Is your stomach sore or distended more days than it feels flat, settled and free of pain? Has constant tummy bloating turned you into a master at dressing to disguise your chronic belly bump? Though occasional stomach and digestive troubles are a normal health hiccup, having them constantly is a whole different ballgame and may indicate you have Irritable Bowel Syndrome (IBS), which affects around one in five Australians.

IBS is a frustrating and uncomfortable condition that is 1.5 times more common in women than in men. An estimated 15–20 per cent of the adult population grapple with IBS symptoms and it’s also the most common disease diagnosed by gastroenterologists. Some people have only mild symptoms or symptoms that come and go. Others suffer more extreme health effects that are chronic and interfere with their quality of life.

Recognising IBS

IBS often causes:

• Abdominal pain or cramping
• Bloating
• Gas (both burping and flatulence)
• Diarrhoea or constipation (or alternating bouts of both)
• Mucus in your stool

This uncomfortable and frustrating chronic condition is usually diagnosed after abdominal pain and discomfort have been present for 12 weeks or more, along with other indicators such as tummy distension or changes in the frequency or consistency of your stool. It’s important to check out IBS symptoms with your GP, who will go through a process of elimination to rule out other health conditions, such as infection or bowel cancer.

An estimated 15–20 per cent of the adult population grapple with IBS symptoms and it’s also the most common disease diagnosed by gastroenterologists.

Blood and stool tests may also be conducted as well as investigations such as colonoscopy or sigmoidoscopy where a flexible tube is used to take a close look at a section of your bowel or the entire colon. Having these checks can rule out underlying conditions such as cancer and diagnose other specific conditions such as colitis or Crohn’s disease, which could be causing your bowel issues.

If no obvious culprit is detected, your cluster of belly symptoms will be dubbed IBS. That doesn’t mean you should ignore any changes in bowel habits over time. Deviations from your usual pattern, such as going to the toilet more often, having diarrhoea or constipation, a sense of incomplete evacuation of your bowels or darkened stool (which can indicate blood), should always be investigated by your GP.

Conventional treatment

The Western medicine approach is generally to treat IBS with medications, which may include:

• Antidepressants or anti-anxiety medications if stress is a prominent trigger.
• Anticholinergic drugs. These help to relieve too much spasm in the bowel by acting on the autonomic nervous system.
• Medications to treat diarrhoea or constipation if either or both of these problems are chronic.
• Antibiotics, where unhealthy bacteria growth is suspected as a major cause.

Though medications may be helpful in alleviating IBS symptoms in some people, they can also cause unpleasant side-effects that could have knock-on effects on your hormone balance or other health factors. Plus, they don’t do anything to address the root causes of the condition.

Research suggests that, on its own, irritable bowel does not cause a higher risk of developing bowel cancer. However, it often stems from problems in your digestive system that can have huge and problematic impacts that compromise the health and functioning of your entire body. As good digestion is also the foundation of good health, it’s important that you don’t just put up with constant belly problems.

Tummy triggers

Research suggests that IBS runs in families due in part to genetic differences in the sensitivity of the gut. IBS can also be kick-started by changes to the bowel that result in over-reactiveness in the nerves and muscles that control sensation and motility of the bowel. This can then cause a slowing or spasm that affects the contractions that move food through your digestive system. Getting to the root cause of your most common IBS triggers can take time, but it’s a worthwhile process.

The following triggers are to blame for many chronic digestive issues and on their own, or in combination, they may be the underlying cause of IBS.

SIBO (Small Intestinal Bacterial Overgrowth)

The small intestine is a long section of digestive tract located between your stomach and large intestine. It’s made up of sections called the duodenum, jejunum and ileum, where your food is broken down and most of your nutrient absorption takes place. SIBO occurs when bacteria that normally only live further along in your large intestine migrate to the small intestine or start to take hold there due to issues like inflammation, food sensitivities or stress, causing slow bowel function, which allows food to sit for too long.

More than one-third of people with IBS show evidence of SIBO (Small Intestinal Bacteria Overgrowth).

