Hard to stomach: Overcoming IBS
Irritable bowel syndrome makes life hell for one in five Britons. But Karen Attwood found a way to control her symptoms – without giving up her favourite treats
Irritable bowel syndrome is an embarrassing illness. The symptoms are unpleasant: painful stomach cramps, bloating, diarrhoea and constipation, and in the worst cases can be so debilitating as to prevent people from working. Yet IBS affects one in five people – many of whom are suffering in silence – and is twice is common in men as in women.
I was 22 when I first started having problems with my digestion, but the symptoms of IBS crept up on me so gradually that for the first six months I didn't realise there was anything wrong. I was living in the countryside in the southern Japanese island of Kyushu, where hardly anyone spoke English. As a consequence, I was lonely and often very stressed, and these feelings were compounded by trying to keep up a long-distance relationship with my boyfriend at the time who was living in London. My weekends were spent with friends karaoke bars, and initially I just put down my IBS-related symptoms to too many nights on the beers and cocktails.
My diet had also changed. I had been vegetarian for six years but in Japan I started to eat fish, as it would have been almost impossible to live there without it. I was teaching English in junior high schools and began to drink a bottle of school milk every day with the students, as I thought I could do with the protein and calcium. This, I know now, was probably the worst thing I could have done.
I started to suffer from excruciating stomach cramps and my digestive system became more and more messed up. Worried I was suffering from Crohn's disease, which is a chronic inflammatory condition of the gastrointestinal tract, the stress made my symptoms worse.
Eventually, I took myself off to a hospital to find out what was wrong. My Japanese was getting much better and with the help of an electronic dictionary I discovered that geri was the Japanese for diarrhoea and somehow managed to explain a little of what was wrong to a doctor. However, unimpressed by my mostly vegetarian diet, his sole piece of advice was to tell me to avoid drinking orange juice. As I had been caning a couple of cartons a week, I thought he probably had a point and immediately cut it out of my diet.
My symptoms persisted, on or off, for the rest of my four-year stay in Japan but I was never in the UK long enough to get to a doctor to sort it out. As it never got so bad that I couldn't leave my home, I just assumed I would have digestive problems for the rest my life and tried to put it to the back of my mind.
On my way back to the UK, I paid a visit to my brother who was living in Arizona. Seeing me looking painfully thin after I had experimented in cutting out wheat and dairy from my diet, he immediately sent me off to see a specialist who booked me in for a sigmoidoscopy, which is a scary-sounding examination of the lower part of the large bowel. It was actually a painless procedure and the doctor assured me he could see nothing serious that could point to cancer in the lower bowel. Shortly after, back home and living in London, I registered with my GP who immediately booked me in for a colonoscopy, a more detailed examination of the whole of the large bowel, and a series of allergy tests.
The main purpose of the exam – to rule out Crohn's – showed I didn't have the more serious disease, and the allergy tests revealed I was mildly lactose intolerant. My milk habit had not been one of my greatest ideas and had perhaps been one of the triggers for IBS.
IBS is not an illness as such. It is generally diagnosed when doctors can't find anything else wrong to explain the symptoms. Still, to have a diagnosis after five years of distress and hospital visits was a massive relief. It confirmed I had nothing life-threatening and also meant I could now work around trying to manage the problem.
IBS is one of those mystery ailments that affects a large proportion of the population but doesn't have an obvious cause. It is believed to be linked to stress, which would explain why I developed it in Japan, while certain foods are thought to be triggers, provoking bouts of the disease.
As NHS Direct explains: "The precise cause of irritable bowel syndrome is unknown. The condition often begins during a period of emotional stress and symptoms worsen in stressful situations. Up to 60 per cent of people with the syndrome have psychological symptoms such as anxiety and depression. The disorder sometimes develops after a gastrointestinal infection. An increased sensitivity or intolerance to certain foods may also contribute."
There is no cure for IBS, though the symptoms do often ease or even disappear. So, once I had a label for my condition, I experimented with ways of controlling it. I started out with colonic irrigation, which is recommended to flush out the bowel, but it is not for the faint-hearted. I decided two sessions was more than enough, but I believe it kick-started my sluggish system into action.
At the same time, on the advice of the therapist, I cut out wheat, gluten, dairy, meat, alcohol and caffeine, in fact almost all things that makes eating and drinking fun, and also took a course of probiotic supplements to add healthy bacteria to my gut.
I was supposed to keep a food diary and gradually introduce items into my diet so that I could work out what affected me most. But I found it difficult to stick to the diet and soon got bored on an alcohol-free, wheat-free diet. Although I have more or less given up caffeine, I didn't want to cut out bread, pasta and alcohol all together.
It was then that I had a bit of a breakthrough. My mum gave me Dr Gillian McKeith's You Are What You Eat book with its explanation of a "food separation diet". The TV presenter is not a medical doctor, but her regime has helped to turn my life around. She advises those with a weak digestive system to avoid eating proteins and carbohydrates together as it makes them more difficult to digest, so tuna steak and salad for lunch is fine but not tuna steak and potatoes. And most important of all she says never eat fruit after a meal as it is the easiest food to digest. If eaten after a meal it can get stuck behind other foods, causing it to ferment in the stomach.
She also advises drinking warm water with lemon first thing in the morning instead of cold water which acts as a freeze on the system, and chewing food slowly. The last is perhaps an obvious suggestion but as I used to almost gobble my meals whole, it had an impact on my ability to digest.
Although I was only able to stick to food separation for a couple of weeks, my IBS symptoms gradually disappeared over the next six months until I realised that I was more or less "cured". Not everything can work for everyone. But I believe that by taking on board those suggestions that appeared to do me some good and combining this with a balanced diet packed with fresh vegetables, I have improved my general well-being.
I am also now convinced my digestive system got wrecked through years of abuse at university, through far too many late nights on the booze, and was compounded by the stress of living in Japan in an unhappy relationship. By taking the time to cleanse the system and giving my body a break, I am now able to eat all those foods that I was advised to avoid.
If you experience persistent diarrhoea, constipation, stomach cramps and bloating, visit your GP, who may suggest a colonoscopy.
Get tested for food allergies and intolerances – many tests are free on the NHS.
Consider colonic irrigation to cleanse the system
Try a food separation diet, eating fruit separately from other foods, and eating carbohydrates and proteins separately. Vegetables can be eaten with either carbs or proteins.
Start the day with warm water with lemon to kick-start your system
Eat a balanced diet packed with fresh and raw vegetables
What is IBS?
The most common symptom is crampy abdominal pain and bloating, which may be relieved or worsened by opening the bowels or passing wind. Sufferers may also have constipation or constant diarrhoea and often find they have an urgent need to open the bowels, especially in the mornings.
Some sufferers find their symptoms are worsened by alcohol, caffeine, or by spicy foods. Emotional stress appears to exacerbate symptoms for many. The artificial sweetener sorbitol, found in many sugar-free gums, has been found to be a trigger in some people.
The cause of IBS is not known, but it is thought that the normal contractions in the bowel wall are stronger and more frequent in people with IBS. Some people develop IBS after previously having gastroenteritis.
Depending on symptoms, your doctor may want to perform tests to rule out other conditions.
There is no cure for IBS, but most sufferers find they can gain some control over their symptoms by avoiding trigger foods, drinking plenty of water and taking regular, moderate exercise. Stress management techniques may also help.