As a result of my laxative abuse and eating disorder - I did some damage internally, and it pains me... and its name is Irritable Bowel Syndrome (IBS).
Everyone is talking about IBS. What is it?
Around one in five Australians experiences the symptoms of IBS at some time during their life. The symptoms may include abdominal pain, bloating, gases/indigestion and alternating diarrhoea and constipation. It may seem that people with IBS have sensitive bowels that are easily ‘upset’. And unfortunately for us XX chromosome lasses, more women than men are prone to IBS, and symptoms tend to first occur in early adulthood.
The cause for IBS is largely unknown, but environmental factors such as changes of routine, emotional stress, infection and diet can trigger an attack. Research has shown that the neurotransmitter serotonin may be important in the symptoms of IBS, by altering the function of nerve cells in the bowel and causing changes in pain sensation and bowel function. Therefore lots of medications that affect serotonin inhibition or reuptake can have side-effects similar to IBS. Cue - a range of anti-depressant medications.
Irritable bowel syndrome can be subdivided into three major categories:
Constipation-predominant – the person tends to alternate constipation with normal stools. Symptoms of abdominal cramping or aching are commonly triggered by eating.
Diarrhoea-predominant – the person tends to experience diarrhoea first thing in the morning or after eating. The need to go to the toilet is typically urgent and cannot be delayed. Incontinence may be a problem.
And finally Alternating constipation and diarrhoea.
So what causes it?
So the underlying cause(s) of irritable bowel syndrome is still unknown, but certain factors have been found to ‘trigger’ attacks in individuals. These include:
Infection – an episode of gastroenteritis will often result in persistent bowel symptoms, long after the offending bacteria or virus has been eliminated. The cause of this is unknown, but may involve changes to nerve function in the bowel or changes in the normal bacterial population of the bowel. Up to 25 per cent of IBS may be due to this problem.
Food intolerance – impaired absorption of the sugar lactose (found in dairy and many processed foods) is the most common dietary trigger for IBS. Other sugars believed to trigger IBS are fructose (present in many syrups) and sorbitol.
General diet – low-fibre diets can exacerbate the constipation of constipation-predominant IBS. Some people find spicy or sugary foods cause problems. However, many experts are sceptical about the role of general diet, once specific food intolerances have been eliminated.
Emotional stress – strong emotions, such as anxiety or stress, can affect the nerves of the bowel in susceptible people.
Medication – certain types (such as antibiotics, antacids and painkillers) can lead to constipation or diarrhoea.
and the diagnosis is...
If you suspect you have irritable bowel syndrome, it is important to seek medical advice to make sure your symptoms aren’t caused by any other illness, such as diverticulitis, inflammatory bowel disease or polyps. Coeliac disease (an immune intolerance to gluten, present in wheat and other grains) may produce many of the same symptoms as IBS. Lactose intolerance may produce bloating, cramps and diarrhoea.
Diagnosis methods include:
full medical check-up
blood tests, including blood tests for coeliac disease
investigation of the bowel lining by inserting a small tube (sigmoidoscopy)
investigation of the bowel under sedation (colonoscopy) or barium enema, if necessary.
IBS cannot be cured with medication or special diets. The primary preventative measure is to identify and avoid individual triggers.
Treatment options may include:
A modest increase in dietary fibre, together with plenty of clear fluids
reducing or eliminating common gas-producing foods, such as beans and cabbage
Reducing or eliminating dairy foods, if lactose intolerance is a trigger
antidiarrhoea medication, such as imodium or lomotil – these can be an essential part of management in those with diarrhoea-predominant IBS.
Pain-relieving medication – opiates such as codeine can provide effective pain relief. One of their most common side effects, constipation, may also relieve the diarrhoea of diarrhoea-predominant IBS
Antispasmodic drugs, which may ease cramping – examples include mebeverine, belladonna, hyoscine and peppermint oil capsules
Tricyclic antidepressants – these can be effective in treating the pain of IBS, but are best prescribed for a trial period with monitoring of symptoms. Use of these does not mean that IBS is caused by depression.
Stress management, if stress seems to be triggering the attacks.
Establishing eating routines and avoiding sudden changes of routine.
A group of carbohydrates called FODMAP's is now believed to contribute strongly to symptoms of IBS in many people. A low-FODMAP diet can be tried in these instances. This diet can be commenced with the supervision of a dietician experienced in management of IBS.
finally to FODMAPS
Put simply, FODMAPs are a collection of short-chain carbohydrates (sugars) that aren’t absorbed properly in the gut, which can trigger symptoms in people with IBS. FODMAPs are found naturally in many foods and food additives.