Low stomach acid and conditions like celiac disease and diverticulitis (where small pouches catch food) can also lead to SIBO. These bacteria love to feed on carbohydrates, so eating a diet high in refined carbs and sugars can contribute to SIBO or ramp them up.

More than one-third of people with IBS show evidence of SIBO, according to research from Cedars Sinai Medical Centre in the US. The by-products created by this bacteria lead to all kinds of symptoms, including chronic bloating, burping, flatulence and issues like heartburn or nausea. SIBO may also kick-start disruption of:

• The mucosal lining and integrity of the small intestine, which may then increase food sensitivities, even if you were never affected before. The resulting inflammation may lead your body to release inflammatory chemicals like cytokines and cause changes that damage the function of the villi — little finger-like projections that increase the absorption of your nutrients.
• Digestion of food and peristalsis of the stomach, which moves food along the digestive tract.
• Fat absorption. This can occur because the bacteria actually deconjugate (break the bonds) of your bile acids so they don’t work as effectively in breaking down your food, particularly fats. This is why some people find that fatty foods, as well as sugars, upset their SIBO symptoms.
• Absorption of nutrients, which can over time lead to nutritional deficiencies. This can cause exhaustion, because the bacteria are actually eating some of the nutrients in your food before you get the chance to absorb it.

People with SIBO may try cutting out certain foods, such as gluten, but still find their symptoms persist because the bacteria imbalance is not completely treated. They often try probiotics only to find that they make their symptoms worse, not better. This may sometimes indicate that you already have too much of a good bacteria strain and that imbalance is part of your SIBO problem. Or it could be that initially the probiotics are causing the bad bacteria to die off. For this reason, when using probiotics always start with a small dose.

Help for SIBO

• Take antimicrobial herbs. Oil of oregano, berberine extracts, thyme and wormwood can work together like broad-spectrum antibiotics to reduce populations of small intestinal bacteria. They are as effective as a targeted antibiotic called rifaximin (which is only absorbed into your intestine but not into your bloodstream), shows research by Johns Hopkins University and the University of Pittsburgh in the US.
• Eat garlic. This, too, has natural antibiotic properties. Like onion, it’s a member of the allium family, meaning it’s high in sulphur, which also boosts detoxification and liver function. Raw garlic (but not cooked) is also a natural anti-bacterial. However, if you have FODMAP issues (see later), you might need to test whether the high levels of fructans (oligosaccharides) in garlic worsen your SIBO symptoms. Research from the American Chemical Society has also found that sprouted garlic boasts higher antioxidants levels than the fresher, younger bulbs, so don’t throw out your older garlic bulbs. If you’re worried about getting garlic breath, eating raw mint or apple can reduce the scent.
• Cut alcohol intake. Moderate alcohol intake of a few wines or beers a day has been shown to be a strong risk factor for SIBO in research by the Department of Gastroenterology and Hepatology at the Cleveland Clinic in the US. So keep your tipples to a minimum or aim to cut out alcohol altogether until your SIBO is more under control.
• Reduce carbs. As carbohydrates are the preferred foods for unhealthy bacteria, eating too many carbs can worsen SIBO symptoms. Low-grain and low-carb diets often used to treat SIBO include the GAPS (Gut and Psychology Syndrome Diet) and the Specific Carbohydrate diet. The FODMAP diet can also be beneficial because it cuts back on a range of carbs that can often cause bacteria and fermentation issues. For best results, people with SIBO often cut out all grains for some time until their bacteria are under control.
• Take digestive enzymes. These can help you more effectively digest and absorb your food so the bacteria don’t take all the best nutrients because you can’t effectively break them down. Look for a combination that includes enzymes such as bromelain, lactase, lipase, cellulase and papain. These will help you digest a wide range of ingredients.

Leaky gut

The lining of your digestive system is a little bit like a “smart wall” that opens up tiny spaces between the cells to allow nutrients through and then closes up again. Yet sometimes damage to that gut wall can lead tiny junctions to open up and stay open. These increase your gut permeability, which simply means that the lining of your gut no longer fulfils its proper barrier function. As a result, it allows bacteria, toxins and partially undigested food particles to leak into your bloodstream, causing havoc with your hormones and triggering issues like inflammation, autoimmune disease and allergy.

