From Gut to Social Life: Tracing the IBS Onset in Millennials
Written by Melissa Schenkman, MPH, MSJ
Do you ever worry about how the food you choose to eat will affect your digestive system? Do you make decisions about where you are going to eat out socially and what you choose to eat based upon that?
For people who live with irritable bowel syndrome, or more commonly known as IBS, that is exactly what life is like. Yet, you may never know someone has it because it’s an invisible condition and people often do not talk about it because it involves the taboo topic of digestion and using the bathroom.
As someone who was officially diagnosed with IBS in high school and has lived with it for decades now, I can tell you that eating and how your body will react to the foods you eat is one of the greatest challenges and fears that people with IBS, like myself have to face.
The unpredictability of IBS flare-ups has made my daily food choices center around my very busy work schedule and whether or not I will be working remotely and have easy access to a clean bathroom or will be out in the field. When it comes to going out socially, I always have to look at the menu beforehand to look for any pitfalls with menu items and make sure there is something on there that I can eat without getting a flare-up.
The good news: I can say firsthand that a person who lives with IBS can live a very full, active lifestyle involving social gatherings and working out. You just have to plan ahead and make smart choices to do so. This is what makes it possible to have a fun and active social life personally and professionally, and balance the unpredictability this condition can sometimes bring with it.
To take this invisible condition and bring much-needed visibility to its interworkings, I talked with fellow millennial and gastroenterologist, Cari Sorrell, MD. She brings to light why IBS has the reputation of a “catch-all” diagnosis, the impacts it has on millennials’ and Gen Z’s lives, why it can be such a challenging condition to treat, foods that trigger flare-ups, and the different types of treatments available for this condition for which to this day there is no cure.
What is IBS and How Does It Develop?
For those of you who have heard of the acronym IBS but do not know much about what’s behind it, IBS is a type of chronic disease affecting the intestines that can be very uncomfortable and highly unpredictable.
One of the things that makes it so complex is that a person’s emotions can directly impact their gut and the severity of symptoms and frequency of symptoms.
“IBS is a derangement in the brain–gut axis we all have coupled with psychological factors (stress and anxiety) that lead to abnormalities in pain processing and bowel derangement. Since this processing and the psychological factors that play a role, all vary person to person, each person experiences their symptoms differently,” Sorrell said.
I have always wondered if IBS is something we are born with or something that we develop over time like lactose intolerance (an inability to digest lactose, a type of sugar found in milk). Sorrell tells me the answer is still unclear.
“We know that it is not one single thing but a combination of exposures to certain infections, certain foods, our gut microbiome, and early-life stress that develop overtime and influence our symptoms. We also know it has to do with the nerve endings in our intestine being unusually sensitive which could be something we are born with,” she said.
Cari Sorrell, MD, is a gastroenterologist in Lubbock, Texas. She is also the Co-Host of The MedEdit Podcast, a podcast in which her and her Co-Host Jessica Gray, MD, cut out the noise of medical misinformation that we constantly hear and replace it with quality health information through using their day-to-day clinical experience and years of medical expertise.
Sorrell earned her MD from the University of Texas Health Science Center at Houston and completed her internal medicine residency and fellowship in gastroenterology at the University of Texas Health Science Center in San Antonio.
Why IBS is Common Among Millennials
Did you know that IBS is the most commonly diagnosed digestive disorder in the United States?
Up to 20% of American adults receive a diagnosis with IBS, which has a reputation for being an easy “catch-all” diagnosis.
Interestingly, IBS is more commonly diagnosed in people who are in their 20s to 40s—millennials and some Gen Z. Also, women are twice as likely to get IBS than men.
“I think IBS is thought of as this ‘catch-all’ diagnosis because it can present in so many ways and looks slightly different in each person making it an easy thing to label someone with,” Sorrell said. “No two peoples’ IBS is identical. Also, the diagnostic criteria are broad which also makes it easier to fit someone into those criteria.”
In fact, due to IBS having such highly variable symptoms (presenting differently in each person, and alternating days of abnormal and normal bowel movements) that is why researchers came up with the classification system that they did. The type of IBS a person has or is diagnosed with is based on how a person’s stools look only on the days they are having IBS flare-ups.
IBS with diarrhea (IBS-D) – Most of your stool is loose and watery.
IBS with constipation (IBS-C) – Most of your stool is lumpy and hard.
IBS mixed bowel habits (IBS-M) – Bowel movements alternate between having the characteristics of IBS-D and IBS-C.
Most of Sorrell’s patients have IBS that is diarrhea predominate. Type really does matter because certain treatments only work for specific types of IBS.
Challenges Millennials Face
IBS can have a major impact and a negative one on the quality of life of anyone who has it, but especially for millennials and Gen Z.
We are at a prime social age where we are going out with friends and professional colleagues to gatherings, in which case IBS symptoms can disrupt our ability to enjoy and even participate in these shared social experiences.
