The Link Between Stress, Microbiota Dysbiosis and Irritable Bowel Syndrome: Part Three
Despite its astonishing prevalence in the United States and developed countries, a singular defined cause of Irritable Bowel Syndrome (IBS) has yet to be identified. However, Part One of this article series did uncover six possible contributing factors of IBS – abnormal gut motility (constipation or diarrhea), visceral hypersensitivity (abdominal pain), altered brain-gut function, low-grade inflammation, intestinal permeability (aka leaky gut) and psychosocial factors. Another consideration is stress. In fact, stress has been shown to play a starring role in the life of IBS sufferers. Stressful life events, anxiety and depression are all well documented in IBS patients. Additionally, Part One of this article series established a link between stress and each of the six contributing factors of IBS symptoms.
In Part Two, you learned stress also has been shown to affect and be affected by the microbiota – the community of bugs living in your digestive tract. Part Two also revealed a link between microbiota balance and the six contributing factors in IBS. Additionally, as you’ll see in this last installment, there may be a connection between diet and the severity of IBS symptoms. If you missed the previous installments, you can read them in online back issues at www.essentiallivingmaine.com to learn more about the six contributing factors of IBS, the community of bugs living in your digestive tract, how the body responds to stress, and the role stress plays in the health of your gut community as well as your risk of suffering IBS.
IBS sufferers may not know just how much stress, gut dysbiosis and dietary choices are contributing to their symptoms. But, having this new-found knowledge can be powerful! Finding a road back to better health when dealing with IBS may seem elusive or even impossible, but when you understand which tools are best for your situation, better health is right around the corner. That’s what this final article is about – helping you understand the best tools when dealing with IBS.
Although the symptoms of IBS are gastrointestinal stress plays a destructive role in the condition. As Hans Selye explained in his book The Stress of Life: “Stress is essentially reflected by the rate of all the wear and tear caused by life…although we cannot avoid stress as long as we live, we can learn a great deal about how to keep its damaging side-effects, ‘distress,’ to a minimum.” This “distress” lies at the root of IBS. Therefore, it is not surprising that several stress management techniques have been shown to improve IBS symptoms. Successful stress management techniques include:
- Exercise. Three separate studies showed less or improved symptoms for patients who were physically active.
- Yoga. Yoga decreased anxiety levels, pain levels and gastrointestinal symptoms in IBS patients.
- Hypnotherapy. Review of seven studies indicated hypnotherapy reduced pain, decreased symptom severity and improved overall IBS symptoms as well as quality of life.
- Cognitive Behavior Therapy. This goal-oriented psychotherapy has been shown to reduce symptom severity, especially visceral pain, as well as improve other IBS symptoms.
- Biofeedback Therapy. One study revealed biofeedback therapy improved IBS symptoms in 50% of participants.
Rebalancing the Microbiota
Predictably, most of the stress management techniques above also impact the gut microbiota in a positive way. Therefore, stress management further assists the IBS sufferer in their goal of rebalancing the microbiota. When considering probiotics, there are two important groups living in your gut community that are known to keep pathogens at bay – Bifidobacterium and Lactobacillus. If there is a reduction in either of these species and an increase in pathogenic species, the door is opened for dysbiosis and worsening IBS symptoms. However, when these and other probiotics are replenished in the gut community, all of the six contributing factors in IBS will be improved.
1. Altered gut-brain function.
Both Lactobacillus and Bifidobacterium species produce short chain fatty acids (SCFAs), a substance that may play a role in gut-brain function. Not surprisingly, levels of SCFAs have been shown to be altered in IBS patients. Therefore, rebalancing SCFA producing probiotics in addition to stress management techniques may normalize gut-brain function in IBS sufferers.
2. Abnormal gut motility.
The short chain fatty acids mentioned above also help control movement through the digestive tract. SCFAs are produced after certain probiotics consume fiber the human body cannot digest. Consequently, fiber not only helps move things through the digestive tract on its own, it becomes food for the probiotics in charge of controlling movement. In fact, specific microbiota species found in a healthy gut can influence speed on both sides of the spectrum. Lactobacillus acidophilus and Bifidobacterium bifidum can increase transit time through the gut, while Escherichia coli and Micrococcus luteus can delay gut motility. Finding the correct microbial balance based on bowel habits may normalize gut motility in IBS patients.
3. Intestinal permeability.
Probiotics may also help improve intestinal permeability, also known as leaky gut. One specific short chain fatty acid produced by probiotic bacteria, butyrate, helps maintain a healthy intestinal lining. Certain probiotic strains, specifically Lactobacillus acidophilus and Bifidobacterium infantis, have been shown to decrease intestinal permeability. Additionally, dopamine, produced by the probiotic Bacillus, has a protective effect on the intestinal lining. Lastly, treatment with L. farciminis prevented stress-induced intestinal permeability. This indicates both probiotics and their metabolites may improve leaky gut as well as IBS symptoms.
4. Low-grade inflammation.
Bifidobacterium, Lactobacillus and short chain fatty acids also have a positive impact on inflammation. In one study, B. infantis tempered immune activity which, in turn, blunted an inflammatory response. Another study showed Bifidobacterium subspecies improved the immune activity of stressed animals and partially protected against stress-induced dysbiosis. L. farciminis was even shown to prevent stress-induced inflammatory markers such as IL-1β, IL-6 and TNFα. Furthermore, the short chain fatty acid butyrate may also reduce inflammation. This means probiotics and their metabolites also play a role in reducing inflammation which may improve IBS symptoms.
