Introduction
Understanding the gut-brain axis and its relationship to IBS is essential for those living with Irritable Bowel Syndrome (IBS) IBS can feel overwhelming, often leaving individuals frustrated and defeated. While dietary choices are commonly associated with IBS management (GutsUK), crucial factors are often overlooked: how you E.A.T. – your Emotions, Actions, and Thoughts. This comprehensive guide aims to delve into the intricate relationship between IBS and the gut-brain connection, exploring effective strategies for long-term remission from IBS, not just short-term IBS relief.
What is IBS?
Irritable Bowel Syndrome, or IBS, is a chronic disorder of the gut-brain interaction. Although it is characterized by symptoms such as abdominal pain, bloating, flatulence, diarrhoea, and constipation (NHS.UK), it's a complex condition and IBS symptoms include:
Physical:
Digestive Discomfort: Individuals with IBS often experience symptoms such as abdominal pain, bloating, gas, diarrhoea, constipation, or alternating bowel habits. These symptoms can be unpredictable and vary in intensity, leading to physical discomfort and distress.
Fatigue: Coping with chronic digestive issues can be draining, leading to feelings of fatigue and decreased energy levels, which can affect daily activities and productivity.
Nutritional Challenges: Dietary restrictions or fear of triggering symptoms may cause limitations in food choices, potentially affecting nutritional intake and overall physical health.
Emotional:
Anxiety: The uncertainty surrounding IBS symptoms can trigger anxiety about when symptoms might occur and how they will impact daily life. Fear of embarrassment and being unable to find a restroom in time, can be particularly distressing.
Depression: Coping with the chronic nature of IBS, along with its impact on daily functioning and quality of life, can contribute to feelings of sadness, hopelessness, and loss of interest in once enjoyable activities.
Stress: Managing the physical symptoms of IBS, along with the emotional toll it takes, can lead to heightened stress levels, worsening digestive discomfort, and creating a cycle of distress.
Click here to find out more about the links between IBS and stress.
Cognitive:
Hypervigilance: Individuals with IBS may constantly check their bodies for signs of discomfort or impending symptoms, leading to hypervigilance and heightened awareness of bodily sensations.
Catastrophic Thinking: Fear of the worst-case scenario, such as having a severe flare-up in a public setting or being unable to manage symptoms effectively, can contribute to catastrophic thinking patterns that worsen anxiety and distress.
If you suffer from overthinking and IBS, click here to read this helpful article.
Negative Self-Talk: Chronic illness can sometimes lead to negative self-talk, where individuals blame themselves for their symptoms or feel inadequate for being unable to take part in some daily activities.
Behavioural:
Avoidance Behaviours: Fear of symptom flare-ups may lead individuals to avoid certain foods, social gatherings, or activities that they perceive as potential triggers. This avoidance can limit social interactions and negatively affect the overall quality of life.
Impact on Work and Productivity: As discussed in this article, managing IBS symptoms can interfere with work responsibilities leading to absenteeism, decreased productivity, or difficulty concentrating due to discomfort and distress.
Altered Daily Routine: Individuals with IBS may adapt their daily routine to accommodate symptoms, such as scheduling bathroom breaks or avoiding activities associated with symptom exacerbation.
Relational:
Strained Relationships: The impact of IBS on physical and emotional well-being can strain relationships with family members, friends, or romantic partners. Difficulty attending social events or changes in mood and behaviour due to symptoms may lead to misunderstandings or feelings of frustration.
Social Isolation: Fear of symptom flare-ups in public settings or embarrassment about discussing digestive issues may lead individuals to withdraw from social interactions, leading to feeling lonely and isolated.
Support System Dynamics: Support from loved ones can be instrumental in coping with IBS, but misunderstandings or lack of awareness about the condition may strain support system dynamics. Open communication and education about IBS can help foster understanding and empathy within relationships.
Overall, the impact of IBS extends beyond physical symptoms, affecting emotional well-being, cognitive processes, behaviour patterns, and relational dynamics. Addressing these multidimensional aspects of IBS is essential for promoting holistic healing and improving the overall quality of life for individuals with IBS.
The Gut-Brain Interaction
The gut-brain axis plays a significant role in IBS. The bidirectional communication between the gastrointestinal tract and the central nervous system, influences gut function, immune response, and mood regulation. Disruptions in this delicate balance can contribute to the onset, or exacerbation, of IBS symptoms. This can also lead to gut dysbiosis.
