What really causes irritable bowel syndrome?

Perusing this week’s copy of the British Medical Journal, I came across an article about psychological approaches to irritable bowel syndrome. This condition, characterised by symptoms such as abdominal bloating and discomfort, wind and constipation and/or loose bowels is common. Yet, within the conventional medical establishment, this ill seems poorly understood. No wonder then, as the the BMJ article points out, that medical treatment for it is often ‘highly unsatisfactory’ [1].

The authors of the article recommend, where relevant, tackling IBS through a predominantly psychological route. Antidepressants, cognitive behavioural therapy and hypnotherapy are among some of the potential approaches put forward. While all of these have merit, I’ve very rarely found the need to resort to such therapies in practice.

Over the years, perhaps like a lot of naturally-oriented practitioners, I have found a couple of underlying factors in IBS which, once dealt with, almost always lead to very substantial or even complete relief from symptoms. One important factor here seems to be food sensitivity, while the other is an imbalance in the microbial ‘eco-system’ that resides in the gut.

Below, I have added a couple of articles which explore these two mechanisms in more depth. They also offer some pointers about how to manage these issues. Applying the principles here may well offer significant relief for IBS sufferers without recourse to psychological-based treatment.

References:

1. Hayee B, et al. Psychological approach to managing irritable bowel syndrome BMJ 2007;334:1105-1109,

Avoiding certain foods can really help the symptoms of irritable bowel syndrome – 17th April 2004

While my career path veered away from orthodoxy more than a decade ago, I remain a regular reader of the British Medical Journal. One thing I like about this particular publication is it’s ability to email-alert me to any nutritionally-related content. Recently, the BMJ published an editorial on the management of irritable bowel syndrome (IBS) – a condition characterised by symptoms such as constipation and/or loose stools, abdominal bloating and wind, but for which no specific cause can be found. As I had not had electronic notice of this review, I imagined the BMJ’s automatic alerting service had somehow broken down. All became clear, however, when I read the review and discovered it contained not a single reference to diet.

Even those without any explicit knowledge of the inner workings of the digestive tract might suspect that symptoms emanating from this organ may well have something to do with food. This does indeed turn out to be the case, as IBS symptoms are quite often triggered by unwanted reactions to specific foods. This mechanism has not gained widespread acceptance as an underlying factor in IBS by the medical establishment, which usually advises IBS sufferers to increase fibre intake. However, one study found that increasing roughage in the diet was generally ineffective, and actually exacerbated symptoms in more than half of individuals afflicted with IBS. This seemingly paradoxical reaction is likely to be explained by the fact that individuals seeking additional fibre will generally find this in bran-filled breads and cereals based on wheat – which many nutritionally oriented practitioners (myself included) find is the most common offender in IBS of all.

While wheat is a frequent trigger factor in IBS, it is not always at fault, and other foods can be implicated too. Individuals with IBS can therefore benefit from individual identification of problem foods. Several methods of testing exist including kinesiology (muscle testing) and dowsing. My belief is that all such methods have some validity, though individuals who are more comfortable taking a more ‘scientific’ approach may have their blood tested for what are known as IgG antibodies to specific foods. One study published last year in the journal Gut found that elimination of these foods identified with this form of testing was generally beneficial for IBS sufferers. For more details on IgG blood testing see www.allergy-testing.com.

No tests are foolproof, however, and there is usually no reason why individuals should not make self-styled changes to their diet without testing. I generally advise such individuals to try a diet devoid of wheat (e.g. pasta, bread, biscuits, pastries, and breakfast cereals) and cow’s milk (another common offender) for a week or two. Better tolerated grain include rice and oats (e.g. oat-based muesli, porridge and oatcakes), and rice and oat milks are good swaps for dairy milk too. Next week, I’ll be focusing on what I find to be the other major underlying factor in IBS, namely an imbalance in the microbiological ecosystem that resides within the gut. In the meantime, IBS sufferers might find dietary exclusion does much to reduce the risk of unwanted gut reactions.

