Irritable bowel disorder (IBS) is a common gastrointestinal abnormality affecting up to 20% of the U.S. population. Patients experience sporadic episodes of bloating, diarrhea, constipation, and abdominal pain. These symptoms come and go depending on a patient’s lifestyle choices.
Learn more about IBS in our last post: Irritable Bowel Syndrome: Symptoms and Causes.
So what makes irritable bowel syndrome worse? Certain foods such as those high in FODMAP are known to induce IBS symptoms. Other key variables such as stress, lack of exercise, and even hormonal imbalances can trigger symptoms.
Below are the top triggers for IBS, and understanding how to manage them.
Food and Diet
How Can Food Trigger IBS?
Patients with irritable bowel syndrome have a difficult time processing food compared to unaffected individuals. Food sensitivities from IBS aren’t caused by an allergy or intolerance. Instead certain foods can lead to an increase in the water uptake in the large intestine, creating a micro-environment where bacteria can thrive.
Dietary changes are administered to IBS patients to help soothe cell abnormalities in the gastrointestinal region, while ensuring that the gut is favorable for beneficial bacteria growth.
FODMAPs and Other IBS Food Triggers
What people thought of as non-coeliac gluten sensitivity in IBS patients turned out to be an adverse reaction to a specific group of short-chain carbohydrates. Researchers from Monash University were able to identify the source of bloating, gas, and diarrhea triggered by certain foods.
The scientists discovered a group of carbohydrates that were poorly digested or impossible to absorb in the small intestine, leading to IBS symptoms. When foods containing FODMAPs enter the system, the gut bacteria ferments these carbohydrates, resulting in excessive gas production which can also trigger the other IBS symptoms.
This group of carbohydrates are now known as FODMAPs: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The FODMAP components in food are:
- Fructose: Found primarily in high-fructose foods such as some fruits (apples, watermelons, grapes), honey, and corn syrup. The intestine is able to manage fructose absorption when accommodated by glucose. However, some patients have a hard time breaking down fructose altogether, which triggers IBS flare-ups.
- Lactose: Found primarily in dairy products like milk and cheese. Lactase enzymes responsible for breaking down lactose are lacking in some individuals, resulting in diarrhea and distension.
- Polyols: Found primarily in synthetic sweeteners and are naturally occurring in certain fruits and vegetables. Common in sugar-free food options and processed foods such as jams and marmalade. Most common forms are erythritol, sorbitol, and mannitol — all of which can be found in most processed food.
- Oligosaccharides: Found primarily in legumes, wheat, and rye. The human body does not contain enzymes to properly digest oligosaccharides; even individuals without IBS have a hard time absorbing this chain of carbohydrates. Consumption of foods high in oligosaccharides result in bacterial fermentation, which leads to gassiness.
Although a low FODMAP diet has been proven to help with IBS symptoms, not every IBS patient will have the same response to high FODMAP foods. We recommend getting help from your dietitian and gastroenterologist before banning foods from your diet.
Diet Modifications For IBS Patients
IBS patients can still enjoy certain food groups while avoiding trigger foods. For example, those who enjoy their everyday milk can still enjoy it in the form of soy milk or by choosing lactose-free alternatives. Choose cheeses with lower lactose levels such as mozzarella and brie.
There are various fruits and vegetables on the low FODMAP list. These include:
- Lemon and lime
- Bok choy
- Baby spinach
In place of wheat and rye, patients can look for gluten-free fiber options such as oats, quinoa, and brown rice. For protein sources, beef, lamb, pork, chicken, and fish are all acceptable options as long as these aren’t cooked and served with high levels of saturated fat.
Drugs and Medication
How Drugs Worsen Irritable Bowel Syndrome
The aggravation of gastrointestinal symptoms after medication abuse isn’t a coincidence. Studies show that gastrointestinal complications can be medication-induced because of how long-term drug usage affects the gastrointestinal physiology.
For instance, dependence on non-steroidal anti-inflammatory drugs (NSAIDs) are known to produce toxic ulcers to the intestinal lining, dealing irreversible damage to the system. Improper use of antibiotics can lead to a disruption in the gut bacterial flora, which can make the intestine susceptible to a bacterial infection.
