How to survive Christmas with IBS

The festive season is traditionally a food and drink extravaganza. With party food all around and alcohol flowing freely, it can be a real challenge to manage your IBS during the month of December.

However, surviving Christmas with minimal suffering is perfectly achievable with a few adjustments and a bit of planning ahead:

  1. Make a contribution

Many IBS sufferers dread going out for meals, as it can feel impossible to avoid known triggers. If you’re invited to a friend or family member’s house for a Christmas meal this
year, ask if you can bring one of your own dishes to help out. This ensures there will always be something on the table that you know you can tolerate, so you can load up your plate without stress or fear.

  • Don’t overdo it74802043781259757_G9yOBXY3_c

The average Christmas dinner contains around 70% of an adult’s overall daily calorie intake. While it might be traditional to pile your plate with a mountain of food, your gut won’t thank you for it. Breaking down your daily food intake into several smaller meals (rather than one big blow-out) makes far lighter work for your digestive system – resulting in significantly less digestive discomfort.

  • Trim the fat

High fat foods are a common IBS trigger. Before you cook your turkey, prick the skin to allow the fat to drain out then cook it on an upturned ovenproof plate so it’s not sitting in the fat. Serve with lots of steamed vegetables and be sure to remove the skin before you eat it.

  • Drink wisely

39406565459135133_4f8KUedZ_cIf you’re prone to bloating and gas, steer clear of fizz such as champagne, prosecco and carbonated mixers, which can leave you feeling embarrassed and uncomfortable. Instead, stick to soft drinks or alternate gentler drinks (such as white wine and soda) with non-alcoholic alternatives.

  • De-stress

Stress and anxiety can exacerbate the symptoms of IBS, and Christmas is commonly a hectic and stressful time. Acknowledging this – and taking appropriate steps to manage stress – can be a real turning point. Make an effort to take the pressure off this Christmas and factor in some proper time to relax.

  • Keep active

Your digestive system is much more efficient when you keep active, so slumping in front of the television won’t do your IBS any favours. A brisk walk after lunch can speed up a sluggish digestion and help relieve stress to boot. Even 30 minutes of moderate exercise will help.

Here’s to a happy, healthy Christmas.

© Sarah West Nutrition

The facts about Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a term used to describe re-occurring disruption to the function of the stomach, digestion or colon in the absence of any specific, detectable cause.

It is a common disorder with an estimated 10-20% of people in England suffering from some form of IBS (NICE, 2010).

Diagnosis

IBS is considered a ‘functional’ disorder (referring broadly to an impairment in normal function), as diagnostic testing does not reveal any visible disease process. Doctors sos cropped(1)therefore make a diagnosis of IBS based purely on a patient’s symptoms, which can include a combination of any of the following:

  • Abdominal pain/ cramping (often worsened by eating and relieved by passing a stool)
  • Changes in bowel habits (such as frequent diarrhoea and/ or constipation)
  • Flatulence (including wind and gastrointestinal reflux) and bloating
  • Abdominal spasms / stomach rumbling

Symptoms may be intermittent and will often vary in severity from day to day. Several conditions may present with symptoms similar to IBS, including coeliac disease, inflammatory bowel disorders (such as Crohn’s Disease or Ulcerative Colitis) and parasitic infections. It is therefore important to see your doctor for tests to rule out these conditions. If you have any signs of blood in stools or experience significant, unexplained weight loss then it is particularly important that you seek advice from your GP.

Causes

The exact cause of the impaired digestive functioning seen in IBS is unclear, but possible triggers include:

  • Food Intolerance – lactose (milk sugar), fructose (fruit sugar) and sorbitol (an artificial sweetener) are common triggers in IBS patients. In addition wheat, dairy, coffee, eggs, corn, potatoes, onions and yeast can often cause problems.
  • Psychological factors – It is thought that IBS is a disorder of the interaction between the brain and the gut, with sufferers experiencing increased sensitivity within the gut to external stimuli such as stress. The frequency of depression, stress, anxiety and other psychiatric disorders in IBS patients is high (DeNoon, 2010).
  • Use of certain medications – article-newantibiotics, non-steroidal anti-inflammatory drugs such as ibuprofen (e.g. Nurofen) and diclofenac (e.g. Voltarol) plus stomach acid suppressing drugs/ antacids may worsen symptoms.
  • Gender – women tend to be more susceptible. Many women with IBS find their symptoms are particularly bad around the time of their period, suggesting that female hormones may play a part.

Management

There is no cure for IBS, but symptoms can often be eased by changes to diet and lifestyle. No treatment is guaranteed to eliminate symptoms completely; instead the goal is to relieve them sufficiently to prevent them from interfering with daily activities. The following suggestions may be helpful:

Dietary modification

Treatment plans for IBS are highly individual, but symptoms are generally improved by alterations in food intake. It may firstly be helpful to complete a 2 week food and symptom diary in order to establish links between food consumption and IBS attacks. This can be a tedious process, but a simple record of what you eat and how you feel may help to identify one or more foods that are problematic. These triggers can then be reduced or eliminated.

