IBS, Bloating and Other Digestive Issues

Your digestive system is incredibly complex.  In clinic we talk about digestive symptoms in relation to many other conditions including inflammation, autoimmune conditions, thyroid conditions, fertility and hormonal issues, skin health, mood and brain health to mention just a few!

Some symptoms you might experience: 

• Acid reflux
• Heartburn
• Indigestion
• Feeling of food not going down
• Feeling full very quickly
• Feeling hungry straight after eating
• Bloating
• Pain or spasms
• Feeling of a ‘blockage’
• Constipation
• Diarrhoea
• Irregular and changing bowel movements
• Foul flatulence

Your digestive system is essential for health

We talk about digestion with almost all of our clients as it is so fundamental to health.  There are three main reasons for this;

• We need a good digestive system in order to absorb nutrients out of our food. There is no point in having a great diet if your gut isn’t able to absorb nutrients properly.   Nutrient deficiencies can exist even where people seem to be eating all the right foods and this can have endless knock on effects.
• Our beneficial bacteria are fundamental to our health. Our digestive system houses much of our microbiome, the huge population of bacteria that live with us. They produce some vitamins and fatty acids that help feed our cells, they are absolutely essential to our immune system, they play a role in mental health and brain function and they help us to maintain weight amongst many other roles we likely don’t even understand yet.
• Much of our immune system surrounds our gut. Up to 80% of immune cells are found around the gut. Protecting the gut lining and preventing damage will help to keep our immune system balanced.

If you suffer from digestive problems you will know that bloating, pain, irregular bowel movements or flatulence can really bring you down. It can make you feel sluggish, fatigued and even depressed or anxious over coping with difficult or potentially embarrassing situations.  If your digestion is getting in the way of enjoying your daily life, it is time to take a look at what is really going on.

Reflux, heartburn, indigestion

Starting from the top, let’s take a look at reflux or indigestion.  Some may experience a characteristic burning in the throat which can be extremely uncomfortable, disturbing sleep and everyday activities.  Others do not feel this burning and then find it difficult to make the link between reflux and what seems to be just a scratchy throat, dryness, hoarseness or a continuous need to clear the throat.

Other signs might be a ‘knot’-like pain in the upper stomach or at the end of the oesophagus (the tube the food goes down). This pain may also be felt lower or even sometimes in the back. Reflux or indigestion can also cause nausea, feelings of fullness, like the food has nowhere to go sitting high in the stomach or simply not moving on.

There are a number of causes for reflux which should be ruled out.  Long-term damage to the oesophagus can lead to an overgrowth of cells called Barret’s Oesophagus and your GP needs to be informed of these symptoms in case an endoscopy is required.  An endoscope is a camera that goes down your oesophagus to look for signs of damage and inflammation.  You may also wish to consider specific probiotics and other supplements which may help support bacterial balance and restoring the health of your stomach.

There are other reasons for reflux which include food intolerances such as dairy and wheat, bacterial imbalances in the stomach or small intestine (see Small Intestinal Bacterial Overgrowth), stress and nutrient deficiencies.  We recommend talking to our Nutritionists to see what the most likely root cause is for you so that you can begin to address it.

Your doctor may prescribe medication to reduce acid in the stomach which can be effective in reducing symptoms of reflux and indigestion. These are some of the most commonly used medications in Ireland and are a class of drug called Proton Pump Inhibitor (PPI). These can be useful in the short term.  However long term use can lead to nutrient deficiencies (especially zinc and calcium) and exacerbate bacterial imbalances by altering the natural pH or acidity in the digestive tract.  If you are taking PPIs, we do not recommend you stop them straight away but rather work with us to improve your digestive health while you reduce your need for this medication if possible.

Bloating and flatulence

Bloating is an extremely common symptom but is not in fact a normal process in the body.  Often we see patients who have adapted to years of chronic bloating and have accepted this as their new normal.  We also see patients who start the day in one size clothing and may have to open buttons or change into looser clothing after they come home from work to accommodate a swelling abdomen.

There are many reasons for bloating.  However the main cause is a bacterial imbalance. Bacteria in our digestive tract will eat the food that we eat. They ferment this food and produce gas.  This can get absorbed into our bloodstream and leave our system in our breath, or it can sneak out the other end.  A small amount of flatulence is quite normal. However, when there is excess gas produced, this can lead to trapped wind and bloating.  It may also result in excessive flatulence or foul flatulence which can be difficult to cope with.

When we feed our bacteria high sugar, high processed food diets, this might increase the levels of bacteria that ferment these foods. This leads to more gas production.  Healthy bacteria feeding on a well balanced diet high in fibre and plant-based foods should produce a normal amount of gas.  That said, if you have an established bacterial imbalance, dietary changes may be insufficient to restore the natural state. You may need to use probiotics, anti-microbials, prebiotics and specific nutrients (polyphenols and phytonutrients) to help restore your natural bacterial population.  The best way to do this, is to find out what imbalances are present to begin with.  We use a comprehensive stool analysis which uses highly accurate DNA analysis to detect bacteria in our gut or a breath test to detect bacterial overgrowth in the small intestine (SIBO).

