IBS Explained: Symptoms, Diagnosis and Getting Relief

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS, able to eat the food I love again, travel whenever I want, and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started! Welcome everyone to the IBS Nutrition Podcast. I’m Jessy Wong, your host, and today I am joined by my wonderful co-host, fellow IBS dietician, Brooke. Hi, Brooke.
Brooke Keenan 00:00:52 Hi, everyone. Hi, Jesse.
Jessie Wong 00:00:54 Hi. I’m so happy for you to be here. And today we are diving deep into irritable bowel syndrome.
Jessie Wong 00:01:00 And what are some of the IBS symptoms that are more common, less common, and why? Tracking your symptoms can be a game changer in managing your IBS, a topic that both of us are incredibly passionate about. And before we dive into the topic, I want to make a quick note. Today is world IBS day, and I want to give you a few statistics to share with you that you are not alone. And because IBS is an invisible illness, we like to call that here because nobody talks about it. Everybody’s worried about talking about it. Sometimes it’s embarrassing, or sometimes they’ve talked about it enough that they’re being written off by everybody around them whenever they mention it. So it’s best to just not bring it up so that you don’t feel like people are gaslighting you. But we want to remind you here that this condition affects up to 10 to 15% of the world population. And we are talking about up to 45 millions of Americans alone. So you are definitely not the only one out there.
Jessie Wong 00:01:59 And on average, it takes six years to get a diagnosis. And this episode we’re going to talk about different symptoms that you need to track to hopefully help you get to the correct diagnosis faster. And in 2 in 3 IBS patients are female. We don’t fully understand why the condition affects women a little bit more than men, but we know that it does, and it really does significantly affect a person’s quality of life. Now, IBS sufferers usually restrict their activities roughly around 73 days out of one year because of their IBS symptoms. So if that’s you, you know, you want to listen to our episode today so that we can share with you more about symptoms and maybe also some strategies on managing your symptoms as well. And another staggering statistics. It was a survey that was done internationally. About 2000 participants, and a majority of them voted to say that they are willing to lose 10 to 15 years of their life for an instant cure of IBS. I want you to just think about that for a minute.
Jessie Wong 00:03:11 You know, that really tells us how much burden or how difficult it is to deal with IBS. So much so that people are willing to cut their life short for an instant cure. And I think that’s just not talked about enough. And there are a lot more research going on in IBS, and we’re still learning so much about it. But a lot of the times we feel like, well, our patients may feel like, yes, this is not a life threatening condition. I’m not being taken seriously. Well, you know what? You are not alone in that. And we take IBS very seriously here. Brooke, what do you think of the statistics?
Brooke Keenan 00:03:50 Yeah, it really is, kind of astounding. I mean, 10 to 15 years off someone’s life. You know, it just shows what kind of a huge impact IBS can have on people and how debilitating it can be, even though there’s technically, you know, nothing functionally wrong.
Jessie Wong 00:04:09 Exactly. Okay. Well today we are going to talk about IBS, IBS symptoms and why tracking your symptoms is a game changers.
Jessie Wong 00:04:17 And we are really passionate about talking about tracking symptoms because it can’t really tell us so much more about what is going on.
Brooke Keenan 00:04:26 So for our listeners that are new to the term, what exactly is IBS?
Jessie Wong 00:04:32 Okay. Great question. So IBS or irritable bowel syndrome is a chronic condition that affects the large intestine mainly. And also our government connection. It’s like the digestive systems version of a troublemaker. Sometimes it’s calm and other times it throws a bit of a tantrum. Right. And symptoms can include a domino pain, bloating, gas and changes in bowel habits, and also constipation or diarrhea and sometimes maybe both. And it is important for us to know that IBS is a combination of symptoms. So because we call it irritable bowel syndrome, like there’s no specific damage to the gut or the digestive track. However, there is a bunch of symptoms that we look for when we are getting a diagnosis of IBS.
Brooke Keenan 00:05:25 Yeah, it’s so common. We don’t in general talk enough about it. But what do we know what causes IBS, right.
