IBS is actually what brought me to nutritional therapy in the first place.
I struggled with it really badly in my younger years and know first-hand how debilitating digestive symptoms can be. The bloating, the pain, the unpredictability, the anxiety around food, the effect it can have on confidence, social situations, work and everyday life. When your gut feels broken it can affect far more than just your digestion.
The good news is that I have managed to almost completely eliminate my own symptoms. Of course, we all get the odd digestive symptom from time to time, that's perfectly normal. The difference is that IBS no longer affects my day-to-day life, and it hasn't for many years.
That doesn't mean everybody's journey will be the same, but it does mean I understand both personally and professionally how much symptoms can improve.
I also have a real passion for this area because there is now so much more research than there was when I wrote my dissertation on IBS nearly 18 years ago. Our understanding of the gut, the microbiome, the nervous system, the immune system and the gut-brain connection has advanced hugely.
Since then, I have worked with hundreds of people with IBS and digestive complaints, and one thing has become very clear.
IBS is a very individual condition.
What is IBS?
IBS, or Irritable Bowel Syndrome, is currently classified as a disorder of gut-brain interaction.
Doctors use recognised diagnostic criteria based on symptoms, whilst also considering whether other conditions may need investigating. These might include inflammatory bowel disease, coeliac disease and other gastrointestinal conditions that can present with similar symptoms.
The diagnosis itself is based on symptoms such as abdominal pain, bloating, diarrhoea, constipation or a combination of both.
The word syndrome is important here.
A syndrome simply refers to a collection of symptoms that tend to occur together. It doesn't look at why those symptoms have developed.
From a medical perspective, the diagnosis is important.
For me, however, a diagnosis of IBS is usually the starting point rather than the conclusion.
Once somebody has been diagnosed, I want to understand how their symptoms developed, what factors may be contributing to them, what might be maintaining them and, most importantly, what may help improve them.
That's where the detective work begins.
What Does the Research Tell Us?
One of the reasons IBS can be confusing is that it isn't a single condition with a single explanation.
Research over the last couple of decades has shown that IBS is far more complex than we once thought. We now know that factors such as gut-brain communication, gut motility, the microbiome, immune activity, previous infections, hormones and psychological stress may all play a role.
Not everybody with IBS will experience the same combination of these factors, which helps explain why symptoms can look very different from one person to the next.
This also helps explain why there is rarely a single diet, supplement or treatment approach that works for everybody.
What I Look For in Clinic
One of the first things I do is ask lots of questions.
I want to understand when symptoms started, how they have changed over time and what else was happening around that period.
Was there a gut infection beforehand?
Several courses of antibiotics?
A particularly stressful time?
Hormonal changes?
A major life event?
Sometimes the clues are obvious and sometimes they are much less so.
Over the years, I've found that taking the time to understand somebody's story often helps make sense of symptoms that previously felt random, confusing or unpredictable.
Many people arrive feeling frustrated because they have tried numerous diets, supplements and pieces of advice without really understanding what may be influencing their symptoms.
My role is to help make sense of that picture and build a plan that is appropriate for them as an individual.
Looking Beyond the Gut
Although IBS is considered a digestive disorder, many of the people I see are dealing with much more than bloating, constipation or diarrhoea.
They may also be experiencing fatigue, brain fog, sleep disturbances, headaches, anxiety, food sensitivities, hormonal symptoms or histamine-related symptoms.
This doesn't mean IBS is causing all of these symptoms. However, it does remind us how interconnected the body's systems are, particularly the gut, and why it can be helpful to look at health as a whole rather than focusing exclusively on digestive symptoms.
What Improvement Often Looks Like
One thing I have noticed over the years is that people often underestimate how much progress they have made.
Many clients arrive feeling restricted by their symptoms.
They avoid certain foods.
They worry about travelling.
They worry about eating out.
They spend a huge amount of mental energy trying to manage their gut.
As symptoms begin to improve, the changes are often gradual.
People start to be able to eat a wider range of foods.
They feel more confident going out.
They think about their symptoms less.
Their world becomes bigger again.
One of the most common things I hear is:
"I'd forgotten how bad it used to be."
My View on IBS
IBS is a very real condition and the symptoms can have a significant impact on quality of life.
The diagnosis matters, but the questions I'm usually asking are different.
How did these symptoms develop?
What factors may be contributing to them?
What might be maintaining them?
And what practical steps might help improve them?
After working with hundreds of people with IBS, I've learned that whilst the diagnosis may be the same, the story behind it rarely is.
That's why I believe IBS should always be approached as an individual condition and why, for me, a diagnosis of IBS is often the beginning of the investigation rather than the end of it.
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