Irritable Bowel Syndrome (IBS) Information

Introduction

There are many conditions in Western industrialised societies today that were unheard of, or at least very rare, just a century ago. The same conditions are still unheard of in primitive peoples who do not have the 'benefits' of our knowledge. There is a very good reason for this: They eat what Nature intended; we don't. The diseases caused by our incorrect and unnatural diets are those featured on these pages.

Dietary causes:

Introduction

IBS is a common but poorly understood disorder that causes a variety of bowel symptoms including abdominal pain, diarrhoea and/or constipation, bloating, gassiness and cramping. While these symptoms may be caused by a number of different bowel diseases, IBS is usually diagnosed only after your doctor has ruled out the possibility of a more serious problem. Its severity varies from person to person. Some IBS patients experience intermittent symptoms that are just mildly annoying, while others may have such severe daily bowel problems that IBS affects their ability to work, sleep and enjoy life. In addition, IBS symptoms may change over time, such that an individual may have severe symptoms for several weeks and then feel well for months, or even years. Under normal circumstances, most people are never cured of IBS but, again, all that may be needed is that you reduce your intake of carbs. It is amazing how quickly this can work.

The idea that unrefined foods have an important influence on health goes back at least to Hippocrates. Writing in 1585, Stubs asked pointedly: 'Doe we not see the poore man that eateth browne bread health fuller, stronger, fayrer complectioned and longer living than the other that fare daintelie every day?'[1]

Prior to the mid twentieth century dietary fibre, which was then called 'roughage', was regarded as harmful. In people with gut disorders such as diverticular disease, the advice was to avoid bran and adopt a low-fibre diet. Later, the notion that constipation was central to human disease gave rise to some quaint practices and a huge breakfast-cereal industry. Population studies in East Africa seemed to show a protective effect of fibre[2] and high-fibre diets became the fashion. Dr Dennis Burkitt and colleagues were concerned with colon cancer, diverticular disease and constipation. By implication IBS was also included in this group. And so high-fibre diets became the standard treatment for IBS, even though the effectiveness of this treatment on IBS had never been tested.

Fibre causes IBS

So by the 1980s, fibre had been a popular way to treat IBS for about ten years, and despite there being several studies between 1976 and 1985, they showed no convincing effect of bran on overall symptom patterns in IBS. In addition doctors noticed that there seemed to be little evidence that the practice helped IBS patients. In 1987, doctors at St Bartholomew's Hospital, London, set out to rectify this by conducting a trial of bran in IBS.[3] Two groups of IBS patients were fed either high-bran biscuits or low-bran biscuits as a placebo for three month periods, and then the two groups were swapped for a second three months. Naturally the IBS patients weren't told which biscuits they were getting, although some may have guessed. The overall responses indicated that bran was not helpful, as IBS in both groups improved significantly with both the bran biscuits and the placebo biscuits with no significant difference in IBS symptoms between the two groups. In 1994, doctors at the University Hospital of South Manchester, looking at the weight of evidence so far, say 'we got the impression that wholemeal wheat and bran products made people with the condition worse rather than better'. So they did a trial — and proved that their impressions were correct. They conclude that their evidence 'suggest that the use of bran in irritable bowel syndrome should be reconsidered' as there was a 'possibility that excessive consumption of bran in the community may actually be creating patients with irritable bowel syndrome by exacerbating mild, non-complaining cases'.[4]

The weight of all the evidence suggests that bran, wholemeal bread and wholemeal cereals are more likely to cause IBS than they are to cure it. Also, because it is indigestible, bran ferments in the gut and can induce or exacerbate flatulence, distension and abdominal pain.[5] And it is the same story with diverticular disease.

Fruit may also cause IBS

A study presented by Young Choi and colleagues from the University of Iowa to the American College of Gastroenterology, built on previous research showing that between one third and one half of patients suffering from IBS symptoms are fructose intolerant.[6] Fructose is the sugar found in fruit.

The team initially tested 80 patients suspected of having IBS for fructose intolerance, and confirmed IBS in 30 (37.5%). The IBS patients were then instructed on how to eliminate fructose from their diet and, after a year, 26 were interviewed to assess their IBS symptoms. The team also reported that in 13 IBS patients who complied with the fructose-restricted diet, IBS symptoms such as abdominal pain, bloating and diarrhoea were significantly reduced, as was the prevalence of IBS itself. IBS symptoms remained unchanged in patients who did not comply with the diet.

AJ came to a weight-loss class I was running, although she wasn't really overweight. The diet was low-carb, high fat, as I advocate on this website. Two weeks in, she hadn't lost any weight. But, she told, she was still delighted because 'My IBS, which I have had for years, has cleared up'.

References

[1]. Stubs P. The anatomie of abuses. London, 1585, p61.
[2]. Burkitt DP, et al. Effect of dietary fibre on stools and transit times, and its role in the causation of disease. Lancet 1972; ii: 1408-11.
[3]. Lucey MR, et al. Is bran efficacious in irritable bowel syndrome? A double-blind placebo controlled cross-over study. Gut 1987; 28: 221-5.
[4]. Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994; 344: 39-40.
[5]. Editorial. The Bran Wagon. Lancet. 1987; i: 782-3.
[6]. 68th Annual Scientific Meeting of the American College of Gastroenterology, Baltimore, Maryland, USA, October 2003