Help for leaky gut

• Cut out gluten. In some sensitive people, foods like wheat are the major trigger for leaky gut. Gliadin, one of the components of gluten, stimulates the release of a substance called zonulin when it makes contact with the cells of the small intestine. At the University of Maryland School of Medicine in the US, groundbreaking research by Dr Alessio Fasano is exploring how zonulin affects gut permeability. He has found that, like a gatekeeper, it opens up the junctions between gut cells to allow nutrients to pass through. However, sensitivity to zonulin can interfere with this process so that the wall of the small intestine becomes “leaky”. This may then allow fragments of gluten to cross into the bloodstream where they can trigger all kinds of inflammatory or autoimmune health issues.

If your immune system is run down, you are very inflamed or you are eating gluten two or three times a day, you are also more likely to be reactive to zonulin or have too much zonulin, which will trigger IBS symptoms. As a result, your junctions get stuck in the open position and don’t close up again. Removing gluten from the diet can reverse this problem, allowing the leaky openings to close up again and your gut to become healthier.

• Watch intake of lectins. These chemicals, which help protect plants in the wild, are found in grains like wheat, rice and spelt and foods like soy, peanut, tomato and eggplant. Though lectins are fine in small amounts, if you are sensitive to them or very inflamed in your gut, they can wreak havoc on your digestive system.
• Reduce painkiller medications. Particularly Non-Steroidal Anti-Inflammatories (NSAIDs) such as Ibuprofen, as these have well-documented negative impacts on the gut lining. Chronic use of these painkillers can lead to stomach ulcers and bleeding. Even if you only use them once or twice a week, they may be causing extreme irritation to your gut lining, weakening its structure and increasing intestinal permeability.
• Take gut-healing supplements. These include:
  • L-glutamine. An amino acid that does more than help promote the growth of muscle, L-glutamine is very good for the repair and sealing of the junctions between cells that increase intestinal permeability, helping to restore the barrier function of a leaky gut.
  • This is made from the skin, bones and connective tissues of animals such as beef, chicken and pigs and contains collagen. This important protein acts a little like a natural glue, helping to rebuild and strengthen the tissue in the lining of your gut wall. Research from the University of Catania in Italy shows that gelatin reduces inflammation in the intestine. It has a gelatinous texture, which helps to sooth and protect the mucosal lining of your digestive tract, working a little like mortar to seal up the spaces in the gut wall.
  • Slippery elm bark. Used as a herbal remedy by Native American Indians, this amazing healing bark becomes a slippery gel when mixed with fluid. In your belly, it creates a mucosal barrier that helps line the gut wall and protect it so inflammation can heal.
• Avoid bowel irritants. These often include caffeine, alcohol, spices and any foods you are sensitive to. Medications for heartburn, such as proton pump inhibitors, can also be problematic because they reduce the normal acid balance in your stomach, which can, over time, actually trigger more food sensitivities due to increasing gut inflammation.
• Activate your grains, seeds, nuts and beans. They contain chemicals such as phytates, which can block your nutrient absorption by binding to minerals such as calcium and magnesium. These chemicals can also cause chronic digestive irritation and inflammation. In turn, this can change the mix of bacteria, contributing to SIBO. So make sure you soak legumes like chickpeas and grains like rice, buckwheat, millet and quinoa overnight in water that contains apple-cider vinegar or lemon juice to trigger the sprouting process. The same goes for nuts and seeds (which are often activated using salty water).

Belly bacteria imbalance

Your belly is a barometer of your overall wellbeing. It’s Home to some 100 trillion types of different bacteria, according to the findings of the Human Microbiome Project by America’s National Institutes of Health. This means you have 10 times more bacteria in your body than you have cells. A great deal of that bacteria sets up house in your digestive system and, when the bad bacteria outweigh the good, as can happen after a stomach bug, antibiotics use, Travel, a period of poor diet or chronic stress, you can end up with chronic IBS symptoms.