FODMAPs are found in a wide range of foods. FODMAPs are the ‘fast food’ for the bacteria that live naturally in a humans large bowel. If molecules are not absorbed in the small bowel, they continue the journey to the large bowel. The bacteria that live there see these food molecules as ‘fast food’ and quickly break them down, which produces hydrogen, carbon dioxide and methane gases. Multiple types of FODMAPs are usually present in any one meal. Because they all cause distension in the same way once they reach the lower small bowel and colon, their effects are cumulative. This means that the degree of bowel distension can depend upon the total FODMAPs consumed, not just the amount of any individual FODMAP consumed. If someone who cannot digest lactose well and absorbs fructose poorly eats a meal that contains some lactose, some fructans, some polyols, some GOS and some fructose, the effect on the bowel will be 1 + 1 + 1+ 1 + 1 = 5 times greater than if they ate the same amount of only one of those. That is why we have to consider all FODMAPs in food when modifying our diet.
What is a low-FODMAP diet?
The Low-FODMAP Diet has been proven to work in the treatment of IBS symptoms in both the short and long term. When you start the Low-FODMAP Diet you should avoid all FODMAPs – fructans, GOS, lactose, excess fructose and polyols. If you know you can completely absorb fructose, however, you need not restrict your excess fructose intake, and if you know you can completely absorb lactose, you need not restrict your lactose intake.
Bananas, blueberries, carambola, durian, grapefruit, grapes, honeydew melon, kiwifruit, lemons, limes, mandarins, oranges, passionfruit, paw paw, raspberries, rockmelon (cantaloupe), strawberries, tangelos, tomatoes
Alfalfa, bamboo shoots, bean shoots, bok choy, broccoli, capsicum (pepper), carrot, celery, choko, choy sum, corn, cucumber, eggplant (aubergine), green beans, lettuce (butter, iceberg), marrow, olives, parsnip, potato, pumpkin (squash), silverbeet (Swiss chard), spinach, spring onion (green part only), squash, swedes, sweet potato, taro, tomatoes, turnips, yams
Lactose-free milk, rice milk, ‘hard’ cheeses and other mature, 'ripened' cheeses including brie and camembert, lactose-free yoghurt, gelato, sorbets, butter and margarine
Gluten-free bread and cereal products, amaranth, arrowroot, buckwheat, corn (maize), millet, oats, polenta, potato, quinoa, rice, sorghum
Sugar (sucrose), glucose, stevia, any other artificial sweeteners not ending in '-ol' (eg. aspartame)
Garlic-infused oil as an onion and garlic substitute, fresh and dried herbs and spices, chives, ginger, maple syrup and golden syrup as honey substitutes.
I tried everything, increasing fiber intake, drinking peppermint tea, taking pre and pro-biotics, used specialised treatments like Iberogast and nothing worked...
I was sick of the constant stabbing pains after I ate certain foods and the gassy bloated feelings.
My partner was as disgusted in me as I was in myself.
I belched a lot, and I farted a lot. And they smelt like something had actually died inside me.
I went to the doctors - who originally listed off all the things I had tried, including potentially using laxatives again which I quickly shut down. I ended up doing some tests, first a Hydrogen Breath test to see whether or not I had Heliobacter Pylori, and then further stool testing to rule out any major inflammation of my bowel associated with Crones disease. This test tests for Faecal Calprotectin.
Both of these tests returned negative, I was devastated as there appeared to be no resolution. But also quite glad that I didn't have any diseases.
My doctor told me to look into low-FODMAP diets for IBS symptoms - so I promptly downloaded an app by Monash University who have led research into the use of low-FODMAP diets for treating GI issues.
The app is super user-friendly, and definitely worth the download if you have any symptoms of IBS. Through the restriction of the different food groups I found that I was sensitive to Lactose (this I already knew), Fructans mainly from processed grains, garlic and Onion, and to some extent Galactans if I consumed them in large enough servings and over consecutive days. This limiting of GOS really destroyed my current diet - which was reliant on beans, lentils and chickpeas for completing proteins. So I supplemented my protein sources with more consumption of Eggs and becoming a Pescetarian, by treating myself to fish once a week or once a fortnight (if it took my fancy).
Eating out is such a challenge, and camp food is even worse - added garlic to everything and sneaky onion wherever you look. But at least I know now my limitations and my gut is much happier and healthier for it!