You are reading this because you have IBS or you know someone that does!
If your asking yourself “Do I know someone with IBS” the answer is most likely “Yes”.
With almost 1 in 5 people suffering from IBS its likely that some of your close family or friends do!
Once you’ve had a camera up your bottom and various blood tests it can come as a relief that your diagnosis isn’t something more life threatening.
Anxious,Overwhelmed, Confused and Worried are common terms expressed by some of my patients.
You’re likely to have a lot of questions that your tapping into search engines.
What actually is IBS?
How do I manage IBS?
What do I eat?
The additional anxiety and worry is unlikely to make your symptoms any better!
Understanding Irritable Bowel Syndrome does exactly what it says on the tin.
This post will help you understand IBS and hopefully answer some of those burning questions.
What is IBS?
“Irritable Bowel Syndrome is a gastrointestinal disorder characterised by altered bowel habits in association with abdominal discomfort or pain in the absence of detectable structural and biochemical abnormalities”.(1)
Irritable Bowel Syndrome can be characterised by the presence of the following symptoms:
Alternating bowel habit
Bloating and distension
Urgency to visit the loo
Symptoms range from diarrhoea to constipation, a combination or the two along with abdominal pain and discomfort existing alongside abdominal distension(2).
IBS is sub grouped into predominant bowel pattern –
IBS with constipation-hard or lumpy stools > 25% and loos or watery stools < 25% of bowel movements
IBS with diarrhea-loos or watery stools > 25% and hard or lumpy stools stools < 25% of bowel movements
Mixed IBS-loos or watery stools > 25% and hard or lumpy stools stools > 25% of bowel movements
Unsubtyped IBS-insufficient abnormality of stool consistency to meet criteria for IBS-C,D or M
The degree of symptoms along with variety and frequency varies immensely between individuals.
Some may suffer excruciating chronic pain whilst others have intervals which can last from weeks to months(3).
For example episodes of constipation followed by urgent, explosive diarrhoea.
There is currently no biochemical, histological or radiological diagnosis of IBS, while the diagnosis of IBS being based mainly on symptom assessment(2).
Rome IV Criteria.
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with ≥2 of the following:
Related to defecation
Associated with change in stool frequency
Associated with change in stool form (appearance)
Criteria should be fulfilled for at least 3 months with symptoms onset ≥6 months prior to diagnosis.
Upon presenting these symptoms, your Gastroenterologist may want to investigate further if you have any of the following red flag indications.
The above symptoms are NOT suggestive of IBS and must be investigated further by your Specialist Gastroenterologist.
A routine assessment can include a Colonoscopy, stool tests and blood tests which identify whether there is any inflammation.
Hopefully these investigations will rule out more serious conditions including:
Inflammatory Bowel Disease
Following these investigations, your consultant may come to the conclusion that there is no structural abnormalities to identify your symptoms.
This is likely to come as a sigh of relief when you’re told that your diagnosis is IBS and not life threatening.
It’s only weeks later when your symptoms return and you think of all the questions that you should have asked your consultant.
Who does IBS effect?
Irritable Bowel Syndrome is one of the most common gastrointestinal disorders. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics.
Reason 1- Vitamin D is essential for Calcium absorption.
Reason 2- Vitamin D deficiency is a global problem.
Reason 3- If you’re avoiding dairy in your diet, you may be deficient in Calcium.
I decided to cover this topic because vitamin D is essential for Calcium absorption, Calcium being another Micronutrient deficiency is a global he
Over a billion people worldwide are vitamin D deficient or insufficient
Vitamin D is an extremely important vitamin for your skin and beauty, bones and strength, and overall health and immunity.
When an estimated 1 billion people worldwide have a vitamin D deficiency, it’s important to know what vitamin D is, how to know if you are lacking this vital vitamin, and what you can do about it.
WHAT IS VITAMIN D?
Vitamin D is a fat-soluble vitamin, meaning it can travel into your blood circulation and be stored in your body’s tissues.
It is the only vitamin that can be produced in the body on its own, making it more of a hormone than a vitamin.
It does so when your skin has direct sun exposure, and it can also be found in some food sources as well as Vitamin D supplementation.
Vitamin D, also described as “the Sun Vitamin” is a steroid with hormone like activity.
It regulates the functions of over 200 genes and is essential for growth and development. There are two forms of vitamin D.
Vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).(2)
Vitamin D status depends on the production of vitamin D 3 in the skin under the influence of ultraviolet radiation from sun and vitamin D intake through diet or vitamin D supplements.
Usually 50 to 90% of vitamin D is produced by sunshine exposure of skin and the remainder comes from the diet.
Natural diet, most human consume, contain little vitamin D.
Traditionally the human vitamin D system begins in the skin, not in the mouth as Dietary sources of Vitamin D are limited.
However, important sources of vitamin D are egg yolk, fatty fish, fortified dairy products and beef liver.(3)
Foods fortified with vitamin D are the main sources of dietary vitamin D in some industrialized countries but such programs are practically nonexistent in most low- and middle-income countries.
In the absence of food fortification programs, a majority of the populations in the world solely depends on the sun for their vitamin D nutriture.
However, sunlight alone is not considered a reliable or adequate source as production of vitamin D in the skin minimizes in winters.
In the UK there is not enough ambient sunlight between the months of October- April for the skin to synthesise vitamin D.
Dark skin color exacerbates the problem of low endogenous vitamin D production.
