What is IBS
Irritable bowel syndrome is best understood as a long-term or chronic condition that lasts longer than 6 months for most people. People with IBS experience reoccurring issues with abdominal pain, bloating, or discomfort related to their bowel movements. These disturbances of signals to the brain can produce symptoms of abdominal pain or discomfort, bloating or a sense of gaseousness, and a change in bowel habits (diarrhea and/or constipation).
There is NO mistaking why the first word is “irritable” or highly sensitive. I have had IBS since I was a kid. There have been periods when it was managed entirely, then bouts of misery have made me want to sleep it off when sometimes that’s the only relief I could find. Research finds that individuals with IBS restrict their activities an average of 73 days out of the year. I can attest to that.
When your gut is in distress, your life feels like a mess.
It’s important to understand that in IBS, the digestive system appears normal on routine tests. For this reason, it has been referred to as a functional gastrointestinal (GI) disorder. Functional GI disorders, now called Disorders of Gut-Brain Interaction (DGBIs), include motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system processing. The Rome diagnostic criteria categorize functional gastrointestinal disorders.
However, there is increasing evidence that the GI symptoms experienced in IBS may be caused by one or more of the following:
- Abnormalities in gut motility
- Improper functioning of the immune system (over or underactive)
- Abnormal amounts of bacteria and other organisms (like viruses and fungi) in the gut (microbiota)
- The central nervous system interprets painful signals coming from the gut.
The brain regulates these gut-related activities. This may also be impaired, so IBS is often called a brain-gut disorder.
Getting a diagnosis
It is important to speak to your doctor and not “self-diagnose” IBS. Physicians can rule out serious conditions such as celiac disease, inflammatory bowel disease, and endometriosis.
Common tests may include blood tests, stool tests, and colonoscopy.
Be aware that other tests are widely available and do not help diagnose IBS. These include:
- Breath tests
- IgG food intolerance tests
- Fecal microbiota testing
The Enteric Nervous System – “The Second Brain”
As any sufferer will tell you, the worst part about IBS isn’t necessarily the physical aspects but the brain-gut connection. Researchers find evidence that irritation in the gastrointestinal system may send signals to the central nervous system (CNS) that trigger mood changes. I know this to be 100% true as a person with IBS.
The ENS is two thin layers of over 100 million nerve cells line the gastrointestinal tract from the esophagus to the rectum. Its primary role is to modulate digestion through the action of swallowing, the release of enzymes, and controlling blood flow that aids in nutrient absorption and the elimination of waste. These signals from the ENS are sent back to the brain. When the gut is inflamed, and in distress, the person feels that distress. Defining what comes first in origin, depression first, then gut distress OR gut distress cues depression, is challenging to determine.
Factors that may contribute to IBS
There are several lifestyle and nutrition factors to consider, but researchers don’t know the exact mechanisms, and therefore diagnosing IBS is difficult. The amount of stress, type and intensity of exercise, the composition and amount of food, the gut microbiota, and the motility of the gut all play a role. It is difficult to connect one singular aspect to IBS for these reasons.
Exercise and training
Research shows that increased physical activity from a sedentary level has positive long-term, positive effects on IBS symptoms and psychological symptoms. A moderate level of exercise can improve symptoms with appropriate warm-up, level of intensity, and cool down.
During training, the sympathetic nervous system works to elevate the heart rate, but the parasympathetic nervous system regulates how high the heart rate goes. The parasympathetic nervous system maintains the increase in heart rate, blood pressure, sweat rate, and breathing rate. If you’re not warming up correctly, or in a constant state of stress outside of exercising (life’s everyday stressors), then the sympathetic nervous system will take over and continually keep that heart rate high.
Athletes commonly find that GI symptoms occur with their sport. Bloating, cramping, diarrhea, and vomiting are common symptoms in many sports, typically known in endurance sports as runner’s diarrhea or “runners trots.” A well-nourished athlete can train their gut to improve symptoms and performance. Counseling with a Sports Dietitian will help map out a strategy for fueling correctly.
As a competitive athlete nearly all my life and with a history of dieting and restriction and excessive training, I now have to find a balance in what I choose to participate in. Some studies show that yoga or more mindful methods of movement like walking may help with pain, quality of life, and mood.
If you have been diagnosed with IBS, you can take steps to improve symptoms. One of the most common strategies is an elimination diet with a Registered Dietitian. Monash University research showed that IBS symptoms improve in 3 out of 4 people who follow a low FODMAP diet.
FODMAPs are a collection of short-chain carbohydrates (sugars) that aren’t absorbed properly in the gut, triggering symptoms in people with IBS. FODMAPs are found naturally in many foods and food additives.
FODMAPs may not always present a problem. Often, a sudden change in diet to add more fiber and the types of fiber added or eliminated can cause shifts in the functioning of the gut.
The low FODMAP diet can be very restrictive, and it is advised to work with a qualified Dietitian to guide you. The food itself may not pose a problem, but when combined with others and in various quantities can be. I have found relief in taking out foods that I have found to trigger some symptoms. These include sugar alcohols, some alcoholic drinks in specific quantities, high fatty foods, high fructose, high fructans found in onions, and some legumes. Since many healthful foods are high FODMAPs, careful elimination and reintroduction can ensure that various nutrients are still included in the diet.