IBS - factors that contribute
It could be as simple as how you react to stress and anxiety, or the type of fibre you eat, so check which issue is the culprit that gives you irritable bowel syndrome (IBS).
Most people associate irritable bowel syndrome (IBS) with what they eat, or don’t eat for that matter. You'd be surprised that anything from your menstrual cycle to the antacid you use for heartburn could be the cause of this condition.
Hormonal levels are often a strong factor that contribute to irritable bowel syndrome (IBS). Post- menopausal women have fewer IBS symptoms (e.g. pain, headaches, mucous in stools, nausea and flatulence) compared to menstruating women, especially at the time of the menstrual period.
This is an ecological imbalance of the gut caused by disrupted gut flora, and is consistent in people who suffer with IBS. Dysbiosis can also lead to increased intestinal permeability where pathogens, undigested foods and toxins pass into the bloodstream. The immune system is activated, causing inflammation, pain and altered bowel habits. In this depleted state the body will be more prone to food intolerance's and allergies.
People who haven’t been breastfed or have used antibiotics often in the past are common candidates, as well as those on a high sugar and starch diet that includes processed foods.
Note, some cases of IBS arise after a bacteria or parasitic pathogen, for example candida, has caused an infection in the GI tract.
Stress and anxiety
Stress and anxiety don’t appear to be the cause of IBS, but certainly contribute to gut hypersensitivity. Increased fight or flight stress hormones affect the chemical messenger neurotransmitters, thereby altering communication between the brain and gut.
Levels and activity of the neurotransmitter serotonin, in particular, appears to be somewhat abnormal in people with IBS with about 50 percent of people seeking IBS treatment also experiencing depression or anxiety (Spiller 2007).
This relationship appears to be bidirectional, meaning that IBS may cause stress, and stress may contribute to IBS symptoms. Stress exacerbates spasms and increases the contractions of the intestine that propel food through the digestive tract and leads to abdominal pain and irregular bowel function.
Drugs and their impact
Antacids for heartburn and indigestion may give temporary relief but have shown to damage the epithelium and compromise intestinal permeability. Antibiotics destroy both good and bad bacteria in the gut, while antidepressants may mask the discomfort but not address the reason for IBS.
Diet is a major factor in IBS and symptoms will often be triggered by certain foods or food groups. A lack of dietary fibre, foods with a high sugar content and food allergies will affect the incidence and contribute to IBS.
Many features of IBS are similar to food allergies where an inappropriate immune response to a component of the diet is experienced, and the immune system “attacks” particles of the problematic food.
The dysbiosis associated with IBS produces an abnormally high amount of gas in response to certain foods, particularly those high in fermentable carbohydrate. Undigested carbohydrates stimulate the growth of pathogenic microbes, which results in an increase in abdominal bloating, pain and flatulence that’s normally reversed by avoiding those foods.
Gluten sensitivity is shown to trigger gut symptoms with abdominal pain, bloating, fatigue, stool consistency and overall IBS symptoms coming to the fore. Gluten is a protein component found in grains, especially wheat (bread, pasta, cake flour, etc.), but also in barley, oats, rye and couscous.
Gluten encourages mucous build-up on the gut wall and this sticky coating irritates and makes the system sluggish. Grain sensitivity is found in 40 to 60 percent of IBS sufferers.
Brown rice, quinoa, millet and amaranth grains are all gluten free and are easier to digest. Also stick to vegetables such as sweet potato, pumpkin and butternut. Sourdough and/or sprouted wheat, as well as gluten-free alternatives such as buckwheat, spelt or other grains are recommended too.
Dairy sensitivity in IBS sufferers usually relates to milk, cheese and ice cream. Lactose commonly irritates the gut wall of the intestinal tract and is difficult to break down. Avoid dairy for a couple of weeks or try lactose-free alternatives. Fermented dairy such as buttermilk, cottage cheese and yoghurt are good options too.
As sugar (refined carbohydrate) levels rise, it decreases and slows down the motility of the gut. Sugar is also a feeding substrate for yeast to flourish, which can outnumber the good bacteria, leading to dysbiosis.
All sugars, including glucose, sucrose, malt, maltose, corn syrup, fructose, brown sugar, honey, maple syrup and lactose, are disaccharides that need to be monitored carefully. Check the sugar content in everything from fizzy drinks, dried fruit and chutneys, to flavoured yoghurts and tinned foods.
The question of fibre
Insufficient dietary fibre diminishes the ability of the colon to move food through the digestive tract. Over time, the continued ingestion of insufficient fibre will weaken the intestinal muscles. However, it’s the choice of fibre that’s most important, as not all fibres are equal.
Insoluble fibre, for example wheat bran and wholegrain, may help the stomach to eliminate waste quickly which in turn will ease IBS symptoms. But this is a short-term solution as this rough fibre causes bloating and has been shown to be very abrasive, further exacerbating IBS. The bran also leaches minerals from colon cells and eventually lacerates the cells of the lining, weakens peristalsis and leads to chronic colon problems.
Soluble fibre foods contain more fluid and water, which create a soft gel that’s gentle, non-irritating and which helps to avoid a spastic colon. Soluble fibre is found in fruits and vegetables, for example apples, pears, beetroot, spinach and linseeds. Psyllium husk is particularly good as it swells in the stomach and pulls and eliminates toxins.
Remember to drink more water when eating fibre.
Foods to monitor
The following foods have shown to cause irritation:
- Nuts and seeds – they may get stuck in the pockets of the gut causing pain and inflammation
- Citrus fruits, in particular oranges, are a common allergen (but lemon and lime seem to cause no problems)
- Spicy foods
- Gas-forming foods including beans, lentils, legumes, cauliflower, broccoli and cabbage (consume in moderation and make sure to cook softly)
- Shellfish, soya, eggs and corn are common allergens
- Fructose, especially overconsumption of dried fruit or fruit juices
- Yeast that’s found in bread, stocks, cheese and mushrooms
- Onions and garlic
- Artificial preservatives, sweeteners and additives, for example sorbitol/mannitol in sugar- free gum, MSG, tartrazine, citric acid and nitrates in preserved meats
- Coffee and alcohol, as both can create and acidic response
- Fried foods, especially those fried with hydrogenated oils or that contain trans fatty acid (e.g. hard brick margarine)
- Poor-quality meat (e.g. processed meat) and dairy may cause inflammation
- Processed baked goods, including most packaged breads, pastries, cakes and cookies contain refined sugar, bleached white flour, preservatives and bad fats
If you’re experiencing IBS symptoms, it’s worth starting a food journal to note which foods are triggering your symptoms. Once these foods are identified, try and avoid them for a couple of weeks to give your body a break and time to heal.
If the problem persists once you've resumed your old diet, it may be best to reconsider the food choices you make.