Medical Myths: IBS myths and facts

Dr. Farhadi told Medical News Today that although research is uncovering more about IBS, we still do not know what causes it.

While certain foods such as dairy products or spicy foods may trigger symptoms, they do not cause the condition.

He noted, however, that post-infectious IBS can be caused by bacteria such as Campylobacter jejuni.

In recent years, research has suggested that levels of mental stress influence gut bacteria composition and play a key role in IBS via the gut-brain axis.

Dr. Farhadi says, however, that people with and without IBS generally face similar amounts of stress, meaning that it may be how people manage stress — rather than stress alone — that influences whether or not they may experience IBS symptoms.

“In my book on IBS, [I wrote about a study showing] that when a person is stressed, numbers of mast cells in their gut increase. So stress doesn’t just increase the release of hormones and mediators in the gut; it also changes the anatomy of the gut in a way that makes it more sensitive to stress,” he explained.

“This means that even if you come out of that stressful period, your gut is not the same gut you had before. IBS symptoms triggered by stress can thus linger even though the stress is gone. And this is very common in patients with IBS,” he added.

Dr. Farhadi also mentioned a study he conducted that found that subjective perception of well-being is linked to fewer symptoms of IBS.

Previous research has also suggested that psychological, social, and genetic factors may all play a role in the development of IBS symptoms.

“IBS can be diagnosed without fancy tests,” Dr. Farhadi told us. “With the right clinical criteria, doctors can diagnose IBS with 97% accuracy in 5 years. No other test in the medical field has that kind of accuracy.”

“We diagnose IBS based on the Rome IV criteria: Patients with IBS should report symptoms of abdominal pain at least once weekly — on average — in association with a change in stool frequency, a change in stool form, and/or relief or worsening of abdominal pain related to defecation,” explained Dr. Jackson.

“There are subtypes of IBS, and you may have predominantly diarrhea, constipation, or a mixed pattern. Patients often also experience bloating, but his symptom is not needed in making the diagnosis,” she added.

There are different ways of treating IBS, including a mixture of prescription medication and lifestyle changes tailored to each person’s individual situation.

“I can assure you in the overwhelming majority of cases, management is very cheap and simple: fiber, probiotics, reassurance, and exercise,” said Dr. Farhadi.

When it comes to medication, according to Dr. Farhadi, it can be a “trial and error” experience. However, it can help relieve the symptoms caused by IBS, alongside other interventions.

“Ultimately, there is no cure for IBS,” Dr. Farhadi noted, and sometimes medication may “only [work] like a bandaid for symptom relief. I have to repeat prescriptions for medications like management of bacterial overgrowth with antibiotics. Ultimately, there is no cure for IBS.”

“IBS is often a chronic, debilitating, and common disorder of the gut-brain interaction,” said Dr. Jackson.

Its “prevalence in North America is 10-15% and is associated with increased health care costs,” she emphasized, adding that “[I]t can significantly affect patients’ quality of life.”

“One study highlighted the negative impact of IBS with patients reporting that they would give up 10–15 years of their life expectancy for an instant cure for their condition.”

While Dr. Farhadi agreed that some kinds of exercise do help IBS, he said that not all exercise is the same.

“Competitive exercise doesn’t relieve stress — it produces stress. The same is true for weight-lifting in the gym if you have to pay a lot of attention to what kind of weight you’re lifting, how you’re pulling this muscle, and how you’re pushing that muscle,” he noted.

He also said that many runners have what is known as “runner’s run,” or diarrhea after running for long periods. Thus, he warned, it is very likely that long periods of running can cause IBS symptoms to flare.

While some studies suggest that meditation may help relieve symptoms of IBS, research is ongoing.

“We are continuing to understand the brain-gut-microbiome axis and how it plays a role in IBS,” said Dr. Jackson. “Gut-directed psychotherapies have been shown to be beneficial in improving IBS symptoms.”

“Meditation and mindfulness have shown to help stimulate changes in the brain and how we process thoughts, sensations, and emotional responses, and this may positively affect how we perceive and interpret signals from the gut, thus improving IBS symptoms,” she added.

That said, different kinds of meditation may work differently for different people. While it may not work for everyone, Dr. Farhadi recommends “mindless meditation,” which includes walking for 30 minutes per day on the same route until it gets so boring that one stops paying attention to their surroundings.

“That’s a meditative walk — you do meditation and walk together. It’s a stress reliever to reboot your system. But it needs a lot of practice. After 1 year, you may get into that zone for 1 minute out of the 15 you’re trying to do,” he said.

A recent review found that, although many patients with IBS report milk intolerance, there is no conclusive link between IBS and lactose intolerance.

As around two-thirds of the world’s population is lactose intolerant, it is reasonably likely for someone to be lactose intolerant and have IBS. This means that cutting out dairy products may help relieve gastrointestinal symptoms.

“Many patients with IBS associate their symptoms with eating and try to ease their symptoms by avoiding certain foods,” said Dr. Jackson. “An elimination diet involves removing multiple foods out of your daily diet and then slowly reintroducing them to help identify trigger foods.”

“The most studied diet for IBS is the low FODMAP diet. FODMAP foods can lead to increased gas and distension and the triggering of meal-related symptoms in patients with IBS. Dairy is a high FODMAP food, and for some/many may be a dietary trigger, but this is not universally true,” she explained.

“Food choices can be overwhelming and if available, a gastrointestinal dietician can help guide you in this process,” she added.

Natural remedies such as peppermint oil and cardamom have shown some promise in relieving symptoms of IBS and gastric ulcers. However, research into natural remedies is limited, so they may not be universally helpful.

“Black cardamom seeds and spearmint are muscle relaxants for the gut, and so they could reduce symptoms,” said Dr. Farhadi.

“People can try these natural remedies and others as long as they are not really strong chemicals. Many herbal remedies have been around for thousands of years, and people are using them with no problem,” he added.

Nevertheless, it is always recommended to check with a doctor before taking on any new line of treatment.

“Imagine you have an engine, and the engine has a problem. Now you turn it off. Or course, you may not have any problems as long as it’s off, but how long can you keep it off?” said Dr. Farhadi.

“So, if you reduce the number of times you eat from perhaps three to two times per day, you may reduce the number of symptoms you experience per day. It may help, but it isn’t necessarily the way to go,” he explained.

“Fasting, however, is good for other things — such as weight loss and memory,” he added.

If a patient has chronic constipation, Dr. Farhadi said that fiber could help. However, if overdone, fiber can lead to bloating from excess gas in the gut.

To avoid this, Dr. Farhadi recommended consuming fiber via a pinch of water-soluble fiber psyllium — a prebiotic — on a spoon of Greek yogurt, which is a probiotic.

“There’s no specific diet for IBS,” said Dr. Farhadi.

“Diets are not only individualized; they are dynamic. One person may be able to drink coffee when on vacation yet experiences problems with it during finals. As there is no specific diet for different individuals, there is no specific diet for individuals at all times,” he advised.