causes of irritable bowel syndrome

Dr. Stephen Wangen of the IBS Treatment Center.
Dr. Stephen Wangen of the IBS Treatment Center.

Patients with irritable bowel syndrome (IBS) and other digestive problems such as constipation, diarrhea or abdominal pain often wonder if they have a problem with their gallbladder.

Problems with the gallbladder can indeed cause IBS symptoms. However, many people find that having their gallbladder removed did little or nothing to help their IBS, or even made it worse.

What Does the Gallbladder Do?

The gallbladder does exactly what its name describes; it is a small bladder that stores gall. Gall is more commonly known as bile. Bile is produced by the liver and piped over to the gallbladder via the bile duct.

What is Bile?

Bile is a highly concentrated yellow green fluid that contains bile acids. Bile acids are important for digesting fats. When you eat, your gallbladder contracts and secretes bile into the small intestine to help you digest your food. If your gallbladder has been removed then it will be more difficult for you to digest fats. In such cases, eating too much fat may cause loose stools.

When Does That Gallbladder Need to be Removed?

In some people, stones develop inside of the gallbladder. These stones, when small, can become lodged in the bile duct, which can cause severe pain and be very dangerous if they also clog the pancreatic duct. Larger stones are not able to pass into the bile duct, but their presence can cause severe pain. Sometimes this is worse when the gallbladder is contracting. In either case, removing the gallbladder usually relieves the pain and you feel much better.

When is it Questionable to Remove the Gallbladder?

It is often tempting for physicians to blame the gallbladder for abdominal pain and digestive problems even when there is little or no evidence that the gallbladder is the culprit. It’s a relatively simple procedure, and most people don’t miss it too much. If stones are present, then the decision is easy to make.

However, in some cases physicians recommended that the gallbladder be removed even when stones are not apparent on any exams. The recommendation is based primarily on symptoms and a lack of any other visible problem. Gallbladder function tests also may indicate that the gallbladder is not functioning at 100%. However, that does not mean that it is the cause of the problem. If the gallbladder is functioning at a below normal level, removing it will only guarantee that it will not function at all.

Studies have shown that patients with IBS symptoms and/or abdominal pain are more likely than others to have gall bladder removal surgery (cholecycstectomy) when they do not have gall stones. This exposes the patient to the increased (though small) risks of surgery and to further digestive problems caused by the abscence of a gall bladder. Testing for food allergies and other causes of IBS symptoms, and treating those conditions can enable patients to avoid unnecessary surgery and achieve good digestive health.

Study Explores Connection Between Reflux and Irritable Bowel Syndrome


This 10 year study found a strong correlation between reflux and IBS. We are not surprised. Many of our IBS patients experience reflux, and often both the reflux and the IBS is gone once they receive treatment here. But you don’t have to have IBS to be successfully treated for reflux.

Excerpt from the study The natural history of gastro-oesophageal reflux symptoms in the community and its effects on survival: a longitudinal 10-year follow-up study from National Institutes of Health:

Data on mortality and cause of death at 10 years were obtained from the Office for National Statistics. Baseline demographic data, lifestyle factors, gastrointestinal symptoms and quality of life were recorded at study entry. The effect of all these factors on persistent and new-onset GERS, and 10-year mortality, were examined using univariate and multivariate analysis, with results expressed as odds ratios (ORs) or hazard ratios (HR) with 99% confidence intervals (CI).

Gastro-oesophageal reflux symptoms persisted in one-third of individuals, whilst new-onset gastro-oesophageal reflux symptoms were associated with poor quality of life, irritable bowel syndrome and higher body mass index. Gastro-oesophageal reflux symptoms did not impact adversely on survival.

Click here to read the complete study.

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Most physicians are trained to think of Irritable Bowel Syndrome (IBS) as stress induced or as a type of psychosomatic disorder.

This is because there has not been an easy medication cure for IBS, therefore it has been framed in a way that suggests that it is more your problem than the physicians.

