IBS is a functional bowel disease that mostly affects middle-aged women. Despite the obvious complaints of the patients, usually there are no findings in laboratory, radiological and endoscopic tests. A communication problem between the central nervous system and the digestive system of IBS patients is presumed to be the reason. The digestive system has exaggerated reactions to both internal and external stimuli.
The patients might complain of:
There are many factors that cause IBS. Most patients have multiple etiological factors. These are:
• Genetic predisposition
• Changes in brain-intestinal axis
• HPA axis (hypothalamo-pituitary-adrenal axis) changes
• Intestinal surface hypersensitivity
• Immune system dysfunction
• Increased intestinal permeability (leaky gut)
• SIBO (excessive bacterial growth in the small intestine)
• History of intestinal infection (gastroenteritis)
• Psychological predisposition
• Adverse childhood experiences
• Food intolerance
• FODMAP sensitivity
• Wheat sensitivity
• Non-celiac gluten sensitivity
• Food allergy
Spasms occur in the intestine due to the loss of rhythmic movements of the intestinal muscles. The gut is hyper reactive and reacts abnormally to normal internal and external stimuli. Complaints are seen within 15 minutes of eating in 1/3 of patients, and within the next 3 hours of eating in 93% of patients.
Food and its content may cause symptoms by:
Causing leaky gut.
Activating the immune system and mast cells.
Causing intestinal gas formation leading to intestinal wall stretching
Due to the chemical effects of natural or synthetic ingested molecules (such as salicylate, amine, benzoate and glutamate).
One of the food items that triggers IBS symptoms is wheat. The proteins (such as gluten) and carbohydrates (fructans, mainly FODMAP) found in wheat are responsible for this triggering. There are other proteins other than gluten in the wheat grain. One of them, amylase trypsin inhibitors are potent activators of the innate immune system. Wheat germ agglutinins are another type of protein found in wheat that has cytotoxic effects on intestinal epithelial cells.
Some IBS patients who are sensitive to wheat proteins may also be sensitive to milk (casein), yeast, soy and legume proteins.
IBS is most common in women aged 30-50 years. Hormones may be responsible for this difference. As IBS is more prevalent in patients with adverse childhood experiences, research suggests that women may be more likely to be exposed to physical, sexual and emotional trauma during childhood and adolescence, leading to IBS symptoms in adulthood.
Experiencing childhood trauma, especially emotional violence and neglect, and sexual abuse are important risk factors for IBS. IBS findings in these patients are usually accompanied by; repressed anger, eating disorders, chronic pain disorders, anxiety and depression. Traumas are thought to cause increased intestinal permeability by disrupting the HPA axis. Both increased intestinal permeability and concomitant depression lead to low-grade inflammation.
Increased intestinal permeability can lead to food intolerance and IgG antibodies to ingested food. Food intolerance may increase IBS findings via histamine and mast cell related inflammation. Patients report significant improvement of their symptoms on discontinuing food items that they have IgG antibodies for. Reducing the total daily carbohydrate intake also reduces IBS symptoms and increases well-being and daily functioning of the patients.
IBS is rarely seen alone; it is often accompanied by:
• Chronic fatigue syndrome
• Sleep disorders
• Atopic diseases
• Gastro esophageal reflux disease
• Pelvic pain
• Erectile dysfunction
• Interstitial cystitis
• Non-celiac gluten intolerance
• Celiac disease
• Food allergy
Celiac disease can be found in 4% of IBS patients, especially those with diarrhea or diarrhea/ constipation episodes.
People with a suitable genetic background yet no previous complaints may reveal signs of IBS after a severe stress or a gastrointestinal infection, giardial infection in particular. Patients may develop IBS by 4-31% within 3 years of the infection. Patients who are stressed or depressed when they have gastroenteritis have a higher risk of developing IBS.
Having IBS increases the risk of Parkinson’s disease, dementia and allergy /asthma.
What NOT to eat if you have IBS:
• Wheat and wheat products (durum wheat is the worst, einkorn wheat
(antique wheat) is better)
• Cow’s milk and dairy
• Goat, sheep and buffalo dairy
• Onion, garlic, leek
• Processed meat
• Apple, peach, orange
• Fried foods
• Smoked foods
• Food additives
• Alcoholic products
• Caffeine and caffeinated products
• High amounts of amine-containing foods (tuna, salami, cheese, wine, beer)
• Foods that cause histamine release (fermented food, milk, wine, beer, tomatoes, spinach)
I think I have IBS, what should I do?