It’s safe to say irritable bowel syndrome (IBS) has become a modern-day epidemic! 🙁 Not only does it run rampant among my clients – a global Gastroenterology study published in 2021 concluded that about 40% of the entire population has a gut issue of some kind. (1) But while many people have heard the term “IBS”, most people don’t realize they have it because they don’t fully understand what it is.
On the other hand, others are under the impression they’re suffering from IBS when in fact they have other underlying medical issues in disguise as IBS.
…If you’ve landed here, you’re likely suffering from “gut issues” and trying to figure it out. Maybe you’ve heard of IBS, and maybe you even suspect you have it – but how do you know for sure? What if it’s something else?
I’m going to shed light on all of these frequently asked questions about the infamous “IBS,” so you’ll have a better understanding of what it is, what causes it, what you can do about it, and more.
Disclaimer: This article is meant to be educational and informative. This information is not medical advice! If you have IBS or another type of gut health issue, make sure you’re working with a doctor and holistic dietitian (or functional dietitian nutritionist) to determine the best plan of care for your individual needs!
Affiliate disclosure: This article contains affiliate links. As an Amazon Associate, I may make a commission for qualifying purchases.
Table of Contents
What is IBS?
IBS is a functional gut health disorder that plagues millions of people (about 11% of the population) worldwide. (1)
- A “functional” health disorder or condition is one that is chronic and burdensome, but not clinically unstable, debilitating, or life-threatening.
In the case of IBS, people are suffering with chronic symptoms of digestive discomfort which usually follow within a few hours after eating.
Doctors will typically diagnose you with IBS when medical conditions such as inflammatory bowel disease (IBD) have been ruled out, and when you meet specific diagnostic criteria.
IBS diagnostic criteria
Starting in 2006, a panel of international experts united to create the “Rome criteria”, which have since evolved into formal diagnostic criteria for IBS. (2)
- The most recent iteration of the Rome criteria (aka “Rome IV”) was released in 2016. (2)
Clinically speaking, in order to “qualify” for an IBS diagnosis according to the Rome IV criteria (2), you need to experience at least two of the three signs of gut imbalances listed below, for at least three consecutive months:
- Pain with bowel movements at least once a week
- Altered (abnormal) stool consistency
- Altered (abnormal) stool frequency
While that may look pretty simple, IBS symptoms still vary greatly in type, frequency, duration, and severity among each individual.
Symptoms of IBS
IBS symptoms usually show up within a few hours after eating a meal, snack, or specific type of trigger food.
The specific types of foods that trigger IBS symptoms are different from person to person, but IBS symptoms are typically frequent and chronic among IBS sufferers across the board.
If you have IBS, you’ve most likely had to deal with a cluster of the following symptoms on-the-reg:
- Frequent stomach aches or abdominal cramping
- Unexplained nausea
- Constipation (small, hard-to-pass, and/or infrequent bowel movements)
- Diarrhea (loose, excessive, and/or sometimes lighter-colored stools)
- Heartburn or acid reflux
- Adverse food reactions (sensitivities and/or intolerances)
- Subsequent depression and/or anxiety
Subtypes of IBS
Did you know there are three subtypes of IBS? (These were also started by the Rome criteria, since IBS can manifest differently for each individual but with some basic common ground.)
While everyone’s IBS symptoms are unique to them, according to Rome criteria, your IBS will respectively be either constipation-predominant, diarrhea-predominant, or both (aka “mixed”):
- Constipation-predominant IBS = “IBS-C”
- Diarrhea-predominant IBS = “IBS-D”
- Mixed IBS = “IBS-M”
Knowing your IBS subtype (combined with what you learn about your suspected root causes) may help you in narrowing down which types of interventions (such as functional nutrition lab tests, IBS diets, etc.) could be the most helpful and relevant for you, as next steps on your journey to IBS recovery.
Another important dictator of your functional nutrition treatment plan is uncovering and addressing any and all root causes that led to the manifestation of your IBS. (This is something you can and should do with help and supervision from youre doctor and holistic / functional dietitian nutritionist!)
Below I’ll share some examples of some common factors that can contribute to the development of IBS over time, if left unchecked for too long.
What causes IBS?
This is quite the loaded question! There are dozens and dozens of underlying root-causes of IBS. And in my experience, as I mentioned earlier, IBS is not caused by ONE thing but rather the culmination of lots of different events/predispositions which have built up over time.