Jessie Wong 00:05:34 this is a great question, a very complex one. So to date, we don’t fully understand what causes IBS. However, we know there are many different root causes to different types of IBS. And it’s very important to understand your personal root cause. But again, you know, there’s just no one size fits all exact cause of IBS. But factors like gut sensitivity, gut motility, psychological stress, and sometimes maybe food intolerances can play a significant role in the conditions manifestation. And there’s also a new aspect that we’re still learning more about is how our gut bacteria and diet influence IBS symptoms, especially when it comes to fermentable carbohydrates such as FODMAPs. And we’re definitely going to talk about the low Fodmap diet when maybe in a future episode.
Brooke Keenan 00:06:23 Yeah, we will definitely dive deeper into FODMAPs in a future episode. The American College of Gastroenterology categorizes IBS as a functional gut disorder, and they recognize it as a disorder of the gut brain interaction. So it’s not just about the digestive systems physical condition, but how the gut talks with the brain and how the interaction between the gut and the brain can play a crucial role in how your IBS symptoms manifest.
Jessie Wong 00:06:53 Yeah, absolutely. And, the gut brain axis. Right. What we usually refers to is a complex network of signaling pathways between the GI tract and NF system. It involves many components, such as our gut microbiome, our immune cells, our neuroendocrine cells, which all of them contributes to how the brain perceives sensation from the gut. And in IBS, the communication can become dysregulated, meaning that normal digestive process may be experienced as painful or uncomfortable, and stress or psychological factors can exacerbate GI symptoms.
Brooke Keenan 00:07:34 Yeah, it’s it’s really important to understand IBS as a disorder of the gut brain interaction, because then it helps us manage the symptoms more effectively. It helps us acknowledge the importance of not only addressing just, you know, dietary and lifestyle factors, but also considering stress management, psychological well-being, and that these are really integral parts of treatment. And so this comprehensive approach can really help us manage symptoms and improve the quality of life for people living with IBS.
Jessie Wong 00:08:05 Absolutely. Okay, now onto our second topic for this episode.
Jessie Wong 00:08:09 What are some common IBS symptoms? Not so common IBS symptoms, and what are some red flags that we really want to, you know, investigate further that may not be related to IBS or maybe related to, another condition that have very similar symptoms. So there are many, many different IBS symptoms. Can you give us some examples?
Brooke Keenan 00:08:31 yes. Bloating, gas, constipation, diarrhea are the most common symptoms that we see. They can change from constipation to diarrhea. But those are the most common symptoms we see.
Jessie Wong 00:08:45 Right. And what about some less common symptoms. And we actually see them quite a bit as well.
Brooke Keenan 00:08:51 Yeah reflux nausea fatigue those are the slightly less common symptoms I don’t actually see too much nausea usually. But reflux and fatigue for sure. Yeah.
Jessie Wong 00:09:05 Yeah. And sometimes we see nausea kind of related to IBS constipation. Asian people necessarily make the connection? okay. This is a very important thing. Right. So we just mentioned a bunch of symptoms that could be related to IBS. But one thing we really want to point out is that all GI conditions have the same symptoms.
Jessie Wong 00:09:25 And it’s really, really important for you to go to your doctors and get tested for the other conditions first before getting an IBS diagnosis. Because of the GI conditions, it’s all symptoms in your gut, right? And it’s hard to tell whether it is from, say, celiac disease or inflammatory bowel disease, where these two conditions do change the structure of your gut. There are markers that we can test for in blood tests, in stool tests, or maybe scopes. And it is really important to document your symptoms, bring it to your doctor. And then they decide what test to perform to rule out these other conditions for you before giving you an IBS diagnosis. And because of this diagnosing IBS, could, you know, be a long and difficult journey. And again, you know, per research, it takes about six years for patients to get an IBS diagnosis since first experiencing symptoms. Now we are getting better at this. I want to say that, you know, the medical community is getting better at testing and ruling out other conditions and giving people an IBS diagnosis.
