Is Your Tummy Trouble All in Your Head?

May 24, 2018 Susan Watkins, RD, CDE


What is IBS? IBS is different from IBD (inflammatory bowel disease) such as Crohn’s or Colitis. It is a disorder affecting the large intestine that can include gas, bloating, cramping, diarrhea and/or constipation. IBS is less a serious problem then IBD because it does not cause inflammation, ulcers or damage to the bowel; however, it can severely affect the quality of your life and keep you from doing the things you love.

Types: There are 3 types of irritable bowel syndrome: IBS-D (diarrhea predominant), IBS-C (constipation predominant) and IBS-M (alternating diarrhea and constipation). IBS can come and go for periods of time; and in the past, there was not much in the way of successful treatment or help for this population.

Is it all in your head? Many doctors and medical professionals believe that IBS is “all in your head,” meaning those with IBS have psychological problems, stress, anxiety or depression that is causing their symptoms or creating pain. This thought process has left many people with IBS essentially untreated, says Susan Watkins, RD, CDE. Patients are often told to try to decrease or manage their stress as the sole way to manage their condition. But new research is finding that although stress and anxiety can exacerbate symptoms, in many cases it is not the root cause.

What Causes IBS? There have been many theories over the years for the cause of IBS, and the answer may not be the same for everybody. The theories have included alterations in the gut brain axis, increased pain sensitivity, stress, anxiety, spasming of the colon in response to stress or certain foods, altered gut movement, and even low-grade inflammation. But now, the role of bacterial overgrowth or altered gut microbiomes is emerging.

What are gut microbiomes and how do they affect IBS? These are the entire community of bacterial organisms that live in our body as part of the enteric nervous system, often described as a second brain. The gut is the central location for these bacteria. We depend on these bacteria to digest our food, produce vitamins, regulate our immune system and protect us against disease-causing bacteria, says Watkins. Studies show that people with IBS typically have altered fecal bacteria or microbiome. The thought is bad bacteria can be the cause of IBS and can start with something like food poisoning. Once the gut bacteria are negatively altered, symptoms of IBS begin.

How can altered gut bacteria be treated? Antibiotics are showing promise in treating IBS-D. Xifaxan is the only FDA-approved treatment that alters gut bacteria linked to IBS-D. This shows that in some cases there is an altered bacteria connection. It is often only taken for a short period of time to provide relief, with sometimes the need for a second or third dose. This is very promising for those that suffer from this often embarrassing and potentially debilitating condition. Although some people find them helpful, probiotics currently have not been shown to have the same positive affect for the treatment in IBS-D.

Diet: Diet can also play a big role in IBS management. Often, the foods people consider healthy — like raw fruits and vegetables and high-fiber grains — are hard to digest and can cause IBS triggers. So, eating easier-to-digest foods can help. Try cooking vegetables and starting with small amounts or removing the skins and seeds on foods. Also, high-fat food can trigger IBS symptoms such as bloating and cramping. So, going for lean, low-fat foods and being careful when eating out (paying attention to how food is prepared) is important. Coffee is also a gut stimulant and can trigger IBS symptoms for many. Check out some of our favorite gut-healing snacks and ingredients.

Soluble fiber before meals can also play a role in normalizing the stool consistency, creating more consistent bowel movements and decreasing or eliminating bloating and cramping. The key with taking soluble fiber is starting slow and getting to the correct dose. Also, be careful that it is pure soluble fiber and has no other added ingredients that can act as irritants. “I have seen soluble fiber work wonders in many of my patients,” says Watkins.

Lifestyle: Although for many people stress may not be the sole cause of IBS, it can make IBS symptoms much more severe. Stress can be a trigger for many other health problems as well. Practicing yoga, meditation and even taking an MBSR program (mindfulness-based stress therapy) can play a huge role in improving not only your physical health but your wellbeing as well. This can be used as a tool to help prevent IBS and also control symptoms once they start.

There are many tools out there to help manage your IBS and the key is finding the right one for you. Here are some more simple solutions that could hold the key to IBS relief. The goal is to get on the road to feeling your best!

Providence St. Joseph Health has registered dietitians that specialize in IBS and that can help you determine your triggers and control your symptoms. To meet with a registered dietitian for your IBS or other conditions, call the Center for Health Promotion at:

Brea (714) 618-9500
Santa Ana (714) 628-3242

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.


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