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April is irritable bowel syndrome awareness month and has been since 1997 when the International Foundation for Gastrointestinal Disorders declared it so.
But what exactly does it mean?
Well, during the month of April more attention is given to the condition that affects approximately 11% of the world’s population[i]. In this article, we explore what IBS is, what causes it, how it can be treated, and of course, the link between IBS and the gut microbiome.
Irritable bowel syndrome is a common, chronic disorder that affects the gut and can have a serious impact on a person’s quality of life. IBS is often a lifelong condition and although there is currently no cure, there are medicines and lifestyle changes that can help to control the symptoms.
The prevalence of IBS is high across the world and is estimated to be between 4.4 and 4.8 percent in the United States, Canada, and the United Kingdom. The condition is more common in women and people under 50 years old[ii].
A quick note on IBS and inflammatory bowel disease (IBD). IBS and IBD are not the same things. Although both are chronic, manageable and, share many of the same symptoms, there are some distinct differences. Perhaps the biggest difference is IBS is a functional disorder, a condition that impairs the normal function of bodily processes, and IBD is an inflammatory disease.
Irritable bowel syndrome symptoms include:
The exact cause of irritable bowel syndrome is unknown but there are many factors that are believed to contribute to the development of the condition. The causes are often environmental, such as:
Interestingly, IBS is more common in women who, incidentally, are more vulnerable to stress[iv], an environmental factor implicated in IBS development.
When the body becomes stressed, it isn’t a sign that it is weak but rather that it is reacting to something that it considers to be a threat. When the body perceives a threat it causes a hormonal response from a dedicated response system called the hypothalamic-pituitary adrenal axis, or HPA for short.
When the stress response is activated, it initiates a cascade of behavioural and physiological alterations to help increase the chance of survival. Physiological changes can include a rapid heartbeat, increased breathing rate, redirected blood flow to organs and tissues that are most in need, and the obstruction of non-essential functions, like reproduction[v].
The release of specific chemicals and hormones, such as adrenaline, can cause specific muscles to work quicker than usual. In the digestive system, this means the muscles in the intestines work faster, causing less fluid to be absorbed and diarrhea. So, that’s why being stressed can cause people to get the runs!
Of course, that’s not all. Recent research shows that an imbalance in the gut microbial communities, also known as dysbiosis, may also be a contributory factor to the development of IBS.
Dysbiosis occurs in the gut when the overall composition of the gut microbiome is out of balance and pro-inflammatory bacterial species are dominant. In a healthy gut, the gut microbiome is balanced and massively diverse, with many different species peacefully coexisting.
There is evidence to suggest that dysbiosis can influence IBS via the gut-brain axis, a unique bi-directional communication between the gut and the brain. The theory behind this is that an imbalanced gut triggers the activation of the gut’s immune system, resulting in low-grade inflammation. The main reason for this is the risk of developing irritable bowel syndrome increases radically after a bout of gastroenteritis (a bacterial or viral tummy bug causing vomiting and diarrhea)[vi].
As well as infections, IBS is also more prevalent after antibiotic use[vii] and these bacterial busting medicines are known for disrupting the composition of the phenomenal ecosystem that resides in the gut.
That’s not all. An imbalanced microbiome is also associated with a leaky gut or increased intestinal permeability. In short, a balanced gut microbiome is responsible for maintaining the gut lining which consists of tight junctions. If these junctions do not remain tight, then bacteria and toxins are able to leak through the wall and pass into the bloodstream, where they can wreak havoc around the body[viii].
Currently, there is no cure for IBS but there are medicines available that can help to control symptoms, as well as lifestyle changes that can also help.
It is important to note that there isn’t just one diet, lifestyle change, or medication that works for everyone with IBS, it may be a case of trial and error to find what works best personally. Often treatment regimens are based on the main symptoms an individual is experiencing[ix].
A good start in the management of IBS is lifestyle modifications and education, including removing gas-producing foods and following a low-FODMAP diet.
We know what you’re thinking, what on Earth is a low FODMAP diet? Put simply, it’s a diet that is low in fermentable carbohydrates that the body is unable to digest, so your gut bacteria do it for you.
Although this is great, FODMAPs can increase the production of gas and are responsible for some of the nasty symptoms of IBS like, stomach cramps, diarrhea, constipation, and bloating.
