Irritable bowel syndrome: Diet, stress and what can be advised at the counter

What it is

Irritable bowel syndrome (IBS) is a functional disorder: recurrent abdominal pain with changes in bowel habit (diarrhoea, constipation or both), with no lesion to explain it. It is common and, although not serious, it greatly affects quality of life.

The diagnosis is made by the doctor after ruling out other causes. At the counter the role is supportive: diet and lifestyle measures, a product with evidence (enteric-coated peppermint oil, soluble fibre) and, above all, recognising the warning signs that mean referral.

Three pillars of the approach

There is no single treatment; there is an approach:

DIET: the low-FODMAP diet has good evidence, but it is restrictive and best done with a professional.
STRESS: the gut–brain axis means stress and anxiety worsen the symptoms; managing them helps.
MICROBIOTA AND FIBRE: soluble fibre (psyllium) helps; some specific probiotics have modest evidence.

At the counter

When to recommend it

Ask when it gets worse: particular foods, stress, routines
Suggest a symptom and food diary to identify triggers
Enteric-coated peppermint oil capsules for pain and spasms
Soluble fibre (psyllium), starting with a small dose

When not to

Do not promise a 'cure'
Do not label as IBS symptoms a doctor has not diagnosed, especially if there are warning signs
Do not recommend insoluble fibre (bran): it usually makes bloating worse

What to say at the counter. The useful line: 'irritable bowel is controlled, not cured, and it usually improves with several measures together: diet, stress and a specific product.' And before anything else, check that a doctor made the diagnosis and that there are no warning signs.

Warnings

Important WARNING SIGNS: blood in the stools, weight loss, anaemia, fever, symptoms that wake them at night, onset from the age of 50, or a family history of bowel cancer or coeliac disease. Refer.
Important DIAGNOSIS: if nobody has ruled out other causes (coeliac disease, inflammatory bowel disease), the first step is the doctor, not a product.
Caution LOW-FODMAP DIET: it is restrictive; the elimination phase lasts a few weeks (2–6) and then foods are reintroduced in a guided way.
Caution PEPPERMINT AND REFLUX: peppermint can worsen reflux; enteric-coated capsules do so less, but it needs watching.
Worth knowing TIME: improvement is measured in weeks or months, and symptoms tend to come and go.

Pharmacokinetics

Absorption: Counter measures act mainly in the gut itself.
Distribution: Stress acts through the hypothalamic–pituitary–adrenal axis and the enteric nervous system.
Metabolism: Fermentation of certain sugars (FODMAPs) produces gas and draws in water, causing bloating and pain in sensitive people.
Elimination: Symptoms improve as the triggers are reduced, not overnight.

Measures in irritable bowel syndrome

Aspect	What it helps	What to expect
Low-FODMAP diet	Bloating, wind, pain	Good evidence; best guided by a professional
Managing stress	Fewer flare-ups	Useful as part of the package
Specific probiotics	Bloating, general discomfort	Modest, variable improvement
Enteric-coated peppermint	Pain and spasms	Reasonable evidence, relief within weeks
Soluble fibre	Bowel habit	Useful, especially with constipation

Irritable bowel responds better to several combined measures than to a single product.

Self-assessment

Three questions. When you check your answers you will see the explanation for each one.

Which factor is the most important in irritable bowel syndrome? Stress alone Diet alone The combination of diet, stress and other factors
How long does the elimination phase of the low-FODMAP diet last? One or two days For life A few weeks (2–6), followed by guided reintroduction
A customer with irritable bowel and reflux asks about peppermint. What do you tell them? Take it as a tea, it's good for digestion If they use it, it should be enteric-coated capsules, and they should watch whether the reflux gets worse That it is always contraindicated

Training content. It does not replace the summary of product characteristics or clinical judgement.

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