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.
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who → see → years
Take Tim – not his real name – who arrived in my clinic recently after enduring debilitating diarrhoea for four years.
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who → take → years
He had been diagnosed with IBS years earlier after tests ruled out more serious conditions, including bowel cancer and inflammatory bowel disease.
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tests → diagnose → cancer
But he had been left with the impression that there was little that could be done about it.
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that → leave → it
So he simply learned to live with it.
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he → learn → it
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.
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who → cause → it
The result is that countless people spend years putting up with symptoms that can make everyday life miserable.
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life → spend → symptoms
Yet I believe that, for many, this suffering is avoidable.
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suffering → believe → many
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.
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who → ’ → NHS
First, though, it’s important to understand what IBS actually is – and what may be behind its rise.
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what → ’ → rise
IBS diagnoses are rising, perhaps partly because people are more willing to talk about bowel problems than they once were.
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they → rise → problems
Even celebrities, such as reality TV star Millie Mackintosh (pictured), have spoken about living with IBS
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celebrities → picture → 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.
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that → cause → tests
Instead it is diagnosed based on symptoms – including stomach pain, bloating, diarrhoea and constipation – while ruling out other possible causes.
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it → diagnose → causes
The exact cause is unknown, but IBS is thought to involve changes in the way the gut and brain communicate.
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gut → think → way
Food may move through the bowel too quickly or too slowly, while the nerves in the gut can become unusually sensitive.
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nerves → move → gut
A stomach bug can trigger the condition while stress can worsen symptoms.
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stress → trigger → symptoms
Studies have also linked IBS with irregular eating and diets high in ultra-processed foods.
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Studies → link → foods
Diagnoses are rising, perhaps partly because people are more willing to talk about bowel problems than they once were.
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they → rise → problems
Even celebrities, such as reality TV star Millie Mackintosh, have spoken about living with IBS.
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celebrities → speak → IBS
Yet while awareness has improved, many patients are still left believing there is little they can do to prevent their symptoms.
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they → improve → symptoms
There is good evidence one nutritional approach – called the low-FODMAP diet – can significantly improve symptoms in many people with IBS.
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approach → be → IBS
FODMAPs are a group of carbohydrates that are poorly absorbed by the gut.
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that → absorb → 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.
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which → draw → sufferers
They are found in a range of foods, including certain fruits and vegetables, onions, garlic, wheat and some dairy products.
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They → find → fruits
The diet involves temporarily cutting out foods high in FODMAPs to see whether symptoms improve.
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symptoms → involve → FODMAPs
This can be challenging at first because so many everyday foods are affected – but the restrictions are not meant to be permanent.
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restrictions → affect → ?
After a few weeks, foods are reintroduced one at a time to identify which particular FODMAPs trigger symptoms.
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FODMAPs → reintroduce → symptoms
The idea is that patients can then avoid or limit only their personal triggers while returning to as normal a diet as possible.
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patients → avoid → diet
Studies show this approach can significantly improve symptoms and quality of life in those with IBS.
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approach → show → IBS
However, at present, GPs are not supposed to simply recommend that patients try the diet.
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patients → suppose → diet
NHS guidance says the low-FODMAP approach should be delivered by a healthcare professional with expertise in dietary management – typically a specialist dietitian.
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approach → say → management
This is because there are worries that, without the advice of a specialist, the early stages of the diet can lead to malnutrition.
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stages → be → 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.
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problem → ’ → IBS
It is impossible for every patient to be seen by a dietitian, so what’s the solution?
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solution → see → dietitian
There is good evidence that another popular diet is naturally low in fermentable carbohydrates.
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diet → be → carbohydrates
This is the famous Mediterranean diet, which contains mostly plants, fish, whole grains and olive oil – with little meat, dairy and sugar.
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which → contain → meat
The diet has been linked to a lower risk of heart disease, cancer and death.
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diet → link → disease
But it would seem it also reduces IBS symptoms.
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it → seem → symptoms
The Mediterranean diet isn’t quite as effective as the FODMAP diet – probably because it contains some fermentable carbohydrates – but studies show patients who follow the Mediterranean diet see a significant reduction in symptoms.
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who → contain → symptoms
…and 29 more, not listed.
The Aporia
