The Many Faces of IBS - and food intolerance - 2006

Margaret Moss is a nutritionist who has practised for many years in Stockport where she has successfully treated several Foods Matter readers suffering from food intolerance.
Using examples from her own practice she looks at some of the many different causes of IBS - and treatments that might be appropriate.

Irritable bowel syndrome is a label given to different digestive problems that have not been shown to have specific diagnoses like cancer, Crohn’s Disease or ulcerative colitis. There are various reasons why digestion may not function well, and treatment should depend on why there is a problem.

The Problem - over-refined diet
Nancy was constipated, and had premenstrual syndrome, which was not surprising, as she lived on white bread, margarine, jam, tea, sugar, milk, white pasta and pot noodles. She had had several courses of antibiotics.

The Solution - more fibre and magnesium

The challenge was to find some sources of fibre and vitamin C that she would accept. I suggested figs or golden linseeds for fibre, but she wasn’t keen. She didn’t mind bananas. She didn’t fancy chewing nuts, but would spread cashew nut butter on her bread. She replaced some of her wheat by potato. Oranges were not sweet enough, but she was surprised to find satsumas rather pleasant.

She agreed to take a one month course of probiotics, to replenish the good gut bacteria that had been killed off by the antibiotics. It is important to have enough bacteria living in the gut, as the dead ones increase the amount of faeces, making them easier to excrete.

The magnesium in the nut butter and bananas made her more relaxed, and she did not lose her temper once before her
period. She was glad that the constipation disappeared, and it was a bonus that she felt less lethargic. She enrolled on a pottery course, and made friends there. Life seemed altogether more worth living.

The Problem - the wrong wholefoods
John had read about healthy living, and had All Bran and skimmed milk for breakfast, brown rice with tomatoes, peppers, chilli and spinach for lunch, and wholemeal bread, margarine, radish, tomatoes, lettuce, watercress and cucumber in the evening, with two glasses of pure orange juice. He felt annoyed that his attempts to live a healthy life were resulting in abdominal pain, urgent diarrhoea, aches in his back and shoulders, and fatigue.

The Solution - a major dietary rethink

I explained that a diet that suits some people is not suitable for others. All Bran and wholemeal bread contain lectins, which bind to n-acetyl glucosamine in connective tissue, causing aching, and to the gut wall, causing diarrhoea, but only in some people. Whole grains also contain phytate, and spinach contains oxalate. These bind to minerals, causing them to be excreted. Some margarine contains unhealthy transfats, and others contain additives which are better avoided.

John changed to butter, which contains butyric acid, which feeds intestinal cells. I explained that it is important to avoid milk, which contains sugars that damage the arteries, rather than avoiding butter.

Sulphate is needed by the gut wall, and it is transported by phenolsulphotransferase enzymes. These enzymes work less
efficiently when you eat radish, spinach and orange.

Tomatoes, peppers and chilli contain much boron, which causes the excretion of vitamin B2 (riboflavin), which is needed to make sulphate. Sulphate is needed to prevent the gut wall from being too leaky. It attaches to histamine, and therefore reduces inflammation. It is needed for the production of digestive enzymes.
It wasn’t easy for John to change his ideas about what food is healthy for him, but he was desperate enough to have a go at
a new diet.

He also agreed to bath a few times a week in Epsom salts, which are magnesium sulphate. Magnesium deficiency causes spasms in the gut and elsewhere. He agreed to have fish every other day, which provides anti-inflammatory essential fatty acids. He took a good quality multivitamin and mineral tablet, which provided molybdenum, and vitamins B2 and B5, which help the body to make sulphate.

Within a month his gut was comfortable. He only occasionally had loose stools, and he usually realised he had broken the diet on these occasions. His back ached a little at times, but most of the time he was unaware of it. For the first time in years, he woke up feeling bright, and ready for the day.

The Problem - Grumpy, Aching - and Diarrhoea!
Alice came to me with diarrhoea, which left her exhausted. She too ached. She already knew that whole grains and pulses did not suit her. Nor did milk.

She knew she was difficult to live with, but she could not
control her temper.

Her diet was a mango for breakfast, homemade carrot,
potato, onion and split pea soup for lunch, and meat and three
vegetables in the evening.

The meat might be beef, lamb or liver, casseroled with
carrot, peppers and onions, and the vegetables were potato or sweet potato, with kale, spinach or spring greens, and swede or turnip. She took cod liver oil, a multivitamin pill, and an anti-

I asked if she had pressure in her head. Oh yes, she said. How did you think of that? Her doctor had considered she might have a brain tumour, but luckily she did not.

