Understanding Irritable Bowel Syndrome (IBS)

Understanding Irritable Bowel Syndrome (IBS)

  • Gut Health

  • By Desiree Nielsen, Registered Dietitian

    Is your gut feeling irritable? According to the Canadian Digestive Health Foundation, as many as 5 million Canadians have irritable bowel syndrome – one of the highest rates in the world1. Across the globe, as many as 12% of people show symptoms of irritable bowel syndrome such as abdominal pain and bloating and an urgent need to go to the bathroom.

    Irritable bowel syndrome (IBS) is distinct from diseases such as celiac disease or ulcerative colitis in that upon examination of the gut, it looks indistinguishable from a healthy digestive tract. Instead, it is considered a functional disorder; in IBS, the function of the gut is altered from healthy patterns… but it doesn’t make irritable bowel syndrome any easier to cope with. Many people living with IBS miss work because they need to stay near a bathroom – or are physically unable to sit as bloating and pain are too uncomfortable while seated. And because of the nature of the symptoms, many of us aren’t talking about our challenges – making irritable bowel syndrome a silent scourge weighing on our quality of life.


    What are IBS symptoms?

    Your experience of irritable bowel syndrome can change; some days, you may have more pain. Others, diarrhea… and yet others, extreme bloating. Historically, due to the subjective and changeable nature of IBS, many people were told that their symptoms are in their head. Digestive issues like IBS have been difficult to diagnose, particularly because there is no simple test to confirm a diagnosis, like with celiac disease. However, we now have strong diagnostic criteria, created by the ROME Foundation, which outlines the following:


    “Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

    1. Related to defecation
    2. Associated with a change in the frequency of stool
    3. Associated with a change in the form (appearance) of stool

    These criteria should be fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.”2


    IBS may be a daily burden before the condition is managed; however, one of the biggest challenges is that those that suffer from these symptoms may have a hard time teasing out what is normal or not. For example, diarrhea may happen from time to time – but if you have consistently loose stools for months or years, that is not normal… even if it is YOUR normal.


    It’s not all in your head… but your nervous system is involved

    Irritable bowel syndrome is admittedly complex and there is still much to understand. However, it also appears to be a perfect example of a gut-brain disorder, as the nervous system strongly contributes to IBS symptoms3-6. Psychological stress plays a large role in moderating gut function – and in the symptoms of someone with IBS, for example, increasing pain sensations and altering bowel movements. If you’ve ever had a ‘case of nerves’ send you to the washroom, you know firsthand how the brain can alter your gut function.

    In irritable bowel syndrome, that gut-brain connection goes even deeper. Depression and anxiety are also commonly seen in patients with IBS and those with IBS are more likely to have depression or anxiety4. Early research suggests that changes in the enteric (gut) nervous system may be driving changes in hypersensitivity and motility independent of the brain – suggesting that it isn’t just function that changes… the physiology of someone with IBS is changing too at microscopic levels5.


    Inflammation, bacteria and YOU

    Irritable bowel syndrome isn’t considered an inflammatory disease; however, research suggests that there is immune activation at the level of the gut tissues. For example, researchers have observed an infiltration of immune cells called mast cells in the gut tissue of someone with irritable bowel syndrome3,6. Mast cells release mediators like histamines, which influence immune response and the permeability – or ‘leakiness’ - of the gut barrier6. In fact, a recent study suggests disturbances in barrier function, AKA ‘leaky gut’, create inflammatory cascades that damage the gut and can lead to passage of gut bacteria into the body6.

    In all of this, we cannot forget to look at the role of our gut bacteria in the development of irritable bowel syndrome. It is now widely accepted that dysbiosis – or an imbalance in the bacterial community of the gut – is connected to IBS symptoms6. Getting the bacteria back in balance is, therefore, an important goal in irritable bowel syndrome, as gut bacteria interact with your digestive health in many ways, such as:

    • altering immune function
    • influencing intestinal motility
    • altering hypersensitivity and pain sensations
    • changing bowel movements
    • influencing gas production and bloating

    Research suggests that probiotics play a beneficial part of improving life with IBS7. In my practice, Bio-K+ is the probiotic that I rely on to help bring my clients’ guts back into balance; Bio-K+ is crafted to be effective, through a rigorously controlled manufacturing process, and commitment to clinical research that allows them to demonstrate its effectiveness in peer-reviewed research. In fact, Health Canada recently bestowed a health claim for Bio-K+ probiotics, as it helps improve quality of life in people with diarrhea-predominant irritable bowel syndrome.


    How to better manage and live with IBS

    Because of the multifactorial and diverse presentations of irritable bowel syndrome, we recommend taking an integrative approach to support yourself while dealing with IBS. If you find yourself under a great deal of stress, taking careful steps towards managing that stress is just as critical as making the right dietary choices. This could mean limiting obligations or screen time; engaging in meditation or yoga or finding a regular time to spend in nature.


    Does an IBS diet exist? From a dietary perspective, we are fortunate, as there is an evidence-based dietary approach called low FODMAP that is effective in as many as 80% of those with irritable bowel syndrome8. FODMAPs are unique carbohydrates that are poorly absorbed, such as lactose or fructans in grains; these foods may draw water into the gut and increase fermentation in those with IBS8. A 4-6 week elimination of FODMAPS as part of a program that includes regular exercise, stress management, and a daily probiotic is recommended. Research has shown that a low FODMAP protocol can help lower inflammation and change the gut flora – however, because of this, it is not a permanent dietary strategy. Post-elimination, be sure to be guided towards an anti-inflammatory plant-centered diet for long term health.


    Irritable bowel syndrome appears to be a fact of modern life; however, life with IBS doesn't have to slow you down. A well-balanced lifestyle, including a plant-focused diet, regular exercise, and Bio-K+ probiotics can help you feel truly well.


    Do you have any other questions about your gut health? Ask us in the comments below. If you are looking to stock up on Bio-K+, head to our store locator. For more information on Bio-K+, probiotics and digestive health, contact us, find us on Facebook and Instagram or join our community



    1. Canadian Digestive Health Foundation Public Impact Series 3: Irritable bowel syndrome in Canada. Incidence, prevalence, and direct and indirect economic impact - PMC (nih.gov)
    2. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome - PMC (nih.gov)
    3. Irritable Bowel Syndrome: Is It Really a Functional Disorder? A New Perspective on Alteration of Enteric Nervous System - PMC (nih.gov)
    4. https://www.ncbi.nlm.nih.gov/pubmed/24705634
    5. Changes in Enteric Neurons of Small Intestine in a Rat Model of Irritable Bowel Syndrome with Diarrhea - PMC (nih.gov)
    6. Vasoactive Intestinal Polypeptide and Mast Cells Regulate Increased Passage of Colonic Bacteria in Patients With Irritable Bowel Syndrome - PMC (nih.gov)
    7. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis - PMC (nih.gov)
    8. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis - PMC (nih.gov)


    Also! Did you know that Desiree Nielsen RD has an IBS program – if you want to link: https://desireerd.com/product/banishthebloat/

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    Desiree Nielsen Registered Dietitian
    About the author
    Desiree Nielsen is a registered dietitian, author and host of the vvegetarian ccooking sshow, The Urban Vegetarian. Desiree takes an evidence-based, integrative approach to her dietetics work, with a focus on anti-inflammatory, plant-centredcentered nutrition and digestive health.
    View all articles by Desiree Nielsen
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