Since IBS, or irritable bowel syndrome, affects nearly 45 million people in the United States, chances are that you, or someone you know, struggles with gas, bloating, cramping, and diarrhea or constipation.
IBS is a functional gastrointestinal (GI) disorder, which means that the structure of your GI tract appears normal, but it doesn't function normally.
The cause of IBS is multifactorial, meaning that a number of triggers may contribute to this dysfunction. It appears that abnormal muscle contractions (too strong or too weak) in the stomach and intestines, as well as poorly coordinated nerve signals between the brain and GI tract may lead to the condition.
Here’s what we do know.
Women are almost twice as likely to have IBS
The condition is more common in those with a family history of IBS, as well as people with anxiety and depression.
Anxiety and stress alone do not cause the condition, but they can aggravate it.
People with IBS are more prone to experience other GI conditions such as heartburn and SIBO.
Those with IBS may also experience non-GI disorders such as chronic fatigue, chronic pelvic pain, depression, and anxiety.
Early celiac disease, a condition where antibodies form to toxic proteins in wheat (gluten/gliadin) can mimic IBS and must be ruled out with specific testing.
If IBS is causing you discomfort and limiting your activities, it’s time to look at food triggers and these other contributing factors.
IBS Trigger #1: Food
Food sensitivities or intolerances like those found in some high-carb foods, spicy or fatty foods, coffee or caffeine, fructose, alcohol, chemical additives and preservatives, fructose, sorbitol) found in the Standard American Diet (SAD) are some of the main culprits of intestinal disorders.
Eating large quantities of highly fermentable carbohydrates (FODMAPs) like milk, beans, broccoli, onions, and garlic can play a significant role. Learn more about FODMAPs here. Lactose, or milk sugar, is a highly fermentable carb that can be a trigger of IBS. Fructose, the primary fruit sugar, is another FODMAP.
IBS Trigger #2: Stress
Because the function of the intestines is controlled by the autonomic nervous system, stress and anxiety often exacerbate IBS. Stress triggers the sympathetic nervous system, putting us into the “fight or flight” response, which shuts down digestive enzyme output and diverts blood flow away from the gut to the muscles so we can flee from the perceived stressor.
Proper digestion occurs when we’re in a parasympathetic state, or the calm “rest and digest” phase. The vagus nerve (sounds like Las Vegas) nerve is a key player here. The vagus nerve runs from the brainstem through the chest to innervate the heart and lungs, and the stomach, pancreas, liver, gall bladder and small and large intestines.
When the vagus nerve is functioning optimally, our digestive tract releases the right enzymes at the right time, and promotes proper peristalsis, those muscular contractions that propel food through the gut, leading to optimal digestion and elimination.
Additionally, there is a connection between serotonin, a calming neurotransmitter, and IBS. One of the jobs of serotonin is to help stimulate peristalsis. Since 95% of a body’s serotonin is found in the gut, drugs were formulated to regulate gut serotonin levels, but have since been withdrawn from the market due to serious side effects.
Instead, use calming practices such as daily meditation, breathing exercises and yoga, as well as singing, chanting, and gargling, which stimulate the vagus nerve as it runs through the back of the throat, to help bring balance to the neuro-hormonal connection.
IBS Trigger #3: Hormones
Monthly hormonal changes in women seem to aggravate IBS. You may experience it as increased bloating and either diarrhea and/or constipation. We don’t fully understand how hormones influence IBS yet, but women who work on cleaning up their diets, putting extra effort into staying hydrated, and those who dump coffee and alcohol the week prior to their period report a significant reduction in digestive distress.
IBS Trigger #4: Infection
One in nine people who experience food poisoning or gastroenteritis develops IBS. A form of IBS, post-infectious irritable bowel syndrome (PI-IBS) is not only caused by food poisoning and infections but can contribute to an autoimmune reaction in the gut. There are three main types of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (diarrhea-constipation mixed).
Post-infectious IBS almost always has a diarrheal component, with patients suffering from symptoms of IBS-D or IBS-M. If you experience IBS-C, it is less likely that you have post-infectious IBS.
If you think that you have PI-IBS, ask your doctor about a definitive new test has been developed to identify bacterial toxins, which can then guide an effective treatment plan.
Here’s What You Can Do Now
Since only you know which, specific foods seem to trigger a “run for the bathroom” episode, start keeping a food diary now so that you can begin eliminating foods that are giving you problems. Consider food antibody testing to learn how your immune system responds to the foods you eat - it can be life-changing!
Some people experience relief by using pure, natural peppermint teas and oils to relax the smooth muscles in the intestinal wall. Peppermint oil has antispasmodic properties that seem to relieve symptoms like pain, constipation and/or gas.
Meditation is a common technique for managing stress. Use it along with guided imagery and deep breathing.
Exercise is also a primary stress-reducer that can be used to moderate the symptoms of IBS and promote proper digestion. Before entering any exercise program, check with your doctor.
If gas, bloating, heartburn and other intestinal distress is putting a dent in your healthy, active lifestyle, it’s time to work with a naturopathic or functional medicine doctor, who will listen to your complaints and do a comprehensive workup to identify and address your specific triggers.
My patients receive a complete functional workup that includes testing for food reactions, a Comprehensive Digestive Stool Analysis to assess microbial balance, the presence of parasites, digestive enzyme output, as well as markers of inflammation or past infection, and SIBO.
Stay tuned for future posts in which we’ll further explore SIBO, or Small Intestinal Bacterial Overgrowth, learn more about FODMAPS, heartburn and GERD, and how to restore proper gut function.