Approved Medication for IBS Patients
Not all medication can worsen IBS. There are drugs available for diarrhea, constipation, and general pain relief. These drugs include:
- Eluxadoline (Viberzi): Best for patients with IBS-D. Reduces muscle contractions and fluid uptake in the intestine, which helps with diarrhea. Possible side-effects include mild constipation and abdominal pain.
- Alosetron (Lotronex): Also ideal for patients with IBS-D. This drug is prescription-only, and is used for severe cases of diarrhea. Alosetron slows the movement of waste through the bowel, which helps with diarrhea.
- Rifaximin (Xifaxan): Ideal for all patients with IBS. Used to discourage bacterial infestations, while also alleviating diarrhea symptoms.
- Linaclotide (Linzess): Ideal for patients with IBS-C. This drug increases fluid uptake in the small intestine. Sometimes used to induce bowel movement.
- Lubiprostone (Amitiza): Also applicable to patients with IBS-C. Generally prescribed for women patients who exhibit severe symptoms and are not responsive to other treatments. Functions the same way as linaclotide by increasing fluid uptake in the small intestine.
A new drug called Blautix is currently undergoing clinical trials and has been cleared for further investigation by the U.S. FDA. Preliminary research showed that the drug resulted in an 82% improvement in affected individuals.
The drug is designed to introduce an active bacteria called Blautia hydrogenotraphica in order to remove excess hydrogen in the intestines. Researchers believe that this will reduce bloating and flatulence in IBS sufferers.
The Science Behind Hormones and IBS
Hormones are chemical messengers being transported throughout the body. They are released by cells and help regulate various bodily functions. A substantial number of studies suggest that hormones may in fact affect IBS symptoms.
Two specific intestinal hormones, motilin and cholecystokinin (CCK) are being investigated for potentially eliciting bowel responses immediately after eating. CCK is responsible for stimulating digestion and releasing bile from the gallbladder, while motilin is responsible for controlling intestinal muscle contraction and transporting food through the intestines. An abnormal rise in the production of these two hormones is believed to result in a more reactive gastrointestinal system.
One research showed that CCK reactivity is heightened after patients were made to eat a meal high in fats. On the other hand, eating a regular meal and drinking water produced a lower motilin response in patients. These studies show that disrupted hormone behavior can elicit urgent bowel movement in patients.
Another study suggests that there might be a link between motilin reactivity and stress. Scientists found that there was an increase in motilin production in response to stressful stimuli.
The sex hormones estrogen and progesterone are the most studied hormones in relation to IBS. The gastrointestinal system is built with estrogen and progesterone receptors, so it’s apparent that the intestine can respond to these hormones accordingly.
As women are twice as much vulnerable to IBS, more research is being funneled into understanding how individuals with high levels of estrogen are predisposed to IBS and aggravated IBS symptoms.
Menstruation and IBS
Bloating, abdominal pain and changes in bowel movement have been reported by individuals with and without IBS during different phases of the menstrual cycle.
During the menses period (the first four to seven days of the cycle) abdominal pain and bloating was increased compared to other phases of the cycle. During this phase, women secrete low levels of progesterone, which is believed to be a “pain blocker” hormone. Individuals also observed more frequent bowel habits during the menses period. This is apparent even in women without IBS.
There are other findings that solidify estrogen’s role in the exacerbation of IBS symptoms. Female IBS patients have fewer instances of bloating compared to postmenopausal women. Consequently, postmenopausal IBS patients who were undergoing hormone replacement therapy had decreased incidences of bloating compared to those who didn’t.
Anxiety and Stress
How Does Stress Affect IBS
The impact of stress on IBS has long been a topic of clinical curiosity. A paper published in the World Journal of Gastroenterology showed that there is a direct link between what the researchers called “an irritable bowel and an irritable brain”.
