This article was written by Consultant Registered Dietitian – Kirsten Jackson.
Irritable bowel syndrome (IBS) is a common and debilitating condition. In this article we cover 10 key facts about IBS to help you understand this it.
No.1 – It’s not in your head! IBS is a real condition
Sufferers of IBS often feel that their diagnosis was rather vague. This is because the symptoms of IBS can vary so much and there is no single specific test. Despite this, IBS is very much a real condition which is defined by the ROME IV classification system (1);
“Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation [going for a poo]
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
No.2 – Other conditions can mimic IBS
People with IBS suffer with symptoms such as bloating, stomach pain, diarrhoea and constipation.
These symptoms are also common in other conditions such as coeliac disease and inflammatory bowel disease. This is why it’s important to be diagnosed by a health professional who can rule out other conditions (2).
No.3 – IBS is a common condition
Research looking at the prevalence of IBS in the UK, US and Canada have shown that around 1 in 10 people have the condition (3).
No.4 – Gluten is not an IBS trigger
Many foods which contain gluten also contain a type of FODMAP called fructans. Fructans are an IBS trigger and this is why people often find foods such as bread and pasta cause symptoms (4).
People who have an intolerance to fructans will have a tolerance level and can often manage small amounts in their diet such as 1 slice of bread at a meal. People who have coeliac disease can not tolerate even tiny amounts of gluten-containing foods.
Spelt sourdough bread and seitan are examples of foods which contain gluten but not fructans. These foods are easily tolerated by people who have IBS.
No.5 – 37% of people with IBS have depression (5)
There is a strong link between IBS and mental health due to the gut-brain axis. This is when the brain and gut communicate to each other through a system of hormonal, microbiome and nervous system changes.
Mental health treatments such as antidepressants, cognitive behavioral therapy and mindfulness have been proven beneficial for those with IBS (6, 7, 8).
No.6 – The low FODMAP diet can improve IBS symptoms (9)
FODMAPs are a group of carbohydrates that have been linked with worsened IBS symptoms. Not everybody is sensitive to high-FODMAP foods, but many people have a specific tolerance level to these.
With this diet, FODMAPs are avoided for 4-6 weeks, before gradually reintroducing each FODMAP to see which high-FODMAP foods (if any) and which amounts of these foods trigger IBS symptoms.
However, research shows that the gut microbiome needs a varied diet (10). Completing the FODMAP process allows IBS sufferers to only avoid known triggers rather than having an overly restricted diet.
Please note, the low FODMAP process is complicated and should only be done under the supervision of a registered dietitian.
No.7 – IBS may be a genetic condition
Researchers are not 100% sure what causes IBS. Antibiotic use, mental health conditions and stomach bugs have all been linked to the onset of IBS but nothing has yet been proven.
Interestingly, research is now suggesting there may be a genetic link. This would explain why we often see IBS running in families (11).
No.8 – IBS can affect a person’s quality of life
The symptoms of IBS can impact all areas of a person’s life from their mental health, social life and even what they wear on a day to day basis. Research has shown that people with IBS experience a lower quality of life than those without the condition (12).
No.9 – There are 4 different types of IBS (1)
Understanding the type of IBS someone may have can help them to tailor their management accordingly.
Insert Bristol Stool chart image
- IBS – C (constipation dominant) – mostly type 1 – 3 stools
- IBS – D (diarrhoea dominant) – mostly type 6 – 7 stools
- IBS – M (mixed type) – a mixture of constipation and loose stools
- IBS – U (unspecified) – symptoms that do not fit any of the categories
No.10 – 31% of people with IBS are thought to have small bowel bacterial overgrowth (13)
Small bowel bacterial overgrowth (SIBO) occurs when someone has an unusually high level of bacteria in their small bowel. The symptoms are similar to that of IBS.
People who have both IBS and SIBO may have simply been misdiagnosed initially and they actually do not have IBS. Or, their IBS may have caused the SIBO.
IBS is a common condition which can reduce a sufferer’s quality of life. It is important to get an accurate diagnosis via your doctor rather than self diagnosing based on symptoms. IBS management can come in the form of medications, mental health therapy, nutritional changes or a combination of all three.
- Rome IV Criteria – Rome Foundation. Rome Foundation. 2016. [accessed 30 Mar 2022] Available from: https://theromefoundation.org/rome-iv/rome-iv-criteria/
- Overview | Irritable bowel syndrome in adults: diagnosis and management | Guidance | NICE. Nice.org.uk. 2008. [accessed 30 Mar 2022] Available from: https://www.nice.org.uk/guidance/cg61
- Palsson O, Whitehead W, Törnblom H, Sperber A, Simren M. Prevalence of Rome IV Functional Bowel Disorders Among Adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020;158(5):1262-1273e3. [accessed 10 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/31917991/
- Skodje G, Sarna V, Minelle I, Rolfsen K, Muir J, Gibson P et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. 2018;154(3):529-539e2. [accessed 3 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/29102613/
- Kabra N, Nadkarni A. Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India. Indian Journal of Psychiatry. 2013;55(1):77. [accessed 6 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/23439939/
- Kułak-Bejda A, Bejda G, Waszkiewicz N. Antidepressants for irritable bowel syndrome—A systematic review. Pharmacological Reports. 2017;69(6):1366-1379. [accessed 30 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/29132094/
- Krogsgaard L, Bytzer P. Cognitive behavioural therapy for refractory irritable bowel syndrome. Ugeskr Laeger. 2021;3(183):18. [accessed 30 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/33998440/
- Naliboff B, Smith S, Serpa J, Laird K, Stains J, Connolly L et al. Mindfulness‐based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterology & Motility. 2020;32(9). [accessed 27 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/32266762/
- Varjú P, Farkas N, Hegyi P, Garami A, Szabó I, Illés A et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLOS ONE. 2017;12(8):e0182942. [accessed 30 Mar 2022] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555627/
- McDonald D, Hyde E, Debelius J, Morton J, Gonzalez A, Ackermann G et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3). [accessed 30 Mar 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/29795809/
- Eijsbouts C, Zheng T, Kennedy N, Bonfiglio F, Anderson C, Moutsianas L et al. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nature Genetics. 2021;53(11):1543-1552. doi: 10.1038/s41588-021-00950-8
- Kopczyńska M, Mokros Ł, Pietras T, Małecka-Panas E. Quality of life and depression in patients with irritable bowel syndrome. Gastroenterology Review. 2018;13(2):102-108. [accessed 30 Mar 2022] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040097/#:~:text=Despite%20IBS%20is%20a%20non,life%20compared%20to%20healthy%20controls
- Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Frontiers in Psychiatry. 2020;11. [accessed 30 Mar 2022] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366247/