When Food is Pain: Living With Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a chronic, functional disorder of the gastrointestinal tract characterized by lower abdominal pain (often severe), gas, bloating, vomiting, diarrhea, constipation, or a combination of both, typically over months or years. In addition, in a study conducted by the Urogynaecology Unit of St. George's Hospital in London, researchers found that an irritable bladder is part of the irritable bowel syndrome as well. That is, for an IBS sufferer frequent urination can be a problem as well.

According to the International Foundation for Functional Gastrointestinal Disorders, an estimated 15-20% of all Americans suffer from irritable bowel syndrome, 60-70% of which are women. The average age of IBS onset is late teens to early twenties, but it can also start in childhood. There is no known cure as this problem is a syndrome, not a disease.

IBS has been called by many names including colitis, spastic colon, and functional bowel disease but these are false synonyms because irritable bowel syndrome is not caused by any physical abnormalities. IBS is diagnosed only if the patient has the classic symptoms mentioned above in addition to the absence of physical abnormalities. This is determined by a complete medical history, laboratory tests, and diagnostic tests such as x-rays or endoscopy. Moreover, since food allergies, gluten intolerance, inflammatory bowel diseases, colon cancer, endometriosis, ovarian cancer, and gallstones can all mimic the symptoms of irritable bowel syndrome, they must also be conclusively ruled out.

Irritable bowel syndrome causes a great deal of pain and emotional/physical distress, but it does not cause permanent damage to the intestines and has not been shown to lead to any other syndrome or disease. To be more specific, no link has been established between IBS and inflammatory bowel disease or colon cancer.

What Triggers IBS?

Eating causes the colon to contract. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. For IBS sufferers this urge may come even sooner and with greater urgency and frequency. Food, stress, or a combination of both can trigger an IBS attack but the specific foods and/or the level of stress varies from person to person. In addition, for many women irritable bowel syndrome is triggered by menstrual cramps due to the excess hormones present at this time.

IBS sufferers seem to fall into two categories, those whose attacks are triggered solely by stress, who need only to be careful about what they eat during times of stress in order to prevent an attack; and those whose attacks are triggered by a combination of stress and diet, and who must carefully watch what they eat at all times.

Biologically speaking, the colon is partially controlled by the nervous system. So it makes sense that stress would cause colonic spasms in people with irritable bowel syndrome. However, while stress may worsen IBS symptoms, research suggests that a person must first have a hypersensitive, hyperactive colon in order for stress to trigger an IBS attack.

Eating Safely for Irritable Bowel Syndrome

Just as there is no one universal trigger for irritable bowel syndrome, there is also no standard way to treat it. Nevertheless it is agreed that prevention is the best treatment. First and foremost is figuring out one's individual trigger foods, which means keeping a food diary. Once you pinpoint which foods trigger your symptoms you can then decide if these foods need to be eliminated from your diet, substituted, or eaten in smaller quantities.

Eating safely for irritable bowel syndrome means following the FDA food pyramid, which recommends eating 6-11 servings of grains, 3-5 servings of vegetable, 2-4 servings of fruit, 4-6 servings of protein, and eating fats and sweets sparingly as these latter two foods are most likely to trigger IBS attacks. This has numerous benefits, the most notable being controlling your symptoms and thus eliminating the problem. Other benefits include lowering your risk of heart disease, cancer, arthritis, diabetes, high blood pressure, and obesity.

Eating for IBS simply means replacing your known trigger foods with safer, wiser choices. For example, instead of eating a solid chocolate candy bar, which has a high fat content, an IBS sufferer can enjoy a cup of hot chocolate or baked goods made with cocoa powder instead.

Another solution is to eat smaller meals more often or to eat smaller portions. The purpose of this is to keep the gastrointestinal muscles gently stretched around a full colon and not tightly clenched around an empty colon, which can trigger an IBS attack.

Natural remedies include Metamucil or Citrucel (sources of soluble fiber) taken daily; Fibercon capsules; chamomile and peppermint tea and mints made with oil of peppermint such as Altoids all which serve as mild muscle relaxants. If these natural remedies do not help, an IBS patient may have to rely on antacids/anti-gas medications or anti-diarrhea medications. A physician may also prescribe an anti-spasmodic medication such as Bentyl or Levsin.

Finally, make sure you get up and move around after each meal for at least 10 minutes. Sitting down for a long period of time or lying down for a nap immediately after a meal slows down the digestive process and can trigger an IBS attack -- especially after eating a possible trigger food.

