Are you looking to figure out what might be triggering your IBS? Maybe you are frustrated by the lack of information you're getting from your current health care provider? Or maybe you have been told that there are no triggers, there is nothing you can do, just take the medication? In our practice we treat a lot of people with IBS and other digestive issues and most often, there are things you can do. This video (below) and article will discuss five categories of things to consider as IBS triggers and some things you can do about these triggers.
Some people tell us, they were told by health care professionals that foods are not triggers. After treating hundreds of people with IBS I can tell you that diet and foods can and are triggers. So we will get into these details as categories not just five foods. We will talk about the 5 categories of triggers, including food, that are most likely to trigger IBS. Removing them will help improve your digestive health. Now there may be six, seven, or even ten of them depending on how you look at it. All of these IBS triggers are interrelated in some ways. To simplify we compartmentalize and them so it is easier to think about and discuss. Just know that they are interrelated. For instance, your mood may affect your digestion which may to your microbiome. For clarity, I'm going to break it down into five categories.
1. IBS Trigger: Stress/ Anxiety
The first IBS trigger has to do with how your nervous system affects you digestion. Stress and anxiety can be an immediate type of trigger for some people. You will know this is you if when stressor occur you immediately have to go to the bathroom. In other cases you might get more constipated by higher stress. When this is occurring chronically, what's going with your body is a shift in the body’s energy. It shifts away from the normal digestive function and more towards activities of fight or flight. You see, your body has to two main modes of functioning, "rest and digest" and "fight-or-flight."
These modes are tied in with the autonomic nervous system. The part of the autonomic nervous system called parasympathetic is more for "rest and digest." The sympathetic part is more for "fight-or-flight." So if you are stressed out or anxious and eating food, you're body is not going to have the parasympathetic activity. The parasympathetic activity is needed for enzyme production, proper peristalsis, and the migrating motor complex in small intestine. These are all the things that are inherent parts of what's suppose to happen with digestion without even thinking about it. So if you're stressed out you may not be producing as much enzymes. This could lead to the food sitting in the stomach longer which can lead to constipation. It just takes longer for food to move through in some cases too. It may lead to diarrhea because the food particles aren't digested fully. The food is not absorbed and then water can rush in leading to an osmotic type of diarrhea.
So that's the first IBS trigger. It is pretty important to consider, the inherit digestive function and how is stress and anxiety affecting your digestive function. Many many times when people have digestive issues and IBS there's a component of stress and anxiety going on.
2. IBS Trigger: Microbiome
The second IBS trigger to look at is microbial related. There is actually a subset of IBS referred to as Post Infectious IBS. What happens here typically is you get the flu or some sort of gastrointestinal bug, like a 24 or 48-hour thing. After this the person's digestive tract does not really recover. So the digestive tract is either in a chronic state of inflammation and never fully recovers or something shifts in the intestines. Typically the shift occurs in the large intestine or microbiome and interferes with the normal function of the digestive tract. There are other theories on why people get Post Infectious IBS like leaky gut syndrome. However for this post we will not get into too much detail on you the mechanism of post infectious IBS.
There are other microbial triggers too. For instance, pathogenic microbes like parasites you might get from traveling to certain countries. Sometimes even if you're not traveling people still get parasites even here in the US. Also there are pathogenic microbes that are only pathogenic when they're in larger quantity, also known as potentially pathogenic. There's also SIBO which many of you heard of and SIFO. Where SIBO is small intestinal bacterial overgrowth and SIFO is small intestinal fungal overgrowth. I referred to this with the stress and anxiety interrupting the migrating motor complex. This could be a trigger for SIBO an SIFO as well.
There is also a dysbiosis picture which means an imbalance in the normal inherent microbes that are supposed to be in the large intestines. With dysbiosis you can have excess of certain strains and species and not enough of others.
3. IBS Trigger: Diet
The third IBS trigger is diet. Now a lot of people believe that there's some dietary component to what’s triggering their IBS but sometimes they just can't quite pinpoint what it is. So I wanted to give you some ways to think about diet and how it may be triggering your IBS symptoms or digestive issues. Conventional medicine seems to throw that out suggesting it's not diet and there is nothing you can do diet wise.
This conventional wisdom has been called in a question more recently with more research going on. In my experience it has a big impact. Processed food, like junk food type stuff in general is not good for people with IBS. They are more sensitive to food and often more inflammation going on in their digestive system. Processed food has more pesticides in it by nature of how they are made. The more processing that’s occurring typically means cheaper food which has more pesticides sprayed on it. That’s just the nature of how packaged food is made.
