9 Myths About IBS That Might Surprise You

Abdominal pain, bloating, diarrhea, constipation. If you're dealing with these symptoms on a regular basis, you may have irritable bowel syndrome (IBS).

While IBS is a common condition that 25 to 35 million people in the U.S. deal with, there's still a lot we don't know about it, per the International Foundation of Gastrointestinal Disorders.

Trying to distinguish between fact and fiction when it comes to IBS can be tricky. But it's also crucial to getting the care you need when you have the condition.

That's why we spoke with Sarah Robbins, MD, gastroenterologist and founder of Well Sunday Health Corporation, and Marlee Hamilton, RD, a gut health dietitian with Ignite Nutrition Inc., to help us debunk common IBS myths.

It isn't accurate to say IBS is "all in your head," Dr. Robbins says. While psychological stress can make IBS symptoms worse, IBS is a real gastrointestinal (GI) disorder characterized by physical symptoms like abdominal pain, bloating and altered bowel habits, Dr. Robbins says.

What's more, many biological factors can contribute to the development of IBS. These include changes in gut bacteria, genetics, nutrition, visceral hypersensitivity (i.e., having an extra-sensitive digestive tract) and changes in gut motility (i.e., the movement of the digestive tract), Dr. Robbins adds.

Still, like many other conditions, mental health does come into play with IBS. Anxiety can often make symptoms worse, for example. And on the flip side, having a strong social support system may help ease some IBS symptoms, Dr. Robbins says.

IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) are two distinct conditions, Dr. Robbins says. While they often have similar symptoms, they differ in how they begin, how they're diagnosed and how they're treated, she adds.

IBS is a ‌functional‌ GI condition, meaning that symptoms crop up because of the way the GI tract functions, not because of any structural issues.

IBD, on the other hand, which includes Crohn's disease and ulcerative colitis, is a more serious condition that triggers chronic inflammation in the digestive tract, which can lead to ulcers, cuts and damage to the gut lining, Dr. Robbins says.

While IBS management focuses on relieving symptoms through dietary changes, medications like Bentyl and laxatives, talk therapy and lifestyle changes (i.e., stress relief), IBD treatment focuses on reducing inflammation, controlling symptoms and preventing further damage to the gut, with medications like corticosteroids, immunosuppressants and biologic agents, Dr. Robbins says.

Your gut has a protective barrier that keeps harmful substances from getting inside. When you have a "leaky gut syndrome" that barrier has been somewhat broken down, per Dr. Robbins.

While some studies have found a connection between "leaky gut syndrome" and IBS, it is not clearly established as a direct cause, Dr. Robbins says. (In fact, experts still aren't sure what causes IBS.)

What's more, "leaky gut syndrome" is purely hypothetical at this point, according to the Cleveland Clinic. While there are theories, it's not a recognized medical diagnosis, and there's very little quality research on it.

According to Dr. Robbins, treatments for "leaky gut syndrome" may not work on IBS symptoms. That's because "leaky gut syndrome" is more often thought of as a potential side effect of complex IBDs like Crohn's or ulcerative colitis, per Cedars Sinai, which require different treatment than IBS.

IBS can seriously affect the quality of life of people living with the condition. The symptoms of IBS, like abdominal pain, bloating and changes in bowel habits, often lead to physical discomfort, psychological distress and social isolation, Dr. Robbins says.

Plus, the unpredictability of flares can worsen feelings of anxiety and depression in people with IBS, Dr. Robbins adds.

Apart from its effect on individuals, the costs of IBS to the health care system are considerable, Dr. Robbins says.

According to a September 2023 study in ‌Clinical Gastroenterology and Hepatology‌, IBS was associated with an increase in direct health care costs, such as GI clinic visits and mental health visits. IBS was also connected to indirect costs like missed work days and lost productivity.

IBS symptoms can vary greatly among people with the condition and can be categorized based on three broad subtypes, which including the following, per Dr. Robbins:

• ‌Diarrhea-predominant IBS (IBS-D)‌, which includes "frequent loose stools, urgency and abdominal pain. It is thought to be caused by changes in gut motility, bile acid metabolism and visceral sensitivity, all of which contribute to the rapid movement of stool through the digestive tract and the development of symptoms."
• ‌Constipation-predominant IBS (IBS-C)‌, which presents with infrequent bowel movements, hard or lumpy stools and abdominal discomfort. Dr. Robbins explains some contributing factors include slowed bowel movements, changes in your gut-brain interaction and an increased sensitivity to intestinal stretching.
• ‌Mixed type IBS (IBS-M)‌, a mix of both diarrhea and constipation, often alternating, making it difficult to manage.
  