When your bad bacteria are ruling your belly, they can cause all kinds of health issues, including skin rashes, inflammation, weight gain, depression, anxiety and lowered immunity. An unhealthy microbiome can also cause all kinds of digestive and belly symptoms, including stomach pain, chronic bloating and wind and diarrhoea or constipation (or a see-saw between both).

Help for bacterial imbalance

• Avoid antibiotics. Obviously, there are some situations where antibiotics are needed to prevent a health issue from becoming dangerous or severe. But taking them for things like cold viruses or acne should be avoided as antibiotics may cause unhealthy domino effects that could last for years by knocking out your good bacteria as well as the bad.
• Eat fermented foods. Mix them up so you enjoy a range of bacteria. Good choices include yoghurt, sauerkraut, pickled cucumbers, miso, kvass (a fermented beetroot drink from Eastern Europe), kefir (a probiotic milk drink) and kimchi (a fermented Korean vegetable side dish). If you tend towards candida problems, avoid kombucha tea as this can be high in yeasts.
• Serve more prebiotics. These contain natural, plant-based fibres such as inulin and oligofructose and act as fuel to feed the good bacteria in your gut, as well as stimulate the growth and activity of these bacteria. There’s good evidence that prebiotics are effective in changing the profile of gut micro-organisms, particularly increasing the population of Bifidobacteria. Prebiotic fibres appear to improve intestinal function and mineral absorption and may have beneficial effects on your immune system and also reduce the risk of gastrointestinal infections.
• Take apple-cider vinegar. It contains acetic acid, which can help to support good belly bacteria populations. If you take it before a meal it will have the added benefit of minimising blood sugar spikes.
• Invest in a good-quality water filter. This helps remove chemicals like chlorine and fluoride, which can kill off good bacteria in your digestive system.
• Plate up with plant foods. Research from Harvard University has shown that, after just two days of eating an animal-based diet of meat and dairy foods, including bacon, ribs and cheese, volunteers showed an increase in potentially problematic bacteria in their gut. They also experienced higher colonisation of fungi and viruses and more micro-organisms that can trigger inflammatory bowel disease. Changes kicked in within 24 hours. By contrast, the balance of their belly bacteria rapidly improved when they undertook a vegetarian diet. This is proof that an unbalanced diet can quickly harm the makeup of your microbiome.
• Feed good bacteria with fibre. Foods like oats, lentils, bananas, cashews and potato (that has been cooked and cooled) are good news for your bacteria balance because they contain a special kind of fibre called resistant starch. This passes through the small intestine without being digested and is only absorbed once it travels to the large intestine (colon). Resistant starch resists digestion, so when it reaches the colon it’s fermented by the bacteria there to produce by-products called short-chain fatty acids. In particular, it increases the production of a short-chain fatty acid called butyrate, which is very important in keeping the lining of your gut healthy. Butyrate also has a range of positive health impacts, such as reducing inflammation and lowering the risk of colon cancer.
• Take probiotics. These good, live bacteria may prevent harmful bacteria from attaching to your gut lining and growing there. They can also destroy toxins released by certain “bad” bacteria that can make you sick. Meanwhile, probiotics send signals to your cells to nourish the mucus in your intestine, helping it act as a barrier against infection. And they help reduce deficiencies in some of the B complex vitamins.

There is evidence that some strains of probiotics, such as Lactobacillus plantarum, Saccharomyces boulardii, Bifidobacteria infantis and Bifidobacteria animalis, may help to reduce abdominal pain, flatulence and belly distension. A review of 34 studies published in The Lancet also found that probiotics reduced antibiotic-associated diarrhoea by 52 per cent, the risk of traveller’s diarrhoea by 8 per cent and diarrhoea from any cause by 34 per cent. This overview found that the most protective strains were Saccharomyces boulardii, Lactobacillus rhamnosus, Lactobacillus acidophilus and Lactobacillus bulgaricus.

