15th November 2019 Alex Evans

Irritable Bowel Syndrome: The surprising role played by the brain

Have you ever heard the gut described as the “second brain”?  We are starting to find out more and more about how what we eat can affect how we feel – and vice versa! This is sometimes called the “gut-brain axis”, and can have an effect on Irritable Bowel Syndrome (IBS) symptoms.

Is it your mood or is it the food?

This idea shouldn’t really surprise us.  Most of us are familiar with the idea that we get “butterflies in our tummy” when we are excited or nervous, or that we may feel “sick with nerves” before and exam or test.

However, when it comes to Irritable Bowel Syndrome, most people automatically blame the food that they are eating.  The problem with this is that sufferers start excluding various foods from their diet in an attempt to find the culprit.  Often there is no significant improvement, leading to more exclusions and the risk of a difficult, expensive diet and the loss of the enjoyment that eating meals should bring.

On the flip side, some people have been told by their Doctors that their symptoms are psychological and these patients may feel as if they have been told that their pain isn’t real; that their symptoms are “all in their head” – very discouraging when you are coping with pain, bloating, diarrhoea or constipation on a daily basis!

So what is really going on?

The impact of stress on IBS

Stress caused by anxiety, depression or an overly busy lifestyle actually does have real, physical effects on the gut.  Such conditions may “start” in the mind, but stress causes the release of chemicals such as hormones which then have a definite physiological effect on the gut.  Stress can change the way in which it moves – causing cramps, constipation (if it slows down) or diarrhoea (if it speeds up).  It can change the way the gut handles fluid and the way digestive enzymes are released.  Sensitivity to pain can be increased, and finally, stress can change the balance of bacteria in the bowel (I have written about the role of “friendly bacteria” in IBS in another blog post).

So – you can see that mental state is an extremely relevant factor in the development of irritable bowel syndrome!

Common phrases I hear from my IBS patients include “I’m always on the go” or “my friends say I’m 100 miles an hour”.  Another frequent issue is that people report that “sometimes I’m fine with a particular food and sometimes it causes terrible problems – there’s just no pattern to it!”.  This is frustrating for them but often a sign to me that the cause of their symptoms is not just food-based.  Patients will often be surprised to spend a large part of the consultation talking about stress management techniques, rather than being given a list of foods to avoid!

How to manage stress

Successful strategies can include meditation, mindfulness, regular enjoyable exercise and breathing techniques.  Often particular attention needs to be given to someone’s stress levels around mealtimes in particular.  Of course, I will always check someone’s diet as well!  I just want to emphasise that how someone eats is often just as important as what they eat.

Research is ongoing, and the more we learn about the gut-brain axis the better we will understand how to find effective therapies for the common – but often difficult-to-treat – condition of IBS.


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