A third of people with IBS say they are fatigued, and we know that burnout or chronic fatigue can increase your risk of IBS by more than double. IBS sufferers (as well as those suffering burnout or chronic fatigue) often have a history of high stress exposure and commonly report food sensitivity issues. The latter has often led to them restrict their diet which in the long term can cause other problems.
In the UK it is estimated that 17% of people suffer from Irritable Bowel Syndrome (IBS), it is slightly higher in women (23%) than men (11%) and can have a significant negative impact your quality of life. IBS is diagnosed by disturbances in bowel habits (diarrhoea or constipation) and abdominal pain, as well as bloating, changes in sensation in the gut including urgency to go, post meal symptoms like cramping as well as depression, and anxiety. Many people also report hypersensitivity (being able to feel movement or pain in the gut more than is normal) and fatigue as significant problems.
There is no one single cause of IBS. Finding out what the root causes and triggers are for you as an individual, and creating a specially tailored plan to address them is the best way forward. Potential triggers can include infections, food sensitivities, coeliac disease, leaky gut, lactose intolerance, hormonal imbalances and stress.
So why does IBS happen? Well there are various theories about how our gut is affected by various lifestyle factors including diet, exercise and stress as well as some of the more specific triggers. Our bodies are complicated and our brain and gut are very interconnected in the messages they send each other. Scientists call this our gut-brain axis and it is a very important communication pathway in the body as it regulates stress as well as supporting digestion and our immune system (70% of our immune system is in the gut). Signals from our nervous system are sent to the gut by neurotransmitters including serotonin (sometimes called our happy hormone) and dopamine (our reward hormone) which signal our gut microbes and can help change their behaviour. Amazing isn’t it!
Fatigue and IBS – Why The Two Go Together
First off a lot of people with IBS end up eating a restricted diet in an effort to avoid dietary triggers that cause them pain and discomfort. If you continue eating a restricted diet for a long period you may not be taking in all the nutrients you need to support your health and your energy. In particular you may be unwittingly restricting the micronutrients that you need to support your energy pathways.
Inflammation in the gut is common in IBS and alongside inflammation there is often an immune system response. Mounting an immune response, especially if it is chronically activated (ongoing) is going to take a lot of energy and it may cause the body to restrict energy supplies and encourage you to rest to prioritise this work.
As you will see stress is major contributor to IBS and stress is also a key factor in fatigue. In each cell of our body we have little organelles called mitochondria which use molecules that absorbed from our food and they turn it into energy for our body. Too much stress can switch the mitochondria from their energy producing mode into a defence and protect mode. This can happen all over our body, for example in our brain causing brain fog, and research is beginning to indicate this can happen in our gut too resulting in malfunction of the cells lining the gut.
What Factors Can Contribute to IBS?
Sometimes IBS can become a problem after a gut infection, something like a bacterial or viral gastroenteritis. For a quarter of people IBS was triggered by an infection which resulted in inflammation in the gut wall.
Inflammation & Leaky Gut
Inflammation can play a big role in IBS as it may trigger changes in the gut lining which can impact our immune system. One reason for this is that when our gut is exposed to a bacteria or a toxin it sets off an inflammatory response which can result in changes in the gut lining allowing it to become leaky and enable more particles to pass into our blood stream. Leaky gut is 50% more common in people with IBS. If particles of undigested food or other particles such as pollen can cross over the gut lining then they are at risk of being identified by the immune system as foreign substances that should be destroyed. This can result in a localised immune system response which can contribute towards IBS symptoms. Studies have shown this can include visceral hypersensitivity where you can feel pain in your gut more easily than normal and you may be able to feel pulsing or cramping too.
Our diet can influence IBS in several ways. The quality of food we eat can play a significant role in our gut health. Highly processed foods containing refined starches and sugars as well as emulsifiers, colourants, preservatives and stabilisers can all have a negative effect. This includes many common foods such as sliced breads, cereals, cereal bars, biscuits and cakes. Research shows that these foods can create an inflammatory situation in the gut which can create problems for our gut bacteria and even contribute towards leaky gut.
When we eat a high quality diet including lots of fruit and vegetables we are providing food to support our gut bacteria which in turn ferment it to produce short chain fatty acids, one of which butyrate. Butyrate can influence the amount of the hormone serotonin which can alter the rate at which food moves through our gut with a resulting effect on constipation and diarrhoea. Serotonin can also be raised by a large increase in insulin after eating a meal high in refined carbohydrates.
