Medical Myths: Exploring Misconceptions about Irritable Bowel Syndrome (IBS)
This Medical Myths series explores misconceptions about irritable bowel syndrome (IBS). Among many misunderstandings, we address what causes IBS and what to know about exercise and diet changes.
In our Medical Myths series, we tackle medical misinformation directly. Utilizing expert insights and peer-reviewed research, MNT distinguishes fact from fiction, providing clarity in the often confusing world of health journalism.
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder affecting around 11% of adults worldwide. Symptoms include:
- Abdominal pain
- Excess gas
- Bloating
- Sudden, urgent need to use the bathroom
- Changing bowel habits
While relatively common, IBS is often misunderstood. To help dispel some prevalent myths about this condition, we spoke with Dr. Ashkan Farhadi, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, and Dr. Mollie J. Jackson, a gastroenterologist at the University of Kansas Health System.
We know what causes IBS
Learn more about post-infectious IBS and its causes here.
Dr. Farhadi explained that although research is uncovering more about IBS, the exact causes remain unclear. Certain foods, such as dairy products or spicy foods, may trigger symptoms but do not cause the condition. However, post-infectious IBS can be caused by bacteria like Campylobacter jejuni.
Stress causes IBS
Explore how stress influences gut health here.
Recent studies suggest that mental stress levels influence gut bacteria composition and play a key role in IBS via the gut-brain axis. Dr. Farhadi notes that individuals with and without IBS generally face similar amounts of stress. It may be how people manage stress—not stress alone—that affects whether they experience IBS symptoms.
“In my book on IBS, I wrote about a study showing that when a person is stressed, the number of mast cells in their gut increases. So stress doesn’t just increase the release of hormones and mediators in the gut; it also changes the anatomy of the gut in a way that makes it more sensitive to stress,” he explained.
“This means that even if you come out of that stressful period, your gut is not the same as it was before. IBS symptoms triggered by stress can thus linger even though the stress is gone. And this is very common in patients with IBS,” he added.
Dr. Farhadi also mentioned a study he conducted that found a subjective perception of well-being is linked to fewer IBS symptoms. Previous research has suggested that psychological, social, and genetic factors may all play roles in the development of IBS symptoms.
Doctors only diagnose IBS via ‘fancy tests’
For details on the Rome IV criteria, visit this resource.
“IBS can be diagnosed without fancy tests,” Dr. Farhadi stated. “With the right clinical criteria, doctors can diagnose IBS with 97% accuracy within five years. No other test in the medical field has that kind of accuracy.”
“We diagnose IBS based on the Rome IV criteria: Patients with IBS should report symptoms of abdominal pain at least once weekly on average, in association with a change in stool frequency, a change in stool form, and/or relief or worsening of abdominal pain related to defecation,” explained Dr. Jackson.
“There are subtypes of IBS, and you may have predominantly diarrhea, constipation, or a mixed pattern. Patients often also experience bloating, but this symptom is not required for the diagnosis,” she added.
IBS is curable
Read more about current IBS management strategies here.
There are various ways to treat IBS, including a combination of prescription medication and lifestyle changes tailored to each person’s individual situation.
“I can assure you that in the overwhelming majority of cases, management is very affordable and simple: fiber, probiotics, reassurance, and exercise,” said Dr. Farhadi.
Regarding medication, Dr. Farhadi described it as a “trial and error” experience. It can help relieve IBS symptoms alongside other interventions.
“Ultimately, there is no cure for IBS,” Dr. Farhadi noted. Sometimes, medication may only serve as temporary relief. He often prescribes medications for managing bacterial overgrowth with antibiotics, but reiterated, there is no cure for IBS.
IBS is uncommon and does not affect quality of life
“IBS is often a chronic, debilitating, and common disorder of the gut-brain interaction,” said Dr. Jackson. Its prevalence in North America is 10-15% and is associated with increased healthcare costs. “[I]t can significantly affect patients’ quality of life.”
“One study highlighted the negative impact of IBS, with patients reporting that they would give up 10–15 years of their life expectancy for an instant cure for their condition.”
All types of exercise help IBS
While Dr. Farhadi agrees that some kinds of exercise can help IBS, he cautions that not all exercise is beneficial.