5. Visceral hypersensitivity.
Probiotic intervention has also been shown to reduce abdominal pain in IBS patients. Specifically, Lactobacillus acidophilus (L. acidophilus) has been shown to alleviate visceral pain, L. paracasei may reduce visceral hypersensitivity perception, and B. infantis was shown to reverse visceral hypersensitivity in anxious rats. Additionally, lactic acid producing bacteria have been shown to relieve abdominal discomfort. Lactobacillus and Bifidobacterium probiotics are proving to be important strains to consider when dealing with IBS.
6. Psychosocial factors.
Another benefit of Lactobacillus and Bifidobacterium species is that they can produce the calming neurotransmitter GABA. Certain strains of Lactobacillus and Bifidobacterium – specifically L. rhamnosus, L. helveticus, B. longum and B. infantis demonstrated antidepressant properties. Also, B. infantis reversed anxious behavior and separation anxiety in rats. Another probiotic group of species, Bacillus, can produce the pleasure neurotransmitter dopamine. A certain category of probiotics, called psychobiotics, have shown they can improve mood in subjects who had poorer mood at baseline. Furthermore, two separate MRI brain scan studies showed probiotics have the ability to alter brain activity related to emotion and even reduce negative thoughts. So, there are several ways in which probiotics can improve mood, reduce depression and anxiety, and possibly improve IBS symptoms.
The use of probiotics, specifically Bifidobacterium and Lactobacillus subspecies, has been shown to improve several IBS symptoms. Also, probiotics do not need to come in supplement form to be beneficial. Many traditional fermented foods – kefir, yogurt, raw cheese, kombucha, sauerkraut, miso, tempeh, natto and kimchi – are packed with probiotics, including Lactobacillus subspecies. So, incorporating fermented foods into your weekly diet can be beneficial. This third piece of the puzzle – diet – is as important as stress management and rebalancing the microbiota when dealing with IBS symptoms.
Amazingly, diet can shape both the microbiota community (aka your gut bug community) and its functional properties within the human body. That is because the microbiota feed off of what the host (aka human) eats, and each food choice affects which microbiota species thrive. One case study following the first 2 ½ years of an infant’s life showed that each dietary change correlated with a subsequent microbiota change, highlighting how diet affects microbiota balance. This change in microbiota occurred whether dietary changes were gradual or radical.
The food choices you make can either enhance health and balance the microbiota or create dysbiosis and increase risk of disease. A “Western” diet high in carbohydrates, sugars and processed foods has been shown to create a less diverse microbiota. Additionally, changes in the microbiota due to a high fat diet, especially trans fats and saturated fats, may lead to increased risk of inflammation. On a positive note, a hunter-gatherer diet has been shown to create a more diverse gut bug community and a vegan diet may reduce the potential for pathogenic species. Polyunsaturated fatty acids may also have benefit; they have been shown to alter microbial composition, improve cognition, inhibit HPA axis activity and enhance adherence of probiotic bacteria to the gut lining. Of particular interest is a specific type of polyunsaturated fat, omega-3 fatty acids, which has been shown to reduce depression. Consuming a hunter-gatherer type diet with emphasis on including omega-3 and other polyunsaturated fats as well as probiotic-rich foods may help improve IBS symptoms.
Prebiotics may also have some benefits, with a special caveat. Although studies on prebiotic use showed a similar reduction in IBS symptoms as the use of probiotics Bifidobacterium and Lactobacillus, prebiotics at high levels actually exacerbated problems such as bloating and flatulence. These results support the dietary protocol that is becoming well-known to IBS patients, the FODMAPs Diet.
FODMAPs is an acronym for certain types of carbohydrates – Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These include fructose from fruits, honey and high fructose corn syrup; lactose from dairy; fructans from wheat, onion and garlic; galactans from beans, lentils and soy; and polyols from sweeteners such as sorbitol and xylitol as well as stone fruits like avocados, peaches and cherries. If eaten in excess, these carbohydrates may not be broken down or absorbed properly, leaving them to ferment in the gut and cause symptoms. The FODMAPs diet is a protocol designed to reduce intake of FODMAPs for people suffering with IBS. Although there is no specific recommended dietary protocol for IBS patients, it has been indicated that reducing FODMAPs might moderate and improve IBS symptoms. In fact, a 4-week FODMAP restricted diet was shown to improve bloating and overall symptoms of IBS patients. Moreover, a change in microbiota corresponded with improvement of gastrointestinal symptoms in a group of IBS patients on a low FODMAPs diet.
Certain herbal supplements may also provide some hope for IBS sufferers. Peppermint oil, artichoke leaf, turmeric and an herbal mixture of nine plant extracts called Iberogast® all showed a decrease in IBS symptoms in clinical trials. Therefore, both dietary and supplement changes may be beneficial for IBS patients.
The more therapies you focus on – stress, microbiota and diet – the more potential for a compounding benefit to your condition. For that reason, each avenue should be considered equally important to work on for maximum benefit. So, in your journey to better health, find the guidance you need from a qualified therapist and nutritionist to help you get back to a healthier, happier you!
Stephanie Walsh, CPT, CNTP, CEPC is a Certified Nutrition Therapy Practitioner, Certified Eating Psychology Coach and Certified Personal Trainer. Contact Stephanie at (207) 730-2208 or email her: firstname.lastname@example.org. www.theholistichealthapproach.com.