Leading gut expert Dr Anthony Hobson gives you the real deal on IBS and how to manage the symptoms
It is IBS Awareness Month, and it’s estimated that 20 percent of the UK population suffers from the often debilitating symptoms. Dr Anthony Hobson of the Functional Gut Clinic explains some of the myths around the condition and offers the latest advice.
Myth #1: IBS is caused by gluten and dairy intolerance
Reality: Not true. It’s possible that some people with IBS (symptoms of which are typically flatulence, stomach pain, bloating and diarrhoea or constipation – or both) might have intolerances to gluten (proteins found in wheat, barley and rye) and/or milk-sugar or lactose in dairy products. But there are also many people who have these intolerances who don’t have IBS.
Lactose intolerance is relatively rare in people of North European descent (although common in those of East Asian origin) and of those who are lactose intolerant, emerging research suggests it may be the proteins in milk (a mixture of A1 and A2 proteins) – not the lactose – they are sensitive to. I recently carried out a small trial at the Clinic to show switching to A2 Milk (available from Waitrose and Sainsbury’s) might enable those who struggle with cow’s milk to drink it without adverse effects.
Myth #2: You just need to eat more healthily
Reality: Current guidelines suggest we should be eating ten portions of fibre-rich fruit and veg a day and adopt a Mediterranean style of eating, but this is not necessarily the healthiest option for IBS sufferers. Typically healthy foods can make symptoms worse. This is because the sugars found in highly fermentable foods like fruit, vegetables and pulses are not well-absorbed in the gut and become fermented by bacteria, producing characteristic IBS symptoms such as gas and possibly pain and diarrhoea. It’s not that you should not eat fruit and veg, but you need to know which ones are most likely to aggravate your symptoms – which is why a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, a group of carbohydrates known to aggravate symptoms) diet should be the first line of treatment for anyone with IBS. I suggest downloading the Monash University Low FODMAP diet app to help find IBS-friendlier foods.
It’s not that you should not eat fruit and veg, but you need to know which ones are most likely to aggravate your symptoms.
Myth #3: It’s all in your head
Reality: Tell that to the IBS sufferers who have diarrhoea so severe they cannot leave the house or have to plan their day around access to the nearest toilets. The relationship between stress and IBS is bi-directional: IBS can cause the stress rather than the other way around. IBS is a functional disorder, meaning there are no obvious signs of illness such as inflammation, but that certainly doesn’t translate as the condition being ‘in your head.’ This is not to say stress and anxiety are not factors (the more ways you can reduce and manage stress levels the better,) and it can exacerbate the condition, but seeing it as a psychological condition, rather than a physical one, does not get to the root of what is causing your IBS.
The relationship between stress and IBS is bi-directional: IBS can cause the stress rather than the other way around.
A functional diagnosis for IBS should be the first positive step in a treatment pathway to relieve IBS symptoms, and that in itself should help to reduce stress. Other techniques such as diaphragmatic breathing (belly breathing) can also be very beneficial.
Myth #4: Tummy bugs are bad
Reality: There are billions of bacteria present in a healthy gut, and these normally have a beneficial effect helping to protect against infection. When the good bacteria get disrupted (say after suffering food poisoning or gastroenteritis or after a course of antibiotics) it can trigger IBS symptoms in those who may have a particularly sensitive gut or a genetic predisposition to symptoms. Restoring the levels of good bacteria can involve a mixture of dietary changes (eating fermented foods like sauerkraut and prebiotic ones like Jerusalem artichokes can be helpful.) Some people find probiotic supplements can help. I’ve seen positive results with the probiotic Alflorex. I recommend natural, unsweetened yogurt as a dietary probiotic.
Myth #5: It can’t be cured
Reality: It is commonly thought that there is no cure for IBS, and the range of available medication is aimed at managing symptoms, including antispasmodics to reduce abdominal pain and cramping, laxatives to ease constipation and antimotility medicines to ease diarrhoea. However, there is mounting evidence that a large proportion of IBS patients develop symptoms after a gut infection (such as traveller’s diarrhoea) and that in a proportion of cases these ‘bad bugs’ stick around in the small bowel, causing small intestinal bacterial overgrowth (SIBO.) Large-scale studies in the U.S. have shown that an antibiotic called Rifaximin (championed by U.S. gastroenterologist Dr Mark Pimentel) could be beneficial for some when taken over a couple of weeks and in many can be a cure for IBS symptoms. Unfortunately, it’s not yet widely available in the UK for use in IBS apart from in the private sector, where results have been very promising.
Myth #6: White carbohydrates are bad for you
Reality: The idea that anyone should be eating more white carbohydrates like white bread, pasta and rice cuts across most current dietary advice. But in many patients with IBS, these are better tolerated and eating them (in moderation) tends to reduce symptoms. This is because the more complex the carbohydrate (like oligosaccharides found in beans and pulses) the harder it can be to digest. High fibre is also a problem in IBS. Nobody is suggesting you should be having a diet mostly made up of bland white foods (there are plenty of nutritious foods you can eat including good quality basmati rice, organic sourdough bread, blueberries, etc.) but many IBS patients say white carbohydrates are just easier to stomach than brown ones.
Many IBS patients say white carbohydrates are easier to stomach than brown ones.
Myth #7: Diet drinks are better for you…
Reality: Sugary, fizzy drinks get bad press, and rightly so, but taken in moderation (one a day) could be better for your IBS than consuming diet drinks. This is because the sweeteners in diet drinks often contain difficult-to-digest carbohydrates, which can get fermented in the colon and cause severe bloating. Lay off the sugar-free sweets for the same reason. Too much fruit juice can cause the same issues, so water should always be the drink of choice.
If you think the low-calorie or calorie-free versions are better for you, you’d be wrong in terms of IBS symptoms, but remember: everything in moderation.
As told to Jane Collins
Dr Anthony Hobson is an internationally renowned consultant clinical scientist with experience across the NHS and private healthcare sectors as well as in academia and the pharmaceutical industry. Dr Hobson trained in Manchester and gained a broad base of experience in assessing gut function from ‘top to bottom’ covering areas such as gastro-oesophageal reflux disease, Irritable Bowel Syndrome (IBS), incontinence and constipation. Anthony’s industry experience provided further training in designing and implementing clinical trials to test experimental approaches and novel treatments in conditions like IBS, an area he is still passionate about.