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Ask a Medcan dietitian: How can I reduce symptoms of Irritable Bowel Syndrome (IBS)?

The best approach recruits three specialists to address the Gut-Brain Axis

Person holding their stomach in pain

We all know these feelings far too well:  that heavy knot in your stomach after receiving bad news.  The butterflies we get before a presentation.  We’re quick to dismiss these symptoms as being in our head; but if we pay close attention, therein lies the real reason of why we feel what we do.

The gut-brain axis (GBA) refers to a set of nerves and chemical signals that the digestive tract and brain use to communicate.  It starts with the vagus nerve which connects the brain to the gut.  This nerve uses chemical signals, called neurotransmitters, and our intestinal bacteria to “talk” and coordinate the processs of digestion.  It’s this same system that leaves us with fluttering butterflies in our stomach.  With millions of nerve cells lining our intestinal wall, it’s no wonder the gut has earned the nickname “the second brain”.

In the average person, the GBA works behind the scenes unnoticed.  But in people with digestive issues, such as irritable bowel syndrome (IBS), symptoms are very apparent.

What is IBS and what are its symptoms?

IBS is a digestive disorder that includes chronic bloating, gas, stomach pain, cramping and changes in bowel movements like diarrhea and constipation.  But here’s the catch: there’s nothing physically wrong with the gut itself.

This has mystified the medical community:  how can a gut that behaves so abnormally be completely normal?   Science is beginning to recognize that these symptoms aren’t “in one’s head” but rather the result of a rewired GBA.

Three traits common to people with IBS include:

  • Increased visceral hypersensitivity – nerves in the gut sense pain and sensations more strongly than in people who don’t have IBS, which is why bloating and cramps may feel more painful
  • Dysmotility – the gut does not move in a coordinated fashion; it can move too fast (diarrhea) or too slow (constipation) and may not absorb certain carbohydrates as quickly
  • Dysbiosisan imbalance of gut bacteria and fewer healthy gut microbes

The link between IBS and our ability to manage stress

Interestingly, 34% of Canadians with IBS also report having anxiety.  Since gut bacteria help produce neurotransmitters, this creates a chicken and egg scenario: does anxiety trigger the nerves in the gut and cause IBS? Or do gut bacteria change neurotransmitters and trigger anxiety?

Poorly controlled IBS symptoms can be frustrating and may leave you feeling hopeless.  After all, what can you do if your physical hard wiring is different from someone else’s?

Managing IBS with a team-based approach

If you have IBS, tummy troubles, or you’re afraid how you’ll feel after eating, leaning on a supportive care team can help you take control of your symptoms and improve your quality of life.

Effectively managing your symptoms, requires the help and expertise of three very important people: a gastroenterologist, a dietitian, and a psychologist.

Gastroenterologists are digestive tract specialists that can help with a key piece to IBS management – a true diagnosis.  They can rule out other conditions such as Celiac disease, Crohn’s disease, ulcerative colitis, and bacterial infection.   It’s easy to fall prey to Dr. Google, but the correct diagnosis ensures the best possible care since treatment plans are different for each condition.

The role of dietitian is to assess your diet, make recommendations, and identify food triggers. This is typically done using an elimination and challenge diet.   When it comes to diet, people with IBS often find that even healthy foods, such as apples or garlic, cause grief.

“Fermentable carbohydrates can be a significant trigger since they’re often poorly absorbed by the gut.  Bacteria in the large intestine feed off these carbohydrates which can create excessive gas, bloating, cramping, distention and changes in bowel movements,” says Megan Scully, a registered dietitian and my colleague at Medcan.  “I work with my clients to determine their tolerance and threshold to food triggers while ensuring they meet their nutritional needs. In many cases, prebiotics and probiotics may be helpful”.

IBS management is not complete without a psychologist to tackle the brain component of the GBA. Dr. Jonathan Danson, psychologist at Medcan, stresses the importance of using cognitive behavioural therapy to challenge beliefs and fears around digestive triggers.

“Many patients with IBS tend to avoid situations that make them anxious, or engage in behaviours that make them feel more comfortable. They may, for instance, avoid being in crowds that would make access to a washroom difficult.  Or, they may carefully plan outings to ensure access to washrooms at all times. While these behaviours provide short-term relief, they actually continue to feed into symptoms.  In counselling sessions, clients challenge feared situations so they can realize that they’re not as catastrophic as they might believe, or that they’re capable of coping with them effectively.  Our clients  also benefit from learning strategies to help regulate their emotions and tolerate distress.”

The GBA is a complex system so powerful that disruption to it can cause severe digestive symptoms.  For people living with IBS, getting the support of a care team is key.

Have more questions?  Reach out to me by email This video is also helpful

Stefania Palmeri is a dietitian and proud promoter of Nutrition Month 2018: Unlock the Potential of Food.  Look beyond food as calories but as a means to heal and prevent.  Follow us on social media for daily updates, posts, and videos on what RDs can do! Instagram @medcan_livewell Twitter @medcanclinic

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