Dr Rangan Chatterjee has been a practising GP for almost 20 years, and in his time in clinic, as the BBC’s Doctor in the House and teaching other clinicians, he’s encountered one particular health issue that’s mushrooming at an alarming pace, among women in particular: IBS .
Never has IBS been more prevalent than now, as Alison Reid, CEO at The IBS Network says: "In these challenging and uncertain times we've seen a substantial increase in people contacting us for help and support. Stress and anxiety play a significant part in triggering a flare-up for those living with IBS."
Chances are, if you haven’t experienced it yourself, you know at least one woman close to you who has – the NHS reports that two thirds of cases occur in women, many of whom have endured years of discomfort and severe symptoms before they receive a diagnosis. While there’s no definitive cause or cure and no concrete insight as to why women suffer more than men, Dr Rangan reckons it’s a condition that’s previously been trivialised and poorly understood by the medical profession.
Given that there’s been a ‘pain bias’ in medical history since the dawn of time, with a lack of research, associations with female hysteria and recent studies showing that women face longer delays at A&E, for diagnoses’ and often for medical treatment than men, it’s perhaps unsurprising that the impact of IBS has been on the whole brushed under the carpet. Here’s Dr Rangan's guide to getting your IBS properly assessed, why your digestive health could be linked to your mental health, and how IBS consideration and treatment is changing for the better.
Why IBS is on the rise
As The IBS Network pointed out, there's been a sharp rise of cases in 2020 and stats show that 20 per cent of the UK population will suffer from IBS symptoms at some point. That’s one in five of us and it’s an epidemic. It’s partly to do with the food we’re eating, but also the gut-brain connection. I always tackle food with IBS patients, but monitoring stress levels is just as important. I can’t get patients better unless we address both at the same time.
IBS is predominantly a Western, modern problem. More traditional societies and communities such as the Hadza tribe in Tanzania don’t get IBS. There’s something within the lifestyle that we live, be it stress levels, gut bacteria, our food habits or all of these combined that’s making IBS cases soar. Interestingly, in my private clinic, patients that come to me suffering with IBS are almost exclusively women, normally between 35 and 55. Many also have anxiety problems and I’m convinced that’s strongly linked. To put this into perspective, IBS now makes up at least half of my clinic day.
IBS is thought of as a diagnosis of exclusion- if we don’t know what you’ve got after running a roster of tests, we’ll call it IBS. We’ve been derogatory about it before and patients have been convinced that it’s all in their heads. It’s not been taken seriously enough and patients have rightly felt let down.
How IBS treatment is changing
The trickiest element with IBS is that, when speaking about gut health, a lot of the foods that we’d recommend for a healthy gut environment can cause IBS flare-ups. This can include foods such as broccoli, cauliflower, onions, cabbage, or simply eating lots of fruit (the NHS recommends limiting fruit to a maximum of 240g per day if you suffer from IBS).
In IBS, your gut isn’t functioning as well as it should, so it’s not in a state to deal with certain foods, even if they’re technically ‘good for you’. Hence why the low FODMAP diet helps some patients, although it’s a short-term way to reduce symptoms. What you want to do is identify the ultimate cause of your digestive issues, fix that problem and introduce foods back into your diet. In medicine too often we don’t look for the root cause, we just treat a symptom. Say, for IBS related diarrhea , you’re told to take a medication that bungs you up, then for constipation you can take a laxative. I prescribed in this manner for years, but I wouldn’t approach IBS like this now- below is a rough outline as to how I address IBS with my patients.
3 new ways I’m treating IBS
Bugs and breathing
Your gut bugs should all live in your colon, but modern living means that they’re increasingly ending up in your small intestine, leading to discomfort, bloating, constipation and other complaints. This is called small intestinal bacterial overgrowth ( SIBO ), and it’s a big cause of IBS- your gut bugs have a party where they shouldn’t and cause a spike in symptoms, especially when you’ve eaten the kind of fibre rich foods that are normally good for you. Rather than cut these foods out long term, the key is to fix SIBO itself. It’s not a case of bad bugs, it’s that the bugs are in the wrong place. I’ve seen improvements by way of antibiotics, funnily enough, but probiotics [Dr Rangan recommends Symprove , £79 for one month's supply] have shown remarkable results too and the NHS now recommends trying a course of probiotics for at least a month to see if they help.
Lifestyle and stress also impact on digestion and gut function- we’re designed to digest food in relaxation mode, so eating at your desk is one of the worst things you can do for gut health. Being in fight or flight mode means that reaction times are sharper, but as a sacrifice elements such as our digestion and libido switch off. Resources are diverted to make the stress hormone cortisol. If we live our lives in fight or flight, it doesn’t matter how organic or ‘wholefood’ our diet is- we’re not going to digest food and its nutrients properly.
To combat this, I recommend trying the ‘3-4-5’ breathing technique. You breathe in for three seconds, you hold your breath for four seconds and then you breathe out for five seconds. When you breathe out for longer than you breathe in, you promote relaxation and help to clear the body of heightened cortisol. I ask my IBS patients to do this for a minute before every meal, away from their desks. It’s easy, simple and has a remarkable effect when it comes to reducing bloating after a meal.
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Check your vitamin D levels
IBS can be seasonal- sun and time outdoors definitely have a beneficial effect, and vitamin D could play a part in this. The fact that every cell in our body has a vitamin D receptor shows you how vital it is in our body, yet around a quarter of the UK population is deficient in vitamin D, rising to a third during the winter months.
Vitamin D actually works as a hormone, and it’s linked to our immune function, bone strength and potentially IBS too. I’ll optimise vitamin D in every single one of my patients, no matter their health issue. A bit like gut health, vitamin D is related to our overall wellbeing in so many different ways. I won’t give patients supplements if they have optimal levels already, but if they’re a bit low I’d do that straight away. If you’ve got IBS and low vitamin D levels, increasing vitamin D may well help your symptoms. I’ve seen it happen for one recent patient of mine in particular, and while vitamin D isn’t the holy grail of IBS treatment, when we look at our health in a holistic fashion, addressing deficiencies is a good place to start.
Movement and ‘me time’
I’d recommend a minimum of ten minutes of ‘me time’ a day for IBS patients. General downtime, listening to music, reading- all can work wonders, especially alongside the likes of temporary elimination diets where we cut out foods that seem to cause flare-ups.
Add in movement, which definitely doesn’t just mean the gym (walking is as efficient), plus possibly a probiotic, and you may nail it. It’s not easy, and eight years ago I didn’t believe it was possible to cure IBS, but I passionately believe that patients can live symptom-free. It’s so debilitating, so it’s worth taking on every angle. One reason that I think that IBS is so prolific in women is that they don’t get a chance to relax or breathe, or they put pressure on themselves to smash tough gym workouts, which can cause cortisol levels to soar on days that are already stressful, or when they’re sleep deprived . Add in bolting food down because you don’t have enough time in the day for yourself, and IBS is all the more likely to escalate. Swapping to more gentle forms of daily exercise and prioritising your wellbeing, starting with a non-negotiable ten minutes a day, can make a lot of difference.
There’s currently no cure for IBS if you look at it at symptom level, but if you cure SIBO, your IBS may disappear as a result. We’ll never tackle this in one area- as with many modern health problems we now face, it’s a bigger issue, but listening to patients, going beyond symptoms to identify the real crux of any problems and empowering patients with the tools they need to stay well is the way we need to be going.
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