My Experience with IBS-C as a Registered Dietitian

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March 17, 2022. *Important: “My Experience with IBS-C as a Registered Dietitian” is an opinion piece written by Robyn Barefoot, RD, MSc. This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in recommendations and treatments that your physician may recommend based on individual facts and circumstances.

The Journey: How did it begin?

Irritable Bowel Syndrome (IBS) has been a part of my journey for what feels like a lifetime, but in the scheme of things is quite a new diagnosis. In my late 20’s I was diagnosed with IBS-C, constipation predominant type. Coming to this diagnosis was not easy, and it’s hard to imagine experiencing this journey without the background of a Registered Dietitian and the clinical knowledge I am fortunate to have under my belt (literally). Growing up, I watched my mom rotate through an assortment Metamucilâ powders, cookies and capsules thinking some peoples’ bowel habits were different than others – and in our family, constipation seemed to be standard. But beyond the irregularity, what about everything else that came along with IBS-C for me? I went away to school thinking “pooping” once a week was the “norm”. I had listened to endless nutrition lectures on the topics but never associated myself with having a gastrointestinal “disease”. I mean, after all that sounds so serious. I remember associating IBS with extreme urgency, diarrhea and passing gas, nothing to what living with IBS was like for me. Before my diagnosis, I honestly remember feeling lucky with a once weekly urge – avoiding the embarrassment of “having to go” in communal dorm bathroom as I entered first year university.  

Why me?

As a family, we grew up eating relatively healthy, recognizing the importance of good nutrition and fuelling appropriately before many childhood sports. Throughout my university years and learning more about nutrition, I gradually increased the number of healthy foods in my diet but still celebrated after late nights with Greek fries, pizza and so forth.  There was a balance of healthy foods with the occasional fun foods – just like your average student. For 3 years during this time, I decided to go vegetarian, eliminating animal products and at one point being so iron deficient and requiring extra supplementation. My levels were monitored every 6 months until they returned to normal. At this time, I was prescribed a supplement but didn’t comply as I feared of – you guessed it, more constipation! I remember spending hours researching which supplement is best and “easiest on the stomach”. I felt alone and again, couldn’t imagine the lack of support without having my background.

Fast forward a few months, I started drinking coffee to help with those all-nighters at the library. To this day, 4 espressos a day is embedded into my morning routine, which would make anyone “go”, right? Nope, not me. I slowly learned that no amount of coffee, prunes, exercise, meditation or water helped with the constipation I was experiencing. As a group fitness instructor, I recognize the importance of regular physical activity and stress management. I favour aerobic activity, which you might know has been shown to play a positive impact on our digestion1. I carry nearly a litre of water with me EVERYWHERE, yes everywhere I go in fear of not getting enough fluids. If my urine is yellow, it’s an ordeal – if you recall, it should be a pale yellow or clear in colour2. I’m not perfect but I do practice what I preach – variety, colour, whole grains and so forth. So how could I possibly be constipated to the point of pain and pebbles? 90% of the time, if you recall the Bristol Stool Scale, for me type 1 is normal and type 2 if I’m lucky. 

Impact to Daily Life

Symptoms of IBS-C include hard stools, straining, incomplete evacuation, infrequency of defecation and gas just to name a few3. I check the box on all the above. While cramping is second nature, I am fortunate that I don’t have it as bad as others in this department. Add a high pain tolerance to that and I would label the cramping as a sense of discomfort in my everyday life. However, this made coming to a diagnosis difficult especially because there is no test to diagnose IBS4. Again, researching and researching, for a long time I wondered if I could be suffering with a condition called “Chronic Idiopathic Constipation”. But, you add in the burping, the reflux, the non-cardiac chest pain (from the GI tract contracting)5 and IBS certainly makes sense. If anyone knows me, they know I could win a belching contest after a meal in a heartbeat.

Should we dare talk about judgement? Having IBS-C has a significant impact on quality of life – for many reasons. I mean sure, there isn’t much more embarrassing than using a toilet without a plunger in sight, but it’s the criticism and judgement that tops this. It’s common during “poop” conversations for me to hear “that’s not normal”, or “it’s probably because you eat too much fibre”, or “you should know … you’re a dietitian”. People are quick to judge and not fully understand digestive conditions such as IBS, especially IBS-C. For the record, in a healthy individual, as long as fibre is increased gradually, along with activity and consumed with plenty of fluids, eating “too” much fibre should not cause constipation6. In all fairness, Canadians only get ½ the recommended fibre intake7. Yet, anyone with IBS-C might wonder how the general population still manages to have regular bowel habits.