Stress & Depression
Research shows that people suffering from IBS often also suffer from anxiety or depression and tend to have a higher exposure to stress in their lives. Again this is thought to be linked to the gut-brain axis and alterations in brain function in IBS, even without suffering depression or anxiety, can make you more vulnerable to stressful environments. One of our stress hormones, noradrenalin, has been found to increase the presence of unhelpful bacteria in our gut whilst also reducing the number of helpful ones leading to an imbalance in our microbe population.
So as we have already seen our gut bacteria can play a big role in IBS. As well as infectious bacteria and viruses having a negative effect we have seen how our helpful bacteria can be affected by diet and stress. Studies have found that people with IBS have different intestinal microbes compared to a normal healthy human with more unhealthy bacteria, such as Streptococcus species, less helpful ones such as Lactobacillus and Bacteroides species. IBS sufferers often complain of bloating which may be due to higher levels of gas-producing bacteria, the gas creates a pressure inside the bowel stopping it from relaxing and hence causing pain.
Recent findings have shown that a neurotransmitter called GABA dampens down our stress response and also plays a role in visceral sensation, pain and in the normal motions of our intestines. Our gut bacteria are thought to be able to produce GABA from certain foods and the right food or perhaps a probiotic, might help alleviate these symptoms.
Bile acids are produced in the liver where they are stored together with proteins. They are separated in the intestines in a process by our gut microbes. When this happens there is an increase in chloride production and a decrease in sodium absorption which can lead to changes in the water content of the intestines. If there are too many bile acids then diarrhoea may occur or if insufficient then constipation may result. Problems with the amount of bile acid production have been linked to an imbalance of helpful and unhelpful gut bacteria.
In summary I think you can see that all of this suggests that looking after your gut, your microbes and your stress levels can all be very helpful in managing IBS.
Practical Strategies For Your Irritable Bowel?
1. Ensure plenty of fruit and vegetables. A diet high in colourful fruit and vegetables provide plenty of fibre as well as lots of anti-inflammatory polyphenols. High fibre diets are suitable for most people with IBS but may need to be reduced in some people with diarrhoea. Avoiding very high fibre foods such as wheat bran may be helpful especially if there might be a hypersensitivity to wheat or gluten.
2. Food Sensitivities. To help identify and problematic foods it can be a good idea to keep a food and symptom diary for a few weeks. The most common culprits are wheat, corn, dairy, coffee, tea, citrus fruit and chocolate. That way you will be able to look for patterns and see if any particular food is causing a problem. A nutritional therapist can help you with this and help you eliminate any problem foods on temporary basis while you work to improve your gut health.
3. Try Probiotics. There are plenty of studies suggesting that probiotics might help with IBS symptoms. Those that are multi-strain including Lactobacillus and Bifidobacteria are best.
4. Peppermint Oil. Enteric coated peppermint oil is an anti-spasmodic and has been found to be very helpful in calming the intestines and reducing the amount of visceral hypersensitivity. The enteric coating helps it get past the stomach acid which would dissolve it and into the intestines where it can go to work.
5. EPA/DHA in Fish or Algae Oil. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are essential fatty acids found in both fish oils and algae oils which have an anti-inflammatory action that may help reduce pain and inflammation in IBS.
6. Stress Reduction. Stress can play a big role in IBS. Even if we think we are not stressed we often are in the fast paced lifestyle we lead today compared to our hunter gatherer ancestors. There are plenty of thing you can do to try and find something that works for you, such as gentle exercise, meditation and yoga. If you like to go more technical you could try biofeedback using an App and device such as Heart Math which uses breathing exercises to regulate your stress levels or a device like Sensate which uses sound vibration to calm your nervous system.
7. Herbal Tea. Another option is to try herbal teas like lemon balm, chamomile, passionflower and valerian. They can help to calm the nervous system and some have antispasmodic properties that may help to relieve and expel gas and pain.
8. Avoid highly processed and sugary foods. I probably don’t need to say this but try to avoid all foods that don’t look like they come directly from a plant or an animal. Generally these are not good news for your gut or your helpful gut bacteria.
9. Reduce your alcohol and caffeine. These two guilty pleasures can often be a source of irritation for the gut and reducing or avoiding them can help some people with IBS.
Would You Like Some Professional Help?
As mentioned earlier, to find long-term, lasting relief from your symptoms it is essential to find out the root cause and any potential triggers for your IBS and fatigue.
Getting your microbiome (your gut bacteria) tested using a functional stool test is a good start. It can help identify infection, inflammation and any bacterial imbalances.
My 3-Month Energy Foundation Package can help you get the foundations in place to boost your energy and vitality, improve your gut health and support you to get your energy back. As part of this package your health history and diet will be reviewed in detail and we will delve into your lifestyle and put together a personalised plan for you with particular attention to nutrition and stress management to help resolve your symptoms.
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