Common Trigger Foods for IBS

The following foods have a high fat content; are difficult to digest; are a powerful stimulant; have a high acid content; or are gas producing. All of these foods are typically powerful triggers although the severity of gastric reactions will vary from person to person.

Red Meat (Beef, Pork, Lamb, etc.)		Coffee, regular and decaffeinated
Dark poultry meat and skin		Alcohol
Dairy products		Carbonated beverages
Egg yolks		Artificial sweeteners
Fried foods		Artificial fats such as Olestra
Coconut milk		Fruit juice and tomato sauce
Oils, shortenings, fats		Garlic, onions, leeks, broccoli, cauliflower, cabbage and Brussels sprouts
Solid chocolate		Whole nuts

Fiber and Irritable Bowel Syndrome

What is frustrating for IBS sufferers is that they are often told to eat more fiber, but aren't told which kind is best for their condition. There are two types of fiber, soluble (which absorbs water) and insoluble (which does not absorb water). And unfortunately, it is insoluble fiber, the one with most health benefits, which is difficult on the digestive tract and can trigger severe IBS attacks. According to a study of the effects of wheat bran on patients with irritable bowel syndrome, which appeared in the April 1999 issue of Lancet magazine, 55% of IBS patients were made worse by eating wheat brann, which is an extremely high source of insoluble fiber.

Nevertheless, because insoluble fiber is essential for good health, it still needs to be a part of the IBS individual's diet. How can you do this without causing problems? Insoluble fiber such as fresh fruits and vegetables have the least adverse affect when eaten last or on a full stomach. So, eating a green salad after the main course instead of before one's meal is a good strategy. Moreover, one's tolerance for insoluble fiber should increase if you are eating it in small quantities on a regular basis.

Soluble fiber, on the other hand, is soothing to the digestive tract. It helps prevent painful spasms and relieves both the constipation and diarrhea of IBS. For the IBS individual, soluble fiber should always be the very first thing you eat on an empty stomach and it should be part of every meal. Foods that are naturally high in soluble fiber include oatmeal, pasta, rice, potatoes, sourdough bread, soy, barley, and oat bran.

The Importance of Stress Reduction

After gaining an understanding of how IBS works and monitoring food intake, the next step for the IBS patient is to acknowledge the role stress has in their life and to take steps to better manage their response to stress. The major benefit of stress reduction as a coping strategy for IBS is that it gives the sufferer a sense of control, which is the key to better overall health and happiness.

Practicing yoga, meditation, journal writing, deep breathing, and visualization on a regular basis (or even in the midst of an IBS attack) are all good ways to reduce stress-related IBS attacks because these methods bring about the relaxation response. Engaging in moderate exercise for 30-60 minutes every day is another good way to take control of one's health and to release feel-good endorphins. Lastly, make sure you get enough sleep because sleep deprivation markedly impairs your ability to handle stress.

A Delicate Subject

Many people do not see irritable bowel syndrome as a real ailment because it is not a life-threatening condition. In fact, IBS sufferers have been thought to fit a certain psychological profile, such as having abusive childhoods or being prone to depression. However, most doctors acknowledge that irritable bowel syndrome is not the result of a personality disorder. Rather, research shows that this is a real physical problem and it should be taken seriously. Moreover, while studies show that IBS sufferers are more likely to suffer from depression and anxiety, it can easily be argued that depression can stem from feeling at the mercy of your digestive system and the anxiety comes from worrying if you will have an IBS day. Like any other chronic condition, depression and anxiety are often the resulting symptoms of IBS and not the cause.

In addition, many IBS sufferers are embarrassed to talk about their condition because bowel movements are a private thing. While it's true that diarrhea and constipation are not topics of polite discussion, this doesn't mean that an IBS sufferer's pain and discomfort does not have a very real and significant impact on almost every aspect of their life. Many sufferers are unable to work, sleep, eat, socialize, or take vacations because they are either enduring an IBS attack or are afraid that another attack will begin. In fact, according to the International Foundation for Functional Gastrointestinal Disorders, irritable bowel syndrome is the second leading cause of work absenteeism. However, in most cases, the IBS sufferer is able to take back control of their lives by learning how to control their symptoms through diet, stress management, and if necessary, anti-spasmodic medication. Clearly, the key is to control your IBS symptoms so that IBS doesn't control you. Irritable bowel syndrome does not have to take over your life.

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