IBS Triggers: Diet, Hormones, and Stress
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When you have irritable bowel syndrome (IBS) , a number of factors can cause symptoms stemming from your large intestine, like cramping, pain, gas, bloating , diarrhea, and constipation . These factors are known as triggers and include a variety of foods and ingredients . Smoking, hormones, and stress can also act as IBS triggers. Triggers vary from person to person. Many people with IBS manage their condition by cutting certain foods out of their diet, though it may take some trial and error to find out which foods are problems for your system. Stress and hormones may not be as easily avoided as certain food triggers of IBS, but that doesn’t mean you can’t do anything about them. You may be able to limit your symptoms through stress management techniques and by taking steps to avoid other triggers during times of hormonal change, according to leading academic medical centers.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292ae1827d-b201-4521-9ee6-0a2dba9a82c8
Foods That Tend to Trigger IBS Foods Exactly how certain foods lead to symptoms of IBS isn’t completely understood. It’s uncommon for a true food allergy to be the cause of IBS symptoms, but other forms of intolerance may apply to a range of foods and ingredients.e60dc2a1-f33c-4a05-9b50-8e3e8e59762971271202-c985-4ba9-b4d8-8c522574c8dd “Everybody responds differently to different foods, but there are certainly more common triggers,” says Zoe Lawrence, MD , a gastroenterologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. These foods and food components, she notes, often include vegetables in the cabbage family, beans, dairy products, fatty meals, and both alcohol and caffeine. Leading hospitals and the National Institutes of Health say that common dietary triggers of IBS include these items:e60dc2a1-f33c-4a05-9b50-8e3e8e597629139923a3-7437-4df3-ad07-f00ba83f4a8c Wheat, and possibly gluten Dairy products, especially those high in lactose Certain fruits, especially citrus Certain vegetables, especially cruciferous ones (like cabbage, cauliflower, and broccoli) Beans and other legumes Polyols (a group of sugar substitutes ) Caffeine Red wine Carbonated beverages While it’s not a specific food trigger, a low-fiber diet can also make you more likely to experience IBS symptoms. Increasing the amount of soluble fiber (fiber that dissolves in water) in your diet — such as taking a supplement containing psyllium — can help ease both constipation and diarrhea in people with IBS, Dr. Lawrence notes. According to a research review published in the International Journal of Molecular Medicine, soluble fiber has been shown to improve overall IBS symptoms by bulking up your stool and feeding healthy bacteria in your colon.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e10435c8-1ad5-4fdb-b81b-5e8dd92e152c Just be careful to go slow when adding fiber to your diet, as too much too soon can cause gas and bloating . The National Institute of Diabetes and Digestive and Kidney Diseases suggests increasing your fiber intake by 2 to 3 grams per day (that’s about a teaspoon of pure psyllium powder) to help prevent gas and bloating . e60dc2a1-f33c-4a05-9b50-8e3e8e597629139923a3-7437-4df3-ad07-f00ba83f4a8c To maintain healthy digestion, try to avoid certain foods, as well as include the right foods in your diet, too. “We have to tailor the recommendations to the symptoms,” says Lawrence. “So for someone with constipation, we might be telling them to eat more fruits that are natural laxatives like berries, pears, peaches, kiwi.” Kiwi, in particular, has been shown to help ease constipation, with one study showing that eating two kiwi fruits daily increased bowel movements and reduced gut discomfort.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c351b13d-57f9-43e5-ba46-190d53942745 For someone with diarrhea, on the other hand, “We might focus more on trying to identify foods that make it worse for them. Maybe they have a nonceliac gluten sensitivity, or maybe they have noticed that dairy makes it worse,” she notes. Staying well hydrated by drinking eight glasses of water (two liters) each day can also help you avoid symptoms — especially constipation — since this helps lubricate your digestive tract, according to the Cleveland Clinic.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299b13dd02-bf10-4681-bc4a-852a7109a34b It can be helpful to keep track of what you eat to try to figure out how your diet may be affecting your IBS symptoms. “I think it’s important to keep a food diary, or to pay attention to what foods are triggers for that particular person,” says Lawrence. You may need to stick to a dietary change for several weeks before you notice a change in your symptoms. Even if you think you have your triggers figured out, it’s possible you’ll need to start tracking your diet again if you experience a change in the frequency or severity of your symptoms. Talking with a dietitian or nutritionist can help. “A lot of times, we talk about doing a trial of a low-FODMAP diet ,” says Lawrence, which involves restricting foods containing specific forms of carbohydrate that may be difficult to digest. This is “a relatively intensive, restrictive diet that, in order to do properly, really needs to be done under the guidance of a nutritionist or dietitian,” she emphasizes. If this restrictive diet helps ease your symptoms, then you’ll gradually reintroduce items to identify what foods or food categories are problematic for you.