If you're someone that's really sensitive and has more of an IBS picture you may want to shift your diet more towards organic. The pesticides in there can cause inflammation for some people. If you're not able to break those pesticides down it will be more of a problem. These chemicals are not good for any of us but for certain genetic types they are more of a problem.
The other thing with food is food sensitivities and food allergies. There's an immunological component which we will discuss below. There's also foods that may trigger someone more if they have a more of a microbial component. As I said earlier all these things are intertwined. If you have stress and anxiety you may be more sensitive to certain foods from a diet perspective. This sensitivity may trigger more of an immune reaction which may eventually lead to some sort of microbial balance (as discussed above). so all these things are intertwined but we are in the mode of compartmentalizing here.
So diet wise you may have issues from processed food, immune related foods such as food sensitivities / allergies, and foods that are triggering a microbial reaction. You also have foods that may worsen histamine intolerance and yet another category that's more of an autoimmune reaction like Celiac's.
So diet is very important it’s important to figure out which foods might be triggering you. However don't make the mistake of just eliminating the foods that are triggering without considering the microbial, autoimmune, or other things going on. If it's just the food and you remove it, everything should get better. The top three most common food sensitivities are gluten, dairy, and eggs. There's is also low FODMAP foods, fructose and lots of other food things to consider.
4 IBS Trigger : Immune System
The forth IBS trigger that I want to mention is that which involves the immune system. Now diet is one of those bigger things that can trigger the immune system. One of the reason that digestion is so important and why I emphasize this with my patients is because it primes your immune system. For instance, if your digestive tract is not working properly your immune system is going to be more likely to be triggered by food or other things. So the thing you want to figure out is why your immune system was triggered to begin with. Put another way, why your digestion is off? Once you resolve that you may not react to so many foods. As an example, a lot of people go on very restrictive diets and eliminate a bunch of foods. They find they felt so great but then when they reintroduce those foods they don't feel good. If this is you, I recommend distinguishing the food itself from what the body and microbiome is doing to the food.
It could be the food itself and you know your immune system just can't handle it. This is the case with food sensitivities and food allergies. Those are just different tags that the immune system puts on the food components as they enter the body. An allergy is a more severe reaction typically and a sensitivities a more mild reaction. Similarly there is also autoimmune reactions, such as things Celiacs disease, Crohn's, and Ulcerative Colitis. All of these autoimmune disease occur through the body's immune system attacking the intestines.
There is also histamine intolerance where the bodies now able to eliminate or break them down histamines efficiently and or producing too much. Microbial problems like SIBO and SIFO will make all of these immune reactions (food sensitive, allergies, autoimmune and histamine intolerance) worse and sometimes create false positive.
For instance, if you take a test for food allergies or sensitives and you have SIBO you will likely get false positive. These test are known to produce some false positives and microbial issues likely account for a good portion of these. There are various testing you can do to figure out and what's important, where to start, and rule out microbial problems.
Those are the basic ideas around the immune system getting activated and triggering IBS symptoms. First figure out why the immune system is getting activated to begin and ensure there is no microbial problem. Then look at the pure food immune system dynamic. Sometimes you have to bring in, leaky gut support as well which can also be tested for.
5. IBS Trigger: Genetics
The last IBS trigger to mention is genetics. So technically genetics would not be a trigger but more a susceptibility. When the right environmental trigger interacts with the susceptible person, the genetics are expressed. Still there are certain genotypes and alterations in your genes that can lead one to be more susceptible to IBS. Basically for all the things mentioned above as triggers, there are some known genetic alterations. There are genetic alterations which create more susceptibility to certain foods, more likely to have stress issues, imbalance microbiome and even immunodeficiency.
There are a lot of genetic links to IBS but the ones that I think are important follow. There are genes that can slow your breakdown of the stress neurotransmitters, like COMT, MAO-B, MAO-A.
From a microbial perspective there are the FUT single nucleotide polymorphisms (SNPs). These have to do with how well your probiotics or good bacteria stick and stay in your intestines. The FUT gene has other functions as well but one important aspect is whether or not your microbes are going to stick and stay in your intestines. If you have a lot of alterations here your microbiome diversity may be compromised.
Of course, there are SNPs related to gluten sensitivity too. There are several HLA family SNPs related to Celiac's and a couple others. There are SNPs for peanut allergies and there are genetic alterations related lactose intolerance.
The immune system itself like immunodeficiency is genetically determined. These are immunoglobulin deficiencies like IgA and IgG but many other type of genetic alterations that can comprises the function of your immune system but the main one would be immunoglobulin deficiencies.
Hopefully this information was useful in helping you better understand what might be triggering your IBS. Keep in mind there is more detailed information for each one of these 5 triggers. If you have questions please ask in the comment section below. If you want one-on-one support and help, click no the link below for a free 15 minute consult.