Muriel Gall BSc RD Msc MBDA - Registered Dietitian

Irritable Bowel Syndrome (IBS)

The most common symptoms of IBS are constipation, or diarrhoea, or both and some people may also have stomach cramps, bloating or wind. Often symptoms start after a stressful life event, depression or anxiety. Alternatively, it may occur after a stomach upset or a course of antibiotics which may affect the bacteria in the gut. It is always advisable to have your symptoms checked out by your doctor to confirm this diagnosis.

Dietary Management
While IBS is not harmful, its symptoms can cause distress and diet can play a role in the management of your symptoms. Dietary management can be considered in three steps:

Step 1 - dietary management should be to look at your overall lifestyle:

Aim to eat a balanced diet.
Eat 3 regular meals each day.
Allow time to relax when eating.
Aim to drink at least 8 cups of fluid each day.
Restrict tea or coffee to 3 cups per day.
Reduce intake of alcohol and fizzy drinks.
Relaxation techniques may also be helpful.
Try to include some regular exercise such as walking.

If, after doing this, you find little improvement in your symptoms, you may wish to consider seeing a dietitian for more specific advice.

Step 2 –Taking your symptoms into account, together we would consider whether modifying your intake of fibre; resistant starch; fructose; lactose may play a role in your symptoms.

Prior to an appointment, I would recommend that you complete a food and fluid intake diary, and record on the same diary any symptoms that you have eg. diarrhoea, bloating or wind. Give each symptom a score out of 5. This is useful for the future, as we can monitor any change.

I would assess your symptoms, examine your current dietary intake and explore what, if any, dietary changes you have tried previously.

Sometimes more than one dietary regimen needs to be tried, before symptoms respond and we would discuss the options of dietary management specific to your individual symptoms which include:

Changing fibre intake – this may be a reduction (low fibre) or an increase (high fibre) depending on your symptoms.
Modifying intake of resistant starch.
Modifying fructose intake.
Increasing soluble fibre such as oats or golden or cracked linseeds.

Step 3 – Exclusion Diet.
Some people find they are unable to tolerate particular foods. The only way of testing this is by eliminating them or trying an exclusion diet.

An elimination diet or an exclusion diet may be advised. This limits the type of foods eaten for a few weeks, then if your symptoms have improved, these excluded foods can gradually be reintroduced to find the particular foods that lead to your symptoms. If your symptoms do not improve after the elimination diet, it is unlikely that your symptoms are food related.

It is advisable that these restrictive diets are only done under the supervision of a dietitian who can assess on the nutritional adequacy of your resulting diet. This is because if specific food groups are excluded, this will affect your nutrient intake and supplements may be required.

I recommend my GOLD PACKAGE of appointments for (IBS) that gives £10 discount if booking an initial appointment with two follow up appointments.

Further Help
It is excellent that in 2008 it has been acknowledged that diet can play a role in the symptoms for some people. (If you want to read more about this – see my link to the NICE guidelines for IBS) However, others may continue to have symptoms and we know that drug treatment and / or psychological support may be beneficial. I think it is important to know where to get this further help where required.

I am fortunate to have recently started working together with Dr Maxwell Asante, Consultant Gastroenterologist, based in Bromley, Kent, who in addition to having a role in the diagnosis of people with IBS can advise about medical management or drug treatment and can refer on to myself or to Adrian Blake, a clinical psychologist if appropriate. Adrian is also based in Bromley, Kent and has been working with people with IBS for around 14 years, using relaxation techniques and gut directed hypnotherapy.

Disclaimer and Confidentiality



	Irritable Bowel Syndrome (IBS) The most common symptoms of IBS are constipation, or diarrhoea, or both and some people may also have stomach cramps, bloating or wind. Often symptoms start after a stressful life event, depression or anxiety. Alternatively, it may occur after a stomach upset or a course of antibiotics which may affect the bacteria in the gut. It is always advisable to have your symptoms checked out by your doctor to confirm this diagnosis. Dietary Management While IBS is not harmful, its symptoms can cause distress and diet can play a role in the management of your symptoms. Dietary management can be considered in three steps: Step 1 - dietary management should be to look at your overall lifestyle: Aim to eat a balanced diet. Eat 3 regular meals each day. Allow time to relax when eating. Aim to drink at least 8 cups of fluid each day. Restrict tea or coffee to 3 cups per day. Reduce intake of alcohol and fizzy drinks. Relaxation techniques may also be helpful. Try to include some regular exercise such as walking. If, after doing this, you find little improvement in your symptoms, you may wish to consider seeing a dietitian for more specific advice. Step 2 –Taking your symptoms into account, together we would consider whether modifying your intake of fibre; resistant starch; fructose; lactose may play a role in your symptoms. Prior to an appointment, I would recommend that you complete a food and fluid intake diary, and record on the same diary any symptoms that you have eg. diarrhoea, bloating or wind. Give each symptom a score out of 5. This is useful for the future, as we can monitor any change. I would assess your symptoms, examine your current dietary intake and explore what, if any, dietary changes you have tried previously. Sometimes more than one dietary regimen needs to be tried, before symptoms respond and we would discuss the options of dietary management specific to your individual symptoms which include: Changing fibre intake – this may be a reduction (low fibre) or an increase (high fibre) depending on your symptoms. Modifying intake of resistant starch. Modifying fructose intake. Increasing soluble fibre such as oats or golden or cracked linseeds. Step 3 – Exclusion Diet. Some people find they are unable to tolerate particular foods. The only way of testing this is by eliminating them or trying an exclusion diet. An elimination diet or an exclusion diet may be advised. This limits the type of foods eaten for a few weeks, then if your symptoms have improved, these excluded foods can gradually be reintroduced to find the particular foods that lead to your symptoms. If your symptoms do not improve after the elimination diet, it is unlikely that your symptoms are food related. It is advisable that these restrictive diets are only done under the supervision of a dietitian who can assess on the nutritional adequacy of your resulting diet. This is because if specific food groups are excluded, this will affect your nutrient intake and supplements may be required. I recommend my GOLD PACKAGE of appointments for (IBS) that gives £10 discount if booking an initial appointment with two follow up appointments. Further Help It is excellent that in 2008 it has been acknowledged that diet can play a role in the symptoms for some people. (If you want to read more about this – see my link to the NICE guidelines for IBS) However, others may continue to have symptoms and we know that drug treatment and / or psychological support may be beneficial. I think it is important to know where to get this further help where required. I am fortunate to have recently started working together with Dr Maxwell Asante, Consultant Gastroenterologist, based in Bromley, Kent, who in addition to having a role in the diagnosis of people with IBS can advise about medical management or drug treatment and can refer on to myself or to Adrian Blake, a clinical psychologist if appropriate. Adrian is also based in Bromley, Kent and has been working with people with IBS for around 14 years, using relaxation techniques and gut directed hypnotherapy. Disclaimer and Confidentiality