Needless to say, IBS is complex and “multifactorial” – meaning usually there are multiple factors that contribute to the onset of IBS over a given timeframe.
There’s also often a “chicken-or-the-egg” phenomenon with some IBS comorbidities in that we don’t always know which one came first. These types of conditions may precede and/or amplify IBS, but they are also caused or amplified by IBS so it can quickly spiral into a vicious feedback cycle.
- For example, this is usually the case with stress/anxiety which typically go hand-in-hand with IBS.
At some point after the underlying issues are left unchecked for too long, you essentially cross an invisible line and will start experiencing noticeable symptoms above the surface level.
Root causes of IBS
Below is a list of top-of-mind IBS root-causes. (Remember, the whole is greater than the sum of its parts! Usually IBS is the sum of multiple underlying predispositions/root causes.)
Feel free to go through this list and see which may apply to you, and take note that this list isn’t exhaustive. (It’s no wonder IBS is a modern-day epidemic, if you ask me!)
- Dysbiosis (which can start as early as infancy)
- Imbalance in gut pH (too much or not enough stomach acid)
- Gut lining damage (“leaky gut syndrome”)
- Anxiety and/or a chronically overactive stress response (aka “fight or flight”)
- An imbalanced diet
- Not chewing food / eating too fast
- Disordered eating behaviors
- Food poisoning
- Medications (which contribute to dysbiosis, altered stomach acid, and/or leaky gut!)
- Birth control
- Acid reducers
- Proton pump inhibitors
- Candida overgrowth
- Mold (“mycotoxins”)
- Food sensitivities and intolerances (also a symptom of IBS)
- Stress and anxiety (also a symptom of IBS)
- Brain damage from a concussion or from a degenerative disease (alters the enteric nervous system)
- Autoimmune disorders which alter gut motility (i.e. Hashimoto’s hypothyroidism or Grave’s hyperthyroidism)
What else can be mistaken for IBS?
Medical conditions are often mistaken for IBS, since there’s a great deal of overlap in the surface-level presentation of symptoms.
Unfortunately, gastrointestinal (GI) symptoms often get brushed off, and people sometimes get labeled with IBS before ruling out every other viable condition.
But if you don’t take the path of leaving no stone unturned until you feel realigned, you run the risk of letting a medical condition fly under the radar for months or years, which will wreak havoc in and of itself.
In my “leave no stone unturned” philosophy and approach (which I often refer to as “Gut Clarity” and pillar #1 of my complete gut repair framework), I recommend advocating for yourself whenever possible.
Your medical team should be doing everything they can to ensure you don’t have any of the following GI conditions before slapping “IBS” onto your medical record:
- Small intestinal bacterial overgrowth (“SIBO”)
- Liver or gallbladder disorders
- Crohn’s disease
- Celiac disease
- Ulcerative colitis
- Bowel cancer
- Bowel obstruction
To make matters even more complex, IBS can also sometimes co-occur simultaneously with any of the above medical conditions.
IBS frequently asked questions
How do I know if I have IBS or IBD or SIBO?
- Determine whether or not your poop is “healthy” and “normal
- Consult with your doctor and possibly a gastroenterologist
1. Assess your poop!
If you have “gut issues”, you’ll be able to tell by looking at a Bristol Stool Chart (a clinical tool often used by gastrointestinal doctors and dietitians).
The following infographics were pulled from my self-published IBS Food Diary* as a point of reference for you:
“Unhealthy poop” will meet at least 2 of the following criteria, or more:
- Too infrequent (less than 3 bowel movements per week)
- Too small/incomplete/hard shape and consistency (type “1” or “2” on the Bristol stool chart, and/or very thin in diameter, and/or less than 6 to 12 inches per day)
- Too loose in consistency (Bristol stool types “5”, “6” or “7”
- Too frequent (more than ~3x/day)
2. Consult with your doctors to run diagnostic testing
Next, first need to consult with your primary care doctor and a gastroenterologist, to rule out all possible types of IBD and SIBO. (These can be ruled out through a series of clinical tests.)
If you receive an IBS diagnosis, you’ll also want to ask your doctor about which IBS sub-type you have.
“Okay, so I have IBS. Now what?!”
