Irritable Bowel Syndrome in 2019
Irritable bowel syndrome (IBS) is very common worldwide and there is still much we don’t know about it. There are often many ongoing studies focused on learning more about this condition. In this article, we will outline some of the newly published research on IBS from diverse geographic locations.
Low-FODMAP Diet Improves Quality of Life
The low-FODMAP diet is a popular treatment method for IBS. It involves cutting down on the amount of fermentable carbohydrates (specifically fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) in the diet, because these carbohydrates can increase symptoms in those with IBS. Typically, people reduce these foods to very low levels for a period of time, then slowly reintroduce them until they achieve a tolerable level. We know that an ongoing low-FODMAP diet can reduce symptoms such as bloating and abdominal pain, but a new study from New Zealand and Australia1 set out to measure the effects of a low-FODMAP diet on other aspects of life. There were 111 patients in the study, and they were measured for quality of life as well as anxiety/depression, fatigue, sleep quality, happiness, and digestive symptoms before starting the low-FODMAP diet as well as after 6 weeks and 6 months on the diet. They found significant improvements in all areas, including overall quality of life, at both the 6-week and 6-month mark, and specifically found a correlation between GI symptom response and these other changes. This shows that the low-FODMAP diet can have a wider range of benefits than just reducing GI symptoms.
Bloating and Symptom Severity
A study from Israel2 looked at 484 individuals, comparing those with IBS to healthy controls, and further split the IBS group into those who experienced bloating and those who did not. They found that the patients who had bloating had worse symptom severity, pain severity, fibromyalgia, dietary restriction, and anxiety than those without bloating. The study authors suggest that physicians should consider these aspects when treating individuals with IBS to ensure that patients get the best treatment for their unique situations.
IBS and PMS
Researchers in Iran wanted to see if there was any link between the intake of trace elements (zinc and copper) and premenstrual syndrome (PMS), painful menstruation/cramps (dysmenorrhea), and IBS, all of which are common in women. The study3 compared four groups of adolescent girls: 67 girls with PMS, 161 with dysmenorrhea, 146 with PMS and dysmenorrhea, and 74 girls with neither condition. They then used the Rome III criteria to diagnose IBS in these individuals and measured blood levels of zinc and copper. They found no significant difference in blood levels of the trace elements between the groups. However, the girls with PMS and dysmenorrhea were more likely to have IBS than the girls without them. They found IBS in 14% of the girls with PMS, 20% of those with dysmenorrhea, 17% of the girls with both, and only 8% of those with neither. Research in the past has resulted in similar findings, which might point to a link between menstrual disorders and IBS in women.
Brain Structure
In the Inside Tract® newsletter, issue 176, Gray Matter Changes in IBS, we mentioned that some research shows differences in the structure of the brain between individuals with IBS and individuals without the condition. A new study from the United States4 wanted to see if these differences were also apparent in children with IBS. They compared brain imaging of 32 girls with IBS to 26 girls without IBS, and looked for differences in grey matter volume and resting state functional connectivity. They then looked for correlations between these measurements and the girls’ laboratory-based pain thresholds. They found that girls with IBS had lower grey matter volume in a number of brain areas, including the prefrontal cortex, basal ganglia, and anterior mid-cingulate, than those without IBS. The girls with IBS also had altered functional connectivity between some brain networks. In addition, there were noticeable differences in pain sensitivity between those with and those without IBS, with a correlation between these brain changes and increased sensitivity to pain. This study suggests that the structural brain changes that can sometimes be found in individuals with IBS likely begin early in brain development.
Negative Events
In the past, some research has linked IBS severity to mental health conditions, such as anxiety and mood disorders. In another study from the US,5 researchers looked at the relations between perceived stressful/negative events in adulthood and IBS. They compared 129 patients with IBS to 108 healthy individuals and collected information on the presence and effects of events in adulthood, IBS severity scores, and IBS-related quality of life. They found that individuals with IBS report more negative life events and individuals with more negative life events are more likely to get IBS. In addition, an increase in negative life events leads to increased symptoms, worse quality-of-life, and a dysregulated stress response in those with IBS. The results of this study help highlight how treating these mental health aspects can lead to fewer IBS symptoms and a better quality of life.
Conclusion
Irritable bowel syndrome is very common, but there are still many gaps in our knowledge of this condition. Medical science is still trying to figure out what causes IBS, what makes it worse, and what we can do to help prevent or treat this condition. Researchers frequently publish new articles that can help us better understand IBS. We also know that the microbiome – the bacteria and other microorganisms that inhabit the gut – likely plays a role in IBS.