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How do you know if you have IBS in addition to IBD?

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Posted 8/24/2015 10:36 PM (GMT 0)
Hi everyone,

I am in a mild flare right now, with some mucus, bowel pain, a small amount of blood, as well as constipation and gas. I've suspected for awhile that I have IBS-C in addition to IBD, because even though cutting out wheat, dairy, peanuts and spicy food has helped with the worst food sensitivities, I suspect there are others as well.

I think broccoli and garlic and high sugar fruits really contribute to the gas and gas pains I've been experiencing. I often have to go to the restroom just to pass gas. I try to eat a lot of high magnesium foods and other foods that should be good for constipation (prunes, healthy oils, etc.) but nothing seems to work and I'm relying very heavily on magnesium citrate laxative (the liquid in the bottle).

If you try a low FODMAP diet, and it helps you, is that how you determine that you have IBS? Are some foods very constipating and best avoided?

I would really appreciate any advice.
Posted 8/24/2015 10:47 PM (GMT 0)
I think it's just about impossible to tell, other than guesswork. about the best clue you can get is if you get a clear scope with no inflammation and yet you continue to have problems. Even then you may be having some kind of problems in the small intestine instead of it being IBS. Not too long ago they came up with a test for IBS but I don't think it has made it's way down to the trenches yet.
Posted 8/24/2015 10:50 PM (GMT 0)
My dietitian that specializes in IBD/IBS put me on the low FODMAP no fructose diet for 5 weeks before reintroduction of high FODMAP and fructose foods for another 5 weeks during the reintro phase, she told me within the first couple of weeks my IBS-C should have subsided IF I had any food sensitivities/intolerence's (other than the lactose intolerance that was confirmed through blood test) we found I had no other food issues, my IBS is stress driven for me....I've also been working with a therapist out of my GI's office that specializes with IBD and other gut issued patients to try and combat my IBS.

If you do the low FODMAP no fructose you have to be an avid label reader to ensure that you're not accidentally ingesting anything that you're not allowed HFCS (high fructose corn syrups are in a lot of packaged products including beverages).

Good luck, it's quite a journey but if I can do it, anyone can.
Posted 8/24/2015 11:41 PM (GMT 0)
From my experience it's a process that takes much time and attention. As you eliminate problem foods you notice improvement. Stress is not a factor for me.

Some foods cause immediate reactions like urgency (trigger foods) those are the easiest to determine once you've eliminated a lot of questionable foods. Others cause different symptoms: gas, constipation, bleeding, diarrhea (different than urgency in my experience).

My problem food list has never fit any particular named diet (yes tried them all, some twice). So in answer to your question:
If you try a low FODMAP diet, and it helps you, is that how you determine that you have IBS? Are some foods very constipating and best avoided?

yes and no. If avoiding certain foods helps your symptoms then yes you have a form of IBS.
However removing gluten made my bleeding stop, that's not IBS, that's UC due to blood.
Gluten was very hard to determine as a problem because it didn't seem to cause problems, gut got quiet, so good right? Actually not good, it was causing my gut to shut down into C and then bleed.

Fiberous foods were the cause of constipation too and eliminating fiber was very positive. I used fiber pills to help and eventually went from 6 fiber pills daily to 1 daily for the last 2 years (and had to experiment with diff. kinds of fiber pills too). C is not a problem any more.

D is also not a problem because dairy caused most of that and it's gone (hard cheese and butter are gut-approved). I was in denial about milk/cream for a long time but when I finally removed these it was a huge improvement. Coconut cream is my replacement.

Like you many fruits are a problem (suspect fructose) but….red grapes are OK but raisins are not, etc.
Spices aren't a problem for me (paprika, chiles in moderation, garam masala, red and green Thai curry pastes) but garlic or lemon are not good.

I have a 4" 8x11 notebook with gluten-free, dairy free, nut-free, fruit-free desserts. And a much smaller one for main dish dinners haha. Desserts are my obsession because everything else is pretty easy to deal with.

Now when I cheat (and I do) I know what to expect. It was way worse when my gut acted up randomly.
Good luck with your search for the right diet for your gut.
Posted 8/26/2015 12:18 AM (GMT 0)
Thank you for the replies. I appreciate them!

@pb4--Thank you, I'll try low FODMAP for 5 weeks and see how it goes! I will keep in mind that stress can cause it too, just in case I don't notice any benefits from the FODMAP elimination/reintroduction.

Also, I will start seeing a psychologist who works with bowel patients very soon. I had the consultation already and my first appt. is next week. She is going to do some cognitive behavioral therapy and gut-directed hypnosis, and I'm looking forward to it. This disease has really caused a lot of stress and I'm hoping therapy will help. I'm so glad it has helped you.

