Irritable Bowel Syndrome: What is it exactly?

Answering some common questions about IBS and possible solutions

Abdominal pain and digestive issues are often uncomfortable to talk about, but irritable bowel syndrome (IBS) affects a large number of people. For example, a recent review in the United States1, estimated that between 10 to 15 percent of adults there complain of the disorder. The figures for the UK are likely to be very similar. Here are some of the more commonly asked questions about IBS:

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhoea, constipation, or both. With IBS, you have these symptoms without any visible signs of damage or disease in your digestive tract.

IBS is a functional gastrointestinal (GI) disorder. Functional GI disorders, which doctors now call disorders of gut-brain interactions, are related to problems with how your brain and your gut work together. These problems can cause your gut to be more sensitive and change how the muscles in your bowel contract. If your gut is more sensitive, you may feel more abdominal pain and bloating. Changes in how the muscles in your bowel contract lead to diarrhoea, constipation, or both.

Does IBS have another name?

In the past, doctors called IBS colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel.

Are there different types of IBS?

Three types of IBS are based on different patterns of changes in your bowel movements or abnormal bowel movements. Sometimes, it is important for your doctor to know which type of IBS you have, although your doctor may still diagnose IBS even if your bowel movement pattern does not fit one particular type. The three types of IBS are:

IBS with constipation (IBS-C)
With IBS-C, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are hard or lumpy and
less than a quarter of your stools are loose or wateryIBS with diarrhea (IBS-D)
In IBS-D, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are loose or watery and
less than a quarter of your stools are hard or lumpyIBS with mixed bowel habits (IBS-M)
In IBS-M, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are hard or lumpy and
more than a quarter of your stools are loose or watery

Bear in mind that many people with IBS have normal bowel movements on some days and abnormal bowel movements on other days.

Who is more likely to develop IBS?

Women are up to two times more likely than men to develop IBS.1 People younger than age 50 are more likely to develop IBS than people older than age 50.2

Factors that can increase your chance of having IBS include:

  • having a family member with IBS
  • a history of stressful or difficult life events
  • having a severe infection in your digestive tract

What triggers IBS?

Whilst factor like stress make it more likely that a person will develop IBS, the immediate triggers to the condition are uncertain, and seem to vary. Likely triggers include the development of food sensitivities or intolerances, changes in gut bacteria (for example after treatment with a course of antibiotics) and carbohydrate malabsorption.

What other health problems do people with IBS have?

People with IBS often have other health problems, including1

  • certain conditions that involve chronic pain, such as fibromyalgia , chronic fatigue syndrome and chronic pelvic pain
  • certain digestive diseases, such as dyspepsia and gastro-oesophageal reflux disease
  • certain mental disorders, such as anxiety , depression and somatic symptom disorder

What treatments will help my IBS?

A range of lifestyle changes can keep people with IBS comfortable. These may include altering diet to avoid large and high-fat meals or any other known trigger foods. Adding probiotics and increasing fibre intake are also helpful to many.

Learning to relax, managing stress, improving sleeping habits and getting more exercise are also know to be beneficial.

When should you see a doctor?

It’s always advisable to see your general practitioner if you have symptoms suggestive of IBS, in order to confirm the diagnosis and rule out any other possible causes of your symptoms.

Symptoms which are not commonly associated with IBS and which should prompt an immediate visit to the doctor include significant or progressive abdominal pain, weight loss, rectal bleeding or bloody diarrhoea. Episodes of diarrhoea that wake you from sleep should also be further investigated.

You should also see your doctor if you have symptoms suggestive of IBS and also a family history of inflammatory bowel diseases like Crohn’s or ulcerative colitis, or you have suffered from anaemia, vitamin deficiencies or electrolyte disturbances.

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References:
[1] Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. Journal of the American Medical Association. 2015;313(9):949–958.
[2] Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393–1407.
Source Material:
National Institute of Diabetes and Digestive and Kidney Diseases and Dr. Stephanie A. McAbee, from the Vanderbilt University Medical Centre Digestive Disease Unit.

Artificial sweeteners: Link to diabetes & obesity seems likely but…

By James Brown & Alex Conner

Many countries have introduced a sugar tax in order to improve the health of their citizens. As a result, food and drink companies are changing their products to include low and zero-calorie sweeteners instead of sugar. However, there is growing evidence that sweeteners may have health consequences of their own.

New research from the US, presented at the annual Experimental Biology conference in San Diego, found a link with consuming artificial sweeteners and changes in blood markers linked with an increased risk of obesity and type 2 diabetes in rats. Does this mean we need to ditch sweeteners as well as sugar?

Sweeteners are generally “non-nutritive” substances meaning we can’t use them for energy. Some of these compounds are entirely synthetic chemicals, produced to mimic the taste of sugar. These include saccharin, sucralose and aspartame. Others sweeteners are refined from chemicals found in plants, such as stevia and xylitol. Collectively, sweeteners are being consumed in increasing amounts with most diet or low-calorie food and drink containing some form of non-nutritive sweetener.

Combating or fuelling the obesity crisis?

