What is visceral hypersensitivity

What is visceral hypersensitivity

by | Aug 10, 2021 | IBS

Woman sitting on the floor, legs crossed; what is visceral hypersensitivity

What is visceral hypersensitivity

This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.

 

When it comes to irritable bowel syndrome (IBS), there can be a lot of long, confusing terms thrown around. It can be difficult to figure out what specifically applies to you since symptoms are incredibly unique and different person-to-person.

Visceral hypersensitivity definitely falls into this category. It’s a reason why, for many people with IBS, you might experience gut symptoms or pain where a person without IBS may not.

It’s estimated that roughly two-thirds of people with IBS experience visceral hypersensitivity, (although surveys have come back with a wide4 range from 33-90% of patients). It also tends to be more common in people with the IBS-D subtype (diarrhea predominant IBS).

Studies have also seen that the reported severity of IBS symptoms in people with visceral hypersensitivity is much higher than for those who don’t experience it.

Visceral refers to the internal organs of the body, so actually visceral hypersensitivity as a term on its own is quite vague. When we think of it in relation to IBS, we’re often referring to it in the large intestine (colon).

This would mean that for people with hypersensitivity, stimulation in the gut can trigger the nerves to send messages to the brain indicating pressure is being experienced. Our brain then reacts and tells us that we are experiencing gut pain or symptoms.

Abdomen of a woman with her hand on her belly; what is visceral hypersensitivity

The gut is home to a huge amount of nerve endings – the enteric nervous system. And when the communication between the gut and the brain via this system is functioning normally, slight changes in volume in the gut don’t create pain reactions. There are two components that are a part of visceral hypersensitivity. One is an increased pain response to stimuli which would normally trigger pain, and the second is a pain response to normal stimuli that normally wouldn’t trigger pain.

Thus, changes in the volume in the large intestine, or perhaps also the muscle contractions that occur to propel our food along the gut for digestion, can kick off this cascade much sooner than it would for people without gut hypersensitivity.

In fact, many people with IBS don’t necessarily create more gas in the large intestine compared to those without IBS – their body is just reacting to the change in pressure at a much lower level than the average person.

Foods that tend to draw water into the gut, and/or are highly fermentable by the gut bacteria in the colon, are therefore common culprits for IBS symptoms when it comes to visceral hypersensitivity (for example, FODMAPs). The gastrocolic reflex can also play a role in triggering symptoms related to visceral hypersensitivity.

The development of visceral hypersensitivity, like IBS, is unknown. Since the two seem to be quite closely linked, many of the possible factors are the same, like GI infections, gut bacteria imbalances, inflammation, stress and other psychological factors, diet, and genes.

While there is a wide range of pharmaceuticals and natural remedies meant to help with visceral hypersensitivity in IBS, there is still a lack in clinical evidence confirming the efficacy of these methods.

 

Figuring out what your specific triggers are – whether that’s stress, exercise, diet etc. is going to offer the most benefits when it comes to managing your IBS and reducing the frequency and intensity that any symptoms occur.

Sources:

Farzaei, M. H., Bahramsoltani, R., Abdollahi, M., & Rahimi, R. (2016). The Role of Visceral Hypersensitivity in Irritable Bowel Syndrome: Pharmacological Targets and Novel Treatments. Journal of neurogastroenterology and motility, 22(4), 558–574. https://doi.org/10.5056/jnm16001

Lenhart, A., & Chey, W. D. (2017). A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome. Advances in Nutrition(8), 587-596.

Mansueto, P., Seidita, A., D’Alcamo, A., & Carroccio, A. (2016). From Food Map to FODMAP in Irritable Bowel Syndrome. In E. Grossi, & F. Pace, Human Nutrition from the Gastroenterologist’s Perspective. Switzerland: Springer International Publishing.

