As a GP, I regularly see people with irritable bowel syndrome (IBS) who have spent years struggling with painful, disruptive and often embarrassing symptoms.
One such patient, whom I’ll call Tim, recently came to my clinic after four years of debilitating diarrhoea.
He had been diagnosed with IBS several years earlier, after tests had ruled out more serious conditions such as bowel cancer and inflammatory bowel disease. However, he was left with the impression that little could be done to help him.
As a result, Tim simply adapted to life with the condition. His experience is far from unusual.
IBS can cause abdominal cramps, bloating, diarrhoea and constipation. Although diagnoses are increasing in the UK, many people receive inconsistent advice about managing the condition – or no advice at all.
That leaves countless patients coping for years with symptoms that can severely affect their daily lives.
But for many people, I believe this ongoing distress could be reduced. A dietary strategy known as the low-FODMAP diet can significantly ease IBS symptoms in some patients, yet many who might benefit from it are not offered the approach through the NHS.
To understand why, it helps first to look at what IBS is and why it may be becoming more common.
IBS diagnoses may be rising partly because people are now more comfortable discussing bowel problems. Celebrities including reality TV star Millie Mackintosh (pictured) have also spoken publicly about living with IBS
Unlike inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, IBS does not cause detectable inflammation or physical damage on routine scans and tests. Instead, doctors make the diagnosis from a person’s symptoms – such as abdominal pain, bloating, diarrhoea and constipation – while excluding other possible explanations. Its precise cause remains unclear, but IBS is thought to involve altered communication between the gut and the brain. Food may pass through the bowel either too quickly or too slowly, and the gut’s nerves may become unusually sensitive.
The condition can develop after a stomach infection, while stress may intensify symptoms. Research has also associated IBS with irregular mealtimes and diets containing large amounts of ultra-processed food.
IBS diagnoses appear to be increasing, possibly because people are more willing to speak openly about bowel problems than in the past. Public figures, including reality TV star Millie Mackintosh, have helped raise awareness by discussing their own experiences.
Even so, greater awareness has not always translated into practical support, and many patients still assume they simply have to tolerate their symptoms.
That is not necessarily the case. Strong evidence suggests that the low-FODMAP diet can substantially improve symptoms for many people with IBS.
FODMAPs are a group of carbohydrates that the gut absorbs poorly. They can draw water into the bowel and are quickly fermented by gut bacteria, creating gas. In people with IBS, this may lead to bloating, abdominal pain and diarrhoea.
These carbohydrates occur in many common foods, including some fruit and vegetables, onions, garlic, wheat and certain dairy products.
The low-FODMAP programme begins with a temporary reduction in high-FODMAP foods to assess whether symptoms improve. It can be demanding initially because so many everyday ingredients are involved, but the restrictive phase is not intended to last indefinitely.
After several weeks, foods are gradually reintroduced individually to establish which FODMAPs, if any, cause problems. Patients can then reduce or avoid their specific triggers while returning to a diet that is as varied and normal as possible. Studies suggest this process can improve both IBS symptoms and quality of life.
There is, however, an obstacle. GPs are not currently expected to advise patients to follow the diet without specialist support. NHS guidance recommends that the low-FODMAP approach be delivered by a healthcare professional experienced in dietary management, usually a specialist dietitian. This is because attempting the initial restrictive stage without expert guidance could increase the risk of malnutrition. The concern is understandable, but the NHS has around 4,500 dietitians, compared with estimates suggesting that as many as 10 million people are living with IBS.
If the NHS cannot provide every patient with a dietitian appointment, what is the answer?
There is good evidence that another popular diet is naturally low in fermentable carbohydrates. This is the famous Mediterranean diet, which contains mostly plants, fish, whole grains and olive oil – with little meat, dairy and sugar.
The diet has been linked to a lower risk of heart disease, cancer and death. But it would seem it also reduces IBS symptoms.
The Mediterranean diet isn’t quite as effective as the FODMAP diet – probably because it contains some fermentable carbohydrates – but studies show patients who follow the Mediterranean diet see a significant reduction in symptoms.
This doesn’t change the fact that the NHS should make it easier for GPs to recommend the FODMAP diet. But for those who want to tackle their symptoms today, I think the best thing is the Mediterranean diet – that’s why I recommended it to Tim.
IBS is not curable but, with the right steps, it can be controlled.
IBS causes stomach cramps, bloating, diarrhoea and constipation and, while the condition is on the rise in the UK, many patients who are diagnosed get conflicting advice about how to manage it, or none at all (picture posed by model)
Have you been left in agony by the NHS?
I am increasingly frustrated that so many of my patients are unable to access chronic pain services on the NHS.
Defined as pain that lasts for more than three months, the condition can be triggered by a range of conditions from arthritis to bowel disease and the after-effects of cancer treatment.
In some cases, it can have no clear cause. Whatever the reason, chronic pain can blight lives, damaging relationships and ruining careers. For most, the best way to ease the suffering is to treat the underlying condition. But when this fails, patients should be sent to a pain specialist, who can offer complex tailored treatments that a GP cannot.
The problem is that waiting lists for these NHS specialists have never been longer.
These days, when I try to refer patients to local clinics, the request is often rejected due to high demand.
Have you tried and failed to access pain services? Please write in and let me know.
Your questions answered
I get cold hands and feet in cold weather and I’m dreading autumn. I wear thick socks and gloves nearly all the time but it’s bulky and uncomfortable. Is there anything else I can do?
Dr Ellie replies: Cold hands and feet can be a sign of a common circulation issue called Raynaud’s disease.
This is a condition where the blood vessels at the end of the fingers and toes spasm, meaning no blood gets in. As a result, the fingers go white and cold. Patients often report a numb or tingling feeling.
In many cases, Raynaud’s is triggered by a separate medical condition, such as arthritis or certain blood diseases. However, it can also be autoimmune – where the immune system accidentally attacks healthy tissue.
Unfortunately, there is no cure for Raynaud’s but there are steps that can be taken to ease the symptoms.
Sufferers are often recommended to keep their whole body warm, rather than just the hands and feet, as this can improve general circulation. This might mean wearing an extra jumper, prioritising warm footwear and remembering to go out with a hat.
Thermal vests and underlayers to keep the core warmer will help.
There is also evidence that exercise can reduce Raynaud’s flare-ups by improving blood circulation.
However, there is a medication that can help – a tablet called nifedipine, ordinarily used as a blood pressure treatment, which has been shown to relieve symptoms.
A GP should be able to prescribe this drug to anyone with severe or persistent Raynaud’s.
Do you have a question? Email DrEllie@mailonsunday.co.uk