Artificially sweetened foods and drinks have become popular largely due to the growing worldwide obesity crisis. As sugar contains four calories per gram, sweet foods and drinks are normally highly calorific. In principle, by removing these calories we reduce energy intake and this helps to prevent weight gain.

Increasingly, however, evidence suggests that consuming artificially sweetened products might be associated with an increased risk of being overweight or obese, although this is controversial. If true, it suggests that using sweeteners is fuelling, not fighting obesity. Research has suggested that consuming lots of artificial sweeteners scrambles the bacteria in our gut, causing them to make our bodies less tolerant to glucose, the main building-block of sugar.

The new research, from the Medical College of Wisconsin and Marquette University, looked at some biological effects of sweeteners in rats and in cell cultures. They wanted to know if artificial sweeteners affect how food is used and stored. These are called metabolic changes and the research combined many different aspects of metabolism to build an overall picture.
The team also looked at the impact of sweeteners on blood vessel health by studying how these substances affect the cells that form the inner lining of blood vessels.

The scientists gave rats food that was high in either sugar (glucose or fructose) or calorie-free artificial sweeteners (aspartame or acesulfame potassium). After three weeks they saw significant negative changes in both groups of rats. These changes included the concentrations of blood lipids (fats).

They also found that acesulfame potassium, in particular, accumulated in the blood and harmed the cells that line blood vessels. The study authors state that these changes are “linked to obesity and diabetes”. These results suggest that consuming sweeteners change how the body processes fat and gets its energy at a cellular level.

Many countries have introduced a sugar tax in order to improve the health of their citizens. As a result, food and drink companies are changing their products to include low and zero-calorie sweeteners instead of sugar. However, there is growing evidence that sweeteners may have health consequences of their own.

New research from the US, presented at the annual Experimental Biology conference in San Diego, found a link with consuming artificial sweeteners and changes in blood markers linked with an increased risk of obesity and type 2 diabetes in rats. Does this mean we need to ditch sweeteners as well as sugar?

Sweeteners are generally “non-nutritive” substances meaning we can’t use them for energy. Some of these compounds are entirely synthetic chemicals, produced to mimic the taste of sugar. These include saccharin, sucralose and aspartame. Others sweeteners are refined from chemicals found in plants, such as stevia and xylitol. Collectively, sweeteners are being consumed in increasing amounts with most diet or low-calorie food and drink containing some form of non-nutritive sweetener.

Combating or fuelling the obesity crisis?

Artificially sweetened foods and drinks have become popular largely due to the growing worldwide obesity crisis. As sugar contains four calories per gram, sweet foods and drinks are normally highly calorific. In principle, by removing these calories we reduce energy intake and this helps to prevent weight gain.

Increasingly, however, evidence suggests that consuming artificially sweetened products might be associated with an increased risk of being overweight or obese, although this is controversial. If true, it suggests that using sweeteners is fuelling, not fighting obesity. Research has suggested that consuming lots of artificial sweeteners scrambles the bacteria in our gut, causing them to make our bodies less tolerant to glucose, the main building-block of sugar.

The new research, from the Medical College of Wisconsin and Marquette University, looked at some biological effects of sweeteners in rats and in cell cultures. They wanted to know if artificial sweeteners affect how food is used and stored. These are called metabolic changes and the research combined many different aspects of metabolism to build an overall picture.

The team also looked at the impact of sweeteners on blood vessel health by studying how these substances affect the cells that form the inner lining of blood vessels.The scientists gave rats food that was high in either sugar (glucose or fructose) or calorie-free artificial sweeteners (aspartame or acesulfame potassium). After three weeks they saw significant negative changes in both groups of rats. These changes included the concentrations of blood lipids (fats).

They also found that acesulfame potassium, in particular, accumulated in the blood and harmed the cells that line blood vessels. The study authors state that these changes are “linked to obesity and diabetes”. These results suggest that consuming sweeteners change how the body processes fat and gets its energy at a cellular level.

Limit your intake

What does this mean for the average consumer of artificial sweeteners? As the study was performed in animals and not humans it would be wrong to draw firm conclusions about what might happen in people. The findings of the study do, however, add to the growing body of research that suggests that sweeteners are not benign alternatives to sugar.

The European Food Safety Authority suggests a daily limit to most artificial sweeteners of around five milligrams per kilogram of body weight, per day. With so many foods including artificial sweeteners now, it is relatively easy to reach this limit.

It is important to note that not all sweeteners are equal. This recent study focused on artificial sweeteners, like most of the research that has identified negative effects. Some sweeteners are associated with health benefits. Stevia, for example, has been shown to improve blood pressure and glucose tolerance while xylitol has been shown to help prevent tooth decay. This means that choosing the type of sweetener that you use may be more important than choosing a sweetener over sugar.

It is likely that the best advice is the blandest: everything in moderation. There is no such thing as good or bad food, only good or bad amounts. Maybe avoid consuming too much of either sugar or sweetener, especially in drinks.

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About the authors and source material:

James Brown is senior lecturer in biology and biomedical Science, Aston University, Birmingham; Alex Conner is senior lecturer in biomedical sciences, University of Birmingham. This article was first published in the online academic discussion journal ‘The Conversation’ on 23rd April, 2018. The original article, with active links and references, may be viewed here