Causes of IBS you may not be looking for

Irritable bowel syndrome (IBS), is one of the most common functional gastrointestinal disorders (FGID), affecting 10-20% of the adult population worldwide. Yet, although it is common, it is one of the most challenging in terms of treatment.

Its symptoms are chronic, recurrent and heterogeneous, manifesting as lower abdominal pain or discomfort, excessive gas production/borborygmi, abdominal bloating and distension, altered bowel motility (constipation and/or diarrhoea) and nausea. Some patients may also suffer extra-intestinal symptoms, such as urinary frequency, headache, dyspareunia, heartburn, back pain, sleep problems, fibromyalgia, and chronic fatigue.

In addition to physical symptoms, IBS sufferers are affected mentally, with mood swings, feelings of hopelessness, anxiety and depression being the most common emotional symptoms. IBS is not known to cause bowel cancer or excess mortality, however, it can seriously reduce quality of life, interfering with daily activities, social and occupational life, and often leads to excessive healthcare costs.

The condition is most commonly found amongst Western populations, particularly affecting females and younger age groups.

What causes your IBS?

The disorder is thought to be due to a complex interaction between biological and psychosocial factors:

• acute gastroenteritis
• small intestine bacterial overgrowth (SIBO)
• increased visceral sensitivity (where nerves and muscles in the bowel are extra sensitive, resulting in pain, discomfort and spasms)
• abnormal gut motor function
• disturbed gas metabolism
• altered gut permeability
• impaired viscerosomatic reflexes and abdominal-wall dystonia
• food intolerances
• sex hormones and genetic predisposition

These are all plausible mechanisms leading to altered gut flora and microscopic inflammation, which in turn may trigger IBS onset.

Additional factors that you may wish to discuss with your doctor:

• Emotional factors – particularly feelings of anxiety or stress.
• Prescription drugs or laxative abuse.
• Chronic use of antibiotics, OCP, HRT and steroids, iron or anxiolytics.
• Lack of dietary fibre.
• Yeast overgrowth (candida).
• Caesarian pregnancy and no breastfeeding.
• Spinal maladjustment (trapped spinal nerve).
• Smoking – nicotine affects the motility of the colon.
• Insufficient chewing – amylase and lipase in saliva start breaking down carbohydrates and fats hence less fermentation lower down in the digestive tract. They also send a signal to the other parts of the digestive system to prepare for food digestion.

Food intolerances and IBS

Food intolerances are among the most common IBS mediators:

1) Lack of enzymes e.g. lactase enzyme breaks down lactose from dairy into galactose and glucose. Lactose ferments in the gut causing gas, pain and bloating due to hydrogen production. There may also be lack of pancreatic digestive enzymes, insufficient hydrochloric acid from the stomach and/or insufficient bile to break down fats, all of which lead to insufficient nutrient absorption, creating a vicious cycle.

2) Reaction to chemicals – all of which can cause different IBS symptoms, depending on the individual but mainly bloating, pain and diarrhoea. Reactions to natural amines (citrus fruit, cheese, red wine, chocolate, coffee), or additives such as MSG, sodium benzoate, nitrates, sulphites, sweeteners (aspartame, sorbitol) and colours (sunset yellow and tartrazine) are all common.

3) Raised IgG antibodies – are associated with inflammation, which damages the wall of the intestines and can cause a leaky gut. Inflammation can also trigger IBS symptoms like pain and spasms associated with particular foods. Gluten intolerance can result in IBS-like symptoms, fatigue, headaches and joint pains; gluten is a sticky protein that “glues” on the wall of the intestine, impairing sufficient digestion and absorption of nutrients.

What other dietary factors can trigger IBS?

• Added and refined sugars – not only do they disturb the balance of the gut flora, but also decrease blood sugar levels. Stress hormones are produced in response, triggering IBS symptoms.
• Salt – can cause water retention and bloating.
• Resistant starch (e.g. amylose in legumes, potatoes, green bananas, rice) – it resists digestion and ferments in the large intestine causing IBS symptoms.
• High saturated fat (dairy, meat) – can result in quicker or slower stomach emptying and muscle spasms. Fat malabsorption means omega 3 is harder to absorb which can increase inflammation, aggravating pain and bloating.