Jessie Wong 00:10:32 But you know, it still takes time. And one thing, it really helps the patients to get to the correct diagnosis faster is documenting your symptoms one way, you know, to really speed up the process, right? It’s keeping a detailed symptom diary. This means recording what you are eating, what symptoms you have, the location of, the symptoms, the duration and the frequency of your symptoms. So these information can be tremendously helpful to create a clearer picture of your condition and also potentially leading to a faster diagnosis and beyond diagnosis. It can help assist in managing your condition to identify your triggers and maybe creating a personalized treatment as well.
Brooke Keenan 00:11:17 Yeah, Jesse, I think it’s important to track your symptoms, track your bowel movements, and then be able to go back to your doctor and say, this is what I’ve eaten, this is what I’ve tried, this is what I’ve died. I’ve done, and this had an impact. This didn’t have an impact. And then that can help them in the short amount of time they have with you.
Brooke Keenan 00:11:37 Pinpoint what’s going on.
Jessie Wong 00:11:40 And choose the right treatment option. Yeah. Right. Yeah.
Brooke Keenan 00:11:43 And get you a diagnosis faster hopefully.
Jessie Wong 00:11:46 Right. Yes. And because there are a lot of IBS mimics that don’t always get tested. And we see that quite a bit in our clinic too. And sometimes we may suspect patients have bile acid diarrhea where it burns. You know, it’s and sometimes we go have diarrhea and nighttime. Now these are red flags that you want to bring up with your doctor. If you have to wake up from your sleep and run to the bathroom, that’s not IBS. You really need to dive deeper with your doctor and figure out what is wrong. And then another red flags that you have to go to your doctor and get tested and see if anything is wrong is if you have blood in your stool. Now, a lot of people have hemorrhoids. If the blood is from the hemorrhoid and is persistent, and if you’ve done scopes and make sure it is hemorrhoid, then it’s probably okay.
Jessie Wong 00:12:34 But if you have not been to your doctor, if you have not gotten scopes done, or maybe biopsies done, and you have persistent bleeding in your bowel movement, you have to go see the doctor. And another thing, this is something we kind of do in a clinic too, right? It’s looking at nutrient profile of a client. So we request some labs. And another red flag we see is if people have iron deficiency anemia, that usually is an indication of mouse sorption or maybe bleeding. But usually when a patient comes to us, they’ve already done all the scopes or the tests ruling out other conditions. But if they have, deficiencies, then we really want to dive deeper to see if there is an overlapping condition on top of IBS, because IBS does not cause, anemia because there’s a lot of discomfort, but not necessarily anemia. And these are things, you know, a really experienced GI doctor will be able to work with you on it. Or maybe a very experienced primary care physician can help you with it.
Jessie Wong 00:13:36 And a lot of the times, what we do is we work with a patient’s physicians to get these tests ordered and also explain the results to maybe the patients and also their physician as well, and tell them what we think that if we think there is further workup needed.
Brooke Keenan 00:13:51 What labs do you like to see from clients?
Jessie Wong 00:13:56 Right. So in our clinic, right, we always want to see the celiac test. We want to see inflammatory bowel disease tests. So celiac tests could be serology. So blood tests could be endoscopy where they take. Seas from your small intestine to make sure there’s no inflammation in specific parts of your small intestine to rule out celiac disease. One thing about celiac is 1 in 100 patients have celiac disease, 1 in 100 in the population has celiac disease. Only 20% about 20% are diagnosed. And oftentimes it’s underdiagnosed or misdiagnosed as IBS. So we always want to review those labs to make sure that you’ve gotten a celiac test done or if you know there’s something else going on, we want to dive deeper and may be asking for more tests in regards to this area.
Jessie Wong 00:14:41 So celiac now inflammatory bowel disease is labs that we will review for our patients. So that could be protected from the stool test. It could be colonoscopy and biopsy to see if there’s inflammation. So we are not one to diagnose but we can review the test to make sure it wasn’t overlooked by your doctor. So those two are tests that we see all the time. What else do we see H pylori. We want it sometimes if it’s more upper GI symptoms, we may request to do a breath test or maybe a stool test to rule out H. Pylori. this is especially true if a patient have had previous positive H pylori. And sometimes this is one thing to think about. If you’ve had a positive pylori tests have gotten the antibiotics to treat your H. Pylori. One thing the literature suggests is get tested again to make sure you are negative. And sometimes we don’t see that being repeated, and it is important to make sure you don’t have H before, you know, before getting an IBS diagnosis because it could potentially be H.