Nybacka, S.; Störsrud, S.; Lindqvist, H.M.; Törnblom, H.; Simrén, M.; Winkvist, A. Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome. Nutrients 2021, 13, 27. https://doi.org/10.3390/nu13010027

Varju ́ P, Farkas N, Hegyi P, Garami A, Szabo ́ I, Ille ́s A, et al. (2017) Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta- analysis of clinical studies. PLoS ONE 12(8): e0182942. https://doi.org/10.1371/journal. pone.0182942

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What is the Gastrocolic Reflex and how does it impact IBS symptoms

What is the Gastrocolic Reflex and how does it impact IBS symptoms

by | Jul 13, 2021 | IBS

Grilled sandwich on a wooden plate on a blue table; what is the gastrocolic reflex

What is the Gastrocolic Reflex and how does it impact IBS symptoms

This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.

 

Have you ever experienced digestive discomfort during or shortly after a meal?

We’re talking about symptoms that start in your gut, like bloating or distention, cramps, flatulence, or diarrhea.

If these symptoms pop up while you’re still eating or 15 to 30 minutes afterwards, there’s a good chance that it doesn’t have much to do with what you were eating. It’s likely due to the gastrocolic reflex that has been triggered just by the act of eating itself.

Everyone experiences the gastrocolic reflex, and it has an important part to play in digestion. In very simple terms, it’s the communication between the stomach and the large intestine. The stomach registers food coming in and senses its walls stretching to accommodate the additional volume. It then tells the gut to move things along from previous meals to make space for the new arrivals. The muscles of the gut walls contract to push the contents along their journey.

While this reaction happens for everyone, people with irritable bowel syndrome can have their symptoms triggered by this communication. The reflex may be exaggerated, creating a more intense response than necessary. In essence, the muscles contractions are more intense than your gut actually requires.

There are also a few things that can trigger a stronger than normal gastrocolic reflex. This includes eating a large meal, meals that are particularly high in fat, as well as drinking a large quantity of cold liquids.

Aside from mealtimes, the gastrocolic reflex is generally more active in the morning just after waking up. This is why many people experience their main bowel movement of the day first thing in the morning!

A group of people sitting around table full of plates of food; what is the gastrocolic reflex

The gastrocolic reflex for IBS subtypes (IBS-D & IBS-C)

With this in mind, if you experience a diarrhea predominant version of IBS (IBS-D), eating smaller, more frequent meals, staying away from high fat, greasy meals, and drinking large amounts of cold liquids could help reduce your chances of triggering symptoms.

Some medications may be helpful in dealing with an overreactive gastrocolic reflex; discuss with your doctor if this may be something for you.

If you’re more susceptible to constipation predominant IBS (IBS-C), you could use the gastrocolic reflex to your advantage to improve the frequency and predictability of bowel movements. Start your day off with a big glass of cool water along with a good-sized, healthy breakfast containing fiber and healthy fats. Some physical activity or exercise can also be helpful.

Giving yourself enough time to have a bowel movement in the morning is also important. Try not to be too rushed and allow the time to relax and use the toilet. Even just making the time to sit there, even if you don’t have a bowel movement could help your system learn and adapt over time eventually making bowel movements more frequent and regular.

 

Curious about what might be behind symptoms that pop up at other times of the day? Check out this blog post for more info!

Sources:

http://www.annalsgastro.gr/index.php/annalsgastro/article/view/156

https://www.ncbi.nlm.nih.gov/books/NBK549888/

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What the timing of your IBS symptoms says about your triggers

What the timing of your IBS symptoms says about your triggers

by | May 4, 2021 | IBS

Blue background, two hands up in the air holding a red alarm clock; what the timing of your IBS symptoms says about your triggers

What the timing of your IBS symptoms says about your triggers

This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.

 

Have you ever experienced a sudden onset of IBS symptoms, but had no idea what triggered them?

The majority of people with IBS tend to point the finger at food for causing their symptoms, but actually figuring out the trigger is easier said than done.

Usually this means you’re looking at the last meal you ate to find the culprit… but this might not be giving accurate information. 

Remember, our digestive system is long.

Like, really long.

The small intestine is around 6 meters in length, plus an extra 1.5 meters for the large intestine.

Our food just doesn’t flow through the gut like water through a pipe, the passage is slower so that our body has time to breakdown and absorb the nutrients out of our food.

Transit time from plate to toilet can range from 10 to even 48 hours!

So what can you gather from the timing of your IBS symptoms?

