It’s not uncommon, as a GP, to see patients with irritable bowel syndrome (IBS) who have been suffering with the distressing and embarrassing symptoms of the condition for years.
Take Tim – not his real name – who arrived in my clinic recently after enduring debilitating diarrhoea for four years.
He had been diagnosed with IBS years earlier after tests ruled out more serious conditions, including bowel cancer and inflammatory bowel disease. But he had been left with the impression that there was little that could be done about it.
So he simply learned to live with it. And he is far from alone.
IBS causes stomach cramps, bloating, diarrhoea and constipation and, while the condition is on the rise in the UK, many patients who are diagnosed get conflicting advice about how to manage it, or none at all.
The result is that countless people spend years putting up with symptoms that can make everyday life miserable.
Yet I believe that, for many, this suffering is avoidable. That’s because there is a dietary approach that can dramatically improve symptoms for some people with IBS – but many patients who could benefit from it are not being offered it on the NHS.
First, though, it’s important to understand what IBS actually is – and what may be behind its rise.
IBS diagnoses are rising, perhaps partly because people are more willing to talk about bowel problems than they once were. Even celebrities, such as reality TV star Millie Mackintosh (pictured), have spoken about living with IBS
Unlike inflammatory bowel diseases such as Crohn’s and ulcerative colitis, IBS does not cause damage or inflammation that can be detected on routine tests or scans. Instead it is diagnosed based on symptoms – including stomach pain, bloating, diarrhoea and constipation – while ruling out other possible causes. The exact cause is unknown, but IBS is thought to involve changes in the way the gut and brain communicate. Food may move through the bowel too quickly or too slowly, while the nerves in the gut can become unusually sensitive.
A stomach bug can trigger the condition while stress can worsen symptoms. Studies have also linked IBS with irregular eating and diets high in ultra-processed foods.
Diagnoses are rising, perhaps partly because people are more willing to talk about bowel problems than they once were. Even celebrities, such as reality TV star Millie Mackintosh, have spoken about living with IBS.
Yet while awareness has improved, many patients are still left believing there is little they can do to prevent their symptoms.
That simply isn’t true. There is good evidence one nutritional approach – called the low-FODMAP diet – can improve significantly symptoms in many people with IBS.
FODMAPs are a group of carbohydrates that are poorly absorbed by the gut. As a result, they can draw water into the bowel and are rapidly broken down by gut bacteria, producing gas – which can trigger bloating, pain and diarrhoea in IBS sufferers.
They are found in a range of foods, including certain fruits and vegetables, onions, garlic, wheat and some dairy products.
The diet involves temporarily cutting out foods high in FODMAPs to see whether symptoms improve. This can be challenging at first because so many everyday foods are affected – but the restrictions are not meant to be permanent.
After a few weeks, foods are reintroduced one at a time to identify which particular FODMAPs trigger symptoms. The idea is that patients can then avoid or limit only their personal triggers while returning to as normal a diet as possible. Studies show this approach can significantly improve symptoms and quality of life in those with IBS.
However, at present, GPs are not supposed to simply recommend that patients try the diet. NHS guidance says the low-FODMAP approach should be delivered by a healthcare professional with expertise in dietary management – typically a specialist dietitian. This is because there are worries that, without the advice of a specialist, the early stages of the diet can lead to malnutrition. It’s an understandable position – but the problem is that there are around 4,500 dietitians working in the NHS, while there are, by some estimates, as many as 10 million people living with IBS.
It is impossible for every patient to be seen by a dietitian, so what’s the solution?
There is good evidence that another popular diet is naturally low in fermented carbohydrates. This is the famous Mediterranean diet, which contains mostly plants, fish, whole grains and olive – with little meat, dairy and sugar.
The diet has been linked to a lower risk of heart disease, cancer and death. But it would seem it also reduces IBS symptoms.
The Mediterranean diet isn’t quite as effective as the FODMAP diet – probably because it contains some fermented carbohydrates – but studies show patients who follow the Mediterranean diet see a significant reduction in symptoms.
This doesn’t change the fact that the NHS should make it easier for GPs to recommend the FODMAP diet. But for those who want to tackle their symptoms today, I think the best thing is the Mediterranean diet – that’s why I recommended it to Tim.
IBS is not curable but, with the right steps, it can be controlled.
IBS causes stomach cramps, bloating, diarrhoea and constipation and, while the condition is on the rise in the UK, many patients who are diagnosed get conflicting advice about how to manage it, or none at all (picture posed by model)
Have you been left in agony by the NHS?
I am increasingly frustrated that so many of my patients are unable to access chronic pain services on the NHS.
Defined as pain that lasts for more than three months, the condition can be triggered by a range of conditions from arthritis to bowel disease and the after-effects of cancer treatment.
In some cases, it can have no clear cause. Whatever the reason, chronic pain can blight lives, damaging relationships and ruining careers. For most, the best way to ease the suffering is to treat the underlying condition. But when this fails, patients should be sent to a pain specialist, who can offer complex tailored treatments that a GP cannot.
The problem is that waiting lists for these NHS specialists have never been longer.
These days, when I try to refer patients to local clinics, the request is often rejected due to high demand.
Have you tried and failed to access pain services? Please write in and let me know.
Your questions answered
I get cold hands and feet in cold weather and I’m dreading autumn. I wear thick socks and gloves nearly all the time but it’s bulky and uncomfortable. Is there anything else I can do?
Dr Ellie replies: Cold hands and feet can be a sign of a common circulation issue called Raynaud’s disease.
This is a condition where the blood vessels at the end of the fingers and toes spasm, meaning no blood gets in. As a result, the fingers go white and cold. Patients often report a numb or tingling feeling.
In many cases, Raynaud’s is triggered by a separate medical condition, such as arthritis or certain blood diseases. However, it can also be autoimmune – where the immune system accidentally attacks healthy tissue.
Unfortunately, there is no cure for Raynaud’s but there are steps that can be taken to ease the symptoms.
Sufferers are often recommended to keep their whole body warm, rather than just the hands and feet, as this can improve general circulation. This might mean wearing an extra jumper, prioritising warm footwear and remembering to go out with a hat.
Thermal vests and underlayers to keep the core warmer will help.
There is also evidence that exercise can reduce Raynaud’s flare-ups by improving blood circulation.
However, there is a medication that can help – a tablet called nifedipine, ordinarily used as a blood pressure treatment, which has been shown to relieve symptoms.
A GP should be able prescribe this drug to anyone with severe or persistent Raynaud’s.
Do you have a question? Email DrEllie@mailonsunday.co.uk