So, if you suffer a tummy bug, consider taking some probiotic supplementation as tummy bugs often prove a pivotal turning point for gut health and can trigger chronic IBS symptoms. Remember, though, that in people who are immunocompromised, have a condition like cancer or are taking a medicine that suppresses the immune system, probiotics could cause serious infection and should be avoided.

Food sensitivities

Do you suffer from hives, bloating, asthma, eczema, irritable bowel, headaches or sinus congestion? Then you could have a food sensitivity, which affects about 10 per cent of people. This is not the same as allergy to a food like peanuts, which causes a sudden reaction by the body’s immune system that may result in serious breathing problems and require the injection of adrenalin via an Epipen. Food sensitivity is often less obvious and occurs when the body reacts to chemicals in food. Symptoms may kick in after several days or accumulate over a week, making the culprit difficult to pin down.

Help for food sensitivities

• Go on an elimination diet. Cut out and then reintroduce the following foods to see if they are triggering your belly symptoms:
  • This protein is found in a range of grains. People with gluten sensitivity may react to wheat but find they can sometimes tolerate the lower level or gluten in oats, rye or spelt (which has a different genetic makeup to that of modern grains). Food examples: wholemeal bread, rye crispbreads, rolled oats and barley.
  • A natural sugar, lactose is present in dairy products. Some people who can’t tolerate milk find they can eat yoghurt. Food examples: cheese, cream, yoghurt, butter, ice-cream.
  • Some people are particularly sensitive to certain carbohydrates in food, most likely due to the makeup of their micriobiome. These carbs then ferment in the bowel. The low-FODMAP diet was developed at Monash University in Melbourne, Australia. FODMAP stands for Fermentable, Oligo-, Di- and Mono-saccharides and Polyols. These substances include fructose, lactose, fructo- and galacto-oligosaccharides (fructans and galactans), and polyols (such as sorbitol, mannitol, xylitol and maltitol), which are poorly absorbed in the small intestine.

Foods high in these substances can make the symptoms of IBS worse, so a low-FODMAP diet is useful in cases of IBS. FODMAP short-chain carbs are also osmotic, which means they can trigger bloating by drawing water to your large bowel. The fermentation and fluid retention can lead to excess wind and tummy bloating, pain and distension, which are common IBS symptoms.

FODMAP food examples:

– Oligo-saccharides: wheat, rye, onions, garlic, legumes and pulses

– Disaccharides: lactose found in milk, soft cheese and yoghurts

– Monosaccharides: fructose in honey, fruits like apples and high-fructose corn syrup

Polyols: sorbitol, mannitol, found in some fruit and vegetables and also used as artificial sweeteners.

• This family of plant chemicals is found naturally in high levels in many fruit and vegetables. Food examples: pumpkin, broccoli, capsicum, watermelon, strawberries, honey, tea and coffee.
• These result when protein is broken down by fermentation.

Food examples: Cheese, chocolate, wines, beer, yeast extracts, bananas, avocado, tomatoes.

• As they grow, these living, single-celled fungi make proteins and vitamins (particularly the B group). Food examples: Vegemite, Marmite, most breads, some crispbreads, beer, wines and some stock powders.
• Specific foods or food groups. Some people find that a single food or food group seems to cause their health problems and is best avoided. For example, soy is a common cause of sensitivity and is not just found in milk but in foods like breads and ingredients like lecithin and dextrose derived from soy. Food examples: seafood, eggs and the nightshade family (eg eggplant, potatoes, tomatoes), soy, fish or seafood.
• MSG (monosodium glutamate). The manmade MSG additive is often found in takeaway or pre-packaged foods, but MSG also occurs naturally in some foods, making them more flavoursome. Food examples: soy sauce, cheese, tomatoes, mushrooms, stock cubes, sauces, meat extracts and yeast extracts. An additive version of MSG is also often added to restaurant meals to pep up flavour in soups, sauces and Asian dishes.
• Food additives. These include artificial colours and preservatives, such as antioxidants, sorbates, benzoates, sulphites, nitrates and propionates. These chemicals are added to everything from processed meats and dried fruit to salad dressings. Food examples: Different processed or packaged foods. Making foods from scratch at home is the best way to avoid colours and preservatives.

