IBS Diet

Digestive Problems Diet

We are an Oxfordshire based Nutritional Therapy Service helping those with IBS and other digestive disorders using a scientific approach to diet.

Irritable Bowel Syndrome

As a name goes, it’s rather catch all.

Our digestive system is 9 metres long from where the food goes in, to where it eventually comes out. Apart from: the mouth, the oesophagus; the stomach; and the anus, the bowel takes up 8.5 metres of it. So that’s 8.5 metres where things can go wrong. And, even then it’s a misnomer as many symptoms have their origins higher up, caused by problems such as: low levels of saliva; teeth which don’t allow us to grind our food; low stomach acid or hiatal hernias. IBS may refer to the bowel but in actuality digestive issues can take place in the whole 9 metres.

The Stomach

Low stomach acid, hiatal hernias, bacterial infections such as Helicobacter Pylori, ulcers, gastritis and general inflammation. We’re only at the beginning of the digestive process but already have issues which can cause dysbiosis. This can be symptomatic locally (heartburn or oesophageal burning for example), or symptoms can arise further down the tract. Low levels of stomach acid result in undigested large protein peptides passing down into the small intestine to cause bloating and cramps. Low stomach acid can also mean that ingested bacteria and parasites are not killed as they should be, leaving them to descend into the intestine where they multiply and cause many of the symptoms of IBS

Large Intestine

Not as sophisticated as the small intestine, most of the large intestine is dedicated to reabsorbing water and using microbes to digest previously undigested plant fibres. Consequently if food hasn’t been able to be digested thus far, issues will arise here. It can take over 6 hours to reach this part of the digestive tract. So if it’s now early evening and that large steak you had for lunch is making itself felt, then it’s here you’re experiencing problems. Consequently resolving IBS can be a slow process of elimination (geddit?) and detective work. Although with dietary change and carefully chosen supplements relief can be immediate it can take time to resolve the underlying cause.

Small Intestine

Although much narrower and shorter than the large intestine the bulk of our nutrients should be digested and absorbed here (food which should already be partially digested by the stomach).

Digestion is assisted by bile from the gall bladder and digestive enzymes from the gut wall and the pancreas.

If any of these mis-function then again, the problems are simply passed along. Problems can also be passed up to the small intestine from the large intestine.

The condition Small Intestinal Bacteria Overgrowth (SIBO), for example, is where the bacterial balance of the small intestine has been compromised, either by bacteria coming up from the large intestine, or arriving unkilled from the stomach acid.

If you find your IBS symptoms coming quite soon after eating, generally after an hour or so, it could be a sign that the problem is here.

Inflammatory Bowel Disease

IBD is a condition which is believed to be auto-immune in origin and which can affect any part of the bowel.

When the small intestine, and sometimes the ascending colon, is inflamed it is generally known as Crohn’s Disease. When it affects the large colon and rectum it is generally known as Ulcerative Colitis. Although similar physiologically they require different nutritional approaches.

Crohn’s Disease

Inflammation which affects the small intestine and sometimes the ascending colon and sometimes has a genetic link. The inflammation can become systemic and lead to other issues such as joint problems. Food intolerances frequently occur, along with the usual symptoms of diarrhoea, abdominal pain and weight loss due to malabsorption.

As an initial approach to encourage remission the nutritional protocol may include a short-term elimination diet such as the Specific Carbohydrate Diet which limits carbohydrates to easily digestible types. When the gut has had time to heal and the inflammation has died down, different foods can be reintroduced gradually. The choice dependent on the individual, their own requirements and desires. Nutritional deficiencies bought about by malabsorption and restrictive diets would also be addressed.

Ulcerative Colitis

Ulcerative Colitis generally affects the large intestine and rectum, although it can sometimes spread to the small intestine.

The general state of inflammation causes pain, diarrhoea, fast and frequent stools and painful lesions and ulcers. The inflammation can often result in food intolerances.

A nutritional protocol would support the immune system, reduce inflammation, reduce animal protein and increase soluble plant fibre.

It would also seek to redress any imbalance in nutrients affected by malabsorption such as zinc, vitamin K and the B vitamins or iron from blood loss. In severe and chronic cases, UC may also be addressed as though a fungal infection is the underlying cause.

