Irritable bowel syn­drome is a painful and some­times em­bar­rass­ing con­di­tion of the gas­troin­testi­nal tract that a ects roughly five mil­lion Cana­di­ans. Luck­ily, there are rel­a­tively easy ways to man­age its symp­toms — it’s just a mat­ter of fig­ur­ing out what w

Best Health - - CONTENTS - | by KAREN ROBOCK il­lus­tra­tion by TRACY WALKER


keep­ing you from en­joy­ing din­ners out with friends, or you’re of­ten run­ning for the bath­room (or wish­ing you were run­ning for the bath­room be­cause you can’t re­mem­ber your last suc­cess­ful trip to the loo), it’s time to talk to your doc­tor.

Irritable bowel syn­drome (IBS) is a chronic con­di­tion that af­fects the gas­troin­testi­nal (GI) tract, caus­ing ab­dom­i­nal pain, bloat­ing, cramp­ing, con­sti­pa­tion or di­ar­rhea. Some IBS suf­fer­ers ex­pe­ri­ence just a few of th­ese com­mon symp­toms, which will wax and wane over time. They’re ex­ac­er­bated by stress, chang­ing eat­ing pat­terns and ill­ness. There can be good days, weeks or months, fol­lowed by times when symp­toms flare and make day-to-day life un­man­age­able.

“IBS has a ma­jor im­pact on many peo­ple’s lives,” says Dr. Ge­of­frey Turn­bull, a gas­troen­terol­o­gist, GI motil­ity ex­pert and pro­fes­sor of medicine at Dal­housie Univer­sity in Hal­i­fax. Its painful and of­ten em­bar­rass­ing symp­toms can in­ter­fere with in­ti­macy, play­ing sports, travel, go­ing to the movies and even mak­ing it to the of­fice. “Ac­cord­ing to one study, IBS is one of the most com­mon rea­sons for work­place ab­sen­teeism, next only to the com­mon cold,” he says.

The vari­abil­ity of symp­toms is one of the chal­lenges of the con­di­tion, says Dr. Jennifer Tan­ner, a natur­o­pathic doc­tor with the In­te­gra­tive Health In­sti­tute in Toronto. “Peo­ple can suf­fer with it for quite a few years be­fore they seek treat­ment, be­cause they start to think it’s just nor­mal for them,” she says. Or they try to ig­nore it be­cause they know that even­tu­ally, in a mat­ter of days or weeks, it will pass. “We don’t re­ally talk about th­ese kinds of prob­lems ei­ther, so that doesn’t help,” she says.

There’s no test for IBS. To make a di­ag­no­sis, your doc­tor will eval­u­ate your med­i­cal his­tory and symp­toms over the past six months, screen­ing for the fol­low­ing cri­te­ria: pain and dis­com­fort re­lated to pass­ing stool, whether the fre­quency is al­tered to a point of con­sti­pa­tion or di­ar­rhea, and whether your pain is re­lieved af­ter a bowel move­ment.

IBS most com­monly f lares up for the first time in peo­ple in their 20s and 30s. The rea­son for this isn’t clear, but some prac­ti­tion­ers at­tribute it to the stress­ful time of life. For a per­son with a sen­si­tive GI tract who’s start­ing a ca­reer, be­gin­ning a fam­ily and mak­ing other ma­jor life de­ci­sions, stress can be what tips them over the edge. “It’s when real life re­spon­si­bil­i­ties start and this can be a time of a lot of anx­i­ety and stress,” says Dr. Tan­ner. “Stress is known to be a huge com­po­nent of IBS.”

IBS can’t be cured, but it can be man­aged. Read on for ev­ery­thing you need to know about con­trol­ling your IBS symp­toms, so they’re not con­trol­ling you.


a food symp­tom jour­nal. If you don’t yet have a han­dle on your trig­ger foods, this can help you fig­ure out what you’re eat­ing or drink­ing that’s up­set­ting your sys-

tem. Write down ev­ery­thing you eat along with any symp­toms you ex­pe­ri­ence through­out each day. At the end of a week, you and your doc­tor may be able to see some help­ful pat­terns. Dr. Tan­ner typ­i­cally fol­lows this with a month of elim­i­na­tion of the sus­pected trig­ger foods to see if symp­toms ease up, or even dis­ap­pear. It takes ap­prox­i­mately 21 days for your in­testi­nal cells to re­ju­ve­nate, which cre­ates a type of clean slate on which to test the foods again, she says. “If we then rein­tro­duce cheese, for ex­am­ple, and all those old symp­toms come back, that cre­ates an aware­ness for the pa­tient that this is a food they’re not go­ing to feel well with.”