Testing for food issues

To detect a food intolerances that may be causing IBS symptoms, the following tests are often conducted:

• Blood tests. These will show up genuine food allergies that produce antibodies in the blood but are not always reliable for showing food sensitivities. With wheat intolerance, for example, elevated levels of a protein called gliadin may show up in the blood. However, sometimes a person has gluten intolerance and the gliadin is not elevated. Or the gliadin may be elevated in some blood tests and not in others, so it’s not always reliable.
• Skin prick testing. A drop of allergen is placed on the skin and the reaction is monitored. Food issues usually lead to reactions like rashes, itching and hives or welts. Again, there can be false positives.
• Breath tests. These can indicate if you have trouble digesting certain natural sugars, like lactose (found in some dairy products), sucrose (found in sugar) and fructose (found in fruit). But some practitioners report they can give false positive and false negative results.
• Elimination diets. These really are the best way to diagnose food intolerances, but make sure you are well informed. For example, if you reintroduce gluten, be careful to be eating the foods from a fairly pure source otherwise, for example with wheat, you could be reacting to the bleach in the flour or the yeast in the loaf and not the gluten at all.

Gluten sensitivity & coeliac disease

Apart from the impacts of zonulin in leaky gut, gluten problems usually take one of two main forms:

1. Coeliac disease. This is on the increase throughout the world and causes antibodies that attack the body’s own tissues. Coeliac disease affects one in 100 people, but up to 75 per cent of those affected are completely unaware they have the condition. If untreated, this autoimmune condition increases the risk of other health issues like bowel cancer and osteoporosis.

Though a blood test can show up antibodies that indicate a gluten reaction, coeliac disease can only be diagnosed by conducting a small bowel biopsy. This can be done during a colonoscopy while under anaesthetic in hospital or via a gastroscopy: day surgery that involves light sedation while a tiny specimen of bowel tissue is taken to be checked under a microscope. If you are diagnosed with coeliac disease, you need to permanently avoid foods containing gluten.

2. Gluten sensitivity. A condition called Non-Coeliac Gluten Sensitivity is on the rise. This may not always show up in tests to check for gluten issues but is obvious simply from doing an elimination of gluten and reintroducing gluten to see if it causes issues like bloating, diarrhoea and constipation, flatulence or stomach pain.

Help for gluten sensitivity or coeliac disease

• Avoid gluten (and watch for hidden sources). Though some sources of gluten are obvious and well known, such as wheat, rye, barley and oats (unless certified gluten free), watch out for less obvious sources such as canned soups, soy sauce (go for tamari), salad dressing, jam, frozen chips, sushi (in the rice and soy sauce) and soy milk (which can contain barley or malt vinegar from gluten). Some medications, supplements and skincare products also contain gluten and should be avoided.
• Don’t overdo other grains. Some people who react to gluten also cross-react to grains like quinoa and buckwheat so, even though these grains are gluten free, if you have gluten issues, you may need to also check how well you tolerate other grains.

Candida

Candida albicans is a fungal strain we all carry in our bodies. It’s opportunistic, so every chance it gets it will multiply. Though we tend to think of candida overgrowth as a trigger for thrush infections, we often forget that it can thrive in all the mucus membranes. If there is candida overgrowth in your digestive tract, it can cause all the classic symptoms of IBS.

Even if you are very careful about your diet and avoid foods that candida loves to eat, such as refined carbs, you can still have a candida problem that was triggered years before when you were eating too much sugar, took many courses of antibiotics (which allows candida to thrive) or, for women, if you were on the contraceptive pill or have taken HRT, as oestrogen can help candida to grow.

