What is Irritable Bowel Syndrome (IBS)?
This post was co-written with The Mission Dietitian intern, Nikki Manduca.
What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder which is estimated to affect around one in five adults. Symptoms often include recurrent abdominal pain in association with altered bowel movements. IBS is diagnosed by process of elimination and there is a specific diagnostic criteria for IBS. Symptoms often overlap with other gastrointestinal disorders such as indigestion or coeliac disease1. Therefore, if you think you may have IBS it is important you first discuss this with your doctor or GP to rule out any other possible causes for your symptoms.
IBS is not a life-threatening condition, but the severity of IBS symptoms can significantly impact quality of life in some. Studies have shown that patients with IBS are more susceptible to suffer from either depression or anxiety compared to healthy individuals2. This is thought to be due to the connection between the gut and brain, via the gut-brain axis (read more about this here).
What causes IBS?
The cause of IBS is still not fully understood but is considered a disorder of the gut-brain axis. This means there is a miscommunication between the brain, and the trillions of bacteria living inside the gut, known as the gut microbiota. This miscommunication then causes an over-sensitive intestine, known as visceral hypersensitivity. As a result, this causes an exaggerated response to various things such as fluctuating hormones, food, drinks and some medications. This explains why most people find their symptoms get worse with poor sleep, stress and after eating and drinking
There is no single cause of IBS, instead several factors which can increase your risk of getting it such as:
● Travellers diarrhoea/food poisoning
● Gender (females are more likely to suffer from IBS than males)
● History of anxiety or depression
● Stress
● Genetics
What to do if you think you have IBS?
Managing IBS varies from one individual to another but the focus is mainly on making diet and lifestyle changes.
Dietary factors that influence IBS3
Regular meals
Eating regularly allows for more equal sized meals throughout the day. Avoid skipping meals as if we miss a meal, we tend to overeat at our next meal and smaller meal sizes may ease symptoms.
Caffeine
Caffeine increases the amount of stomach acid we produce and can increase the rate at which things move through our gut, with coffee being shown to rapidly increase this movement. Caffeine is found mainly in tea, coffee, cola and energy drinks. There are decaf versions of all of these, so look out for them if reducing your caffeine intake. Aim to reduce intake of caffeine-containing drinks to no more than 400mg caffeine per day (three to four cups of coffee), or 200mg if pregnant.
Alcohol
Alcohol can affect the permeability of our gut. When we drink alcohol, our gut becomes ‘leaky’, making it more sensitive to the foods we’re eating4. Limit alcohol intake to no more than 14 units per week, with at least two alcohol free days each week. 14 units is the equivalent to 6 x 175ml glasses of wine (13% ABV), 5 x pints of cider/beer (4% ABV) or 14 x 25ml shots of spirits.
Spicy food
Capsaicin, which is the active component in hot peppers and spicy food, can increase the speed at which things move through our digestive system, and can cause abdominal pain and burning sensations. If you suffer from IBS, reduce your intake of spicy foods.
High fat food
Fat takes longer to digest, and therefore sits in the small intestine which can cause feelings of fullness, abdominal bloating and abdominal pain5. Cut down on rich or fatty foods such as chips, fast foods, pies, battered food, cheese, pizza, creamy sauces and snacks such as crisps, chocolate, cake and biscuits. This also includes takeaways and fast food such as burgers and sausages.
Fluid
It is vital to stay well-hydrated for many reasons, one of which is for digestion. Fluid helps dietary fibre work in supporting our gut motility, preventing constipation, and is also important to prevent diarrhea-induced dehydration among IBS patients6. Aim to drink 1.5 to 2 litres of fluid per day. This includes water, squash, herbal teas and decaffeinated drinks.
Dietary fibre
It is essential to eat enough fibre in our diets. Fibre is what forms the bulk of our poop, feeds our gut bacteria, and helps with gut motility. It is recommended to aim for 30g fibre every day. To do this, include five portions (1 portion equals 80g) of fruits and vegetables every day, choose wholegrain carbohydrates over white varieties, and include plant-based proteins such as beans, pulses and lentils, as well as nuts and seeds regularly in your diet. Remember, fibre requires fluid to work effectively in the gut! So make sure to hit your 1.5-2 litre fluid intake each day.
Lifestyle factors that influence IBS
Various forms of exercise and meditation have also been shown to improve GI symptoms, quality of life, anxiety and stress that is often associated with IBS.
Stress
When the body is under stress, it sends out stress hormones and signals to help you cope. Whilst this does help you cope to a degree, these hormones and signals make your gut a lot more sensitive, especially if there is a prolonged release. For this reason, if you are experiencing IBS, it is important to consider treatment from two angles. Anything you can do to support yourself in respect of well-being, will help to dampen down the stress response making your gut less sensitive.
For example, one study7 looking at a group of people with IBS found that practicing yoga twice a week in fact had equal benefits to the low FODMAP diet (a diet used in those with IBS) in improving gut symptoms, with 80% of people reporting significant improvement to their symptoms.
How does it work?
Breathing: breathing is at the core of yoga practice, and activates the 'rest and digest' (parasympathetic) nervous system.
Physical movement: stretching and compression can help with trapped gas, like giving your gut a little massage!
Mindfulness: yoga is about focusing on the present moment and learning to embrace uncomfortable feelings in the body, which can also be applied when you have tummy aches and pains.
Relaxation: activating the parasympathetic nervous system helps us to relax, improving the connection between the gut and brain via the gut-brain axis.
Not sure where to start when it comes to improving your own gut health? Check out Kaitlin’s ‘28 Day Challenge to Boost Gut Health’ and ‘Wellness Weeks’ over on the highlights on her Instagram.
References
Frissora, C.L. and Koch, K.L., 2005. Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Current gastroenterology reports, 7(4), pp.264-271.
Shorey, S., Demutska, A., Chan, V. and Siah, K.T.H., 2020. Adults living with irritable bowel syndrome (IBS): A qualitative systematic review. Journal of Psychosomatic Research, p.110289.
McKenzie YA, et al. (2016) British Dietetic Association: systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Human Nut & Diet. 29(5): 549-75.
Reding, K.W., Cain, K.C., Jarrett, M.E., Eugenio, M.D. and Heitkemper, M.M., 2013. Relationship between patterns of alcohol consumption and gastrointestinal symptoms among patients with irritable bowel syndrome. The American journal of gastroenterology, 108(2), p.270.
Cozma-Petruţ, A., Loghin, F., Miere, D. and Dumitraşcu, D.L., 2017. Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!. World journal of gastroenterology, 23(21), p.3771.
Salari-Moghaddam, A., Hassanzadeh Keshteli, A., Esmaillzadeh, A. and Adibi, P., 2020. Water consumption and prevalence of irritable bowel syndrome among adults. Plos one, 15(1), p.e0228205.
Schumann, D., Langhorst, J., Dobos, G., Cramer, H. (2018) Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 47(2):203-211