If you have been diagnosed with IBS, it is likely that you have been advised to reduce your stress level. You may have been told to get regular exercise and adequate sleep, and to practice stress reduction techniques such as yoga, meditation, tai chi, deep breathing, journal writing, etc.

All of these practices can indeed improve physical, mental, and emotional health. They provide a host of benefits, from improved personal relationships to enhanced productivity to increased energy and mental clarity, and they just might help with your IBS symptoms.

Although some cases of IBS are no doubt related to mental or emotional issues, and stress and anxiety can aggravate the condition (as well as most other medical conditions), they are not the predominant causes of IBS. More often, Irritable Bowel Syndrome causes you stress rather than the other way around.

Medicine has a long history of blaming medical conditions with no straightforward, obvious organic cause on some form of psychological disturbance, such as stress – only to discover later the organic cause of the problem.

One excellent recent example of this is stomach ulcers. While stomach ulcers were once thought to be a stress-induced disorder, it is now well accepted that the bacteria Helicobacter pylori cause them, and that they are treatable.  Interestingly H. pylori can also cause IBS symptoms, and now that we can test for it and treat it, there is one more reason to believe that stress is too often blamed.

It is true that stress can make the symptoms of IBS worse, and that your digestive system depends on relaxation to function properly. Occasionally stress is the sole cause of IBS. But far more often it is due to something else. If you still have symptoms when you know that there isn’t much stress, then there is more to the problem than stress!

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A recent article from Gastroenterology & Endoscopy News touts major changes in the way that Irritable Bowel Syndrome is viewed. But there’s more to it than that.

“For the first time, investigators have documented structural abnormalities in the small bowel of patients with irritable bowel syndrome (IBS). These findings “will fundamentally change our thinking on the disease,” researchers told attendees of the 2012 American College of Gastroenterology annual meeting.”

When a person’s body isn’t functioning normally, such as in IBS, then there must be something physiologically wrong. It’s good that scientists finally were able to visualize the damage that is occurring in IBS patients. However, this will not  “fundamentally change our [conventional medicine’s] thinking on the disease,”  as the article stated.

Conventional medicine’s primary focus for chronic diseases is on treating symptoms, not curing the disease. The only way to cure chronic disease is to prevent it.  There is no way around this. The article states that IBS will no longer be viewed as a functional disorder. But it was never a functional disorder to begin with. Being a “functional disorder” implies that it’s some random dysfunction in the body for which there is no cause. 

What they also fail to say is that now they view it as a symptom (epithelial cell loss). And that they will try to come up with a way to treat this symptom, rather than try to understand what is causing the symptom.  This is just as useless as viewing it as a functional disorder, and potentially more dangerous. The reason for that is because now drug companies will have another symptom to aim a drug at, which will put more people on more drugs. 

This still won’t cure the problem, and it will lead to more side-effects.

Don’t let this type of thinking and science take you down the wrong path. It’s interesting information, but not much more than that. Until the paradigm is changed to focus on understanding the cause of the symptoms rather than just the symptoms themselves, then we haven’t learned much.


Our intestines are a rich and thriving ecosystem, when we are healthy. The massive surface of our intestines (about the same as a tennis court) provides everything needed for life – space, moisture, and nutrients. Given the ubiquity of anti-bacterial products in our society, many people are surprised to learn that they have about 10 trillion bacteria living in their intestines. But not only do we have bacteria lining our digestive tract, we desperately need them.

There are basically three types of micro-organisms living in our intestines:

  • Good bacteria;
  • Bad bacteria/microorganisms; and
  • Disease organisms.

The good bacteria include species and strains that we evolved with, like acidopholus and bifidobacterium. These are an essential part of our digestive systems and we would not survive without them. They help us to digest food by producing enzymes, manufacture some of the essential nutrients that we need to live, assist in the development of our immune system, and prevent infection by occupying the space in the intestines that unwelcome organisms would thrive in, if they could.