se­ri­ous about your diet. Wheat and dairy are clas­sic trig­ger foods that many peo­ple with IBS need to elim­i­nate from their di­ets, or eat in strict mod­er­a­tion, but there are other foods that some peo­ple need to tweak or re­move to get re­lief. Gas-pro­duc­ing foods like beans, lentils and cau­li­flower can be no-nos for peo­ple with cramp­ing is­sues, for ex­am­ple. Raw veggies in gen­eral can also be gaseous and there­fore prob­lem­atic for some IBS suf­fer­ers. “You may need to cook or gen­tly warm your foods to make them eas­ier for you to di­gest,” says Dr. Tan­ner. “Some peo­ple with IBS also re­spond well to a low-FODMAPs diet,” says Dr. Turn­bull. FODMAPs (fer­mentable oligo-, di- and monosac­cha­rides and poly­ols) are car­bo­hy­drates found in cer­tain grains, veg­eta­bles, fruits and dairy prod­ucts that cause symp­toms in IBS pa­tients.

TRY to think about what you eat as an ad­ven­ture

— it’s a chance to sam­ple some­thing new, not just cut out favourites. You may have com­piled a long list of foods that are “don’ts,” which can feel de­feat­ing, so why not make an even longer list of IBS diet “dos?” If you’re fol­low­ing a low-FODMAPs plan, man­goes may be out, for ex­am­ple, but man­darin or­anges are in! Or you may need to cut out reg­u­lar cow’s milk, but your sys­tem could prob­a­bly tol­er­ate an oc­ca­sional glass of lac­tose-free milk or co­conut milk.

While you’re think­ing about all the great new things you’re adding to your diet, don’t for­get about sup­ple­ments. Since your body may not be ab­sorb­ing nu­tri­ents prop­erly, es­pe­cially if you’ve had chronic di­ar­rhea, you could be de­fi­cient in key vi­ta­mins and min­er­als. Talk to your prac­ti­tioner about whether a mul­ti­vi­ta­min will do the trick or if you need more tar­geted sup­ple­ments.


med­i­ca­tion, if you need it. Diet and lifestyle changes aren’t al­ways enough to re­lieve se­vere symp­toms of IBS. There are drugs de­signed to re­lax the colon and slow the move­ment of waste through the bowel if di­ar­rhea is an is­sue, or in­crease f luid se­cre­tion in the small in­tes­tine to as­sist with the pas­sage of stool if con­sti­pa­tion is the pri­mary prob­lem. An­tide­pres­sants or an­tianx­i­ety med­i­ca­tions may also be re­quired if emo­tional is­sues are your big­gest IBS trig­ger.


your symp­toms closely. Your doc­tor will as­sess whether they might sug­gest some­thing more se­ri­ous or re­quire fur­ther in­ves­ti­ga­tion. If, for ex­am­ple, you’re over 50 and ex­pe­ri­enc­ing IBS-like symp­toms for the first time, or have ex­pe­ri­enced rapid weight loss, rec­tal bleed­ing or re­cur­rent vom­it­ing, you will need ad­di­tional tests — which could in­clude stool stud­ies, a colonoscopy or CT scan, amongst others — to rule out inflammatory bowel dis­ease (IBD). This is an um­brella term for ul­cer­a­tive col­i­tis and Crohn’s dis­ease, two dis­eases that in­volve chronic in­flam­ma­tion of the di­ges­tive tract and can some­times lead to life-threat­en­ing com­pli­ca­tions or the need for surgery.


time for med­i­ta­tion. “Learn­ing how to man­age stress is very im­por­tant for any­one with IBS,” says Dr. Turn­bull. Mind­ful­ness and med­i­ta­tion are help­ful tools, es­pe­cially for peo­ple whose symp­toms are clearly trig­gered by stress or anx­i­ety.


The IBS Elim­i­na­tion Diet and Cook­book by Patsy Cat­sos to help you build a ful­fill­ing and nu­tri­tious diet plan to get last­ing re­lief from your symp­toms while still en­joy­ing de­li­cious meals with your fam­ily — and some of the treats you en­joy!


what works for you. If you know you don’t feel as well when you eat dairy, but love milk or yo­gurt, you may de­cide to have a planned cheat day once a week or opt to splurge on a spe­cial oc­ca­sion, like at a birth­day party. “Once you know what your body can han­dle you can make the choice to have the cake if you want it, so it be­comes about aware­ness,” says Dr. Tan­ner. b

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