Do ‘healthy’ bacteria have a role in the treatment of irritable bowel syndrome (IBS)? – 24th April 2004

Last week I focused on how reactions to specific foods can precipitate the undesirable gut feelings collectively known as ‘irritable bowel syndrome’ (IBS). While IBS is commonly triggered by food sensitivity, this condition can also be related to other internal issues. One other frequent underlying factor in IBS concerns the microbes that reside within the gut. In health, the gastrointestinal tract is home to a variety of bugs that play an integral part in maintaining the good and proper workings of this organ. Should the balance of these gastrointestinal organisms go awry, however, digestive function can go belly up.

The internal ecosystem is chiefly made up of several pounds’ worth of bacteria – a word that most of us associate with ill health and disease. However, the bacteria that reside within the gut, including strains of what are known as the acidophilus and bifidus species, are broadly beneficial: amongst other things, they promote health in the lining of the digestive tract and help protect the gut against disease-causing organisms including parasites and viruses. Some depletion of the gut’s stocks of beneficial bacteria generally comes with age. However, the demise of these microbes can be greatly enhanced by a variety of factors, including the taking of antibiotics. In time, the erosion of beneficial bacteria in the body can compromise the gut’s healthy functioning, and may also lead to the emergence of potentially problematic organisms.

One type of organism that can assume an unhealthy degree of dominance in the gut, particularly as a consequence of antibiotic therapy, is yeast. Yeast is a fermenting organism, and the gas it gives off can give rise to symptoms common in IBS such as bloating and/or wind (often foul-smelling). A glut of yeast in the gut can also be associated with fungal infections elsewhere in the body such as vaginal thrush and athlete’s foot.

One key to getting better balance in the gut ecosystem is to avoid foods that encourage the growth of yeast and other unwanted organisms that may be lurking in the gut. The fundamentals of such as diet involve de-emphasising refined sugar, refined carbohydrates (such as pasta and white rice), and foods that are yeasty, mouldy or fermented such as wine, beer, mushrooms, Marmite, cheese and dried fruit in the diet. Ideally, the bulk of food intake should come from meat, fish, eggs, vegetables, beans, nuts and seeds.

The regular eating of ‘live’ natural yoghurt (which contains generally beneficial bacteria) may also help re-establish balance in the gut. Certain food components feed healthy bacteria, and may encourage growth in these important organisms. One such substance is a plant carbohydrate called inulin, a good concentration of which can be found in chicory. In addition to these dietary changes, I recommend the taking of one of the healthy gut bacterial supplements (known as probiotics) that can be found in good health food stores. Several studies have found that probiotic supplementation can bring significant relief in IBS symptoms within two or three months. Experience shows that for those who suffer from excessive fermentation in the gut, natural germ warfare can bring a breath of fresh air.

16 Responses to What really causes irritable bowel syndrome?

  1. Tiggy 2 June 2007 at 12:06 am #

    Mine went away with Colpermin (peppermint oil capsules) and temporarily giving up tinned tomatoes and orange juice.

  2. Jackie Bushell 8 June 2007 at 9:20 am #

    I can attest to everything Dr Briffa says on this subject. My husband had IBS for many years, until it worsened to the point where he was forced to ‘do something’. His GP diagnosed IBS and referred him to a gastroenterologist. The gastroenterologist did various tests to check for other problems, then confirmed the diagnosis as IBS. Apart from giving him a diet sheet to follow focusing on high fibre foods including plenty of wheat and other grains, and suggesting he try to avoid stress, he had no solutions to offer.

    Knowing a little about the varied effects problems such as nutritional deficiencies, food sensitivities and intestinal yeast overgrowth can have, I suggested my husband visit a specialist in nutritional and environmental medicine. Sure enough, he tested positive for all these problems. After treatment with anti-fungal medicine, nutritional supplementation and a Stone-Age style allergy elimination diet, his IBS improved rapidly. He now considers himself cured. All he has to do to prevent the symptoms coming back is to avoid wheat, sugar, refined carbohydrates and processed foods.