The bad bacteria and microorganisms include many species and strains that don’t symbiotically help us, but rather upset the balance. These can include bacteria that crowd out the species we need or other organisms like yeast. While some bad bacteria and yeast are often present in small numbers in healthy people, excessive yeast growth can upset the balance and trigger all kinds of effects. Since the advent of medical antibiotics it is quite common for people to use wide-spectrum anti-biotics and unwittingly kill off the bacteria they need, allowing bad microorganisms to ‘claim more turf’ and upset the balance.


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The Mayo Clinic has found a round about way to offer up a mea culpa.

They aren’t apologizing for not ever having helped anyone solve their Irritable Bowel Syndrome (IBS), but a Mayo clinic doctor is at least acknowledging that there are many causes for IBS.

However, this isn’t a study, as the article suggests. It’s simply a review of possible triggers. It sounds like he read my book (The Irritable Bowel Syndrome Solution).

Don’t confuse this article with the Mayo Clinic’s ability to help people with IBS. We’ve seen and continue to see many people who’ve already been to the Mayo Clinic. They provide very good care, but when it comes to IBS, it’s exactly the same as the care that you get from any local institution or gastroenterologist. They are simply a brand, and their number one goal is to promote their brand.

Excerpt from

Irritable bowel syndrome is not “all in the head” as has been commonly thought, researchers say.

In a review of the literature, Michael Camilleri, a Mayo Clinic gastroenterologist describes a renaissance in the understanding of the condition, also known as IBS.



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Reason #1: One major obstacle to figuring out which foods are problematic is that, even on an elimination diet, you may not have truly eliminated all of your allergenic foods. Assumptions are often made about which foods are allergenic and which foods are not. These assumptions are often wrong. Even on an elimination diet you may still be eating something that will trigger your IBS, even if you are eating foods that you normally don’t eat.

In order to solve your IBS you may need to stay away from entire food groups, not just one or two foods.

Food groups are much more difficult to avoid than you might think. One food group that commonly causes problems for IBS sufferers is dairy. Dairy is not just milk. Dairy includes cheese, butter, sour cream, cream cheese, ice cream, and yogurt. It’s found in many baked goods such as muffins, breads, and cookies, as well as in many cream soups, some salad dressings, and milk chocolate. Coffee and lattes are another common source of dairy. Even margarine contains dairy. The list goes on and on.

Two key components of dairy are whey and casein, which many people cannot tolerate. These are used as additives in a great variety of foods, even those you wouldn’t consider to be dairy foods. Look at the labels on the packaged or processed foods you buy. Even non-dairy coffee creamer contains casein, for instance.

This example demonstrates how complicated it can be to avoid entire food groups in order to assess the dietary trigger of your symptoms. Many other food groups are just as complicated. If you remove only one part of a food group from your diet, you won’t really know if that group actually causes your symptoms. You need a great deal of information about the foods you eat and what they contain in order to understand which foods trigger your symptoms.

Reason #2: Another problem is that you may react to more than one food. In fact, most people with IBS are sensitive to more than one food or food group. You may suspect that your symptoms are caused by a certain food, but find that, even after you eliminate that food, your symptoms remain. This may lead you to mistakenly see the eliminated food as not part of the problem.


Stomach acid is vital to good health. It is the first major step in breaking down your food, which is so critical to proper nutrition. The myth is that you are what you eat. But in fact, you are what you absorb. Acid is especially important for breaking down proteins into amino acids and is required for the optimal release and preparation of minerals such as calcium, magnesium and iron for absorption.

Vitamin B12 also isn’t adsorbed without this acid. The same cells that produce acid produce intrinsic factor, which is required for B12 absorption. Without B12 you become B12 deficient, leading to fatigue and neurological problems. 
Decreased acid levels can also cause digestive problems further on down the line. Pancreatic enzymes, bicarbonate and bile are all released in the small intestine in response to the acidic load that normally leaves the stomach.

Without these, digestion continues to degenerate, resulting in a far less than optimal nutritional gain from your food and potentially damaging byproducts. The pH, now off in the entire digestive tract, damages the environment for billions of normal/good bacteria, critical to proper digestion and good health.

