What really causes irritable bowel syndrome?

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Perusing this week’s copy of the British Medical Journal, I came across an article about psychological approaches to irritable bowel syndrome. This condition, characterised by symptoms such as abdominal bloating and discomfort, wind and constipation and/or loose bowels is common. Yet, within the conventional medical establishment, this ill seems poorly understood. No wonder then, as the the BMJ article points out, that medical treatment for it is often ‘highly unsatisfactory’ [1].

The authors of the article recommend, where relevant, tackling IBS through a predominantly psychological route. Antidepressants, cognitive behavioural therapy and hypnotherapy are among some of the potential approaches put forward. While all of these have merit, I’ve very rarely found the need to resort to such therapies in practice.

Over the years, perhaps like a lot of naturally-oriented practitioners, I have found a couple of underlying factors in IBS which, once dealt with, almost always lead to very substantial or even complete relief from symptoms. One important factor here seems to be food sensitivity, while the other is an imbalance in the microbial ‘eco-system’ that resides in the gut.

Below, I have added a couple of articles which explore these two mechanisms in more depth. They also offer some pointers about how to manage these issues. Applying the principles here may well offer significant relief for IBS sufferers without recourse to psychological-based treatment.


1. Hayee B, et al. Psychological approach to managing irritable bowel syndrome BMJ 2007;334:1105-1109,

Avoiding certain foods can really help the symptoms of irritable bowel syndrome – 17th April 2004

While my career path veered away from orthodoxy more than a decade ago, I remain a regular reader of the British Medical Journal. One thing I like about this particular publication is it’s ability to email-alert me to any nutritionally-related content. Recently, the BMJ published an editorial on the management of irritable bowel syndrome (IBS) – a condition characterised by symptoms such as constipation and/or loose stools, abdominal bloating and wind, but for which no specific cause can be found. As I had not had electronic notice of this review, I imagined the BMJ’s automatic alerting service had somehow broken down. All became clear, however, when I read the review and discovered it contained not a single reference to diet.

Even those without any explicit knowledge of the inner workings of the digestive tract might suspect that symptoms emanating from this organ may well have something to do with food. This does indeed turn out to be the case, as IBS symptoms are quite often triggered by unwanted reactions to specific foods. This mechanism has not gained widespread acceptance as an underlying factor in IBS by the medical establishment, which usually advises IBS sufferers to increase fibre intake. However, one study found that increasing roughage in the diet was generally ineffective, and actually exacerbated symptoms in more than half of individuals afflicted with IBS. This seemingly paradoxical reaction is likely to be explained by the fact that individuals seeking additional fibre will generally find this in bran-filled breads and cereals based on wheat – which many nutritionally oriented practitioners (myself included) find is the most common offender in IBS of all.

While wheat is a frequent trigger factor in IBS, it is not always at fault, and other foods can be implicated too. Individuals with IBS can therefore benefit from individual identification of problem foods. Several methods of testing exist including kinesiology (muscle testing) and dowsing. My belief is that all such methods have some validity, though individuals who are more comfortable taking a more ‘scientific’ approach may have their blood tested for what are known as IgG antibodies to specific foods. One study published last year in the journal Gut found that elimination of these foods identified with this form of testing was generally beneficial for IBS sufferers. For more details on IgG blood testing see www.allergy-testing.com.

No tests are foolproof, however, and there is usually no reason why individuals should not make self-styled changes to their diet without testing. I generally advise such individuals to try a diet devoid of wheat (e.g. pasta, bread, biscuits, pastries, and breakfast cereals) and cow’s milk (another common offender) for a week or two. Better tolerated grain include rice and oats (e.g. oat-based muesli, porridge and oatcakes), and rice and oat milks are good swaps for dairy milk too. Next week, I’ll be focusing on what I find to be the other major underlying factor in IBS, namely an imbalance in the microbiological ecosystem that resides within the gut. In the meantime, IBS sufferers might find dietary exclusion does much to reduce the risk of unwanted gut reactions.

Do ‘healthy’ bacteria have a role in the treatment of irritable bowel syndrome (IBS)? – 24th April 2004

Last week I focused on how reactions to specific foods can precipitate the undesirable gut feelings collectively known as ‘irritable bowel syndrome’ (IBS). While IBS is commonly triggered by food sensitivity, this condition can also be related to other internal issues. One other frequent underlying factor in IBS concerns the microbes that reside within the gut. In health, the gastrointestinal tract is home to a variety of bugs that play an integral part in maintaining the good and proper workings of this organ. Should the balance of these gastrointestinal organisms go awry, however, digestive function can go belly up.

The internal ecosystem is chiefly made up of several pounds’ worth of bacteria – a word that most of us associate with ill health and disease. However, the bacteria that reside within the gut, including strains of what are known as the acidophilus and bifidus species, are broadly beneficial: amongst other things, they promote health in the lining of the digestive tract and help protect the gut against disease-causing organisms including parasites and viruses. Some depletion of the gut’s stocks of beneficial bacteria generally comes with age. However, the demise of these microbes can be greatly enhanced by a variety of factors, including the taking of antibiotics. In time, the erosion of beneficial bacteria in the body can compromise the gut’s healthy functioning, and may also lead to the emergence of potentially problematic organisms.

One type of organism that can assume an unhealthy degree of dominance in the gut, particularly as a consequence of antibiotic therapy, is yeast. Yeast is a fermenting organism, and the gas it gives off can give rise to symptoms common in IBS such as bloating and/or wind (often foul-smelling). A glut of yeast in the gut can also be associated with fungal infections elsewhere in the body such as vaginal thrush and athlete’s foot.

One key to getting better balance in the gut ecosystem is to avoid foods that encourage the growth of yeast and other unwanted organisms that may be lurking in the gut. The fundamentals of such as diet involve de-emphasising refined sugar, refined carbohydrates (such as pasta and white rice), and foods that are yeasty, mouldy or fermented such as wine, beer, mushrooms, Marmite, cheese and dried fruit in the diet. Ideally, the bulk of food intake should come from meat, fish, eggs, vegetables, beans, nuts and seeds.

The regular eating of ‘live’ natural yoghurt (which contains generally beneficial bacteria) may also help re-establish balance in the gut. Certain food components feed healthy bacteria, and may encourage growth in these important organisms. One such substance is a plant carbohydrate called inulin, a good concentration of which can be found in chicory. In addition to these dietary changes, I recommend the taking of one of the healthy gut bacterial supplements (known as probiotics) that can be found in good health food stores. Several studies have found that probiotic supplementation can bring significant relief in IBS symptoms within two or three months. Experience shows that for those who suffer from excessive fermentation in the gut, natural germ warfare can bring a breath of fresh air.

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