“Competitive exercise doesn’t relieve stress—it produces stress. The same is true for weightlifting in the gym if you have to pay a lot of attention to what kind of weight you’re lifting, how you’re pulling this muscle, and how you’re pushing that muscle,” he noted.
He also mentioned that many runners experience what is known as “runner’s run,” or diarrhea after running for long periods. Long durations of running can thus cause IBS symptoms to flare.
Meditation helps
Find studies on meditation and IBS here.
Some studies suggest that meditation may help relieve IBS symptoms, but research is ongoing.
“We are continuing to understand the brain-gut-microbiome axis and how it plays a role in IBS,” said Dr. Jackson. “Gut-directed psychotherapies have been shown to be beneficial in improving IBS symptoms.”
“Meditation and mindfulness can help stimulate changes in the brain and how we process thoughts, sensations, and emotional responses. This may positively affect how we perceive and interpret signals from the gut, thus improving IBS symptoms,” she added.
Different types of meditation may work differently for different people. While it may not work for everyone, Dr. Farhadi recommends “mindless meditation,” which includes walking for 30 minutes per day on the same route until it becomes so monotonous that one stops paying attention to their surroundings.
“That’s a meditative walk—you do meditation and walk together. It’s a stress reliever to reboot your system. But it needs a lot of practice. After one year, you may get into that zone for one minute out of the 15 you’re trying to do,” he said.
Cutting out lactose helps
Learn about the low FODMAP diet and its impact on IBS here.
A recent review found that, although many patients with IBS report milk intolerance, there is no conclusive link between IBS and lactose intolerance.
Since around two-thirds of the world’s population is lactose intolerant, it is likely for someone to be both lactose intolerant and have IBS. This means that cutting out dairy products may help relieve gastrointestinal symptoms.
“Many patients with IBS associate their symptoms with eating and try to ease their symptoms by avoiding certain foods,” said Dr. Jackson. “An elimination diet involves removing multiple foods from your daily diet and then slowly reintroducing them to help identify trigger foods.”
“The most studied diet for IBS is the low FODMAP diet. FODMAP foods can lead to increased gas and distension and trigger meal-related symptoms in patients with IBS. Dairy is a high FODMAP food and may be a dietary trigger for some, but this is not universally true,” she explained.
“Food choices can be overwhelming, and if available, a gastrointestinal dietician can help guide you in this process,” she added.
Natural treatments work for IBS
Discover research on peppermint oil for IBS here.
Natural remedies such as peppermint oil and cardamom have shown some promise in relieving symptoms of IBS and gastric ulcers. However, research into natural remedies is limited, so they may not be universally effective.
“Black cardamom seeds and spearmint are muscle relaxants for the gut and could reduce symptoms,” said Dr. Farhadi.
“People can try these natural remedies and others as long as they are not strong chemicals. Many herbal remedies have been used for thousands of years without problems,” he added.
Nevertheless, it is always recommended to consult a doctor before starting any new treatment.
Fasting relieves IBS
“Imagine you have an engine, and the engine has a problem. Now you turn it off. Of course, you may not have any problems as long as it’s off, but how long can you keep it off?” said Dr. Farhadi.
“If you reduce the number of times you eat from perhaps three to two times per day, you may reduce the number of symptoms you experience per day. It may help, but it isn’t necessarily the way to go,” he explained.
“Fasting, however, is good for other things—such as weight loss and memory,” he added.
Fiber helps IBS
Get more information on fiber and IBS here.
If a patient has chronic constipation, Dr. Farhadi stated that fiber could help. However, excessive fiber intake can lead to bloating from excess gas in the gut.
To avoid this, Dr. Farhadi recommends consuming fiber through a pinch of water-soluble fiber psyllium—a prebiotic—mixed with a spoon of Greek yogurt, which is a probiotic.
There is an IBS diet
“There’s no specific diet for IBS,” said Dr. Farhadi.
“Diets are not only individualized; they are dynamic. One person may be able to drink coffee when on vacation yet experience problems with it during finals. As there is no specific diet for different individuals, there is no specific diet for individuals at all times,” he advised.
Conclusion
IBS is a complex condition influenced by a combination of biological, psychological, and lifestyle factors. While there is no one-size-fits-all treatment, tailored strategies involving diet, exercise, stress management, and, when needed, medication, can significantly improve quality of life for those affected by IBS.
