Irritable Bowel Syndrome. What is it?

A common question for those diagnosed with IBS is, what caused it? The short answer is we don’t know. The longer, more complicated answer is, there are several possible causes and there are likely more causes out there that we aren’t aware of. Some of the likely causes are:

• Past trauma

• Mental Illness, like anxiety or depression

• Dysbiosis, or disruptions to your gut microbiome from infection or small intestine bacterial overgrowth (SIBO)

• All though food is not a known causes of IBS, carbohydrate malabsorption due to food intolerances is a potential trigger for symptoms as are some other foods that may affect individuals

It’s likely that you would have to be genetically predisposed to IBS for it to be triggered by one or more of the possible causes above.

Beyond what’s going on with your bowel movements, there is a whole slew of other possible symptoms:

• Bloating

• Gas

• Abdominal distension

• Abdominal pain

• Belching

• Nausea

• Early satiety (you get full by eating very little)

• Heartburn

• Fatigue

• Anxiety

• Depression

• Painful urination

• Frequent urination

• Muscle or bone pain

• Severe menstrual cramps

• Pain before, during, or after sex

As you can see the amount of symptoms associated with IBS is dizzying. Likely no one is going to experience all of these symptoms (god I hope not) and what symptoms you may experience are going to be individual to you.

When it comes to what may be triggering symptoms, diet is a common factor. There are some dietary triggers that are common to a lot of GI conditions like caffeine, high fat foods, and alcohol and there are some triggers that are more specific to IBS. FODMAPs, fructose, lactose, and fructans are all carbohydrates that may cause digestive symptoms for those with IBS.

What are FODMAPs, fructans, and fructose? First, FODMAP is an acronym standing for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols, all of these things plus fructose and fructans refer to different types of carbohydrates found in a large variety of foods. Generally most people don’t truly understand what a carbohydrate is so here is a short rant about it.

You can’t just point at a loaf of bread or the bag of sugar in your pantry and say, “that’s a carb”. No, it’s not, it contains one or more types of carbohydrates of which there are MANY. That bag of sugar in your pantry is an easy example. It is made up of sucrose, a disaccharide (die-sa-ka-ride) which in turn is made up of two monosaccharides (mon-oh-sa-ka-ride), glucose and fructose. Sucrose, glucose, and fructose are carbohydrates. The loaf of bread will likely have several kinds of carbohydrates in it depending on the ingredients, like what kind of flour(s) were used, if there is any added sugar or other sweeteners, and if it contains oats, seeds, or nuts.

Now that our very brief carbohydrate lesson is over, we can get back to IBS. If you are intolerant to FODMAPs, fructose, fructans, or lactose, this means your body cannot absorb these specific carbohydrates (not all carbohydrates). Generally, you are able to absorb a small amount, but once you hit that limit in a single meal or snack the extras end up hanging around in your digestive tract (small intestine and colon). This causes water to move into your digestive tract leading to diarrhea and other unpleasant symptoms. For some of these carbohydrates, the bacteria in your colon may be able to ferment them which can lead to bloating, gas, and pain.

Now that we have diagnosis and symptoms covered, let’s talk about treatment. When it comes to diet, some possible interventions are limiting or avoiding trigger foods, elimination diet to discover food intolerances, increasing or changing the types of fibre in the diet, eating smaller, more frequent meals, or using supplements like probiotics, peppermint oil, and digestive enzymes.

If we go down the elimination diet road, I would start by asking the client to keep track of their symptoms and what foods they are eating for 3 days in a journal. I would also ask them to pay attention to their mental and emotional state, sleep, and movement to see if anything else might be triggering symptoms.

Based on their journal and past experience, we would work together to see if we can identify any foods that may be causing symptoms. If we do believe food may be an issue, we would create an elimination diet that is individual to them. This may be a full on low FODMAP diet, or it could be just removing certain FODMAPs, fructans, fructose, lactose, or whatever. Our goal is to keep their diet as liberal or unrestricted as possible.

An elimination diet usually lasts 2 - 6 weeks, depending on if symptoms start getting better. If after a few weeks symptoms have lessened or disappeared then we know that some foods are triggering symptoms. After the elimination period, we start bringing some foods back in gradually increasing quantities to see which foods specifically are causing the issues and how much of those foods are tolerated. The goal is to have a die that is as liberal and sustainable as possible with the fewest symptoms.

Of course, if after 6 weeks of the elimination period symptoms haven’t changed, it’s likely food is not the issue and we consider different avenues of treatment. Some options would be

• Joyful movement

• Psychotherapy

• Hypnotherapy

• Medication (possibly)

IBS is no different than any other condition, if you suspect you have it you should go see your doctor. If your doctor recommends any alterations to your diet ask them to refer you to a registered dietitian. Making changes to your diet, and especially trying an elimination diet, needs to be planned out and monitored more than what a Google search can accomplish.

Warning for elimination diets: IBS and other functional GI disorders have a complicated relationship with eating disorders. IBS can sometimes lead to disordered eating or an eating disorder and an eating disorder can trigger IBS. My warning to anyone out there with IBS is if you have a history of an eating disorder, dieting, disordered or restrictive eating, or purging behaviours, an elimination diet may not be right for you. When we start putting restrictions on our eating, even for a therapeutic reason like relieving IBS symptoms, it can lead us down a dark road that could result in an eating disorder. I’m not trying to be dramatic, but eating disorders have a much higher fatality rate (second highest death rate among mental illnesses) compared to IBS, which doesn’t have a fatality rate because people don’t die from IBS.

Sources:

Born, P. (2007). Carbohydrate malabsorption in patients with non-specific abdominal complaints. World Journal of Gastroenterology, 13(43), 5687. https://doi.org/10.3748/wjg.v13.i43.5687

Eating Disorder Statistics: General & Diversity Stats: ANAD. National Association of Anorexia Nervosa and Associated Disorders. (2021, March 3). https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/.

Fedewa, A., & Rao, S. S. (2013). Dietary Fructose Intolerance, Fructan Intolerance and FODMAPs. Current Gastroenterology Reports, 16(1). https://doi.org/10.1007/s11894-013-0370-0

Nutrition Guideline - Irritable Bowel Syndrome. (n.d.). https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-ng-irritable-bowel-syndrome.pdf.

Werlang, M. E., Palmer, W. C., & Lacy, B. E. (2019). Irritable Bowel Syndrome and Dietary Interventions. Gastroenterology and Hepatology, 15(1).