Stomach acid is also your primary defense against food-borne infections. Bacteria don’t usually survive the stomach, therefore decreased acid increases your risk of food poisoning.

Nutrients provide the building blocks for our entire biochemistry. Optimal health requires optimal nutrition. And that is why you need stomach acid!


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Gluten is a protein found in wheat, barley, and rye, and is responsible for the springiness and stretchiness of bread. Allergies and intolerances to gluten have been the subject of intensive research over the past decade. Much of this research has focused on celiac disease, which is a special form of gluten intolerance. It is a hereditary response to gluten that results in a very specific type of damage to the small intestine. Common symptoms, which can mirror those of IBS, include loose stools, constipation, or both; fatigue; weight fluctuation; dermatitis; and more.

Celiac disease is diagnosed by measuring damage to the small intestine, either by blood testing or, traditionally, with a biopsy of the small intestine. A positive biopsy means that the villi, or small finger-like extensions of the intestinal lining, have been damaged; this is known as villous atrophy. However, recent studies have shown blood testing to be as accurate as a biopsy.

People with celiac disease will show a marked reduction in their villi, almost as if the villi have been worn off. Damage to the villi causes a dramatic reduction in the surface area of the small intestine, resulting in both poor digestion and the poor absorption of many nutrients.

Celiac disease is not the only form of gluten intolerance or allergy. Many people react to gluten by producing elevated IgG antibodies to gluten or wheat, but they do not have damage to the small intestine. Their test results for celiac disease are negative. They become quite frustrated with traditional medicine, with its narrow focus on celiac disease, because they are told that their negative test results meant that they are not allergic or intolerant to wheat, barley, or rye. Yet when they eat a piece of bread they become sick.


Anything can be an allergen. Even carrots! (img thanks to

Anything can be an allergen. Even carrots! I never assume that any one food is good or bad for everyone. Everyone is different.

Study: Component-resolved in vitro diagnosis of carrot allergy in three different regions of Europe.

Carrot is a frequent cause of food allergy in Europe. The objective of this study was to evaluate a panel of carrot allergens for diagnosis of carrot allergy in Spain, Switzerland and Denmark.

Forty-nine carrot allergic patients, 71 pollen allergic but carrot-tolerant patients and 63 nonatopic controls were included. Serum IgE to carrot extract, recombinant carrot allergens (rDau c 1.0104; rDau c 1.0201; rDau c 4; the isoflavone reductase-like proteins rDau c IFR 1, rDau c IFR 2; the carrot cyclophilin rDau c Cyc) were analyzed by ImmunoCAP.

The sensitivity of the carrot extract-based test was 82%. Use of the recombinant allergens increased the sensitivity to 90%. The Dau c 1 isoforms were major allergens for Swiss and Danish carrot allergic patients, the profilin rDau c 4 for the Spanish patients. The rDau c IFR 1 and rDau c IFR 2 were recognized by 6% and 20% of the carrot allergics, but did not contribute to a further increase of sensitivity. Among pollen allergic controls, 34% had IgE to carrot extract, 18% to each of rDau c 1.0104, rDau c 1.0201 and rDau c 4, 8% to rDau c IFR 1 and 7% to rDau c IFR 2. Sensitization to rDau c Cyc occurred in one carrot allergic patient and one nonatopic control.

Component-resolved in vitro analyses revealed a significant difference in IgE sensitization pattern between geographical regions and in the prevalence of sensitization to carrot components between carrot allergic and carrot-tolerant but pollen sensitized patients.

View this study in its entirety on the National Institutes of Health web site.


Ballmer-Weber BK, Skamstrup Hansen K, Sastre J, Andersson K, Bätscher I, Ostling J, Dahl L, Hanschmann KM, Holzhauser T, Poulsen LK, Lidholm J, Vieths S.

Allergy Unit, Department of Dermatology, University Hospital, Zürich, Switzerland.