Gut Dysbiosis and IBS
The gut microbiota, also known as the gut microbiome, refers to the diverse community of microorganisms that live within the gastrointestinal tract. These microorganisms include bacteria, viruses, fungi, and other single-celled organisms, collectively known as the gut microbiota. Gut dysbiosis occurs when the gut microbiota composition becomes imbalanced. Gut dysbiosis is believed to be an initiating factor in the development of IBS. Factors such as diet, antibiotics, and environmental influences, can all disrupt the delicate ecosystem of beneficial bacteria in the gut, leading to inflammation and gastrointestinal distress. Also, according to an article in the World Journal of Gastroenterology Trusted Source, “stress-induced dysbiosis may play a key role in a person developing IBS.”
Read more about IBS and dysbiosis here.
IBS Symptom Relief
Traditionally, the focus of IBS management has revolved around symptom relief rather than addressing underlying causes. Commonly recommended approaches include dietary modifications such as the low FODMAP diet, medications for symptom control, and psychological interventions like Cognitive Behavioural Therapy (CBT).
IBS Dietary Advice: The low FODMAP diet (Monash University) involves restricting certain types of fermentable carbohydrates in the short term to alleviate digestive symptoms. While it can be effective for some individuals, a recent systematic review and meta-analysis evaluating the efficacy of a low FODMAPS diet in treating symptoms of irritable bowel syndrome, by Dionne, J., et al., (2018) reported that “…current evidence for the low FODMAP diet is weak”. Further, Nordin, E., et al., (2023) found that “FODMAPs seem to have a minor effect on IBS symptoms”.
Further, dietary restrictions can do more harm than good to the microbiome in the longer term, and therefore you should carefully consider this before starting any dietary intervention. If you choose this approach, you must work with a qualified healthcare professional to ensure proper implementation and long-term management for IBS relief.
IBS Medications: Pharmaceutical interventions may provide IBS relief from specific symptoms such as abdominal pain, diarrhoea, or constipation. However, they may not address the underlying mechanisms contributing to IBS, and long-term use can be associated with side effects, with several affecting the gastrointestinal system, (which seems more like a bad joke!).
Commonly prescribed drugs for IBS include:
Buscopan: This antispasmodic helps relieve abdominal cramping and pain by relaxing the muscles in the gut.
Imodium: Imodium is an antidiarrheal agent used to control diarrhoea in individuals with IBS-D (IBS with diarrhoea).
Fybogel: Fybogel is a laxative prescribed to alleviate constipation in individuals with IBS-C (IBS with constipation).
Amitriptyline: This tricyclic antidepressant (TCA) can help alleviate abdominal pain and improve bowel function in IBS by modulating neurotransmitter levels in the brain and gut.
Prozac (Fluoxetine): Prozac is a selective serotonin reuptake inhibitor (SSRI) antidepressant that may also provide relief from IBS symptoms, particularly in individuals with comorbid depression or anxiety.
While these medications can offer symptom relief, they may also be associated with side effects. For instance:
Buscopan may cause dry mouth, blurred vision, or constipation.
Imodium can lead to constipation and abdominal discomfort.
Fybogel may cause cramping, bloating, or diarrhoea if overused.
Amitriptyline and Prozac may be associated with side effects such as drowsiness, dizziness, weight gain, or sexual dysfunction.
As with any medication, you must discuss potential side effects with a healthcare provider and weigh the risks and benefits before starting treatment.
Cognitive Behavioural Therapy (CBT): CBT is a therapeutic approach that focuses on finding and changing dysfunctional thought patterns and behaviours. In the context of IBS, CBT can help individuals develop coping strategies to manage stress, anxiety, and gastrointestinal symptoms effectively. Read more here.
However, new gut-focused CBT protocols have recently been developed and clinical studies have proven that they offer safe, substantial, and lasting benefits for individuals suffering from IBS and stress (Everitt, H., et al., 2019). They work by regulating the gut-brain interaction thereby relieving stress.
The Interaction Between Stress and IBS
The interaction between IBS and stress is complex and multifaceted, involving various physiological and psychological mechanisms. One crucial aspect of this interaction involves the hypothalamic-pituitary-adrenal (HPA) axis, which is the body's central stress response system.
When an individual experiences stress, whether it's physical, emotional, or psychological, the hypothalamus in the brain releases corticotropin-releasing hormone (CRH). This hormone stimulates the pituitary gland to produce adrenocorticotropic hormone (ACTH), which, in turn, signals the adrenal glands to release cortisol, commonly known as the stress hormone.