The researchers affirmed that IBS is a stress-sensitive disorder. Stress can stimulate the hypothalamic pituitary adrenal (HPA) axis, which can directly affect gut functions. Psychological stress can gastrointestinal interactions with the nervous system, intestinal bacteria growth, and mucus production. Stress can stimulate the hypothalamic pituitary adrenal (HPA) axis, which can directly affect gut performance.
Psychological distress among IBS patients and vice-versa is common. There is a strong correlation between psychological disorders such as depression and anxiety with the severity of IBS symptoms. With these fundings, it’s clear that stress management should be a priority of any IBS patient.
Soothing IBS With Therapy
Cognitive behavior therapy (CBT) alone specifically tailored to IBS patients is an effective way of dealing with symptoms. A promising study showed that patients who had undergone a 12-month therapy session, in person or on the phone, showed significant improvements in their symptoms compared to patients who were undergoing medication alone.
One of the trial patients reported that the study “helped [me] understand how techniques [I] had been using to avoid problem foods or difficult social situations” were aggravating her condition. Ultimately, CBT teaches patients to become more mindful and aware of the mind-gut connection.
One of the researchers, Dr. Hazel Everritt from the University of Southampton stated that, “The results of this study provide important new evidence of how CBT delivered over the telephone or online can provide an effective treatment for patients living with this chronic and common gastrointestinal disorder.”
Researchers are now working towards making IBS-specific therapy treatments more openly accessible to patients.
Everyday Stress-Relieving Techniques
Therapy isn’t the only stress-relief option available to IBS patients. Below are some techniques patients can do on their own free time:
Keep a diary: It’s important to stay aware of what’s happening between you and your body. Most patients keep a food and symptom log to understand how specific foods trigger certain symptoms. In reality, this can be used for just about any other stimuli.
Are you likely to suffer from constipation when you feel stressed? What kinds of social situations make it hard for you to relax? Knowing these things can give you a better understanding of IBS, and in turn a much better control over your symptoms.
Mindful muscle relaxation: Muscle relaxation involves the intentional movement of various muscles throughout the body. This level of mindfulness can help bring down anxiety and help you calm down during stressful situations.
Simply close your eyes and feel every part of your body by moving certain muscles. Frown your forehead and visualize every line creasing on your forehead. You can rotate your shoulders and envision your shoulder joints working their way to a full rotation. Whatever muscle you choose to move, the point is to make your brain 100% focused on that particular movement.
Does Exercise Help With Irritable Bowel Syndrome?
Working out might be the last thing you want to do as an IBS patient, but science shows this can actually be beneficial. A group of patients were asked to do 20 to 30 minutes of exercise three to five times a week.
After three months, the active group reported better results than the inactive group. Symptoms worsened in 23% of cases in the inactive group, while only 8% of individuals felt worse after 3 months of exercise (source).
Exercise is also a good way to reduce stress. To maximize your workout sessions, we recommend doing the following:
- Don’t eat fatty foods before exercising
- Try to schedule your exercises closer to when your intestines are most “quiet”
- Don’t drink caffeinated drinks such as coffee and energy drinks before working out
- If you have hyperactive bowels, eat first thing in the morning
- Drink lots of water before working out
Top 3 Workouts to Avoid, and What to Do Instead
- Running: Bouncing up and down may induce cramping in IBS patients. Instead of running, try power walking or swimming. This way, you’re still engaging your cardiovascular system without upsetting your stomach.
- Weight Training: This is especially true for compound movements like deadlifts and squats. These movements can prove too intense for the digestive system and induce diarrhea in IBS patients. Stick to lighter weights or do machines that won’t require full exertion from the body.
- High-Intensity Interval Training (HIIT): HIIT workouts are designed to keep your heart rate consistently active for 30 minutes and more. Your body might translate this as stress, which can trigger IBS symptoms. As an alternative, do variations on HIIT exercises to make sure they are less intense and more forgiving for your body.
Manage Irritable Bowel Syndrome
At Gastro Center in New Jersey, we have innovative approaches for managing irritable bowel syndrome symptoms. Get in touch with us today to learn how we can improve your quality of life with dietary modifications, stress-relief techniques, IBS-specific medication, and more.
Together, we’ll find better solutions for your IBS symptoms.