FODMAP stands for:
These are the groups of non-digestible carbs that may worsen or even cause IBS symptoms. Because over 80% of people with IBS report food-related symptoms, and the efficacy of most medications is modest, a low FODMAP diet is a widely accepted approach to controlling and treating IBS[x].
Some foods to avoid if you have IBS are:
Prebiotics and probiotics may be useful in treating IBS. That’s because probiotics are live, health-promoting microorganisms. If consumed in large enough quantities, these beneficial microbes can help to improve human health through their ability to positively impact the composition of the gut microbiome.
Research shows that probiotics containing Bifidobacteria may have a strong effect on improving all IBS associated symptoms. While some Lactobacillus-containing probiotics could help to improve gas and abdominal pain[xii].
Human milk oligosaccharides (HMOs) help to promote the growth of Bifidobacteria species in people with irritable bowel syndrome. A recent study showed that HMOs could increase the abundance of Bifidobacteriain the gut without causing gastrointestinal symptoms as well as support normal bowel habits[xiii]. Check out PureHMO IBS Support below:
Because there is no single cure or treatment for IBS, it’s also important to take care of your overall health. Things you can do to help, include:
Irritable bowel syndrome is a long-term, chronic condition that affects approximately 11% of the world’s population. Although it’s not life-threatening, IBS can have a serious impact on a person’s quality of life.
IBS is referred to as a functional gastrointestinal disorder because it appears normal on routine tests. The exact cause is unknown and there is currently no cure available. Because IBS is so closely linked to the gut microbiome, changing your diet and supplementing it with right prebiotics/probiotics can help to control the symptoms.
If you’re looking for HMOs for IBS support, click here to find out more.
Written by: Leanne Edermaniger, a science writer who specializes in human health and enjoys writing about all things related to the gut microbiome.
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[ii] Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036. PMID: 33315591.
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[iv] Costa C, Briguglio G, Mondello S, Teodoro M, Pollicino M, Andrea C, Verduci, F, Italia, S, Fenga, C. Perceived stress in a gender perspective: A Survey in A Population of Unemployed Subjects of Southern Italy. Frontiers in Public Health. 2021 Apr 1; 9:640454. doi: 10.3389/fpubh.2021.640454
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[vii] Beom J L & Young-Tae B. Irritable Bowel Syndrome, Gut Microbiota and Probiotics. Journal of Neurogastroenterology and Motility. 2011; 17(3): 252-266. https://doi.org/10.5056/jnm.2011.17.3.252
[viii] Chong PP, Chin VK, Looi CY, Wong WF, Madhavan P, Yong VC. The Microbiome and Irritable Bowel Syndrome - A Review on the Pathophysiology, Current Research and Future Therapy. Front Microbiol. 2019 Jun 10;10:1136. doi: 10.3389/fmicb.2019.01136. Erratum in: Front Microbiol. 2019 Aug 13;10:1870. PMID: 31244784; PMCID: PMC6579922.
[ix] Hadjivasilis A, Tsioutis C, Michalinos A, Ntourakis D, Christodoulou DK, Agouridis AP. New insights into irritable bowel syndrome: from pathophysiology to treatment. Ann Gastroenterol. 2019 Nov-Dec;32(6):554-564. doi: 10.20524/aog.2019.0428. Epub 2019 Oct 22. PMID: 31700231; PMCID: PMC6826071.
[x] Black CJ. Staudacher, HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. https://doi.org/10.1136/gutjnl-2021-325214
[xi] Gravina AG, Dallio M, Romeo M, Di Somma A, Cotticelli G, Loguercio C, Federico A. Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation. Nutrients. 2020 Mar 27;12(4):928. doi: 10.3390/nu12040928. PMID: 32230832; PMCID: PMC7231245.
[xii] Asha MZ, Khalil SFH. Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Sultan Qaboos Univ Med J. 2020 Feb;20(1):e13-e24. doi: 10.18295/squmj.2020.20.01.003. Epub 2020 Mar 9. PMID: 32190365; PMCID: PMC7065695.
[xiii] Palsson OS, Peery A, Seitzberg D, Amundsen ID, McConnell B, Simrén M. Human Milk Oligosaccharides Support Normal Bowel Function and Improve Symptoms of Irritable Bowel Syndrome: A Multicenter, Open-Label Trial. Clin Transl Gastroenterol. 2020 Dec;11(12):e00276. doi: 10.14309/ctg.0000000000000276. PMID: 33512807; PMCID: PMC7721220.