Elevated cortisol levels are linked to alterations in the gut microbiome, gastrointestinal motility, sensitivity, and inflammation, all of which are central to the pathophysiology of IBS. For example, cortisol can increase intestinal permeability, leading to heightened visceral sensitivity and exacerbating IBS symptoms such as abdominal pain and discomfort.
Moreover, stress-induced activation of the HPA axis can modulate immune function, contributing to low-grade inflammation and immune dysregulation common in individuals with IBS. Chronic stress can suppress immune responses, making individuals more susceptible to infections and inflammatory conditions, which can further worsen IBS symptoms.
Biological responses to stress, such as changes in heart rate, blood pressure, and gastrointestinal function, also play a role in worsening IBS symptoms. Stress-induced alterations in gut motility and secretion can lead to diarrhoea or constipation, while heightened visceral sensitivity can amplify the feeling of abdominal discomfort.
Furthermore, psychological processes, including anxiety, depression, and maladaptive coping strategies, can influence the severity and frequency of IBS symptoms. Stressful life events, traumatic experiences, and chronic psychosocial stressors can trigger or worsen IBS flares, highlighting the intricate interplay between the mind and the gut.
In summary, the interaction between IBS and stress involves the dysregulation of the HPA axis, alterations in hormone levels, immune dysfunction, biological responses, dysbiosis, and psychological factors. Understanding these complex interactions is essential for developing comprehensive treatment approaches that address both the physical and emotional aspects of IBS management if you want any chance of long-term remission from IBS.
Stress and Dysbiosis
Chronic stress can disrupt the delicate balance of gut microbiota, leading to dysbiosis and increased intestinal permeability. This, in turn, can worsen inflammation and gastrointestinal symptoms in individuals with IBS. Learn more about how to control IBS, by controlling stress, here.
Long-Term Remission form IBS
Cognitive Behavioural Therapy offers an integrated approach to managing IBS by addressing all aspects; physical, emotional, behavioural, cognitive, and relational aspects of IBS. Specifically, it doesn’t just focus on physical elements as most common treatments do. It also concentrates on how people Emote, Act, and Think to relieve stress, retrain the gut-brain axis, and reset the microbiome. This leads to longer-term IBS remission.
Emotions: CBT educates people on the physical and psychological aspects of emotions. Using third-wave CBT approaches such as Compassion-Focused Therapy and Mindfulness-Based Cognitive Therapy the therapist helps individuals to recognise and regulate their emotions, reducing the impact of stress and anxiety on dysbiosis and gastrointestinal function.
Actions: By implementing behavioural strategies such as relaxation techniques and stress management skills, CBT empowers individuals to take proactive steps toward symptom relief. It also teaches specific skills to empower people to overcome worry about, and avoidance of, certain foods, social gatherings, or activities that are perceived as potential triggers. This prevents further dysbiosis and starts to repair the microbiome.
Thoughts: CBT challenges negative thought patterns and beliefs related to IBS. This promotes more adaptive coping mechanisms. Most of these patterns were learned as a child and therefore require specific therapeutic techniques to adjust to more helpful patterns improving overall quality of life, reducing stress, and creating a healthier microbiome.
Summary
IBS is a multifaceted condition influenced by several factors, including diet, gut health, and psychological well-being. Dietary modifications and medications can provide symptomatic relief. However, addressing the underlying mechanisms to relieve stress and retrain the gut-brain interaction, creates a healthier microbiome and enables long-term remission from IBS. Therefore, more holistic interventions, like gut-directed CBT, offer a more comprehensive approach to achieving long-term remission from IBS symptoms.
Relieve Stress, Retrain the Gut-Brain Axis, & Reset the Microbiome.
If you're ready to take control of your IBS symptoms and improve your quality of life, consider exploring the powerful connection between stress management, the gut-brain axis, and symptom relief. With the right support and guidance, you can achieve long-term IBS remission from IBS and reclaim your health and well-being.
If you’d like support to do this, I invite you to a webinar series, IBS Relief: It’s Not Just What You Eat, It’s HOW You E.A.T. which teaches about each of the 3 elements, Emotion, Action, and Thoughts. It is designed to help you understand how to retrain the gut-brain axis and achieve long-term remission from IBS.
Click here to learn more about this transformative series and start your journey towards long-term remission from IBS today.