Multiple Sclerosis, Leaky Gut And IBS Part 2
Wow! I got some really great feedback, questions and emails regarding my take on “Leaky Gut” in part 1 of this months focus on multiple sclerosis and GI symptoms. I do respect a a variety of viewpoints on this and all issues but when it comes down to offering my clinical guidance on the matter I use the evidence to guide me. Just like I would expect my doctors to do. I look forward to the day when clinical research in humans can provide a better understanding of “Leaky Gut”,diagnostic criteria for the condition, the role it plays in the MS disease process and ultimately guidelines for treatment. Currently no such guidelines exist.
Unlike “Leaky Gut”, Irritable Bowel Syndrome (IBS) has diagnostic criteria and existing treatment guidelines. In fact, April is IBS Awareness Month so I am happy to spend some time answering questions I have received regarding IBS and MS. I have worked with quite a few clients who have found significant relief from IBS symptoms. What are your questions regarding MS and IBS?
What is IBS?
IBS is a functional gastrointestinal disorder (FGID), in which the gastrointestinal (GI) tract not functioning normally. IBS symptoms are not associated with structural abnormalities like with ulcers. Instead IBS is considered a disorder of regulation of GI function, which produces dysmotility and visceral hypersensitivity.
Is IBS an autoimmune disease/disorder?
No, IBS is not an autoimmune disorder.
How common is IBS and what factors contribute to the development of IBS?
Ten to twenty percent of all adults experience IBS symptoms.
Women seem to be more likely to develop it.
Increased stress can make IBS worse. And IBS symptoms can increase stress.
GI infections can make IBS worse.
Is IBS common in people with MS?
Very little research is available on the prevalence of IBS in people with MS. However, one study evaluating the issue found that IBS affected MSers nearly twice as often as the general population. Well that certainly seems unfair…..
What does IBS Feel like?
IBS symptoms include:
Feeling of Incomplete Emptying
Change in Stool Frequency or Consistency ( diarrhea or constipation predominant)
IBSD – Diarrhea predominant
Common symptoms with Diarrhea predominant IBS:
Sudden urge to have bowel movement
Accidents or loss of bowel control
IBSC – Constipation predominant
* Constipation is very common in people with MS and is not necessarily IBS-C. Abdominal discomfort or pain is a key symptom associated with IBS bowel function.
Constipation means different things to different people – even doctors. Doctors usually define constipation as hard pellet-like stools. Individuals usually think of constipation as…
difficulty or straining at stools
feeling of being unable to completely empty during a bowel movement
the sensation of wanting to go but not being able to
Common symptoms with Constipation predominant IBS
bloating and/or gas
How do I know I have IBS and not something else, like Celiac Disease?
There are no specific tests for IBS, as it does not cause any obvious detectable abnormalities in your digestive system. Self diagnosis of IBS (or anything else really) is not prudent. Many health conditions share similar symptoms with IBS. For example: Celiac Disease, Inflammatory Bowel Disease, some Gynecological or Bowel cancers, Diverticular disease to name a few. It is important to share your symptoms with your healthcare team.
That said, the IBS Diagnostic criterion based on the Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders is as follows:
Recurrent abdominal pain or discomfort** at least 3days/month in the last 3 months associated with two or more of the following:
Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form (appearance) of stool
Criterion fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
** “Discomfort” means an uncomfortable sensation not described as pain.
Symptoms not related to IBS that should definitely be shared with your MD include:
Unexplained weight loss
a swelling or lump in your stomach or back passage
Blood in your stool or rectal bleeding
Iron Deficiency anaemia
“After receiving an IBS Diagnosis I was told to increase the fiber in my diet. I did and it made the symptoms worse! What am I doing wrong?”
This is probably the single most frequently asked question that I get regarding fiber and IBS and it is a great example of how “the devil is in the details”. The detail that was missed here is that not all fiber is created equal. If you simply added lots of fiber but added the wrong kind it is possible that your symptoms worsened.
Fiber is a type of carbohydrate that the body can’t digest but in some cases can help you digest other food. Understanding the nuances of fiber certainly can be confusing! The fact that in nature many foods contain both soluble and insoluble fiber doesn’t help! Consider an apple or a potato. The peel is insoluble while the flesh is soluble.
Soluble: Fibers that form viscous gels and are fermented by colonic bacteria to form short chain fatty acids. Soluble fiber can be found in oats, some vegetables, fruits, dried beans and nuts /seeds. When water is added to food the soluble fiber thickens and becomes sticky, gummy and gel like.
Insoluble: Too much insoluble fiber can lead to visceral hypersensitivity in people with IBS. Insoluble fiber is found in the skins of vegetables, beans and fruit and the outer husk portion of whole grains.
….And then there are FODMAPs
What are FODMAPs?
FODMAP is an acronym, coined by Australian researchers from Monash University that refers to: Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols.
FODMAPs are specific carbohydrates in food that some people cannot fully digest or absorb. FODMAP carbohydrates include those containing lactose (milk, milk products), fructose (honey, fruit, high fructose corn syrup), fructans (wheat, certain vegetables), polyols (certain fruits, certain sugar-free foods), and galactans (beans, dried peas, soy).
FODMAPs are very common in our diet and many foods and beverages are sources of FODMAPs. FODMAPs ferment rapidly, and provide fast food for gut bacteria which can lead to a visceral hypersensitive response and some uncomfortable symptoms most notably gas and pain.
What should I do if I suspect IBS?
Discuss your symptoms with your doctor to rule out any other conditions that have similar symptoms as outlined above. If IBS is the source of your discomfort I recommend that you work with a registered dietitian to help get control over your symptoms and feel better. Triggers and symptoms vary from person to person and a dietitian can help to tailor an approach unique to your situation. There are a number of nutritional and behavioral factors that can be helpful in relieving IBS symptoms including a Low FODMAP Diet which is a short term elimination and education diet to help you identify specific symptom triggers. The goal is for you to have the most liberal, varied and health promoting diet you can enjoy without symptoms.
If you are looking for someone to help you find relief from your IBS symptoms, feel free to contact me to explore an individualized approach.
Eat better, feel better.