Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by varying degrees of recurring abdominal pain and bloating, diarrhea, constipation, and gas. Even though IBS is frequently diagnosed—reportedly affecting up to 23% of people around the world, and more women than men (1, 2) — the exact cause remains unknown, and medical experts do not fully understand how the disease process works. Unlike ulcerative colitis, Crohn’s disease, and other inflammatory bowel diseases with similar symptoms, IBS is considered a functional disorder, which means symptoms are caused by a dysfunctional digestive system, rather than by chronic inflammation, growth, or permanent damage along the gastrointestinal (GI) tract that can identified in a physical examination. This dysfunction interrupts the normal movement of food through the GI tract, causing the related symptoms. IBS can produce different symptoms in different people, and multiple factors—both physical and psychological—are thought to be involved in its development.

The Brain-Belly Connection

Although IBS is not fully understood, symptoms appear to result from a disturbance in the brain-gut axis—the line of communication that exists between the brain and the gastrointestinal tract—that may include disruptions in the microbiome and the immune system. (3) This, they believe, helps explain why approximately half of all IBS patients, particularly those who suffer from chronic abdominal pain, report mental symptoms and distress along with abnormal and inexplicable symptoms that were once considered to be “all in their heads” because doctors couldn’t find any physical abnormalities. (4)

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A large-scale Taiwanese population study used anonymous medical records to follow more than 4,500 IBS patients ranging in age from 34 to 59 for approximately 6 years from diagnosis. None of the study patients had previously been diagnosed with any type of psychiatric disorders. At follow-up, when the researchers compared the study population to patients in the general population who were never diagnosed with IBS, they found that the IBS patients were significantly more likely to develop mental health conditions such as depressive disorders, anxiety disorders and sleep disorders. IBS patients were also found to be at higher than average risk of developing bipolar disorder, but not schizophrenia. Upon further investigation, the researchers found the highest risk of developing these mental health conditions occurred within a year of being diagnosed with IBS, and while the risk decreased over time, was still significant more than five years after diagnosis. (2)

The Link Between Stomach Issues and Suicide

While this research appears to confirm the findings of numerous other studies, researchers still have many question about the link between IBS and psychiatric disorders. There’s no doubt that IBS causes patients significant distress and is associated with higher levels of mood disorders, anxiety, and other psychiatric conditions. A study of 100 IBS patients found that more than one-third had considered suicide as a result of their symptoms. (5) But just as several factors may play a role in the development of IBS, many different circumstances also play a role in the development of psychiatric disorders. This complicates the work of any researcher seeking to find a definitive link between IBS and mental health issues. Furthermore, it complicates the ability to determine the best treatment. (2, 6)

The Potential Benefits of Probiotics

One area of great interest to researchers looking at IBS, mental health disorders, and links between the two, is the human microbiome, or the diverse population of gut microbia (bacteria) that lives in our gastrointestinal tract, which appears to play an active role in many areas of health. Normally, a balanced population of “good” bacteria keeps our digestive system healthy but when that balance is disrupted, as it can be for a variety of biological, psychological, medical and environmental reasons, an overgrowth of “bad” bacteria can result. Studies are showing this imbalance can have profound negative effects on both physical and mental health. (7)

Ongoing studies are also looking at the benefits of treating both IBS and mental health issues with probiotics—helpful live bacteria—found in fermented foods, taken as supplements, and introduced via a technique known as fecal microbial transplantation that involves introducing bacteria from a healthy person into the gastrointestinal tract of a patient with physical or mental health problems, in a procedure similar to a colonoscopy. (7,8) Research on probiotic bacteria thought to be most beneficial to people with IBS centers on different strains of the species known as Bifidobacterium and Lactobacillus, both considered key to replenishing the gut with good bacteria and restoring a healthy balance to the microbiota. Yogurt, kefir and aged cheeses are probably the most common food sources of these bacterial species in the American diet. These strains also serve as the components of many different brands of probiotic supplements, alone and in combination with other beneficial bacteria. More and better controlled studies are necessary, however, before the effectiveness of different strains, combinations, and doses of probiotics can be confirmed and recommended by medical experts. (9)

Tips for Soothing Your Upset Stomach

While it is clear that more research needs to be done on IBS, mental health conditions, and how the two impact one another, it is important to keep in mind basic rules of healthy living when trying to improve both stomach issues and mental health woes. But don’t underplay any condition that is getting in the way of your life; make an appointment with your health practitioner to discuss the problem.

Here are tips to help you begin the journey to full bodily wellness.

  • Incorporate foods rich in fermentable fibers, called inulin-type fructans, which, studies show, can help nurture beneficial gut bacteria. These are found in foods such as leek, asparagus, chicory, Jerusalem artichoke, garlic, artichoke, onion, wheat, bananas, oats and soybeans, according to nutrition researchers from the UK’s University of Reading. Plant compounds called polyphenols, found fruit, vegetables, tea, coffee, wine, soymilk, nuts and chocolate may also contribute to healthy blood sugar via beneficial effects on gut bacteria, the researchers note.10
  • Avoid artificial sweeteners: they have been shown to change gut bacteria colonies in ways that may contribute to blood-sugar problems, the UK study shows. 10
  • “The best advice for people who want to improve their health and keep their beneficial gut bacteria happy at present is still what we have recommended for many years. Base your diet on plenty of vegetables and fruits and wholegrain breads and cereals. Include nuts, lean meats, and fish, chicken and dairy products. Minimize your intake of highly processed foods that are high in saturated fat, sugar and salt. Try to get at least 30 minutes of exercise each day, and don’t smoke,” says Australian dietitian Nicole Kellow, who is researching gut bacteria in people with prediabetes at Monash University and Baker IDI Heart & Diabetes Institute.
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Last Updated: Feb 18, 2020