A nutritionist or dietician can provide further advice on specialised exclusion or rotation diets that may help to identify triggers and ease symptoms.

Current national guidelines (NICE, 2010) regarding IBS include the following general suggestions which may also help to minimise symptoms:

  • Have small, regular meals and take time to chew each mouthful well. Avoid large meals which can place stress on the digestive system and trigger spasms in the gut.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep stools soft and easy to pass along the gut.
  • Restrict tea, coffee and alcohol consumption (caffeine and alcohol are gastric irritants and act as a triggers in some individuals)
  • Restrict carbonated drink consumption, which may contribute to bloating or cramping.
  • Be mindful of fibre consumption. Fibre can often help to regulate IBS symptoms, but large amounts of insoluble fibre (found in whole grains, bran and fruit and vegetable skins) may worsen symptoms in some individuals. Try introducing gradually and monitoring symptoms until the desired effect is achieved. Soluble fibre (found in rice, pasta, oats, potatoes, beans and barley) may be easier to tolerate.
  • Avoid artificial sweeteners such as sorbitol (found in sugar free sweets, chewing gum and slimming products), particularly if you have diarrhoea.
  • FODMAP dietFODMAP is the acronym for a group of osmotically active, rapidly fermentable, short-chain carbohydrates, thought to be a common IBS trigger. The FODMAP diet is a plan that temporarily eliminate FODMAPs from the diet, and is thought to be very effective.

Supplementation

  • Peppermint oil – has antispasmodic properties and relaxes intestinal muscles (Hadley & Gaarder, 2005). Choose capsules with enteric coating to prevent gastroesophageal reflux.
  • Psyllium (soluble fibre) – soothes and regulates the digestive tract, symprove-132-pstabilises intestinal contractions and normalises bowel function (in cases of both predominant diarrhoea AND constipation) (Ford et al., 2008)
  • Probiotics – may help restore normal bowel flora in the colon and reduce instances of diarrhoea. Faecal samples of IBS patients have showed a reduction in Lactobacili and Bifidobacteria and higher concentration of pathogenic bacteria (Moayyedi et al., 2010). Try Symprove – this clinically proven probiotic contains 4 strains from the Lactobacilli family and works without triggering digestion, ensuring they reach the right area of the gut (unlike other popular dairy-based or freeze dried probiotics) 
  • Digestive Enzymes such as papaya extract, lactase, ox-bile extract, pancreatic enzymes may aid digestion and reduce bloating. 

Behavioural strategies

The relationship between the mind and over activity of the gut is complex. The entire length of the bowel is controlled by a nervous system which carries signals back and forth to the brain, via hormones and neurotransmitters. These signals control the action of the smooth muscle surrounding the intestines and regulate the process of digestion. It is therefore no surprise that emotional issues trigger symptoms of IBS and that people with anxious personalities may find symptoms particularly difficult to control. Intestinal upset is often simply a physical manifestation of stress or anxiety (Kearney & Brown-Chang, 2008., Whitehead et al., 2002).

It is important for IBS sufferers to try to reduce the amount of stress in their lives. Some people find relaxation techniques, stress counselling, cognitive behavioural therapy, psychotherapy or hypnotherapy useful in controlling their symptoms. Regular exercise also helps to helps keep bowel movements regular and reduces stress. Including additional information regarding your mood within a food diary may help to identify emotional factors that are contributing to your symptoms.

Medication

There are a variety of drugs that can help relieve specific symptoms of IBS, such as anti spasmodics for abdominal cramps, laxatives to relieve constipation and antidiarrhoeals to prevent diarrhoea. Low doses of tricyclic antidepressants are sometimes prescribed to relieve pain in patients who do not respond to other treatments. Talk to your doctor or pharmacist for more information.

Outlook for patients with IBS

For most people with IBS, the condition will persist periodically throughout their life. IBS does not pose a serious threat to a person’s health, nor does it cause serious damage or disease of the digestive system. However, it can have a considerable impact on a person’s quality of life for those who are severely affected, often leading to work absenteeism (Maxion-Bergemann et al., 2006, Paré et al., 2006). It is therefore important to learn to recognise and avoid individual triggers in order to manage symptoms as effectively as possible.

© Sarah West Nutrition

References:

DeNoon, D (2010). Irritable bowel syndrome in the brain. Web MD. Retrieved from: http://www.webmd.boots.com/ibs/news/20100725/irritable-bowel-syndrome-in-the-brain

Ford, A., Talley, N., Spiegel, B., et al (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. British Medical Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19008265?dopt=Abstract

Hadley, S., Gaarder S., (2005). Treatment of irritable bowel syndrome Am Fam Physician 72 (12): 2501–6. Retrieved from: http://www.aafp.org/afp/20051215/2501.html

Hammerle & Surawicz (2008). Updates on treatment of irritable bowel syndrome.World Journal of Gastroenterology. 14, 2639-2649.

