Ibs & vegan

[Hcharles]

I am usually well on a low residue diet which is low fibre. It took months working with private dietician to get to this. I’ve kept quite well on it for a few years now.

But something has upset my bowel and it’s playing up with everything i eat. Doctor wants me to try a plant based diet / vegan.

I cannot eat nuts seeds pulses or any raw fruit or veg or things with skins on. I cannot eat brown / whole grain anything.

Do you ever just ignore the doctors advice ? I repeatedly said fibre is my trigger but he things vegan (which is high fibre) with none of the trigger foods would do me good.

I’m confused and wiped out & sore.

What do you think? Shall I try it?

[xjrs]

Which country do you live in? I am pretty sure that a UK based GP would never recommend vegan - it tends to be a personal choice - most GPs would just say to have a 'balanced diet'. I agree with you that vegan may increase the fibre in your diet.

I'm wondering what else you have tried to get on top of your IBS apart from diet? Sometimes a low residue diet works on some people because they have bad bugs in their gut which have the upper hand over good bugs and cause problems. Fibre feeds gut bacteria so if you don't feed the bad bugs by having a low fibre fibre diet your symptoms will die down. However, this is a bit of a sledgehammer to crack a nut. Ideally you want to tackle the root cause of needing to be low fibre. Fibre is very good for your health and your immune system in the long run. Being low fibre long term can be bad for your gut and overall health (don't worry I did this for ages too and regretted it, but at the time I didn't have any choice).

Here is some information about IBS that I have shared with others in this group (apologies regarding any repetition from the above):

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain or disordered bowel movements. There is an interesting infographic on this here:

gutmicrobiotaforhealth.com/....

This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.

You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac) or enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

[Hcharles in reply to xjrs]

Thank you so much for your response. The ibs is only one of a number of complex conditions & treatments which are inter related and affect each other. I will definitely look into your suggestions although some I have already tried.

I am in Scotland 🏴󠁧󠁢󠁳󠁣󠁴󠁿 and my gp I think knew the medication wasn’t working even on quite high doses so perhaps clutching at straws.