Help for candida

• Minimise sugar intake. This is a favourite candida food. So cut right back on sugar or have a sugar-free period to help get your candida under control. Candida uses sugars to strengthen its cell walls and give it the energy to fight off your body’s natural defences. So you don’t just need to avoid spooning sugar into your coffee or tea or onto breakfast cereal. It’s important to also cut back on or avoid sweeteners like honey and maple syrup as well as hidden sugars in processed foods such as fructose, dextrose, malt/maltose, glucose and corn syrup.
• Choose good-quality carbs. Refined carbs like white bread or white rice crackers will only feed the candida and help it multiply. Instead, aim to eat whole grains like rye sourdough, brown rice and buckwheat groats.
• Avoid known candida triggers. These include foods like yeast, alcohol, some fruits (eg rockmelon) and vegetables like mushrooms as well as foods that have been pickled, malted or highly processed or fermented with sugars (such as kombucha).
• Harness natural antifungals. These include turmeric, olive leaf extract, oregano, cinnamon, coconut oil, peppermint, barberry and black walnut. Many of these natural remedies are also good at combatting parasites, which can worsen candida symptoms. If you have a very clean diet and a healthy lifestyle and you still can’t seem to improve your IBS symptoms, it’s worth seeing an integrative practitioner to get some tests to check for parasites. If they are present, you can then seek guidance about the best protocol to help purge them from your digestive system.

Stress

Flash back 20 years and stress was seen as the main cause of IBS. Though we now know there are many other factors, that doesn’t mean stress is not a player. A complex network of nerve and neural connections links your brain and belly, which is why stress can so quickly upset your tummy.

This mind-body response can:

• Cause contractions in your digestive system. Stress can lead your muscles to tighten, causing spasms in the digestive tract. These can interfere with the normal peristaltic motion in your belly and, as a result, gas produced there is not moved along and starts to build.
• Cause over-breathing. When you are stressed, you gulp down more air. Add to this the gas built up from stress slowing your peristaltic motion and, by the end of the day, you can have as much as three litres of air in your digestive tract (which could fill two balloons). Over time, this distension can also cause the muscles in your gut wall to become more elastic, making contractions less strong and less effective, worsening IBS symptoms.
• Reduce blood flow to your digestive system. Your body doesn’t need you to digest food when you’re stressed, so it quickly shuttles blood away from organs like your ovaries and gut to organs like your heart. This means your digestive system gets far less blood and oxygen to nourish it. This can lead to chronic inflammation, which compromises the protective functions of your gut wall. As a result, your stomach may become over-sensitive and over-reactive to many foods or you may suffer discomfort every time you eat. Meanwhile, you are absorbing less nutrients, which only makes you more exhausted and prone to issues like anxiety, which will cause more IBS flare-ups.
• Increase stomach acid. This can lead to conditions like heartburn and acid reflux, which also result in more inflammation, bloating and discomfort.
• Encourage gut bacteria to grow. Studies show that when adrenalin is added to gut bacteria in a Petri dish in a lab, the growth of bacteria like coli increases substantially.

Help for stress

• Make a de-stress plan. Write a list of all the things that make you feel wired, overwhelmed, anxious or pressured. Change whatever you can and make longer-term plans to shift the trickier stress triggers. This might mean you move to a smaller house to downsize and reduce financial stresses, or change to a job that has a healthier work culture.
• Breathe slowly. This can help calm you, reduce stress hormones like cortisol and ensure better circulation to help nourish your digestive system.
• Avoid lifestyle habits that promote air or gas. These include chewing gum, drinking carbonated beverages and using straws for drinking.
• Enjoy slow-moving exercise. Yoga, Pilates, tai chi and walking are great ways to get your circulation going without triggering a huge level of cortisol. They not only help you burn stress hormones but also promote a sense of calm and spirituality.
• Take breaks. Not just lunch breaks at work, but time off, too. Even just a few days to rest and revive can be very important for recharging batteries and reminding you how much better you feel when you’re not rushing or doing too much.
• Build a repertoire of de-stressing techniques. This may include meditation or chanting, singing in a choir, spending some time in nature or enjoying quiet time every day reading a book or listening to soothing music. This will not only benefit your digestive health and help reduce some of your symptoms of IBS but will bring a whole host of other health benefits for your body and mind.