Coming to Diagnosis & Management

Being a complete foodie, nutrition therapy was a huge challenge for me throughout my journey. Following an exclusion/elimination diet was a huge failure and for someone who values and recognizes the importance of variety and balance, the complexity of a FODMAP diet was quite overwhelming for me. This diet requires a lot of time, research, diligence and It is strongly recommended that you follow it under the supervision/guidance of a medical professional.

After neglecting my condition, I started with the probiotic route, and luckily without significant amounts of money spent, I used my knowledge to find a well-researched strain for IBS-C. I came across L.reuteri which really did help with my symptoms (specifically increasing stool frequency), but again compliance and cost was a huge barrier to establishing consistency. I would highly recommend Probioticchart.ca as a credible resource for anyone looking to learn more about probiotics. I also tried nearly every modular fibre supplement in the book, from chicory inulin, pectin and psyllium to name a few – which made a world of a difference, but have you ever thought about mixing a chalky, grey or brown powder into water, juice or oatmeal? The fibre absorbs the water, thickens and creates a gel because of the high soluble fibre content – and yes feels like you’re drinking sludge.

My biggest learning from all of this was taking it all one step at a time. At the end of the day, although we may be eager to come to a solution and relief, you don’t want to try everything at once because you won’t know what helped, making for some expensive placebo effects.

Establishing routine

At this point today my routine includes multiple management strategies to support my journey with IBS-C. I will say, it isn’t always perfect. I have learned that fibre is my best friend, and yes, we’re talking beyond 25g/day for me to make things move. For those that may know, it takes work to reach those numbers. It’s exhausting, repetitive and challenging to stay consistent.  I once read a blog from a fellow RD that expresses the importance of consistency in fibre intake, referring to the “fibre rollercoaster” where intakes vary throughout the week. I find certain weekends can specifically be one of those fibre rollercoasters. For example, being away visiting friends or my boyfriend where I didn’t have much control over food choices and would end up eating a lot more nutrient poor food. Not many weekends followed the half plate rule! I’ve gotten creative adding oats to smoothies, bringing high fibre foods to potlucks to ensure some gut friendly options are available, and tracking fibre intake. I’ve learned that a routine of oatmeal and bran cereal works like a charm, but sometimes realistic looks more like eggs and avocado, fresh baked white bread or bagels with cream cheese and that’s OK. Small, frequent meals are another game changer to support gas, reflux, bloating and abdominal pain.

Next Steps

My advice for any those without a healthcare provider background is to be patient. It’s a long journey and it never ends but there are strategies you will find that work for you! I also suggest to do your research (and use credible resources). Don’t believe everything you read. The web can be a nasty but also very helpful resource. Look past any unsafe practices, supplements that are not researched or cleanses, and remember not everyone is experienced in providing health or nutrition advice. Look for articles written by healthcare practitioners (abbreviations include MD, NP, RD), or by trusted, credible resources. Lastly, always consult your physician or regulated health professional before trying anything new. Good luck! This is not the end – your journey with IBS is just beginning!


References

  1. Peters et al. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut. 2001 Mar; 48(3): 435-439. Doi: 0.1136/gut.48.3.435. www.ncbi.nlm.nih.gov/pmc/articles/PMC1760153/
  2. Health Canada. Health Promotion – Facts on Fluids: How to Stay Hydrated. 2021 Aug.  Web
  3. International Foundation for Functional Gastrointestinal Disorders. IBS with Constipation (IBS-C). https://aboutibs.org/signs-and-symptoms/ibs-with-constipation/
  4. International Foundation for Functional Gastrointestinal Disorders. Testing in IBS. https://aboutibs.org/signs-and-symptoms/testing-in-ibs/
  5. Frankhuisen et al. Functional dyspepsia and irritable bowel syndrome in patients with achalasia and its association with non-cardiac chest pain and a decreased health-related quality of life. Scand J Gastroenterol. 2009; 44(6):687-91.doi: 10.1080/00365520902783709.https://pubmed.ncbi.nlm.nih.gov/19263270/
  6. Focus on Fibre. Unlock Food. https://www.unlockfood.ca/en/Articles/Fibre/Focus-on-Fibre.aspx
  7. Canadian Digestive Health Foundation (CDHF). Recommended Daily Fibre Intake. https://cdhf.ca/health-lifestyle/recommended-daily-fibre-intake/

About Robyn

Robyn Barefoot is a Registered Dietitian living and working in Toronto, Ontario. Robyn attended Brescia University College at Western University and went on to complete her Master’s at the University of Guelph. Over the past 5 years, Robyn has worked in weight management, family health & nutrition, foodservice menu development, and most recently medical nutrition sales. With experience living with IBS-C, digestive health is something she is passionate about. Her goal is to help others manage gut health without the shame and embarrassment that often comes along for the ride.