White wooden table with a charcuterie board filled with sliced meats, cheeses, and fruits; what the timing of your IBS symptoms says about your triggers

IBS symptoms just after eating

If you’re having to run to the washroom within minutes of eating a meal, it’s not the content of that meal that is ready for exit.

It’s more likely due to your gastrocolic reflex being stimulated.

When you consume food, your stomach starts to stretch. This stretching is one of the triggers for the gastrocolic reflex (gastro = stomach, colic = colon/large intestine).

What it triggers are muscle contractions in the colon. These muscle contractions are meant to push along the food from previous meals to make room for what you just ate.

It’s a totally normal process, but many people with IBS have a dysregulated gastrocolic reflex.

If you need to hit the washroom soon after eating, then the gastrocolic reflex that was triggered is exaggerated and strong muscle contractions have created an everybody out situation.

What can trigger an extra-strong gastrocolic reflex? Large meals, meals high in fat, and drinking a large portion of cold fluids quickly.

If you feel like this could be an issue for you, then eating smaller, more frequent meals, making sure the fat content isn’t exaggerated, and drinking smaller but more frequent amounts of room temperature drinks, could all be possible actions to try.

Woman sitting cross-legged on a bed in front of a window stretching with her arms above her head; what the timing of your IBS symptoms says about your triggers

IBS symptoms in the morning

The gastrocolic reflex is also active in the morning just after rising. If you frequently experience symptoms first thing, it could be a combination of this plus stress.

Our stress-system gets a break while we are sleeping, but if you wake up and are immediately on edge, this could be what is triggering your IBS.

Try and incorporate some stress-reduction activities first thing, perhaps some journaling, meditation, or yoga.

On the other side, if you’re struggling with IBS-C, using the gastrocolic reflex to your benefit may help.

Drink some cool water first thing, have a good-sized breakfast with healthy fats, and move your body a bit to really get things moving.

Plus make sure to give yourself some time to use the washroom before you start with your workday. Even if you don’t go every time, creating the routine will help your body start getting use to the rhythm.

 

IBS symptoms a few hours after a meal

If your symptoms are popping up several hours after eating, then it could be that certain foods are the triggers.

Roughly 4 hours or so after a meal, the food would reach your large intestine. Certain foods have a tendency to attract water, and/or be fermented by our gut bacteria and produce gas.

For people with IBS, this normal increase in volume can cause symptoms to be triggered due to the increased sensitivity of the gut lining that many IBS-sufferers experience.

This is where it may be especially helpful to keep a food journal to see if there are any specific foods that tend to correspond to symptoms.

However, keep in mind that it’s not just the food itself; it can also be the quantity consumed that is important.

 

The bottom line

These are just a few specific times when you might experience symptoms and some reasons why they have been triggered.

But, of course, it’s not possible to outline all possibilities and also accurately identify in a blog post for general information what specifically might be happening for you.

IBS is a complex syndrome and there are many different triggers like food, stress, sleep, exercise, etc. And since every body is different, what’s a trigger for one person may not be for another.

In all these scenarios it’s recommended to work closely with someone to help you identify and manage IBS symptoms. This will allow you to understand why they may be happening, help reduce the frequency, and better be able to manage them when they do occur.

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What you need to know about IBS and dairy products

What you need to know about IBS and dairy products

by | Apr 27, 2021 | IBS

Four glasses of milk in a row, women sipping out of third glass with a straw; what you need to know about IBS and lactose intolerance

What you need to know about IBS and dairy products

This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.

 

A little while ago, I polled the members of my online community, IBSuccess, to see if there were any types of food they were avoiding to help reduce their IBS symptoms.

A large number of them replied that they were avoiding dairy products, and dairy avoidance is something I run across often in my practice!

It seems to be a common idea in the IBS community at large that dairy is a trigger food.

So should you be avoiding dairy products in order to improve your IBS?

 

The short answer is… no!

But keep reading for what you need to know about dairy and what to watch out for.

 

Dairy vs. Lactose

Often people are avoiding all dairy in general as a method of avoiding lactose. But these two words do not represent the same thing – and this difference is pretty important.