Jessie Wong 00:15:48 Pylori. what else? Well, if we see. So one thing we see in our clinic is looking at what patients are eating, their medical history, looking at what symptoms they have, what their still looks like. And one of the things we look for maybe is just to color change. If there is change in situ color that we suspect something else is going on, we may ask for tests for epi, exocrine pancreatic insufficiency, or like we said earlier, bile acid sorption about acid diarrhea because these two conditions will require medications. And it’s a very easy fix. And they usually cause more diarrhea than constipation. But then again like these are overlapping diagnosis with IBS that are sometimes not diagnosed. And I was, reading a research paper from Michigan University of Michigan has a huge gastroenterology department, and they publish a lot of studies, and they were suggesting maybe up to 20% of IBS patients may have bile acid resorption, leading them to have non-stop diarrhea. And these are the cases that patients may not be responding to, just the low Fodmap diets alone.
Jessie Wong 00:16:57 Now, am I missing any other test?
Brooke Keenan 00:17:01 Well, I think when someone has chronic diarrhea and we suspect it might not be IBS, B-12, oh yes. And that’s not something that your doctor will just test for. we usually have to ask people to get ask their doctor for it. Yeah.
Jessie Wong 00:17:17 And that’s something we ask for most of our clients. If we suspect a deficiency, we’ll ask for ferritin to check their iron status. We ask for vitamin D level to see if they’re malabsorption, fat soluble vitamins and B12 and folate. These are the ones that we sometimes see. People are stripping, maybe due to an overlapping condition with their IBS. and we make recommendations accordingly if anything shows up to be deficient. And these are maybe vitamins or maybe iron supplements that we make recommend, we may recommend. Now, if you are seeing a provider that are making blanket recommendations on taking supplements, you know, be careful with that. And usually we really want to see the blood work first before making any of these recommendations.
Jessie Wong 00:18:03 Okay. We are talking a lot about symptoms. Should we move on to our third topic and why tracking and documenting your symptoms is so important. And we’ll kind of walk you through how to track your symptoms as well. So I’m just gonna dive really deep in here, okay. Documenting your symptoms will be a game changer. I’m not even going to say can be a game changer, because it will be a game changer for anyone with IBS. And we talked about different types of symptoms. Right. We talked about bloating, pain, gas and changes in your bowel habits. But documenting your symptoms is not just about what symptoms you are experiencing. It’s also about understanding when they start, how long they last, how often they occur, and how severe they are. So these are the type of detailed tracking that can really help your provider understand better what is going on. Okay, I’m going to use bloating as an example. And most people don’t understand this. But there are different types of. Noting a person may experience even within IBS, and that can give us some indication of what may be going on with your gut.
Jessie Wong 00:19:17 and how to go about how to create a treatment plan for you. So number one thing is, one thing we always ask is where is your bloat? Is it upper gi? Is that lower gi? Is it a specific corner of your abdominal area? When does it start? You know, does it correlate to what you are eating or does it correlate to bowel movements or the lack of a bowel movement? How long does your bloating lasts? And how often does it happen? Do you bloat overnight or do you bloat after something triggers it? So these are crucial information. So when we talk about tracking symptoms it really is talking about detail tracking of of all these information about a particular symptoms. And you do this for every other symptoms that you have for example pain. Again where is your pain. When does it start. How long does it last. Does it correlate to food? Does it correlate to your bowel habits or maybe even gas? And how often does it happened? And these can really tell us where the problem is when it comes to your IBS and what to do.