    Oh, and by the way, the severe hay fever he suffered for years has now disappeared, as well. This is apparently a common result of eliminating allergens from the diet, due to the ‘overflowing barrel’ principle. (Your immune system can cope with a certain level of stressors, but add just one more and the barrel overflows, causing a variety of allergy-related reactions. Conversely, reduce just some of the stressors, and the barrel stops overflowing).

    I am sure there are many more people like my husband who suffer needlessly with IBS for years because conventional medicine, and our national health service in particular, just refuses to accept the evidence that there is a cure.

    Keep up the good work, Dr Briffa, of bringing this information to the knowledge of those who need it.

  3. chris 9 June 2007 at 9:57 am #

    that doctor sounds quite out of date ! Doctors often are – as a Dietitian we take a completely different approach. It is perfectly possible to sort the problem out with food but i see alot of clients who go and have “food allergy ” tests – most come out with the same list! I prefer to take the elimination route and this will pick up potential food intolerances – beacuse most of the so called allergy tests are completely useless and have no scientific basis! Of course one of the most important triggers for ibs is not food related at all and john has overlooked – stress. Most people who get IBS seem to lead manic lifestyles and stress is part of the problem.

  4. Ulf_S 14 June 2007 at 6:10 am #

    I’ve been suffering from IBS for years in the past. I work under a lot of pressure, so I figured this might have something to with it. Turns out it didn’t really.

    I tried eliminating things like milk and coffe from my diet, certain vegetables, wheat and so on, to find out if the root cause could be found in my diet. No elimination really made a difference.

    What finally worked was avoiding all grains and starches, something I had never done before. I had only cut one or two things at a time previously, so I was still eating grains or starches in some shape or form. No wonder the “elimination diet” didn’t work!

    I still have the same stressful job, but my digestion works truly flawlessly now. No bloating, no gas, no pain, no irregularities, nothing! I actually noticed a huge improvement very quickly, within a day or two after I made the change.

  5. Dr John Briffa 14 June 2007 at 2:47 pm #

    Ulf/Chris – I’ve very rarely found that the symptoms of IBS cannot be controlled using a natural/nutritional approach without the need for controlling ‘stress’. Stress is a common exacerbating factor in my experience, but it does not appear to be an important underlying ’cause’ in my experience.

  6. chris 14 June 2007 at 6:38 pm #

    well john u must have very differerent clients! I see alot of shift workers and people who have very high stress jobs – both my nhs and private clients. Two examples this week – a young woman in a highly charged call centre and a woman who is a carer and not coping. i think it plays a huge part in ibs – interesting because often the so called allergy tests are useless – and i am suprised u advocate kinseology – quackery in my opinion esp as i went to see one and i have an allergy to fish and she missed it!!! I have found that elimination diets often pick out foods like tuna, green veg and not the so called grains and dairy!
    ibs treatment varies alot from person to person and care in the nhs varies unfortunately so i can see why some go to alternative treatments but its not always successful.

    Ulf – if u do an elimination properly then u really go to a very limited list of foods and it takes months to reintroduce – no wonder it was not working

  7. Dr John Briffa 14 June 2007 at 6:50 pm #

    Yes, Chris, we may see different clients, but maybe not: Many of my IBS patients are what would be regarded as ‘stressed’. However, as I said, proper nutritional/natural management in my experience almost always obviates any need to address ‘stress’ issues when it comes to managing IBS.

  8. chris 14 June 2007 at 7:47 pm #

    so your point is?

  9. Ulf_S 15 June 2007 at 5:46 am #

    Stress doesn’t seem to have a noticeable impact on my digestion now that I’m off grains/starches. Stress used to be a contributing factor when I was eating things I should’ve avoided.

    Like John says, stress doesn’t appear to be one of the causes of IBS and doesn’t really need to be dealt with once you’ve found a diet that works for you. At least that’s true in my case.