Dairy refers to all product originating from milk, like butter, cream, yoghurt, cheese, ice cream, and milk itself.

(FYI… eggs are not a dairy product – this is a common misconception, probably due to the fact that they are often grouped together in the grocery store! When you stop to think about it, it makes sense that it’s not dairy, right?)

Lactose is a type of sugar, or carbohydrate, that is present in some dairy products. Each lactose molecule is made up of two sugar molecules, one glucose molecule and one galactose molecule. In order to digest and absorb lactose our digestive system needs to split the lactose molecule into glucose and galactose. We need the enzyme, lactase to do this.

Lactose intolerance is when someone doesn’t produce sufficient lactase enzymes to break down the lactose being consumed. When that happens, symptoms like bloating, gas, cramps, and diarrhea can result. (Hint, this is why lactose is considered a FODMAP!)

Many people see a decrease in their natural lactase production from childhood until early adulthood. However, some people retain their higher level of lactase production throughout their lives. You can also experience a temporary reduction in lactase as a result of certain illnesses where the gut lining is damaged.

Not all dairy products contain lactose, so even if you are lactose intolerant, there are some products you are likely to be able to eat without issue.

Some people have dairy allergies – this is a reaction to a protein in dairy products (remember, lactose is a carbohydrate). For these people, an immune response can be activated which for some could result in a life-threatening reaction, like anaphylactic shock. These people need to avoid all dairy products. While lactose intolerance can produce some pretty uncomfortable results, exposure to it in sensitive people isn’t going to be life threatening.

(There is a metabolic condition where the person needs to avoid all traces of galactose – one of the sugars in the lactose molecule where the results can be life-threatening, but this is very different from lactose intolerance.)

From here on out, we are going to focus only on lactose intolerance.

Four glasses of A store display filled with rows of different cheeses; what you need to know about IBS and lactose intolerance

What dairy can I consume if I am lactose intolerant? 

Traditional Dairy Products:

Milk and yoghurt are the two big ones when it comes to lactose content. That being said, even with lactose intolerance you may find that yoghurt is digested OK as the fermentation process can improve lactose digestion. This would also count for other fermented milk products like kefir or buttermilk.

What’s also important to note is that most people with lactose intolerance can tolerate small amounts of lactose, so avoiding it completely isn’t necessary. Spreading out the servings across the day can also help.

It’s estimated that lactose intolerant people can tolerate around 12-15 grams of lactose per day, which is roughly 250ml of cow’s milk. This amount could be more if the intake is spread over the day. Milk may also be digested better when it’s been included in the meal, like adding milk to mashed potatoes.

However, as mentioned before, not all dairy contains lactose, so some sources you can consume without an issue even if you’re lactose intolerant!

Butter contains no lactose, and many cheeses are also virtually lactose free. Hard cheeses like cheddar or feta and also some softer cheeses like brie or camembert are essentially lactose-free.

If you look at the nutrition label and see that there are zero grams of carbohydrates, then the cheese is lactose-free! (Lactose is a carbohydrate/sugar, remember?) And as long as the amount of carbohydrates is less than 1g per 100g of cheese, then that cheese should be OK for most people with lactose intolerance.

You can also discuss with your pharmacist about taking a lactase enzyme product. This might help your digestive system breakdown the lactose when you consume lactose-containing foods.

 

Lactose-free products:

There are also many dairy products that you can purchase that are “lactose-free”. These products usually have had the lactase enzyme added to them during production, so the splitting of the lactose molecule has been done for you!

Cow’s milk that is lactose free is virtually the same as regular cow’s milk, except that the lactase has been added. The taste may be a little bit sweeter, but the nutritional value will be the same.

Pink, orange, and white ice cream cones laid out on a table with flowers and blueberries; what you need to know about IBS and lactose intolerance

What to watch out for if your avoiding / limiting dairy products

Dairy products in general are one of the main sources of calcium in our diet. Guidelines can vary, but in general the recommended daily intake of calcium for an adult is around 950mg. For reference, 100ml of cow’s milk contains about 120mg of calcium.

Vitamin B2 is another nutrient that needs attention if you’re limiting your dairy intake.

