symptoms, which include food, alcohol, caffeine, stress, removing them and working on a nutritional regime which includes fibre, digestive enzymes and probiotics.
1. The Most undervalued supplement for IBS Digestive Enzymes.
Digestive Enzymes have been the most valuable addition to easing my clients IBS so let's jump straight in. If your bowel is irritated it will certainly let you know and symptoms such as diarrhoea will mean that you are absorbing fewer nutrients than you should be and therefore finding yourself on a vicious cycle between trying to heal and dealing with an irritable bowel. When undigested foods travel through the intestines they can irritate and potentially damage the sensitive intestinal wall. Over time, this irritation may reduce our digestive capacity and negatively influence the vital absorption process.
Digestive enzymes will help break down the food you eat making it easier on your gut to absorb nutrients, digest the food and eliminate waste. In a clinical study(2) into enzyme therapy with patients showing IBS like systems, 73% said that they experienced good to excellent results compared to those who took a placebo.
Digestive Enzymes are not a long term solution and they should not be depended on, as they are expensive and it is important that you find those foods that irritate or work on stressful periods and managing stress that triggers your IBS. For a minimum of three months take a digestive enzyme with each meal. After this time you can take a digestive enzyme less frequently, perhaps a few times a week, or if you are on holiday or going to a restaurant or having a cosy takeaway and film night in.
As we are all different and because there are so many different reasons for an IBS flare-up there is 'no one size fits all' probiotic. It is important to go for probiotics with good research behind them. The most researched strain is Bifidobacterium infantis, however, there are actually specific strains for specific symptoms to try also. I have actually found that when speaking to clients and customers the prefered time to take a probiotic is in the evening before bed, also try to take away from medication.
Saccharomyces boulardii for Diarrhoea
For frequent bouts of diarrhoea the probiotic Saccharomyces boulardii which has been shown in many clinical trials to help support gut health in those with diarrhoea. Saccharomyces boulardii is a gentle yeast. This is not a gut colonising bacteria so a good general probiotic formula is recommended alongside.
Bifidobacterium lactis BB-12® for constipation
For constipation, we do not want to be straining on the loo so instead of a strain of the probiotic called Bifidobacterium lactis BB-12® is great for helping to maintain regularity (4)
Lactobacillus acidophilus NCFM® and Bifidobacterium lactis Bi-07 for bloating
Lactobacillus acidophilus NCFM® and Bifidobacterium lactis Bi-07 will beat the bloat and in a clinical trial (5) found these two strains combined to be effective for those suffering from IBS and in particular bloating, cramps and abdominal distension. The study also found that the two combined will regulate bowel movements.
Bifidobacterium infantis 35624 for pain and bloating
Bifidobacterium infantis 35624 is also known as 'Bifantis', and has been well researched. The study (6) showed 8-week trial with 75 participants associated B. infantis 35624 with a reduction in pain, discomfort, bloating and constipation.
L. plantarum Lp299v for regularity and discomfort
L. plantarum Lp299v has also been clinically trialled on participants with IBS, with helped with regularity, and discomfort. "All patients treated with LP299V reported resolution of their abdominal pain as compared to 11 patients from a placebo group (P = 0.0012). There was also a trend towards normalization of stools frequency in constipated patients in six out of 10 patients treated with LP299V compared with two out of 11 treated with placebo (P = 0.17). With regards to all IBS symptoms, an improvement was noted in 95% of patients in the LP299V group vs 15% of patients in the placebo group"
With regards to taking supplements many of the clinical trials were studied over a period of 4 weeks. I always recommend a period of 3 months for natural supplements even if symptoms have greatly improved. From studying clinical trials a placebo effect takes on average 3 weeks and quite often we find ourselves feeling better straight away.
3. Organise your Food Diary
Three meals per day, around the same time each day, not too large, home-cooked(3). This may be a huge challenge for some but worth it when battling the flareups.
The idea is to keep a note of what you have eaten and to write down any symptoms associated. If you experience the same symptoms then rate those symptoms out of 10 with the idea is to look for patterns and food triggers.
If you are following the FODMAP diet this may not be a long term solution as it eliminates healthy foods.
4. Try the Elimination Diet
The gold standard food intolerance test is the elimination diet and it is as it sounds.
If you suspect that gluten is a culprit, before starting an elimination phase please make an appointment with your GP for blood tests and diagnosis. Read more at https://www.nhs.uk/conditions/coeliac-disease/dia...
You may have ideas as to what foods trigger your sensitivity but you are not certain. So write a list of all the suspected culprits and avoid those foods for a period of around 6 weeks. At the end of the elimination period, you reintroduce the food to assess how you feel and note down any bowel movements. It is important to introduce these foods slowly.
The idea is not to avoid these foods altogether but to have them in very small quantities moving forwards, this ensures that you control the amount of the trigger food eaten and to avoid a reaction to a sudden reintroduction to the food after a long period of time.
5. Peppermint Tea is soothingly amazing
Peppermint tea is a wonderful addition to a daily regime for digestion after a large meal. A study (8) showed that Peppermint Tea is also effective for soothing the intestines, relieves abdominal pain and reduces bloating.
Enjoy a brew after a meal and steep for at least five minutes in hot water. Ensure that you don't drink the tea when boiling hot and allow to cool so as to not irritate your gut.
6. Relaxation Techniques and Breathing
The ability to relax will help ease IBS symptoms. A study (9) showed that relaxation therapies reduced and helped to calm IBS symptoms.
The International Foundation for Gastrointestinal Disorders recommends Progressive Muscle Relaxation
This method of relaxation focuses on the tensing and then relaxing of the various muscle groups. When used in combination with abdominal breathing, this method of relaxation can have profound effects on one’s level of tension and anxiety by promoting a state of deep relaxation.
An incredibly important base for your health journey is breathing techniques, breathing to release tension and breathing into areas of discomfort within the body, targeting your own bodies healing energy into the area. This has been a practice for Buddhists, yoga practitioners, and eastern healers for hundreds of years and believes that the breath is the foundation of our life force and energy.
For guided breathing practices try Headspace for techniques and exercises.
For any further guidance and support please contact us with any queries you may have.
(1) Irritable bowel syndrome (IBS) Dr Ian Arnott, https://www.bupa.co.uk/health-information/digesti...
(2) Enzyme therapy for functional bowel disease-like post-prandial distress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910...
(3) The Relationship of Eating Habits and Trigger Foods to Symptom Severity of Irritable Bowel Syndrome Journal of Korean Biological Nursing Science
(4) Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657...
(5) Clinical trial: Probiotic Bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 Versus Placebo for the Symptoms of Bloating in Patients with Functional Bowel Disorders - a Double-Blind Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372...
(6) Multi-Center, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study to Evaluate the Benefit of the Probiotic Bifidobacterium infantis 35624 in Non-Patients With Symptoms of Abdominal Discomfort and Bloating https://pubmed.ncbi.nlm.nih.gov/27845337/
(7) A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome https://pubmed.ncbi.nlm.nih.gov/11711768/
(8) The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337...
(9) Relaxation Therapy for Irritable Bowel Syndrome: A Systematic Review https://www.sciencedirect.com/science/article/pii...