“The impact can be huge. Many people report negative impacts on their body image, their relationship with food, their sexual life, and overall, their relationships with people.” Sorrell said. “This can lead to higher rates of depression.”
When you think about it so much of our social interactions center around food. Whether you’re invited out to a dinner by friends, a department-wide holiday potluck at work, or a reception at a professional conference you’ve traveled to which is key for professional networking, it can be really hard to handle for people living with IBS.
While your focus may solely be on the social or professional aspect, for a people with IBS, the fear of how his or her body will react to the food available is always top of mind too.
“Gen Z and millennials are at a very social age when they want to go out and eat with their friends and family. If you are worried you may have to rush to the bathroom, double over in pain or have flatulence (gas) you will avoid these social situations,” Sorrell said. “I think the fear and anxiety around these interactions is something someone without IBS may not understand.”
Potential food triggers to watch out for are everywhere. While there are triggers for all types of IBS, they seem to have a greater effect on people living with the IBS types that are either mixed or are predominated by diarrhea.
If you have IBS and still really want to eat these foods in moderation, it’s better to plan to avoid them in public and eat them to be safe.
Trigger Foods
Common trigger foods include foods that are grouped together as FODMAPs, Sorrell explains to us.
“These are fermentable oligio-, di-, monosaccharides and polyols. This is a fancy term for foods that are more difficult for our body to breakdown,” she said.
These foods include:
Fruits with fructose (a monosaccharide naturally found in fruit) exceeding glucose (a monosaccharide that is your body’s preferred car-based energy source) such as apples, pears, and watermelon
Fructan-containing vegetables such as onions, leeks, asparagus, and artichokes (*Fructan is an oligosaccharide.)
Wheat-based products such as breads, pasta, cereal, cake and biscuits
Sorbitol- and lactulose-containing foods such as apples, pears, blackberries, eggplant, and broccoli; milk, yogurts, and icecream. (*Sorbitol is a sugar alcohol with fewer calories than sugar. Lactulose is a sugar not absorbed by the body that acts as a laxative.)
“Studies have shown that limiting these foods leads to a reduction in overall symptoms,” Sorrell said. “I recommend elimination of as many FODMAP-containing foods as possible and then slowly introduce one food item at a time to create your own low FODMAP diet.”
Helpful Foods
For many people, Sorrell shared, there are things that you can incorporate into your diet to help the symptoms. She recommends:
Trying to increase fiber intake
Following a Mediterranean like diet which can include fish rich in omega-3 fatty acids, and brown rice and fruits or veggies not eliminated on a low-FODMAP diet
Treatments
Unfortunately, as of now, there is no cure for IBS.
The only way to manage any type of IBS is through controlling its symptoms, which can involve the use of traditional medications, alternative medicine, complementary medicine or a combination of all three.
Prescription medications target specific IBS symptoms. So, gastroenterologists recommend medications that target the most dominant symptoms a person is experiencing.
“We can treat abdominal pain, discomfort, and bloating,” Sorrell said. “If IBS is diarrhea predominant, we treat that with anti-diarrheas or medications with an anti-diarrhea side effect. If constipation is predominant, we treat that with fiber or other prescription medications.”
However, IBS-mixed is another story. Of the three types of IBS, it is the most difficult to treat.
“Mixed type can be difficult to manage since you are always changing treatments based on the predominate symptom at the time,” Sorrell pointed out.
Peppermint oil
Other alternative treatments that have been used with some successes are probiotics, peppermint oil, and antidepressants.
She shared that there is evidence from research findings that probiotics have beneficial effects on the symptoms of abdominal pain, bloating, and flatulence.
“Triple coated peppermint oil also has some backing in leading to a reduction in total IBS symptoms,” she said.
Another treatment option, you might be surprised to hear about are antidepressants.
That’s because very interestingly from a biology perspective, the neurotransmitter (the body’s chemical messengers), serotonin, which plays a role in our emotions and happiness, also helps control peristalsis—wavelike contractions of the muscles in the digestive tract. These contractions aide in the formation of stool and production of bowel movements. Yet, like other treatments the type of antidepressant that’s effective depends on the type of IBS.
“Tricyclic antidepressants may cause constipation and may be best suited for patients with IBS-D. SSRIs may cause diarrhea and may be best suited for patients with IBS-C,” Sorrell said.
We often talk about the connection between our physical health and mental health. In IBS, the connection comes full circle.
As much as different foods are triggers, experiencing stress and anxiety will directly affect your gut and cause flare-ups. That’s why reducing your stress levels is key for improving IBS symptoms.
“Stress reduction techniques such as meditation, yoga and exercise can improve symptoms. Cognitive behavioral therapy can also be very helpful. It helps give insight into some of the non-food related triggers for symptoms,” Sorrell said.
“It is tough because if you struggle with stress management or anxiety at baseline and then you have IBS symptoms, you tend to get more stressed and anxious about your symptoms which is a vicious cycle.”
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