5 Things I Wish I Knew About IBS, From a Gut Health Expert
IBS is a functional gut disorder that affects 1 in every 7 people, or 15% of the global population, with two-thirds of those seeking treatment being women. In the UK alone, it is estimated that 1 in every 5 people experience IBS symptoms.
IBS is a tricky and debilitating condition to navigate without the appropriate support. It can affect many aspects of life, including work, social events, relationships, and self-confidence. One study with nearly 2,000 IBS sufferers found that they would be willing to give up 25% of their remaining lifespan to be symptom-free - which reinforces how debilitating this condition can be.
That level of impact is something I personally relate to.
My Story
I grew up with robust health and could eat and drink whatever I wanted without experiencing digestive symptoms, but all that changed after an episode of food poisoning - a slice of pizza that, in many ways, altered the course of my health. Following that event, I spent nearly a decade struggling with unexplained digestive symptoms and, like most of my clients, went through extensive medical testing but was never given a clear explanation.
Eventually, I was told “it’s just IBS”, a diagnosis I wish I had not been given, as at the time it made me accept that no further investigation was needed.
Now, as a practitioner, I often think about how different that experience could have been if I had known what I now share with my clients. It would certainly have saved me years of confusion, frustration, and uncertainty.
What I wish they had told me
Food poisoning is one of the most common triggers of IBS
One in every nine people who experience food poisoning goes on to develop post-infectious IBS, a form of IBS caused by a bacterial infection. Yet not a single health professional I consulted with took into consideration that my symptoms started after gastroenteritis.
It turns out that the most common bacteria that cause food poisoning (Salmonella, E. coli, Campylobacter, and Shigella) release toxins that can alter how the enteric nervous system (the nervous system of the gut) responds to food, making the gut overly sensitive to foods that weren’t previously a problem.
These bacteria also release a toxin that shares molecular similarities with a naturally occurring protein in the body that is critical for proper gut function. Because of this, the immune system can become confused and start producing antibodies against this protein, leading to an autoimmune response where the body attacks itself.
This can result in damage to the gut nerves and impaired functioning of the migrating motor complex (MMC), the gut’s “housekeeper,” responsible for propelling undigested food and bacteria through the digestive tract.
Post-infectious IBS can lead to SIBO
When the migrating motor complex is not functioning properly, bacteria can accumulate in the small intestine, leading to a condition known as Small Intestinal Bacterial Overgrowth (SIBO).
SIBO occurs when there is an excess of bacteria in the small intestine - a location not meant to host large amounts of bacteria. This leads to excessive fermentation of dietary fibre, producing gas as a by-product. The accumulation of gas in the small intestine can result in bloating, abdominal distension, abdominal pain and discomfort, as well as constipation and/or diarrhoea.
In addition, SIBO can promote inflammation in the small intestine, which is where nutrient absorption takes place. If left untreated, it may lead to longer-term consequences such as fat malabsorption and nutrient deficiencies, particularly vitamin B12 and iron - nutrients that are key for overall vitality and energy production.
It’s not all in your head
During my decade-long journey trying to understand IBS, I heard from countless health professionals that my symptoms were “all in my head” and that reducing stress and anxiety would resolve them. I wish that had been true.
While stress can absolutely play a role, there is growing scientific evidence suggesting that alterations in the diversity and composition of the gut microbiome play a fundamental role in IBS.
Individuals with IBS tend to have lower levels of beneficial bacteria such as Lactobacillus and Bifidobacteria. This imbalance has been linked to symptoms such as visceral hypersensitivity (an overly sensitive gut), as well as anxiety and depression. It also affects communication between the gut and the brain, influencing how the brain responds to symptoms like abdominal distension (bloating).
It’s also worth remembering that for every message the brain sends to the gut, the gut sends multiple signals back. The feedback from your gut microbiome plays a significant role in how you feel.
A low FODMAP diet is not a list of yes or no foods
FODMAP is possibly one of the most feared acronyms out there. If you have been diagnosed with IBS, you may have left a consultation with a list of foods to eat and foods to avoid - a very simplified view of what is actually a complex dietary approach.
Having trained in the use of the low FODMAP diet, I now know that it is not about removing FODMAPs completely, but about understanding how much you can tolerate and which specific FODMAPs trigger your symptoms.
Take avocado as an example. It is low in sorbitol at 60g, but high at 90g. But what does that mean for you? Are polyols a trigger for your symptoms? If so, what is your threshold? If not, do you need to avoid it at all? A simple list of yes and no foods doesn’t answer these questions.
IBS requires a multifactorial approach
IBS symptoms are rarely resolved by a single intervention, which is why it rarely responds to a single strategy. Taking a probiotic and hoping symptoms will disappear is rarely the solution.
In most cases, it involves a combination of strategies that address underlying issues, from gut motility and microbiome imbalances to past infections, stress, and, in some cases, immune responses. Without addressing these different layers, symptom resolution is often not successful.
Understanding what is driving symptoms in each individual case is key to making meaningful and lasting progress.
Final thoughts
Being told “it’s just IBS” made me temporarily stop looking for answers. What I’ve learned since is that there is always a reason why symptoms are happening. It may take time to uncover it, but when you do, the path forward becomes much clearer.
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Words by Marilia Chamon for The Well Edit.
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