Glad you asked! This is where I shine, and how I help people (since IBS is majorly impacted by diet and lifestyle). Here’s a 10,000-foot overview of how I help my clients address their IBS:
- Get clarity on your root-causes and IBS triggers via an IBS food diary + functional nutrition lab testing
- Move through the 5R’s of gut repair (at your own pace)
- Establish a maintenance plan with your treatment team
If you and your medical team have determined you don’t have IBD or SIBO, the next step from a holistic and functional nutrition standpoint is get clear on how it happened.
(In my Complete Gut Repair Roadamap online course, where I walk participants through the 6 pillars of gut repair, we refer to this as Pillar #1 or “Clarity.”)
From there you will want to make sure you’re addressing any and all underlying root causes within your control (so genetics aside). In this phase of clarity, you will also want to get crystal-clear on your body’s best and worst foods via a combination of food logging and functional nutrition testing, as needed.
The IBS food diary
If you haven’t already, you may want to grab a copy of this IBS food diary* which I designed and published with YOU in mind!
This IBS food diary is different from other types of food-symptom logs in that I made sure to include tutorials specificially on:
- How to keep a clinically sound, helpful food-symptom journal (step-by-step) and
- How to decipher the patterns and messages your body is trying to tell you based on your adverse food reactions.
2. The 5R protocol
Next, you’ll want to (with help from your treatment team) move through each of the 5R’s of gut repair:
- Remove any offending trigger foods that have been identified (i.e. food allergies and/or intolerances and/or food sensitivities)
- Replace them with alternatives and make sure you’re getting everything you need from a macro- & micronutrient standpoint
- Reinoculate your gut microbe ecosystem by addressing any underlying microbial imbalnaces (aka “dysbiosis”)
- Repair your gut lining with the right functional foods, herbs, and/or nutriceuticals
- Rebalance your lifestyle by addressing the non-nutritional factors impacting your gut health (i.e. sleep, stress, movement, etc.)
Last but not least, once you’re feeling better, it’s important that you figure out what your new holistic lifestyle is going to look like in terms of reintroducing foods, tweaking your supplements, etc.
(I’ve seen far too many people make a lot of progress over the course of a few months, only to fall back into old unhealthy choices once they start feeling better. That is not how people reach IBS recovery!)
FYI – this is a VERY broad, surface-level overview of what it looks like to address your IBS from a holistic and functional nutrtion standpoint. When you’re ready to start navigating all of this, you’ll need to work directly with a doctor and a holistic / functional dietitian.
Either way, equipping yourself with the right knowledge and education can be helpful to get you in the right mindset and level of readiness for this type of journey! That said, I’ve got LOTS more to say about IBS and would love to share more of my insights and perspectives with you.
Feel free to check out any or all of these resources if you’d like to learn more:
- What’s the Best IBS Diet?
- 51+ Tasty Low FODMAP Snacks for IBS
- Smoothie for Constipation Relief
- IBS and Coffee: Can They Coexist?
- IBS and Iron Deficiency: Uncovering the Links
- Spilling the Tea on Sucralose and IBS
- What is a Leaky Gut, and How Do You Know If You Have It?
- Food Allergy vs Intolerance vs Sensitivity – How are They Different?
IBS is a complex and chronic gut epidemic which can show up differently for everyone.
IBS is a last-resort diagnosis people are supposed to receive only when all types of SIBO and IBD have been ruled out. Unfortunately, not all clinicians are going to rule out all other possibilities before diagnosing you with IBS, based on my experience as a past IBS sufferer and as a clinician who works with clients that suffer from IBS. They have a tendency to want to jump right into symptom management, which will keep you stuck treading water indefinitely if you don’t look past the symptoms.
The best way to address your IBS holistically is to first get clear on your diagnoses, your underlying root causes (since things never just happen for no reason), your trigger foods, and your “safe” well-tolerated foods so you can continue to get the nutrition you need from food, while avoiding unwanted sympotms.
Avoiding the foods that bother you is only one piece of the equation when it comes to addressing your IBS, which is why it’s important to work with clinicians (doctors and a dietitian/nutritionist) who specialize in this niche and can walk you through a holistic and evidence-based step-by-step process for gut repair over time.
Either way, contrary to the popular narrative, there really is no such thign as a “be-all-end-all” solution or a “quick fix” for IBS, since each individual’s manifestations and root-causes are going to be unique to them. However, it IS possible to find IBS relief in most cases!
If you’re in a place where you feel ready to start addressing your IBS symptoms head-on, I would LOVE to see if we could be a great fit working together on your journey! If you’d like to connect, I invite you to apply for a Complimentary Connect Call here.
XO – Jenna