When someone with IBS sits in front of me, there’s one thing they want more than anything else: to feel better. They want me, the dietitian, to help them feel better. That’s a profound weight and responsibility to bear, a responsibility that must be met with compassion, empathy, and understanding. Yet, it also demands clear professional boundaries, ensuring that I stay within my scope of practice while supporting the person as a whole.
Irritable Bowel Syndrome (IBS) is more than just a collection of symptoms, it’s a condition that profoundly impacts people’s lives. As a dietitian, I regularly meet individuals burdened by debilitating pain, relentless bloating, unpredictable bowel habits, and the deep frustration of a reduced quality of life. Work becomes a struggle, social events are missed, and the stress of “just managing” can feel insurmountable.
At the heart of every consultation is a structured process to fully understand the person sitting in front of me. The ABCDE dietetic assessment forms a crucial framework for this. It’s not just about the symptoms, they’re only one piece of the puzzle. This holistic approach ensures no stone is left unturned when addressing complex conditions like IBS:
A – Anthropometry: We assess weight, body mass index (BMI), and weight history, taking into account any unintentional changes that may point to malnutrition or other underlying conditions. This helps to gauge the overall nutritional status and identify potential risks.
B – Biochemistry: This includes reviewing key elimination tests to rule out other conditions that can mimic IBS, such as anti-TTG antibodies to screen for coeliac disease and faecal calprotectin to assess for inflammation indicative of inflammatory bowel disease (IBD). Additionally, we consider any relevant surgical procedures the individual may have undergone, which could influence their symptoms and overall digestive function.
C – Clinical Assessment: This step delves into the individual's medical history, coexisting conditions, and medications. IBS often intersects with other health challenges, such as anxiety, depression, or inflammatory bowel diseases, requiring careful consideration.
D – Dietary Assessment: A detailed review of current dietary patterns and eating behaviors is conducted. We explore potential triggers, nutrient balance, and meal timings, as well as the role of common culprits like caffeine, alcohol, and FODMAPs.
E – Environment and Emotion: This includes evaluating lifestyle factors, stress levels, sleep patterns, and the psychosocial impact of IBS. The gut-brain axis is often a significant factor, so understanding the person’s emotional landscape is essential.
Through this comprehensive assessment, I can begin to untangle the complexity of their symptoms, combining clinical expertise with compassionate listening to address both the physical and emotional dimensions of IBS.
It’s a vicious circle. The body gets stuck in the fight-or-flight response, the vagus nerve unable to fully calm the storm in the gut. As symptoms worsen, dietary restrictions tend to spiral, and what starts as a hopeful plan to ease discomfort can turn into a maze of conflicting advice and mounting confusion. By the time many people see me, they feel completely overwhelmed, frustrated, and stuck.
Many of my patients carry more than IBS on their shoulders. Life traumas, significant stressors, and other gastrointestinal conditions often weave themselves into the tapestry of their symptoms, creating a complexity that isn’t easily untangled. While I always aim to stay in my lane as a dietitian, I’ve learned that there’s immense power in simply listening.
Taking the time to let someone offload their worries, frustrations, and fears isn’t just therapeutic for them, it’s humbling and heartwarming for me. I’ve seen people cry, open up, and share the parts of their struggles that go far beyond food. And every time, I’m reminded that behind every symptom is a person who just wants to feel heard and supported.
This is where boundaries play a crucial role. While fine-tuning diets, exploring triggers, and balancing nutrients are at the core of my practice, I recognise that I’m part of a wider team that may include psychologists, gastroenterologists, or other healthcare professionals.
Empathy and compassion are essential, but they must be coupled with a clear understanding of when to refer someone to the appropriate support.
The human connection is what stays with me the most. Listening is often the first step in breaking that vicious circle and helping people find not only physical relief but also emotional clarity. It reminds me that healing isn’t just about managing symptoms; it’s about empowering someone to reclaim a sense of control over their life.
To those navigating IBS: you’re not alone in this. To my fellow dietitians: let’s never forget the impact of a compassionate ear, balanced with professional boundaries. Sometimes, that’s the most powerful tool we have.
Comments