  10. chris 17 June 2007 at 9:23 am #

    that is fine if u have found the cause but just look at how it has developed – when i first qualified i rarely saw ibs but it has become much more prevelant with our fast lifestyles. Of course for some food plays a part in this – but alot of the patients i see have very poor diets along with stress in lots of forms so for john to just dismiss it i dont understand.

  11. Hilda Glickman 31 July 2007 at 12:17 am #

    I think stress is a strange thing. Some people thrive on it! But EATING under stress is a problem,

    However in my practice I have found over and over that wheat is the problem. One lady had been ill for 40 years and recovered in a few weeks! I tell clients that there is nothing wrong with them but something wrong with the wheat. It is now grown differently than before and has been grown to contain higher amounts of gluten , a very indigestible protein. I sometimes give talks to the elderly and find that they tend to have fewer problems than people in their 30s and 40s. I wonder if it coincides with breastfeeding or bottle feeding. I know bottle fed kids were often weaned on to rusks early, so you now have dairy and wheat early on. That coupled with lots of early tonsillitis ( and antibiotics), so candida etc.A child who has never been breastfed, then goes on antibiotics has little chance of building up good levels of beneficial bacteria. Incidentally, I was in a hospital recently and saw that they are doing a trial on FOS for Chrohn’s disease. Nutritionists have been using this for years.

    Tomatoes also seem to be a problem for some.These foods are also addictive. Loads of pizza, pasta places have recently sprung up. What do they all contain? Wheat, dairy and tomatoes. I wonder whY? Hilda

  12. JR 28 May 2008 at 9:21 pm #

    Stress must surely be a factor in IBS, because adrenaline directly affects the bowel. The worst IBS symptom so far as I am concerned is ‘urgency’, and I get it at times of acute anxiety, or when I go for a run – ie, when I have an adrenaiine surge.

    I also find that food sensitivities are worse at times of stress. There must be a relationship between the two factors, and I would say that stress must be more important. It is more difficult to digest food or eat properly with a churning stomach. I am sensitive to yeast sometimes, but can even eat a cheese sandwich on a happy day.

    One good tip I have recently had from my doctor is to increase fibre even if you suffer from diarrohea. I had always thought that would only help with constipation, but not so. But I agree with Dr Briffa that this would not work for everyone, or all the time, and refined wheat should be a treat rather than everyday staple.

  13. phiphi04 2 May 2011 at 5:40 pm #

    i have to say that ive suffered for many years with this and find the information here fantastic, great to know im not alone out there, thank you.

  14. Veronica Smith 22 March 2012 at 8:59 pm #

    I have gone through your messages and I have had IBS since I had Radiotherapy some 12 years ago. It has recently been diagnosed at the hospital and I have been put on anti-depressants. I have also cut out wheat and gluten and now feel more confident to go out on long walks, as before I could just about get round the corner and have to rush home again. I cant say it has been cured but it has somewhat subsided. My boy friend has bought your audio book link on IBS and I look forward to hearing it when next I am at his.

  15. Cindy 7 June 2012 at 8:25 pm #

    I was also diagnosed with IBS for several years and was told it was my stressful job. It was not until I realized I had a soy allergy and worked very hard to eliminate soy from my diet that I found relief. Things like soy and other preservatives that are in everything we eat are hard allergies to find. I did have an allergy test performed that showed I was not allergic to soy but seriously allergic to peanuts. I eat peanuts all the time but soy milk caused my throat to close so I could not breathe and sent me to the hospital. Having eliminated soy (and all processed foods thereto) from my diet has eliminated my “IBS”. I encourage anyone complaining of IBS to do the elimination diet since, apparently, allergy tests are not accurate. It is not easy to do being accustomed to eating easy, but the results and the quality of life make it worthwhile.

  16. Veronica 9 June 2012 at 4:43 pm #

    Thank you Cindy for your comment – I have cut out dairy products now and have only goat’s milk, yoghurt and cheese – have also cut out processed food – I still get the painful attacks but they seem to be getting less. I dont think I will ever be free of it – it is just one of those things you have to put up with. I hope you continue to improve. Regards Veronica

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