Food Intolerance

There are many genuine food intolerances. Here we will discuss some more common issues but if you suspect food intolerance or you know that you react badly to some food, it is best to come and talk to us about this.  Milder or more non-specific food intolerances are often a symptom of an underlying issue rather than a condition in their own right.  Food intolerance testing is not recommended by the Health Protection Regulatory Authority in Ireland.  This is because of ambiguity with the test results and the possibility that you might end up following a very restricted diet if you take out every food you test positive for.  If you have already carried out a food intolerance test, let us help you to interpret this.  It may be that there are certain very reactive foods you could take out in the short term.  You will need to look at the underlying cause though, as removing foods form your diet is unlikely to solve the problem in the longer term.

Gluten

Coeliac disease is an autoimmune condition where gluten is not tolerated in any form. The reactions can be severe with extreme pain, diarrhoea and gas or they can be much milder.  We have identified a number of coeliac patients in our clinic who had no digestive symptoms at all but suffered from skin issues, nasal inflammation or mood changes and depression.  Coeliac disease is more prevalent in Ireland than any other European country.

Non-coeliac gluten sensitivity

There is also a growing body of research around non-coeliac gluten sensitivity and it is believed that many more people may be affected by this.  Current testing remains unproven and very costly. If you suspect an intolerance to gluten, the best option is to avoid all gluten for three weeks before reintroducing it for a couple of days to see if symptoms return. It could be that wheat sensitivity is an issue rather than all gluten-containing foods.  It may also be a component of wheat, a fibre, that is causing the issue.  This might be related to bacterial imbalance or SIBO so it might be important to rule this out before embarking on a restrictive diet.

Dairy

Lactose intolerance

We have an enzyme that breaks down lactose, a natural sugar found in milk.  If you are lactose intolerant, you produce less of this enzyme and cannot breakdown this sugar. This is relatively common in Europe.  Symptoms include discomfort, cramps and diarrhoea. If you are lactose intolerant, you may be able to tolerate lactose free milk or dairy products.

Dairy intolerances

You may also react to proteins and other compounds found in dairy. Symptoms can be much more varied. These may include a wide range of digestive symptoms but also skin issues, nasal congestion or recurrent sinusitis, brain fog and fatigue.  Because these symptoms have a lot of cross over with other issues, it is a good idea to discuss dairy exclusion with your Nutritionist.  Like any restriction diet, it is important to consider the sources of other nutrients including calcium for bone health.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) affects 11% of the world’s population and is an umbrella term for many different symptoms, including pain, discomfort, bloating, diarrhoea and constipation. It is really meant to be a ‘diagnosis of exclusion’ – so where no other explanation can be found, you may be given the label of IBS.  This can be frustrating where you do not know how to improve something when you do not understand the cause.

Constipation can be caused of course by a lack of fibre in the diet, low water intake and slow movement in the digestive tract.  Altered motility can be a feature in a number of conditions. For example, with underactive thyroid, many of our body systems including our gut simply slow down. There are lots of foods and supplements that may be able to speed up slow digestion and can certainly provide symptomatic relief from constipation.  Similarly, certain fibres and foods can add bulk to stools, reducing the symptoms of diarrhoea. These might be useful short-term solutions for you.

However, if you want to get to the underlying cause, it is worth considering  further investigations.  Depending on your symptoms, we will be able to advise you which testing might be most helpful for you.  We know now that in up to 78% of cases of IBS, a bacterial overgrowth in the small intestine may be a major contributing factor.  This is referred to as Small Intestinal Bacterial Overgrowth or SIBO.  Read more here about this, symptoms to watch for and how to find out if this is a factor for you.

Overgrowth and inflammation in the large intestine

Most of our normal gut bacteria reside in the large intestine or the colon, fermenting food after we have finished digesting what we can and forming the stool.  A bacterial overgrowth or even a transient infection here can cause constipation, diarrhoea and many other digestive symptoms also.  The stool analysis uses accurate DNA analysis of the microbes living in this part of the gut to identify levels beneficial and harmful bacteria, parasites, worms, viruses and yeasts such as Candida that may be causing symptoms.

This test also examines intestinal health markers that are critical to our health and immune system.  We need our natural defences to be optimal to control overgrowth of bacteria and other microbes and these defences can be reduced when under stress.  Other markers check for signs of inflammation and damage that may be caused to your gut lining. This may lead to increased intestinal permeability or ‘leaky gut’.  When the gut lining is damaged, the immune system is often on high alert and this can be related to food intolerances, immune and autoimmune conditions.

Tests

Where to start?

Introducing variety is the best way to keep your good bugs happy.  Try eating a wide range of fruit, vegetables, nuts, seeds, herbs and spices. A good range of fibre is essential for a healthy gut.  Reduce processed foods as this promotes the growth of unhelpful bacteria and can crowd out the good kind.

You may find however, that you are reacting to different foods and trying to introduce more becomes complicated.  If you can try to keep track of some of your trigger foods before your appointment, that will be helpful for your Nutritionist although we understand that sometimes the pattern is hard to follow.