Celiac Disease

It would seem that the most common dietary change people make when trying to address digestive issues is to give up wheat.

Wot No Wheat?

Whilst it’s true that it’s a difficult food to digest and people with below-par digestion will get ill effects such as bloating, there are others with Celiac Disease who have a real, and complete, inability to digest most forms of wheat protein (including gluten). This auto-immune condition results in severe inflammation and damage to the intestinal wall.

Failure To Thrive

This damage to the intestinal wall means that many coeliacs suffer from a wide range of illnesses as many nutrients are poorly absorbed. In children specifically this may result in a “Failure To Thrive” as they fall behind their class mates in energy levels and height. If you feel this may be your child ask your family to see if other relatives have digestive issues; coeliac disease is often familial.

Its Not IBS

Whilst there are sometimes no obvious symptoms sufferers often experience a myriad of GI complaints including bloating, cramping, diarrhoea and / or constipation, vomiting, pale fatty stools, weight loss, fatigue, irritability (who wouldn’t be irritable?). Many other issues manifest too with bone and joint pain and even miscarriage.

Lactose Intolerance

The damage which occurs to the intestinal wall of celiac sufferers affects the top most tip of the villi. This is where lactase is synthesised, the enzyme which digests milk sugars. Consequently celiac sufferers frequently cannot tolerate lactase either. Sometimes with a managed diet, and when the intestine has had a chance to recover, milk products can be reintroduced.

The Small Print

The dietary path of the coeliac sufferer is a complex one. It’s not sufficient to avoid pasta, bread and biscuits - food labels also have to be scrutinised for ingredients such as dried hydrolized plant protein or gelatinised starch.

Although many supermarkets now stock gluten-free alternatives these are often of dubious nutritional quality, an issue when years of malabsorption may have to be compensated for. However there are many nutritious and simple alternatives to wheat such as quinoa for cous cous, rice pasta instead of wheat, millet based muesli instead of other cereals, potato flour instead of wheat.

Not the “3 Rs”, it’s the “4 Rs”.

Although a coeliac sufferer may never be free of the disease and relapses can sometimes be more immediate and painful than the original symptoms, remission can be achieved by following a program known as the 4 ‘R’s:

Remove the problem. Which is wheat protein and all the various forms it pops up in. In the short term also diary.

Replace underlying deficiencies caused by malabsorption. Sometimes dietary enzymes too as pancreatic insufficiency is frequently linked to coeliac disease.

Reinnoculate specific probiotics, prebiotics and yeasts which help the growth of intestinal flora

Repair nutrients which help to repair and rebuild the damaged wall such as zinc, vitamins A and D and the amino acid L-Glutamine. Ntrients such as anti-oxidant and omega 3 oils can help reduce inflammation.

Food Intolerance

It's Not an Allergy

Food intolerance is not food allergy. An allergic reaction can range from tingly lips to a life threatening anaphylactic shock. A food intolerance is generally digestive related and can simply be embarrassing excess wind or severe and debilitating stomach cramps.

Where a food allergy is generally a life-long condition food intolerance can be reversed. There are many kits on the market which, for a price, will give you a long list of foods that should be avoided to prevent a reaction. However often the food intolerance is simply a symptom of another digestive issues that is the cause. Particularly if you suffer from food intolerance from many foods.

One Needs a Sieve Not a Colander.

Quite often the term “leaky gut” is used to describe the gut issue which can be behind food intolerance. It describes a situation where the intestinal permeability of the gut increases so that larger molecules, such as food particles, can cross to the blood stream and cause an immune reaction.

The gut wall can be in adversely affected by high levels of stress, excess alcohol or bacterial imbalance. A dietary protocol can be introduced to reduce any inflammation and rebalance the internal bacteria. Over time the foods to which the body has become sensitised can be gradually and singularly reintroduced.

Within a few weeks I really noticed a difference, I’m sleeping

better than I have in a long time. Saffron took the time to understand

my lifestyle and habits and then made recommendations and

adjustments that were easy to build into my everyday life.

Dawn Lillington

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