Religious body-covering habits, staying indoors for the majority of daytime (particularly children, women, and the elderly), and lack of open spaces and direct access to sunlight in high human density habitations have resulted in the high prevalence of vitamin D deficiency, even in countries close to the equator where sunshine is abundant.
With this background, vitamin D can easily be classified as a “problem nutrient” with the potential of high risk of its deficiency in a large proportion of the human population.
Vitamin D3 deficiency can result in obesity, diabetes, hypertension, depression, fibromyalgia, chronic fatigue syndrome, osteoporosis and neuro-degenerative diseases including Alzheimer’s disease.
Vitamin D deficiency may even contribute to the development of cancers, especially breast, prostate, and colon cancers.
Vitamin D3 is believed to play a role in controlling the immune system (possibly reducing one’s risk of cancers and autoimmune diseases), increasing neuromuscular function and improving mood, protecting the brain against toxic chemicals, and potentially reducing pain.(5)
Exposure to sunshine each day helps human body to manufacture the required amount of vitamin D.
However, due to fear of developing skin cancer most people avoid the sun exposure.
To prevent vitamin D deficiency, one should spend 15 to 20 minutes daily in the sunshine with 40% of the skin surface exposed.
High concentration of melanin in the skin slows the production of vitamin D; similarly aging greatly reduces skin production of vitamin D.
Use of sunblock, common window glass in homes or cars and clothing, all effectively block UVB radiation – even in the summer.
People who work indoors, wear extensive clothing, regularly use sunblock, are dark skinned, obese, aged or consciously avoid the sun, are at risk of vitamin D deficiency.
Despite the abundance of sunshine in the Middle East allowing vitamin D synthesis all year round, the region registers some of the lowest levels of vitamin D and the highest rates of hypovitaminosis D worldwide.
This major public health problem affects individuals across all life stages, especially pregnant women, neonates, infants, children and the elderly.
Furthermore, while rickets is almost eradicated from developed countries, it is still reported in several Middle East countries.
These observations can be explained by limited sun exposure due to cultural practices, dark skin color, and very hot climate in several countries in the gulf area, along with prolonged breast feeding without vitamin D supplementation, limited outdoor activities, obesity, and lack of government regulation for vitamin D fortification of food, in several if not in all countries.(7)
Irritable Bowel Syndrome is a Functional Bowel Disorder meaning there is no diagnostic test.
Blood tests, stool samples and radiological scans may have been arranged by your Doctor although these are to rule out other conditions such as Coeliac, Crohns, Colitis and Cancer.
Diagnosing IBS is dependent on the profile of presenting symptoms. For example – bloating / constipation / diarrhoea / pain.
With no way of diagnosing IBS, assessing symptoms can be vague when a patient complains of bloating or diarrhoea.
Fortunately a diagnostic criteria exists for Irritable Bowel Syndrome, another reason to thank the Romans.
IBS is not a new disorder affecting people today with busy lifestyles and convenience foods.
It’s highly likely that people have been suffering from IBS for centuries.
In 1989 a group of Physicians got together in Italy and decided to lay down some criteria for diagnosing IBS- the Rome Criteria was born.
The Rome Criteria outlines the frequency, and duration of specific symptoms aiding in the diagnosis if IBS.
Over the years the criteria has been adapted with a total of 4 being published.
Rome I Criteria- 1989
Rome II Criteria- 1999
Rome III Criteria- 2006
The most recent version being Rome VI Criteria May 2016.
Don’t worry if you were diagnosed before the new criteria were published.
Rome criteria are used globally to diagnose IBS and little is changed other than the wording in the latest revision.
The recent update is more accommodating to terminology rather than symptoms.
Diagnostic Criteria for Irritable Bowel Syndrome
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria:
1. Related to defecation
2. Associated with change in frequency of stool
3. Associated with change in form (appearance) of stool.
Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
The criteria states symptoms must be persistent at least 1 day per week within the last 3 months and over 6 months since onset.
Short lived symptoms of travel diarrhoea or food poisoning would not fit the Rome Criteria.
The symptom profile of IBS can vary between individual. The prominence of IBS symptoms can categorise sufferers into 1 of the three main subgroups including:
1. Diarrhoea Predominant (IBS-D)
2. Constipation Predominant (IBS-C)
3. Mixed Predominance (IBS-M)
IBS with predominant constipation: More than onefourth (25%) of bowel movements with Bristol stool form types 1 or 2 and less than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually constipation (like type 1 or 2 in the picture of Bristol Stool Form Scale (BSFS), see Figure 2A).
IBS with predominant diarrhea (IBS-D): more than onefourth (25%) of bowel movements with Bristol stool form types 6 or 7 and less than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually diarrhea (like type 6 or 7 in the picture of BSFS, see Figure 2A).
IBS with mixed bowel habits (IBS-M): more than on fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and more than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually both constipation and diarrhea (more than one-fourth of all the abnormal bowel movements were constipation and more than one-fourth were diarrhea, using picture of BSFS, see Figure 2A).
IBS unclassified (IBS-U): Patients who meet diagnostic criteria for IBS but whose bowel habits cannot be accurately categorized into 1 of the 3 groups above should be categorized as having IBS unclassified. For clinical trials, subtyping based on at least 2 weeks of daily diary data is recommended, using the “25% rule.” a IBS subtypes related to bowel habit abnormalities (IBSC, IBS-D, and IBS-M) can only be confidently established when the patient is evaluated off medications used to treat bowel habit abnormalities.