Catherine Jeans DipION mBANT CNHC Nutritional Therapist
The family nutrition expert and author of The 30 Day Sugar Detox Programme
One of the problems with IBS and digestive discomfort is that there are so many different symptoms, experienced in such a unique way by each individual sufferer. Also, those with IBS (irritable bowel syndrome) and other bowel issues find that their symptoms can change on a day to day or weekly basis, which makes it very difficult to know what to eat and how to manage symptoms.
In part 1 of this series, we looked at the different gut types and some of the possible underlying causes, then gave you practical tips on how to soothe bloating and cramping, as well as constipation. In this article, we’ll be looking at the next three groups of gut type symptoms, which include diarrhoea and urgency to go, excess wind and fatty stools, with practical dietary, lifestyle and supplement advice that you can start today.
Do remember – if your digestive system and bowel movement suddenly change, or you experience digestive issues, then you should see your GP to discuss further.
Diarrhoea, cramps and urgency to go: what can you do to relieve symptoms?
This can be a very distressing group of symptoms to experience – with the continual fear that you may lose control of your bowels or not be able to find the nearest toilet in time. Sometimes sufferers experience a “vicious cycle” of symptoms, where it’s the concern about being close to a toilet which can contribute to ongoing loose bowels.
When we are anxious and stressed, gut irritability is very common, including diarrhoea and urgency to go. So when I’m working with someone who experiences these symptoms, I always encourage them to address their stress levels and manage anxiety. This might be as simple as daily meditation – just 10 minutes can make a huge difference and there are some really great apps you can get now such as Buddhify, Headspace and Smiling Mind. Look at ways to manage your stress levels, such as prioritising important tasks and finding ways not to sweat the small stuff. Many of my clients have also found hypnotherapy very useful, giving them simple tricks and tips they can use every day to help manage their anxiety response.
When it comes to diet, it can be helpful to have a short period on a lower fibre diet. Although we need fibre to keep our bowel healthy, if the gut is irritated then fibrous foods can initially make the problem worse by stimulating the bowel. So you may benefit from a short-term low fibre, bland diet when symptoms flare up. Do include plenty of protein to help support the health of your gut lining, and include more root vegetables such as potatoes, sweet potatoes, swede, carrots, beetroot, perhaps some courgettes and mushrooms, and avoid the green leafy veg or pulses for a few days. Avoid too much salad, except for avocado, and make sure everything is well cooked.
Soups, stews, casseroles and other slow-cooked meat tend to be easy to digest as well as cooked fruit such as stewed apples or pears. Do also include plenty of good fats in your diet to help reduce any inflammation in the bowel – oily fish, nut butters, omega-3 fish oil supplements are ideal – but stay away from seeds in the short term, as these can loosen the bowel. Include some gluten free grains such as white or brown rice, quinoa, brown rice pasta, rice cakes and well cooked or soaked oats.
In many cases, after a couple of weeks, this helps to calm things down and you can then gradually start to add some foods back in. It may be helpful to keep a food diary to see if you have any reactions to certain foods.
Some people with loose bowels seem to do better without much dairy in their diet, particularly milk and cheese. These products are rich in lactose, and it’s the good bacteria in our bowels which help to process lactose, as they make the lactase enzyme. Someone with diarrhoea and urgency to go may have an imbalance of beneficial bacteria in their bowel, which could be affecting their tolerance to dairy. Try some dairy alternative products such as unsweetened almond milk, coconut milk or unsweetened oat milk. You may be able to tolerate some plain yoghurt, and this can in fact help to add in some beneficial bacteria to your gut. (1)
If you have ongoing loose bowels, it’s important to speak to your GP and discuss whether you should be referred to a gastroenterologist. It may be that your GP feels you should be checked for coeliac disease, or have a stool test to check for any infectious bacteria. There are also many private labs that offer comprehensive digestive stool analysis and parasitology tests, which check for many different organisms which can overgrow in the gut and cause ongoing loose stools. Find a nutritional therapist in your area or online who can work with you.
These symptoms can also be common in someone who has post-infectious IBS, which develops after gastroenteritis or another type of gut infection. In fact, around a third of people with gastroenteritis develop some form of ongoing gut issues, and may be diagnosed with post-infectious IBS. (2) This is another reason to work on replenishing the good bacteria in your bowel, by taking a broad-spectrum probiotic supplement. If you are susceptible to food poisoning when on holiday, take a probiotic for 2 weeks prior, during and after your holiday to help prevent future infections. The probiotic yeast Saccharomyces Boulardii can also be helpful, supporting levels of Secretory IgA in your bowel, which is one of your key immune soldiers that helps to prevent pathogenic bacteria from taking hold (3)
I also recommend that clients take the amino acid L-Glutamine before their main meals, anywhere between 500mg and a couple of grams, 2 to 3 times per day. This may help to slow transit time and support the healing of the gut lining, which may have been irritated by stress, gastrointestinal infection or a poor diet. (4)
Excess wind: managing excess fermentation in your bowel
We all fart and burp sometimes. Fact! But it’s when this wind becomes uncontrollable and causes embarrassment in social situations that it becomes a problem. So why do some of us experience more wind than others?