Jessie Wong 00:20:21 What are the next steps to help you find relief or maybe really understand what is going on? And I think that’s so crucial when you don’t know what is going on, what do you treat right. and I want to mention to everybody who is listening here, we have a symptom tracker that is extremely helpful for you to learn more about your body, ultimately to manage IBS, understanding your body. It’s not taking random supplements. It’s not cutting out food with no end. But it’s really understanding what triggers your symptoms. So we have a free symptom tracker for anybody who needs to learn more about their body. And it’s on our website coop pedia.org/resources. So it’s poo poo PDF pedia.org/resources. there you’ll find a free symptom tracker. It’s amazing. It’s very useful. Print it out and start tracking your symptoms. And on that symptom tracker, we asked you about how much fluids you’re drinking, how much fiber you’re eating, what type of poop you have, what type of symptom you have. We have a diagram of a torso on there to tell you where, you know, different areas are.
Jessie Wong 00:21:34 So when you’re tracking your symptoms, you understand, you know where the symptom is located at. How long does it last? You know, how often does it happens? You know, write it all down. See if you can see any correlation between your symptoms to what you are doing on the tracker. We also ask about your stress level too, about whether you are doing exercise and what day you are on your menstruation cycle. And this is especially important for women because yes, your hormones do affect your bowel habits and it does affect your symptoms as well. And it’s really important to track that.
Brooke Keenan 00:22:13 Yeah. So it really is important to track your detailed symptoms. And like Jesse said, the more detailed the better. And we review journals, at least twice a week. And that’s when we can really see the impact what you’re eating is having on your bowel movements and your pain and your bloating and also stress, are really any factors that are coming up in your life that may be impacting, your symptoms.
Brooke Keenan 00:22:44 And it really is also great to see with the changes that we advise people to make, how they get better and how everything their symptoms get better, how they feel better, how their bloating can decrease. So not only is it helpful to get your diagnosis, but once you have it, it can be really helpful to manage your symptoms. So, Jesse, do you have an example about how this really helped one of our clients?
Jessie Wong 00:23:09 Yeah. actually talking about symptoms and why tracking symptoms is so important. I do have a client story, and this is actually a dietician herself that came to us. Because she had IBS diarrhea. Okay, hear me out on this. So she was having a lot of diarrhea. She didn’t know what was causing her diarrhea. She went to her PCP, went to her gastroenterologist, got lots of tests done. Everything was ruled out and then got an IBS diagnosis. And this is where she would trial medications and also supplements. But none of them stopped her diarrhea. So her doctor recommended for her to try the low Fodmap diet.
Jessie Wong 00:23:51 And being a dietitian herself, she knows that she would need help with the low Fodmap diet because it’s not very straightforward, which we’ll dive deep into in a different episode. But then she came to us, and at that time, she has already cut out 50% of the food that she was eating because she was so afraid of food, and she was still having diarrhea, and she was afraid of even going on a car ride for just ten minutes because she doesn’t know when it would strike her. It made it difficult to live her life, go to work, or even socialize. It was just devastating. And we know, right? Working with patients with diarrhea. Diarrhea is unpredictable. It’s extremely debilitating. It makes it difficult to do things, to do life. And we know that, you know, by resolving diarrhea people will be much happier. But anyways, she joins a program because she was recommended to try out the low Fodmap diet. Now, when she started, the first thing of course we do with her is looking at what she’s eating, what symptoms she has.
Jessie Wong 00:24:56 and what. Type of characteristics her symptoms had, and looking at her bowel pictures and asking her more in-depth history of her diet, her bow habits. What we learned was that she didn’t really have IBS, diarrhea and what she had according to her symptoms. And what she told us was that she had overflow diarrhea. Yes, it is a type of diarrhea, but it is actually caused by chronic constipation. So with overflow diarrhea, what happens is that there may be stools stuck in your rectum or colon that could be from chronic constipation. And but it’s stuck in there. It’s a solid thing that’s blocking everything else from coming out. And in cases like this, people actually tend to have more diarrhea. But every time they eat something or they have any stimulation, they will need to run to the bathroom. But only watery and mushy pieces of stool will come out. So the stool doesn’t really come out because there is a blockage. And that’s what we actually figure it out. She has. So instead of IBS she’s more like IBS mixed bowel type, but more so.