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Candida as seen through a microscope (image thanks to

One of the more common causes of digestive problems is Candida, or yeast. Although there are other types of yeast, Candida is the word usually used to describe a problem with yeast. Although many people think of yeast infections as a female problem, yeast is an organism that can colonize any orifice. In the mouth it is known as thrush. In the digestive tract it is often called a yeast overgrowth, or simply candida. These do not have to occur together. However, they are essentially the same problem. Have you had to deal with Candida? Share your thoughts in our comment section!

What are the symptoms of Candida?

Yeast can cause a large number of symptoms, including all of those of irritable bowel syndrome – gas, bloating, constipation, diarrhea, and abdominal pain.

How do you get Candida?

Candida are a normal part of the environment. However, a problem occurs when they get out of balance with the normal good bacteria found in your digestive tract. Then they can develop into an overgrowth of yeast in the digestive tract and cause problems there as well as elsewhere in your body.

Why does this happen?

One of the most common things that cause yeast to get out of control is the use of antibiotics. There are other causes too, but antibiotics provide an excellent case study. Antibiotics kill bacteria, but they do not kill Candida or yeast. Only antifungals kill yeast. Therefore taking antibiotics kills off bacteria that are in direct competition with yeast for territory in your digestive tract. This is similar to any other battlefield. Everyone wants territory. In this scenario yeast can flourish, potentially creating an environment where there is more yeast than is desirable.

What other symptoms can Candida cause?

People with Candida or an overgrowth of yeast often describe having symptoms such as fatigue, brain fog, and headaches, to name a few. This does not necessarily mean that they have yeast throughout their body. That is highly unlikely and is an extremely dangerous condition. However, the yeast in their digestive tract can create toxins that affect the rest of the body.

How do you test for Candida?



Bad bacteria. (image thanks to purevidanutrition.blogspot)

What makes a bad bacteria bad? The worst bacteria (the ugly) either directly destroy tissue by feeding upon it or produce a toxin that destroys tissue. Other bacteria (the bad) react negatively to food, or are poor fermenters of food, creating IBS symptoms like gas and diarrhea. And some species of yeast and bacteria are bad simply because they take up space, thereby crowding out the good bacteria and depriving your body of all the health-giving benefits that friendly bacteria provide, resulting in the poor digestion of food and the poor absorption of nutrients.

The ugly bacteria are never regarded as normal flora within the body. They are not usually considered to be causes of IBS, but they do cause severe, often life-threatening, conditions. Ugly bacteria include Salmonella, Shigella, Yersinia, Vibrio cholerae, Campylobacter, and certain strains of E. coli. Just a tiny amount of the most virulent strains of bacteria in a person’s body is enough to begin the process of infestation. The symptoms of these bacterial infections usually include severe watery diarrhea, which is often bloody. Some cause vomiting, muscular cramps, dehydration, and permanent intestinal damage. If untreated, they may even cause death. In short, they are nothing to fool around with. Luckily, the medical community is generally good at identifying and treating these kinds of bacterial infestations.

Less dangerous, but still unwelcome, are the bad bacteria, which include the Enterobacteriaceae family of Citrobacter, Enterobacter, Klebsiella, Proteus, and Serratia, as well as Clostridium difficile and Pseudomonas. At very low populations, these bacteria may be considered normal flora in the intestinal tract. However, being normal doesn’t make them good. Each has been documented as causing IBS-type symptoms, and they often need to be eliminated.

Unfortunately most doctors rarely test for them, since the symptoms they cause are usually not immediately dangerous. But, if a bad bacteria has managed to increase its population and gain territory in your intestinal tract, you may experience gas, bloating, abdominal pain, or loose stools. You’re probably not dying, but you are very uncomfortable.

You may be surprised to learn that another bacteria considered normal flora is one strain of E. coli. Due to some recent well-publicized cases of E. coli infestation, the name itself now seems scary. Some types of E. coli are scary, but the strain of E. coli normally found in the intestines is not the toxic strain that causes bloody diarrhea and other symptoms. In fact, we all have E. coli living in our intestines.

Image thanks to purevidanutrition