The Solution - too much Vitamin A
I explained that liver, cod liver oil, her vitamins and her antioxidants all contained vitamin A. Her mango, carrots, split peas, orange sweet potatoes, kale, spinach, spring greens, and swede contain much carotene.

People vary in their ability to convert carotene to vitamin A. Many people need a colourful diet, with deep greens, reds, oranges and yellows, but it is too much for others. The sum total of the vitamin A she consumed, plus the carotene her body made, was too much for the amount of retinol binding protein that she had. Retinol binding protein binds to vitamin A, and makes it safe. Any excess vitamin A that cannot be bound, can cause problems.

We agreed that Alice would continue to avoid whole grains and pulses, because of their lectins, and milk, because of its sugar, which feeds unwanted organisms in the gut. She would continue with soup for lunch, but would make it from low carotene vegetables, like onion, potato, mushroom and red lentils.

Honeydew melon, banana, blueberries, bilberries, strawberries, raspberries, cherries and avocadoes were allowed, but not mango.
She would have the pink sweet potatoes from the Caribbean market stall, and not the orange ones from the supermarket. The pink ones are pale cream inside. Also she would choose white cabbage, Chinese leaves, cauliflower, courgettes, marrow, the pale part of the leek, potato, turnip rather than swede, and mushrooms.

Her food would not look as attractive, but never mind. She would replace liver by fish, reducing her vitamin A, and giving
herself some essential omega 3 fat.

We agreed that Alice would take natural vitamin E, as it is an antidote for vitamin A. She also took an unusual vitamin and mineral tablet, which contains neither vitamin A nor carotene, and magnesium, which is needed for energy and feeling peaceful.

After a month, Alice reported that her partner had used up all the colourful, banned foods, and she had immediately changed to the new diet. She was relieved that the pressure in her head had gone.

She was cross sometimes, but only briefly. Her partner was delighted at how much easier she was to live with. Her aches were less, her diarrhoea was only occasional, and she was tired rather than exhausted.

She wanted to know how long it would take to become really well. I explained that the liver stores vitamin A, and it could take months or years to reduce it to an acceptable level.

The Problem - constipation/diarrhoea and long-term antibiotic use
Phil had had antibiotics for tonsillitis several times, and had also taken antibiotics long-term for acne.

He had Weetabix, sugar and milk for breakfast. Lunch was a tuna sandwich and a sweet fruit yoghurt, containing carrageenan. Tea was lasagne and a chocolate muffin. He then had milky hot chocolate before bed. He took an evening primrose capsule, which also contained carrageenan.

All the antibiotics had probably killed off his colony of beneficial gut bacteria, and the sugars in his diet had fed the undesirable inhabitants, which had taken over the living space and food supply in his gut.

These undesirables might include fungi, possibly Candida albicans. Sugar and milk sugar feed such fungi. It was not surprising that he had alternating constipation and diarrhoea.

The Solution - a low sugar diet & probiotics
He found it hard to adapt to a low sugar diet, but did try.
He took probiotic capsules, containing Lactobacillus acidophilus, and Bifidobacterium bifidum. He took garlic and parsley, as mild anti-fungals. He took zinc, as the acne was probably related to zinc deficiency. He avoided carrageenan, as it has been suspected of causing inflammation, cancer and ulcerative
colitis. He ate butter, mushrooms, and coconut, because they are
useful to the gut wall.

His gut was much improved after a month, and this made it easier to sleep. He reported that he used to be plagued with catarrh, which had now gone. He found it easier to go without food for longer. His brain was clearer.

No Perfect Diet
There is no perfect diet, which would suit Nancy, John, Alice and Phil. We need to look at people as individuals. Some people thrive on whole grains, and colourful fruit and vegetables. Others do not
tolerate them. We need to move from mass advice to the public, to a more careful evaluation of the particular needs of each person.

If you wish to contact Margaret she is to be found at
Nutrition and Allergy Clinic 0161 432 0964


Click here for more articles on the management IBS

Back to top

If you found this article interesting, you will find many more general articles and research reports on coeliac disease here, and lots of information on the management of coeliac disease here.
You can also find articles and research reports on gluten intolerance here and articles on a wide range of other digestive conditions here.

For hundreds of gluten free foods see our freefrom food section here, and for nearly 800 gluten-free recipes see here.

And if you would like to get our FREE fortnightly e-newsletter with new products, recipes, articles and all the latest news from the allergy and freefrom world, just sign up here.