One of the main reasons is excess fermentation in the bowel. This happens when the bacteria and other organisms in your bowel ferment your food and, just like when beer is created by fermentation, gas is produced. This needs to be released somewhere. Either you may experience bloating, caused by trapped wind, or the wind may be continual.
One of the key strategies to resolve excess wind is to look at your diet. What are you putting into your body that creates fermentation? Sugar, white refined carbohydrates and too much fruit can be an issue (as discussed in part 1) when it comes to bloating and cramping. Instead, choose wholegrains, low sugar foods and keep your fruit intake to a couple of pieces per day, mostly berries, apples, pears and citrus.
You’ll also need to address the balance of bacteria in your bowel, as this excess fermentation can happen when you don’t have enough beneficial bacteria, and too many non-beneficial bacteria have grown. This can be caused by many things, including stress, antibiotic use, some medications and a diet too high in sugar and white carbs. Feed the good guys in your bowel with probiotic supplements (not the yoghurt drinks, but a good quality probiotic from your health food store or online supplement retailer). Make sure it has minimum 5 billion bacteria per dose. Also introduce some fermented foods into your diet, such as sauerkraut, kefir, plain yoghurt and cottage cheese.
You’ll also want to make sure that your body is properly digesting your food, as wind can be caused by mal-digestion. Again, remember to chew your food well and eat in a relaxed environment. It may be helpful to use apple cider vinegar, which supports digestion in the stomach. Either make a dressing, using olive oil and apple cider vinegar, or you may find it helpful to mix a teaspoon or two into some warm water with a little raw honey and drink before a meal. Fennel tea can also help to support digestion, and can be drunk before a meal. Some people also find chewing a couple of fennel seeds before a meal can be supportive, or you can bash them up in a pestle and mortar and sprinkle onto your food – they give a beautiful flavour to meat, fish, soups and stews.
Excessively smelly, fatty or floaty stools: what’s going on in your bowel?
If you find that your stools have a very strong smell, look greasy or tend to float, this can be a sign of poor fat digestion. The first thing to do is speak to your GP about whether you should have your gall bladder looked at, as this can point to an issue in this area.
Your gall bladder is a warehouse for bile, storing this important green liquid until it’s needed in the small intestine to help break down fat. It’s your liver that actually produces bile, but your gall bladder holds it in reserve and makes sure you have enough to properly digest your food.
Firstly, make sure you’re drinking enough water because without proper hydration, your body simply cannot make enough bile to help break down fat in your diet. It’s advisable to have around 1.5 litres per day, from water or herbal teas, but this can change depending on how active you are and the levels of exercise you do.
Being overweight can also put pressure on your gall bladder, so working on healthy weight management can also help.
Some people do well with digestive enzymes to support fat breakdown, which include pancreatic lipase and ox bile. There are also some foods which help to stimulate the flow and production of bile. These include:
- Dandelion tea – this may help to gently release stored bile
- Eggs (particularly the yoke) – which provide lecithin to support the gall bladder
- Beetroots – a rich source of betaine to support bile flow
- Mustard greens
Making your own coleslaw is a great way to include some of these foods. Grate up cooked beetroot, red cabbage, apple (skin included) and some fresh fennel bulb. Mix together with a little seasoning and some cider apple vinegar, and some plain yoghurt if you wish.
In part 3, we’ll be looking at what to do if it’s painful when you pass a stool, and how to manage your bowel when you seem to have a mixture of all the symptoms described in these articles.
- He T, Priebe MG, Zhong Y, Huang C, Harmsen HJ, Raangs GC, Antoine JM, Welling GW, Vonk RJ (2008) Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects, J Appl Microbiol.104(2):595-604.
- Ericsson CD, Hatz C & DuPont AW (2008) Postinfections Irritable Bowel Syndrome, Clin Infect Dis 46 (4): 594-599.
- Kelesidis T & Pothoulakis, C (2012) Efficacy and safety of the probiotic Saccharomyces boulardiifor the prevention and therapy of gastrointestinal disorders, Therao Adv Gastroenterol 5(2): 111–125.
- Ameho CK, Adjei AA, Harrison EK, Takeshita K, Morioka T, Arakaki Y, Ito E, Suzuki I, Kulkarni AD, Kawajiri A, Yamamoto S. (1997), Prophylactic effect of dietary glutamine supplementation on interleukin 8 and tumour necrosis factor alpha production in trinitrobenzene sulphonic acid induced colitis. Gut.Oct;41(4):487-93.