Kearney & Brown-Chang (2008). Complementary and alternative medicine for IBS in adults: mind-body interventions.

Paré, P., Gray, J., Lam, S, et al. (2006). Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clinical therapeutics28 (10): 1726–35.

Maxion-Bergemann, S., Thielecke, F., Abel, F., Bergemann, R., (2006). “Costs of irritable bowel syndrome in the UK and US”. PharmacoEconomics 24 (1): 21–37.

Moayyedi, P., Ford, A., Talley, N., et al (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome. Gut59 (3) 325-32. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19091823?dopt=Abstract

NICE Clinical Guideline (2010); Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927 

Whitehead, W., Palsson, O., Jones, K. (2002). Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?. Gastroenterology 122 (4).

How to avoid bloating

Bloating – defined as a general swelling or feeling of tightness in the abdominal area – causes daily discomfort and misery to millions of people in the UK. In some cases bloating can be a symptom of an underlying health problem, but it is more often than not due to poor eating habits:

  • Digestion starts in the mouth. It’s where food gets broken down, not just physically but also chemically (by the digestive enzymes found in saliva). Many of us eat our food far too quickly, meaning that food makes only a passing acquaintance with this vital first stage of digestion. If food isn’t adequately broken down this can cause problems further down the line, in the form of gas and bloating. Always take the time to chew eat bite properly, around 20-30 times. Try putting your knife and fork down between bites, to encourage you to really focus on each mouthful at a time.
  • Your brain is about 10-20 minutes behind slow-foodyour stomach when it comes to registering fullness, so always wait 15 minutes before deciding whether to go back for seconds or a pudding. This will help to avoid you feeling uncomfortably full and bloating after each meal.
  • When you’re eating, do nothing else but eat. Our blood can only be in one place at one time and when we eat the focus is needed in our digestive system. If we are doing something else (such as reading, walking, talking or watching TV), our blood will be diverted elsewhere in the body and taken from where it is needed in the digestive system. Make an effort to sit down at the table for at least a couple of meals each week. Eating without distractions can make a huge difference to your digestion and will help you to notice when you are satisfied.

© Sarah West Nutrition

Fuel your workout

HEALTH:

The best pre-workout meal depends on exactly what time of day you’re going to be in the gym. If you’re an early riser who fits it in before work you’ll need to keep it light. However, if you’re working out later in the day you can get away with a bit more as you’ll have more time to fully digest it.

EXERCISE:

It takes the body approximately four to six hours to digest fat, around three hours to digest protein and about two hours to digest carbohydrates. It is therefore important to keep things simple and focus on consuming mainly carbohydrates directly before a workout.

278378820688404198_jxsLVERX_cBy eating too much fat or protein, your blood will rush to your stomach for digestion while also trying to fuel your exercising muscles. As a result, it might not do a very good job of either (leading to indigestion and lack of energy).

NUTRITION:

Bananas are a great choice if you don’t have long before your workout (i.e. less than an hour). These are a very quickly digestible form of carbohydrate and are also packed with potassium, which aids in maintaining proper nerve and muscle function.

If you are able to eat several hours beforehand, try a meal based around wholemeal pasta. This is a great way to increase stored energy in the muscles and give you the extra oomph you need later in the day.

© Sarah West Nutrition

Are you getting enough?

HEALTH:

Water is a primary component of the human body and is involved in nearly every physiological function.

It keeps us hydrated, maintains body temperature, transports nutrients and waste products in and out of cells, improves digestion and enhances organ function. So with all that going on, it is crucial that you get enough of it!

EXERCISE:

We lose a lot fluid through perspiration, so it is vital to replace that fluid when we exercise. Dehydration impairs both physical and mental functioning and you will be more prone to dizziness, fatigue or painful cramping if you don’t drink enough.

Always keep a water bottle to hand and try a sports drink after strenuous activity to help replace the sodium lost in sweat.

NUTRITION:

As well as increasing your pure water intake, try adding plenty of fresh or frozen produce to your diet.

Most fruits and vegetables contain up to 90% water which will satisfy some of your body’s fluid requirements whilst also providing you with essential nutrients and antioxidants.

© Sarah West Nutrition

Healthy digestion

HEALTH:

Digestion is the process by which food is broken down to be utilised by the body. Once the nutrients from your food have been absorbed, they are used to build and nourish cells and provide the energy needed to keep the body going.

 EXERCISE:

While there are countless ways to improve digestion, one of the most important – but often neglected – methods is through regular exercise.

sos cropped(1)Engaging in just 30 minutes of aerobic exercise each day encourages contraction of the intestinal tract and improves digestive transit.

 NUTRITION:

Chewing is the first stage of digestion. It not only physically breaks down what you eat, but also signals organs to secrete their digestive juices (such as pancreatic enzymes and stomach acids) to prepare for incoming food.

Next time you eat, try putting down your fork between mouthfuls in order to encourage you to really chew your food well. You might be surprised by the difference it makes to your digestion.

© Sarah West Nutrition