@imagardener2, thank you for sharing your experience! I should really keep a food journal again. I've only identified the foods that cause pain in my gut (and diarrhea with dairy and lots of horrible problems with wheat), but not gas and constipation. It's so complicated and exhausting trying to figure this out. Also, I may be overdoing the fiber thing thinking that it helps, but it only helps a tiny bit. I take 4T. of Heather's Tummy Acacia fiber a day, drink gallons of water and eat fruit (especially a small amount of dried fruit) in the hopes that I won't feel dizzy and in pain from the constipation and then need to drink the Mag Citrate laxative. When I eat fish, healthy oils and meat I don't have gas problems, so maybe I should try to just eat those foods for a few days, keep drinking tons of water and see how I feel. Maybe the constipation will improve!
Posted 8/26/2015 12:29 AM (GMT 0)
colitis32 said:
When I eat fish, healthy oils and meat I don't have gas problems, so maybe I should try to just eat those foods for a few days, keep drinking tons of water and see how I feel. Maybe the constipation will improve!

There was a time that meat, water and a few veggies was all my colon could handle. Luckily meat has a lot of vitamins and well cooked carrots and green beans had gentle fiber. Also chicken broth was very restoring. Boring diet but better than the symptoms and gradually I could add foods one by one to make sure they were safe. Healthy oils like coconut and olive are also anti-inflammatory and help a lot but don't overdo them.

You should try and lose the need to use Mag Citrate. For me lower fiber intake alleviated constipation. I use Citrucel cell pill (now avail. generic) because all the other fiber pills were not gut-approved. The Citrucell powder has stuff not gut-approved either.
Posted 8/26/2015 12:53 AM (GMT 0)
Hi imagardener2,

Thank you, your advice is very helpful. My GI is concerned about my dependence on Mag Citrate too. It's just that when I worry about fainting, and everything in my abdomen is tight and doesn't want to move I start to panic, you know? Finding another solution would be much better, though. My body seems to like both Citracel pills and Heather's Tummy fiber. I'll try a more limited diet for a bit. I can't keep doing what I'm doing now since it's not working.
Posted 8/26/2015 12:56 AM (GMT 0)
Colitis32,

Here's the link for the FODMAP to follow and it shows the high FODMAP to avoid as you scroll down a bit you'll see it....


http://www.ibsgroup.org/brochures/fodmap-intolerances.pdf


You'll probably have to copy and paste the link, I will also post how my dietitian had me do the reintroduction for you....
Posted 8/26/2015 1:05 AM (GMT 0)
Here's the reintroduction guide for 5 weeks AFTER you've done the low FODMAP, no fructose (so read labels and avoid inulin) diet... be sure to journal all that you eat/drink from the low FODMAP list as well as bowel movement activity and description of BM like diarrhea, constipated stools etc. during the whole 5 weeks.

week one; reintroduce Polyois (mannitol and sorbitol)
Monday 1/2 cup mushrooms (mannitol) and 1-2 tiny plums (sorbitol and mannitol) and monitor symptoms ( also using a food journal to monitor just as in the 5 weeks while doing the diet)
Tuesday don't eat mushrooms or plums monitor symptoms (as in journaling so you can compare your notes)
Wednesday same foods, plum and mushrooms
Thursday monitor symptoms
Friday same foods, plum and mushrooms
Saturday and Sunday monitor symptoms then move to week 2...

week 2; reintroduce lactose (even if you're not lactose intolerant you should avoid it during the 5 week diet (stay strict on the guideline for those 5 weeks, dairy isn't allowed on it as part of the possible food intolerance issues for FODMAP known as the Disaccharide) Monday 250 ml of milk or 200 g of yogurt and monitor symptoms
Tuesday no dairy, just monitor symptoms, same as week before, you alternate days of eating the reintroduced food and monitor on certain days only as I'm describing.
Wednesday have the milk or yogurt again
Thursday monitor only
Friday have milk or yogurt again
Saturday and Sunday monitor only

week 3; Fructose (monosaccharide) reintroduction
Monday 1/2 a mango OR 1 tsp of honey (not both) and monitor symptoms
Tuesday monitor symptoms only
Wednesday 1/2 mango OR 1 tsp honey and monitor
Thursday monitor only
Friday again 1/2 mango OR 1 tsp honey
Saturday and Sunday monitor only

week 4; Fructans (oligosaccharide)
Monday 1 garlic clove and monitor symptoms
Tuesday monitor symptoms only
Wednesday 1 garlic clove and monitor
Thursday monitor only
Friday 1 garlic clove
Saturday and Sunday monitor only

week 5; Galactans (oligosaccharide)
Monday 1/2 cup lentils or legumes and monitor symptoms
Tuesday monitor only
Wednesday 1/2 cup lentils or legumes and monitor
Thursday monitor symptoms
Friday 1/2 cup lentils or legumes and monitor
Saturday and Sunday monitor only