Jessie Wong 00:26:10 Actually, constipation was the root cause of her diarrhea. And once we knew that, that really changed our whole approach in how to help her or guide her through what to do next. So instead of moving through with the low Fodmap diet, which was what she came to us about. We actually suggest to her to work on her constipation, right? It’s the first thing we did was, you know, let’s try some laxative and see if it helps you. And guess what? As soon as she was having better evacuations every day, her diarrhea stopped completely. Completely. And I think sometime in the middle of the program. So she joins our small group program. And we worked together for 14 sessions together. And it is a three month program and sometimes through the middle of the program, she said. It’s like, how did I not notice it before? Like, how did I not know that if I have good poop, a good bowel movement, I don’t have any of my symptoms? And this is a really big, you know, indication of why checking your symptoms and understanding your body is so important.
Jessie Wong 00:27:18 Instead of blindly following a restrictive diets that may or may not help. Right. and for her case, she came to us for the low Fodmap diet, but we did not do the low Fodmap diet and one other reason why is because she was already so afraid of food. She’s already cut out so much food. So what we really worked on was guided her to regulate her bowel habit. And we also guided her to to food reintroduction sooner rather than later, because very soon after regulating her bowel habits, her symptoms subsided drastically. She still had some symptoms, but it’s way easier to manage. And we did the food challenge one group at a time and bring it back to see if she has any intolerances or what her tolerance level are for those foods. But at the end, she didn’t have any food intolerance, and what we really needed to do was to regulate her bowel habits so that her diarrhea stopped. And the good thing is, she agreed, because sometimes a lot of patients come in and be very stubborn.
Jessie Wong 00:28:17 It’s like my doctor said, I have to do low-fodmap and I have to do a lot for them. Now, we’re not going to argue with you if you need to, but when it’s unnecessary, we would recommend against it. Or at least let’s try something else first before doing any elimination diets. Because all of these diets have their own risk when we are doing it, it’s not benign. It can cause other problems down the road. So she went from having a lot of diarrhea, being afraid of sitting in her car for ten minutes at a time to actually at the end of the program, she picked up a different job. She was able to apply for other jobs because she doesn’t have to stay near her proximity. And she was working at a facility where they help people have better relationship with food at the end. And she was she had to drive an hour to that facility and back every single day, and she had no fear of needing to stop to use the bathroom. Without even, you know, going through an elimination diet because she knows her her body a lot better.
Jessie Wong 00:29:22 Now I’m sharing this because, you know, tracking your symptoms can really tell you a lot about your body and avoid unnecessary food restrictions or supplements, right? Don’t waste your time or money on supplements that you don’t need, and don’t waste your time on elimination diets if you don’t need them. There are indications where we think an elimination diet is needed, but it’s not always the case. And understanding your body first is more important than just cutting out food, because you’re wasting time and money on things that is not helpful.
Brooke Keenan 00:29:59 Yeah, it’s so interesting with the original diagnosis, you know, because someone’s going to the doctor for diarrhea. But when you dive a little bit deeper and only until you dive deeper and track your symptoms, are you going to figure out that it’s not diarrhea. It’s actually constipation. So that’s and you know, no need for a strict elimination diet, which is great.
Jessie Wong 00:30:22 Right? It is great. I mean, those are not benign. We know that. And if you ever recommended trialing any elimination diets, work with a dietician.
Jessie Wong 00:30:30 Because these diets are not benign, they can cause harm in the long run. Okay. Well that’s completes our first episode here. And thank you so much for everyone who are listening. We hope this is helpful for you, and we can’t wait for you to hear more, because we do have a whole host of topics in line for you. So today we talked about symptoms. Next we’re going to talk about tests. We kind of touched on tests this time, but we’re going to talk more about what type of tests you would need. what type of tests you don’t need next time. So stay tuned.
Brooke Keenan 00:31:02 Bye.
Jessie Wong 00:31:03 Thank you all. Bye. Thank you for tuning into the IBS Nutrition podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes.
Jessie Wong 00:31:30 To learn more about your type of IBS and how to identify your own food or lifestyle triggers, Register for a free IBS masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician. Com forward slash masterclass to register and till next time, take good care of your gut and here’s to your health and happiness.