Beyond these subtypes, "people with IBS may also experience other symptoms like bloating and gas. Some people may have mild, infrequent symptoms, while others get severe, daily symptoms that have a negative effect on quality of life," Dr. Robbins says.

Because IBS symptoms can vary so greatly from person to person, IBS treatment plans are often specific and highly tailored to individual needs.

While some people with IBS find relief from their symptoms when they limit or avoid eating gluten and dairy, Hamilton says most people don't need to be this restrictive.

"People with IBS may have a hard time with dairy foods because they have lactose — a type of carbohydrate," Hamilton says. But not all dairy products have high amounts of lactose.

Some dairy products, like hard cheeses, only have a small amount of lactose. Plus, making swaps to lactose-free dairy products can be a good way to avoid the irritant while keeping dairy as part of your balanced diet, Hamilton adds.

Many people also assume that avoiding gluten (a ‌protein‌ found in wheat, rye and barley-based foods) is best for IBS. But "a lot of evidence suggests that it is actually a type of ‌carbohydrate‌ found in these foods that can trigger IBS flares," Hamilton says.

Those carbs are fructans, a type of carbohydrate found in wheat, rye, barley and certain fruits and vegetables. Fructans are also a FODMAP, which stands for "fermentable oligosaccharides, disaccharides, monosaccharides and polyols," Hamilton says.

FODMAPs (which should be limited if you have IBS) are carbohydrates that are fermented by gut bacteria. They also pull water into your gut, which can cause unpleasant symptoms like gas, bloating and changes in bowel movement frequency and consistency for people with IBS, per Johns Hopkins Medicine.

So when it comes to products that have gluten, many people with IBS actually ‌can‌ tolerate them if the food is also low in fructans, Hamilton says. For example, sourdough bread (which has gluten but is low in fructans) is often well-tolerated by people with IBS, whereas things like fruit-filled pastries or cake may not be well-tolerated.

Currently, there is no cure for IBS, and as we've learned, IBS symptoms are different for everyone. "This is why treatment plans have to be customized to each person's individual needs," Hamilton says.

All that said, fiber can be used as a tool to manage IBS symptoms — which often cause stool to be too hard or poorly formed. For people with IBS-D, in particular, soluble fiber can help absorb water and add bulk to the stool, Hamilton says. To get more soluble fiber, eat foods like oatmeal, legumes, psyllium husk, ground flaxseeds and chia seeds.

For people with IBS-C, insoluble fiber — which speeds up the movement of waste through the digestive tract and pulls water into the bowels — can be helpful, Hamilton says. Insoluble fiber can be found in foods like fruits, vegetables, beans, wheat bran and nuts, per the Mayo Clinic.

Overall, fiber plays an important role in maintaining proper movements of the digestive tract, firming up stool and nurturing the gut microbiome, Hamilton says.

That said, fiber cannot completely relieve your symptoms on its own — you'll need to implement other lifestyle and diet changes, too.

If you have IBS, you may think you need to go on a strict elimination diet to relieve your symptoms, but that's not true. In fact, "this could be harmful, especially if you have a history of disordered eating," Hamilton says.

While the low-FODMAP diet is widely used to manage IBS symptoms, it isn't the only option, Hamilton adds.

"As a digestive health dietitian, I often recommend starting with simpler dietary and lifestyle changes based on the NICE guidelines for IBS," Hamilton says.

These guidelines suggest limiting alcohol and caffeine, increasing fluid intake and adjusting your fiber intake, she adds.

"These guidelines also help people consider other factors that can affect symptoms, like poor sleep, stress, medications, supplements and exercise," Hamilton says.

In a similar vein, the myth that IBS is caused by a 'bad' or 'poor' diet is also untrue. The reality is, we don't have enough evidence to support this claim. All we know is that some diet changes could be helpful, Hamilton says.

While you may think that certain foods trigger your IBS symptoms more than others, it can be helpful to think of your tolerance to foods like a bucket, Hamilton says. "The size of the bucket is different for everyone — some people have small buckets, and some people have large buckets," she adds.

People with a larger bucket can eat foods considered IBS triggers like caffeine, high-fat foods, spicy foods and high-FODMAP foods without getting symptoms, Hamilton says.

On the other hand, people with smaller buckets have a lower threshold for IBS trigger foods. (Though there may still room for ‌some‌ trigger foods in small amounts, Hamilton clarifies.)

Bottom line: Some people with IBS can tolerate a larger amount of so-called trigger foods than others.