April is Irritable Bowel Syndrome (IBS) Awareness Month AND Stress Awareness Month. If you don't know what IBS is or what it's like, then consider yourself lucky. Between 25 and 45 million people in the United States (10 to 15% of the population) are affected.

• The exact cause of IBS is not known. Symptoms may result from a disturbance in theway the gut, brain, and nervous system interact. This can cause changes in normal bowel movement and sensation. Symptoms can include diarrhea, bloating, gas, constipation and abdominal pain.
• Stress does not cause IBS. However, because of the connection between the brain and the gut, stress can worsen or trigger symptoms. The relationship between stress and digestive health issues is bidirectional: stress can trigger symptoms and GI distress can lead to anxiety and stress.

The "second brain" and how it responds to stress

When the body is under stress and the "fight-or-flight" response is activated, digestion slows or even stops so the body can divert all its energy to the perceived threat. This also occurs during less severe events like public speaking. Chronic disruptions in digestion will lead to abdominal pain and other symptoms such as constipation, bloating, diarrhea, etc. If you experience chronic stress, seek stress relief measures immediately.

What about Diet?
Many people with IBS experience symptoms following a meal which could lead one to believe certain foods or even eating could be a cause but food and diet are factors affecting IBS, not the cause.

Some foods are known to stimulate the gut which means they could worsen IBS symptoms:

• Meals that are too large or high in fat
• Fried foods
• Coffee
• Caffeine
• Alcohol
• Sugar alcohols (sorbitol)

Other foods can cause excess gas due the type of fiber they contain (insoluble) which could lead to more bloating and gas for those with IBS:

• Beans
• Cabbage
• Legumes (like peas, peanuts, soybeans)
• Cauliflower
• Broccoli
• Lentils
• Brussels sprouts
• Raisins
• Onions
• Bagels

Nutrition Therapy
Sometimes minor adjustments to your eating pattern can lead to big rewards like slowly adding fiber if you have diarrhea. There is no particular "IBS diet" because everyone is unique and will respond differently to the addition or absence of foods. If you have been diagnosed with IBS, keep a food diary for 2-3 weeks and take note of how your body responds to the different foods you are eating. This will be helpful to your health care provider and your treatment plan. Your doctor may suggest that you,

• Eat more fiber- research suggests soluble fiber is more helpful in relieving IBS symptoms (including beans, fruit and oat products)
• Avoid gluten- people with IBS may have more symptoms after eating gluten even in the absence of celiac disease
• Or follow a special diet called the low FODMAP diet for a short time- these foods contain particular carbohydrates that may be hard to digest for someone with IBS

Your doctor may also recommend talking with a dietitian for specific nutrition guidance. IBS can only be diagnosed by a medical professional so see your health care provider for more information and treatment options available to you.

Sources:

• NIH National Institute of Diabetes and Digestive and Kidney Diseases
• Harvard Health Publishing
• International Foundation for Gastrointestinal Disorders