Stress and Irritable Bowel Syndrome (IBS)

Everyday life events can lead to stress:

Work
Your commute
Problems at home
Money problems

Major life events can lead to stress:

Marital separation
Family member leaving home
A relationship ending
Severe illness
Death of a parent
Abuse (emotional and physical)

Do any of your IBS symptoms flare up during times of stress?

Constipation
Diarrhoea
Abdominal pain
Cramps
Bloating
Passing mucous
Feeling that bowel movement is incomplete

LET’S CONNECT THE DOTS BETWEEN STRESS AND YOUR STOMACH

The brain-gut-axis refers to the multiple pathways and other connections the brain uses to communicate with the gut. ⁷
Stress disrupts the brain-gut axis, leading to changes in gastrointestinal functioning: the movement of digestive contents along the digestive tract and the release of gastrointestinal hormones, causing diarrhoea or constipation. ^7,8,9
In patients with IBS, a profound dysregulation of the brain-gut axis (BGA) takes place. ⁷

STRESS DISRUPTS COMMUNICATION AND CHEMICAL PATHWAYS BETWEEN THE BRAIN AND THE GUT, LEADING TO IBS SYMPTOMS OR MAKING THEM WORSE. ^{7, 8,9}

IBS management tips – FODMAPS

What are FODMAPs? ¹⁰
FODMAPs are certain types of carbohydrates that can pass through the small intestine without being fully absorbed. If they move on to the large intestine, they get fermented by the bacteria that lives there, causing gas.

They also draw in water leading to:

F = FERMENTABLE (causes gas)
O = OLIGOSACCHARIDES such as onions, garlic, beans, artichokes, dried fruit, plums, watermelon, wheat, rye, barley, pistachio and cashew nuts. NOTE: not all nuts are high-FODMAP. Peanuts, walnuts and pecans, along with moderate portions of almonds, are low.
D = DISACCHARIDES such as milk and yoghurt. NOTE: many dairy products are low FODMAPs. Enjoy cheeses like parmesan, brie, cheddar and feta, as well as moderate servings of ricotta.
TIP: Many high-FODMAP foods become low-LODMAP in moderate servings.
M = MONOSACCHARIDES such as asparagus, sugar snap peas, apples, fresh figs, cherries, mango, pears, honey, agave and high fructose corn syrup. NOTE: pure maple syrup is an excellent replacement for honey. In baking, it’s a 1-to-1 substitute.
(A = AND)
P = POLYOLS such as peaches, blackberries, mushrooms and snowpeas, as well as sweeteners like mannitol, sorbitol, maltilol, xylitol and isomalt. NOTE: cutting sugar-free foods like gum and mints make these foods easier to avoid.
All patients with IBS should be treated holistically in order to improve their quality of life.¹¹

DOWNLOADABLE IBS TRIGGER DIARY

When you know the things that can make your IBS symptoms flare up, called triggers, you can make a plan to avoid them. That way, you can work on keeping problems with constipation, diarrhoea, abdominal pain, and bloating to a minimum. ²
IBS is different for everyone, but it may help to keep track of how you react to the most common symptom triggers and learn to prevent them. ²
Our downloadable IBS Trigger Diary – available online http://www.stressandmystomach.co.za/ may help you connect the dots in discovering what is making your IBS worse, and importantly, assisting your doctor in treating your symptoms.

The diary is simple to use:

We listed a number of common triggers and situations down the side. ^2,3

Simply complete the diary each day by ticking which emoticon best represents “how you felt” against “how you did” that day

You may not experience all of these situations each day, which is why we suggest you use the diary for at least 4 weeks. You may start to see some patterns emerging and we encourage you to visit your doctor with the completed diary to discuss how best to treat your symptoms.

Medical References

Anxiety and Depression Association of America. Stress. Available at https://adaa.org/understanding-anxiety/related-illnesses/stress Last accessed 14 July 2019
Khatari M. WebMD. IBS Triggers and How to Avoid Them. Last reviewed 25 March 2018. Available at https://www.webmd.com/ibs/ibs-triggers-prevention-strategies?print=true Last accessed 4 July 2019
Qin H-Y, Cheng C-W, Tang X-D, Bian Z-X. Impact of psychological stress on irritable bowel syndrome. World J Gastroenterol 2014;20(39):14126-14131
National Institute for Health and Care Excellence (NICE). Irritable bowel syndrome in adults: diagnosis and management. Clinical guideline. Published: 23 February 2008. Available at nice.org.uk/guidance/cg61 Last accessed 4 July 2019
Gastrointestinal Society. (2018). Rome III to Rome IV: Updates and Developments. [online] Available at: https:// www.badgut.org/information-centre/a-z-digestive-topics/rome-iv/ Accessed 3 July 2019
Quigley E, Fried M, Gwee KA, Khalif I, Hungin P, Lindberg G, et al. Irritable bowel syndrome: a global perspective. World Gastroenterology Organization Global Guideline. Updated September 2015. Available at http://www.worldgastroenterology.org/UserFiles/file/guidelines/irritable-bowel-syndrome-english-2015.pdf Last accessed 4 July 2019
Konturek PC, Brzozowski T, Konturek S. Stress and the Gut: Pathophysiology, Clinical Consequences, Diagnostic Approach and Treatment Options. J Physiol Pharmacol. 2011;62(6):591-599
Tacheé Y, Kiank C, Stengel A. A Role for Corticotropin-releasing Factor in Functional Gastrointestinal Disorders. Curr Gastroenterol Rep. 2009;11(4):270–277
Prins A. The brain-gut interaction: the conversation and the implications. S Afr J Clin Nutr 2011;24(3): S8-S14
What are FODMAPs (Fermentable Oligosaccharides Disacchardies Monosaccharides and Polyols) clambellykitchen.com. Julie O’Hara, Health Coach (c) 2015 – 2016 Julie O’Hara Creative, LLC. All rights reserved. Available at URL:https://calmbellykitchen.com/blog/what-are-fodmaps-simple-guide-for-regular-chicks. Accessed 4 June 2019
Singh P, Agnihotri A, Pathak M, Shirazi A, Tiwari R, Sreenivas V et al. Psychiatric, Somatic and Other Functional Gastrointestinal Disorders in Patients With Irritable Bowel Syndrome at a Tertiary Care Center. J Neurogastroenterol Motil. 2012;18(3):324-331

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