If you go for dairy-free alternative products to things like milk and yoghurt made from products such as soy, oat, almond, etc. you want to be taking care to choose ones that are fortified with, at a minimum, calcium (at least 120mg per 100g) and vitamin B2.

You can check out this blog post for more info on calcium and non-dairy calcium rich foods.

 

The bottom line on IBS and dairy products

IBS and lactose intolerance are not one and the same, and just because you have irritable bowel syndrome does not automatically mean you need to be avoiding lactose.

Many dairy products are naturally low in lactose and can be still enjoyed by people who are lactose intolerant.

Small amount of lactose, especially when spread over the day, may be digested well by lactose-sensitive people without any symptoms.

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Should you take collagen supplements for gut health?

Should you take collagen supplements for gut health?

by | Apr 8, 2021 | IBS, Nutrition 101

Cutting board with vegetables and three bowls of broth, do you need collagen supplements for better gut health

Should you take collagen supplements for gut health?

This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.

Collagen – you might have heard about it over on social media, but exactly what is collagen, and do you need to take collagen supplements for gut health or irritable bowel syndrome?

 

What is collagen?

Collagen is the most abundant protein in our body and is the second most abundant substance overall after water! So it is pretty darn important.

Collagen is found in our connective tissue, which means in our bones, tendons, ligaments, cartilage, skin, hair, and nails. It’s the protein that gives the structure to all of these tissues.

In addition to providing structure to the body, collagen also helps maintaining healthy blood vessels and healing wounds. Most people seek out collagen for either bone and joint health or for beauty purposes (skin/hair/nails) or both!

Collagen is often used in the beauty world to claim anti-aging properties. However, the collagen particles are generally too large for the skin to absorb topically, so the positive benefits tend to be more attributable to the moisturizing properties of the product. That being said, collagen is important in maintaining skin strength and elasticity, it just needs to come from our diet instead.

Like all proteins, collagen is made up of various amino acids, which in this case are namely glycine, lysine, and proline. These amino acids need to be converted into a special form by enzymes to create collagen, a process that requires vitamin C. Therefore sufficient vitamin C is extremely important for the formation and maintenance of healthy collagen.

Other minerals such as zinc, copper, manganese, and sulphur are also cofactors for collagen production and maintenance. 

Factors negatively affecting collagen production

  • general aging –  our collagen breaks down over time
  • high sugar intake levels
  • excessive sun exposure
  • smoking / second-hand smoke
  • autoimmune disorders
  • repeated physical stress on a part of the body
Personal at a table holding a cup of broth, do you need collagen supplements for better gut health

Sources of collagen in the diet

The best source of collagen itself is through consuming something like bone broth. Bone broth is made from cooking animal bones, including the cartilage, for a long period of time so that it breaks down and turn the broth gelatinous. The yolks from chicken eggs also contain collagen.

Other ways to boost your collagen is through consuming foods rich in the cofactors needed by your body to produce healthy collagen. For example:

  • citrus or berries for vitamin C
  • salmon or pumpkin seeds for zinc
  • leafy greens for chlorophyll which is shown to increase the precursor to collagen

There are also some collagen supplements on the market, generally as a powder that can be mixed in with cold or warm liquids. Take care if you are using collagen as a protein powder in smoothies or shakes as it is not a complete protein; it could still be beneficial to add in some high quality whey powder along with it.

 

Do I need to supplement with collagen for IBS?

Are you a generally healthy person following a healthy diet? Then no, you don’t need to supplement with collagen.

The best way to ensure healthy collagen levels in your body is to consume collagen containing foods, or foods with the needed cofactors, rather than relying on a supplement.

That being said, it could be helpful to supplement with collagen during recovery from injuries or surgery.

But the most documented benefit of collagen supplementation is an improvement in skin, joint, and bone health through a reduction in pain and inflammation.

When it comes to gut health specifically, there’s not enough evidence to support collagen supplementation for IBS specifically. More research into this area is definitely needed.

First and foremost, for the average, healthy person, it is always best to start by focusing on a general healthy diet, one that is going to be giving your body naturally the protein, carbohydrates, fats, vitamins and minerals it needs. Any supplementation should only come after this is achieved.

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