How Hormonal Shifts Are Related to Symptoms of IBS Hormonal Shifts In the United States, women are more likely than men to have IBS, according to the Mayo Clinic. One reason for this difference may be hormonal changes related to the menstrual cycle — in fact, many women notice that their IBS symptoms are worse during or around the time of their periods . “I have seen anecdotally, in my practice, that patients with IBS often have worsening of their symptoms around the menstrual cycle,” says Lawrence. In a study involving 102 women with IBS, participants tended to have a higher level of IBS symptoms — and more limitations in their daily activities — during menstrual periods than at other times.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292243400b-9ba8-4c35-ac3e-77a2fd4e6187 Research on the effect of taking birth control pills for IBS symptoms has yielded mixed results. Some studies have shown that taking combined oral contraceptives — pills containing both estrogen and progesterone — is linked to a lower symptom burden in women with IBS.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6ed515e-7656-402e-b31a-3e5c7fc07f54 But a preliminary study presented at the 2023 American College of Gastroenterology meeting (not yet published in a medical journal) showed that females 15 to 45 who took combined oral contraceptives were more likely to develop IBS than those who used a copper intrauterine device (IUD) for birth control.e60dc2a1-f33c-4a05-9b50-8e3e8e597629045f987e-1621-4430-9987-ab8d7177e734 According to an article published in March 2021 in the Journal of Neurogastroenterology and Motility , sex hormones like estrogen may influence a variety of functions related to digestion, including gut motility (digestive action), the barrier function of the intestine (how it prevents certain substances from passing through to the bloodstream), and activation of the immune system in the intestinal lining (to protect you against any harmful bacteria or viruses that enter your gut).e60dc2a1-f33c-4a05-9b50-8e3e8e5976293dc78d43-b400-4efc-a259-b9a0570af6ea Previous research noted that sex hormones may also explain differences in the stress response between men and women.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6ed515e-7656-402e-b31a-3e5c7fc07f54 This suggests that an interactive effect between hormonal changes and external or psychological stressors may worsen IBS symptoms in some people. Different IBS symptoms often occur with different hormonal changes, according to the article. Pregnancy often causes the following changes, which are related to high levels of estrogen and progesterone :e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6ed515e-7656-402e-b31a-3e5c7fc07f54 Reduced pain sensitivity, including digestive pain Worsening of constipation Menopause often causes the following changes, which are related to a drop in hormone levels:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6ed515e-7656-402e-b31a-3e5c7fc07f54 Reduced overall IBS symptoms Increased incidence of constipation But another study found that women tended to have more severe IBS symptoms after menopause, while no similar age-related increase in symptoms was seen in men.e60dc2a1-f33c-4a05-9b50-8e3e8e597629da4b1972-f8f0-4b95-b6fa-a249fbf22568 Hormonal differences may explain why diarrhea is more common in men with IBS than in women, as reported in a review article. Some studies of both younger and middle-aged men have shown that they are more likely to report diarrheal symptoms compared with women, and it may be related to their sex hormones and proteins in the blood that transport these hormones.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6ed515e-7656-402e-b31a-3e5c7fc07f54 Differences in hormone activity may also explain why women with IBS are more likely than men to report fatigue, depression, anxiety, and a lower quality of life.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294f1d733f-2112-4de9-9f56-c37e72250c13
Link Between Stress and IBS Stress Many people with IBS experience a worsening of symptoms during times of psychological stress. “I think the gut-brain axis is really important to understand — the two-way connection between the gut and the brain,” explains Lawrence. “Stress, anxiety, and depression can cause symptoms to worsen.” People with certain mental health issues or who have experienced trauma are also more likely to develop IBS, including the following factors: Anxiety Depression Early-life stress or abuse These ties to IBS indicate that a variety of psychological factors may be related to intestinal function. Researchers are still trying to understand what’s involved in this connection, but recent research has found a link between childhood trauma and levels of different types of gut bacteria later in life — with a greater effect seen in males than in females.e60dc2a1-f33c-4a05-9b50-8e3e8e59762986d10051-5475-46fe-a92b-773ae4435dca One study showed that while traumatic events early in life increased the likelihood of having IBS in adulthood, confiding in others about these events was linked to a lower risk for IBS. These effects were seen in both women and men.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292f124a4e-f216-4038-9507-4723e9d45b00 Other research suggests that both acute (sudden) and chronic (long-term) stress can affect intestinal function during early life and adulthood. Intestinal changes affected by stress may include gut motility (digestive action), secretion of enzymes and juices that break down food, and the intestine’s barrier function (how it prevents certain substances from passing into the bloodstream).e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc1cff83-18b0-4529-a9b9-c0ee907de874 The makeup of healthy and unhealthy bacteria in the digestive tract may also be affected. While it may not be easy to reduce stress in your life, just being aware of the connection between stress and IBS symptoms may be helpful for some people, notes Lawrence. And during stressful periods, “We might need to focus on dietary modifications or introducing medication options” to help reduce symptoms. Taking tricyclic antidepressants can reduce IBS symptoms in some people — especially those with depression or anxiety — due to their effect on the gut-brain axis, Lawrence explains. Other therapies that may help with symptom relief — known as brain-gut behavior therapies — include cognitive behavioral therapy (a form of therapy offered by many trained counselors and therapists), mindfulness training, relaxation techniques, and deep breathing techniques like diaphragmatic breathing.e60dc2a1-f33c-4a05-9b50-8e3e8e59762956c1045f-7dae-42ea-82a4-d968d0c71171
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