If any of the food groups bother you to an extreme or excessively bothersome then stop eating it, wait out the week and wait for the next week reintroduction to continue reintro process. Reason being is if any of the food groups that you're reintroducing causes you noticeable issues as I mentioned then that's the indicator that that/those particular food groups are causing you food intolerance issues and you'll either have to completely avoid them or have very small amounts only and only on occasion or they will continue to bug your gut/IBS symptoms.

Let me know if you have any questions...I never cheated on the 5 week diet at all, I followed it strictly for the money it cost me with the dietitian I wasn't going to waste my time or money cheating/giving up on the diet cuz I wanted to do whatever it takes to get my IBS under control. So if you cheat on it then I have no idea what to suggest since my dietitian never had to instruct me on that.

Good luck, I hope you don't have any food intolerance issues, I never did (other than the lactose but I use lactaid products to aid since I knew beforehand that I was lactose intolerant.

Make sure you keep a food and BM journal while you do the low FODMAP no fructose diet in order to help you more easily determine any possible trigger groups. I'm glad you're soon going to seek therapy with someone that specializes in IBD/IBS and other gut issues, I hope you are able to get things on track. Good luck!!
Posted 8/26/2015 1:26 AM (GMT 0)
Thank you, pb4! This is great! I'll keep a journal and will definitely write again with any questions.
Posted 8/26/2015 1:31 AM (GMT 0)
Awesome, I figure if I could do this diet strictly for 5 weeks and the reintro for the other 5 (well 4 for me cuz of the lactose thing) as well, anyone can lol!

I hope it helps you discover how to deal with your gut issues one way or the other...to be honest I was very happy I didn't find out I had more food intolerance issues, finding out I was lactose intolerant was bad enough, thank goodness for lactaid pills haha! Granted I suppose cutting out an offensive food group might be easier for some than to deal with their IBS being stress driven, gosh let alone both stress and diet, that would suck!....best of luck to you!!
Posted 8/26/2015 2:47 AM (GMT 0)
I agree Alice, and even though each IBSer can vary with symptoms and irritations, I too learned about the dairy, fat and fiber so I've played around with them to find a better balance...for me I was shocked when prunes stopped helping and instead seemed to add to my constipation, dairy, I don't consume much and I was most disappointed to learn I couldn't eat chocolate daily (that really started to make my constipation worse, which was devastating to me cuz I LOVE chocolate so much but the strangest things happened after I did the diet and reintroduction, first I found that I didn't have any specific food group to be the issue for me, then realizing that I no longer got crazy cravings, even when my dietitian gave me the okay on the Udis double chocolate muffins (they don't contain inulin which was a huge deal with her lol) I noticed that if I ate one everyday for more than 3 days in a row that my constipation got worse....I also found that cucumbers eaten daily really help with the constipation too...I'm so glad I don't get crazy chocolate and sugar cravings like I used too and it's been a while since I did the diet and reintro and still no harsh cravings so I'm really glad for that...I just need to work on my stress more and more in hopes that it'll start cutting back the daily frequency...IBS is pretty tough to deal with like any bowel issue is. Having IBS coexist with any other bowel issue like IBD or Celiacs sucks too.
Posted 8/26/2015 5:29 PM (GMT 0)
Thanks Alice22! I am doing a Paleo diet right now, so I'm already not eating dairy but I think I need to avoid more foods. I've been eating a lot of homemade soups, but my two favorites are pea and leek soup and carrot coconut ginger, so I may need to prepare more basic stuff. My (future) husband used to work as an executive chef, and he doesn't want me to feel deprived so he helps me prepare some of my meals.

I'll try some broth-type soups and cucumber and try decreasing the amount of the fiber supplement I'm taking. And I won't eat any dark chocolate for awhile.

I notice in your signature that you take peppermint oil capsules. Do they help a lot and with what symptoms do they help?
Posted 8/27/2015 1:54 AM (GMT 0)
Hi Alice22,

Thank you for sending more info. about your experience with peppermint oil. Lately, I run to the bathroom around three times a day just to pass gas, which feels like a lot. I'm definitely moving forward with the FODMAP diet and food journal, and I hope I see improvement with peppermint oil too. Trying new things really helps me to stay positive!
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