Hi Olivia,

Happy Friday!

Some  fabulous news to share with you that my baby boy is finally here (yes this email was written in advance and scheduled don't worry!). But if you want to hear a little more about this then check out my Instagram for more 'real time' updates.

The topic I prepared for you in advance is around constipation - a common symptom in IBS.

Now you may suffer with constipation and that is quite obvious OR we also see people with a mixture of symptoms and even diarrhoea where constipation is the actual dominant feature and was just missed.

So today, let's check;

1/ Are you constipated?

2/ What you can do about it. 

When you google a definition of constipation it is actually incorrect, talking about having 3 or less bowels motions per week.

In 13 years of practising gut health nutrition, I don't know anyone would comfortably only open their bowels 3 times per week! Just imagine how uncomfortable it would be having all your food sat in your gut, fermenting away for that long.

So constipation is actually a little more difficult to identify. If you are suffering with any of the following then you are may be constipated to some level;

1. Stool appearance of 1-3 on The Bristol Stool Chart.
2. Feeling of having an incomplete movement (aka unsatisfactory poop).
3. Your bloating improves when you open your bowels.
4. Opening your bowels less than once per day.
5. Difficulty 'pushing' your stools out.

If you have a looser tendency then you may even notice that your stools start off more constipated and then end up loose. This can be a 'back up' caused by the constipation.

Now what can you do about this?

There are once again, multiple approaches to constipation. Please note that the low FODMAP diet is not one of them - if anything, avoiding FODMAPs will make your constipation worse.

We wrote a post about this that you can read here.

Here are the best ways to manage constipation;

1. Low hanging fruit - 30g fiber per day, avoiding chia seed, drinking adequate fluid (2-3L per day), eating regular meals and eating more than 1500 calories per day.

2. Fiber supplements - psyllium husk is my favourite!

3. Daily 30 minutes of exercise.

4. Laxatives - you can use a stool softener or stimulant or a mixture depending on your symptoms.

5. Regular sleep and wake times.

6. Avoidance of stress and anxiety which can put your gut 'on hold.' You can also use specific training to reduce the impact of stress on your body (which is more realistic then never being in stressful situations).

7 . Probiotics (which have a strain that has been proven to work for constipation).

Now how do we approach constipation at The IBS Dietitian? - we actually tend to do a combination of EVERYTHING.

Because when clients come to us they are really suffering and so this whole approach of trying a probiotic only and then waiting for 1-3 months to see if it works or not is just too slow.

And, sometimes there are deeper issues. For example, if you are really constipated then eating more than 1500 calories per day is actually quite difficult. We may then temporarily use a laxative medication to get the bowels moving which then allows that person to eat more.

Or, another scenario we see is that a person's fiber intake is really poor. BUT eating more fiber makes them super bloated and uncomfortable. So we may use low FODMAP sources initially.

So I hope this email has helped you identify if you are actually constipated and then more importantly, what you can do about it.

Best Wishes

Kirsten Jackson BSc Hons PGCert RD - The IBS Dietitian Founder

New Book Review - Thank you!

Having had increasingly troublesome digestive symptoms for four years, I have taken steps which will be familiar to many. After testing to rule out "serious" things, I have tried fibre supplements, a low FODMAP diet, hypnotism (using an app), probiotic supplements. When none of these worked in a lasting way, I thought I would try this book.

The book starts on a positive note by telling us some good news (you may not need to cut out gluten or dairy!) and then recites the "things you will have already tried," including most of mine in the list above. It then makes the bold claim that this book will be the last thing you need to try. I took encouragement from this and the fact that the author is not simply a detached specialist, but has a history of IBS herself.

The book makes the case that IBS is "multifactorial," being linked to mental state (including stress and sleep) and physical factors (including exercise) as well as diet/nutrition. As such, there is a substantial opening section, "laying the foundations," which addresses all of these factors and sets out good practice in each area. This is really to optimise your situation, ahead of any more dramatic steps such as the low FODMAP diet.

The next section gets into the low FODMAP diet and how to implement it, in a way that is extremely clear and provides welcome hand-holding, while not losing sight of the "foundations" and the factors other than diet/nutrition. As with the opening four chapters, there is optimism: you are probably not sensitive to all FODMAPs and the tightly restricted diet should be temporary. The endgame is to produce a diet tailored for you, with some manageable adjustments, leaving you with as much freedom and latitude as possible (retaining the ability to eat out, socialise, etc) and a better understanding of what has caused a flare-up when one does happen.

What was my own experience, following the guidance in the book? I started to lay the foundations, using chapters 1-4. With much of it (exercise, sleep, stress) I was already in good shape. However, with two key aspects, I was not. On reading these chapters I realised that there was not *nearly* enough fibre in my daily diet, nor enough fluid intake. The requirements for both are higher than one might think, and there should be plenty of each with every meal.

So I implemented these simple changes, in readiness to get into the low FODMAP diet to follow. However, I never got to the low FODMAP stage (which I had in any case tried 18 months earlier, to little effect). Over the course of a week, my symptoms of four years went away. All of them rectified themselves, in parallel. In fact, this is a possibility predicted by the author in the first four chapters. You might not need low FODMAP at all!

Everyone is different and people's requirements differ (another important lesson about the gut!). However, if you are having digestive issues, you definitely owe it to yourself to give this book a shot. It could be life-changing.