Irritable Bowel Syndrome – Diarrhoea Dominant
Irritable bowel syndrome (IBS) is the name they use for the gastrointestinal disorder is which the patient shows symptoms of abdominal pain (relieved by defecation), and either diarrhoea or constipation or an alternating between the two. The Bristol Stool Chart (see post here) is used along with the Rome IV criteria when making a diagnosis and determining which (diarrhoea (IBS-D) or constipation (IBS-C)) is dominant (Lacy, 2016).
Below is the diagnostic criteria for IBS.
Pathophysiology: It is suggested that diet may come into play with causing IBS-D and the hypersensitivity that is associated with IBS-D. Such as alterations in the gastrointestinal microbiome, increased gastrointestinal permeability, increased proinflammatory responses (either from food sensitivities or the disruption in the microbiome) (Lacy, 2016).
There is some research to suggest that an altered serotonin production may contribute to the increased transit time (see post here about transit times), as serotonin is thought to be an excitatory neurotransmitter. Serotonin is partly made in the gastrointestinal tract and is both used and controlled by the enteric nervous system. Serotonin modulates functions in the gastrointestinal tract such as motility, absorption, mucosal secretion, regulate blood flow, and is involved in immune function! So much we still do not know about this amazing neurotransmitter (Lacy, 2016).
What can it do for your quality of life?
IBS-D is known to reduce the quality of life for those who are impacted by it, with common associations of anxiety, depression, lost working days, and a decreased sense of intimacy (Andrae et al., 2013).
Some RED FLAGS
If you have symptoms of IBS-D and the one of the following, a check up with your doctor is recommended; (Lacy, 2016).
- Anaemia: may suggest colon cancer or celiac disease
- Family history of IBD: may suggest irritable bowel disease (IBD)
- Needing to use the toilet to defecate at night (diarrhoea): colorectal cancer, microscopic colitis or IBD
- Symptoms start after 50 years of age: may suggest microscopic colitis or colon cancer
- Recent use of antibiotics: may suggest colitis or an overgrowth of clostridium difficile
- Rectal bleeding: may suggest IBD, haemorrhoids, or colon cancer
- Weight loss (unintentional): may suggest Ischemic colitis, IBD, celiac disease or colon cancer
- Persistent diarrhoea without passing any blood: may suggest bile acid malabsorption
- Persistent bloating/diarrhoea that is unresponsive to diet changes: may suggest Small intestinal bacterial overgrowth or SIBO.
Dietary treatment options
Probiotics: I’m a fan of probiotics, but not just any probiotics, and certainly not random strains put together in a bottle and marketed as “healthy”. As the goal is to get your gastrointestinal tract working as it should, specific probiotics are recommended based on symptoms and the evidence base for each strain.
FODMAPS/Keto/Gluten-free/Low carb diets: research is often contradictory when it comes to dietary modifications as treatment options for IBS-D (Lacy, 2016), while there is research out there, I would’ve liked to see more, as it can be a very valid treatment option – maybe one reason the studies contraindicate each other is because each person is an individual, and what one person might be sensitive to, another may not. A low-FODMAPS diet has the most research currently, and while showing beneficial results, it is recommended that any dietary restrictions are undertaken under the care of your health professional to avoid any dietary deficiencies.
Anti-inflammatory Diet: The Center for Applied Nutrition has some awesome resources for an anti-inflammatory diet for IBD. This is based on the Specific Carbohydrate Diet, which has been used for IBS.
They recommend eating probiotic-rich food like yoghurt, kimchi, sauerkraut, and miso, alongside prebiotic-rich food (soluble fiber as these support stool consistency and help modulate gastrointestinal motility such as steel-cut oats, cooked really well.
While avoiding pro-inflammatory carbohydrates such as lactose, wheat, refined sugar or sucrose, and corn. Go check out their website to gain a deeper understanding of what an anti-inflammatory diet might include, or alternatively, click HERE to book in with me now for your comprehensive check-up and personalized treatment plan.
NICE Guidelines: Recommends: regular meal pattern; adequate fluids; increase soluble fiber where needed. While limiting caffeine, alcohol, fat, fizzy drinks; reducing fiber and resistant starch; limit fruit to 3 portions per day.
As with all dietary treatment options, if you are restricting whole food groups, it is recommended that you work with a qualified practitioner as to reduce the likelihood of becoming deficient in certain vitamins and minerals. If you would like to visit a naturopath to talk about your bowel habits, dietary needs, or for a comprehensive check-up, click HERE to book in with me.
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Andrae, D. A., Patrick, D. L., Drossman, D. A., & Covington, P. S. (2013). Evaluation of the Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire in diarrheal-predominant irritable bowel syndrome patients. Health and Quality of Life Outcomes, 11(1), 1–12. https://doi.org/10.1186/1477-7525-11-208
Lacy, B. E. (2016). Diagnosis and treatment of diarrhea-predominant irritable bowel syndrome. In International Journal of General Medicine (Vol. 9, pp. 7–17). Dove Medical Press Ltd. https://doi.org/10.2147/IJGM.S93698
Tuck, C. J., & Vanner, | S J. (2017). Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions. Neurogastroenterology & Motility. https://doi.org/10.1111/nmo.13238