I was diagnosed with Irritable Bowel Syndrome (IBS) in 2008. I went to two Gastroenterologists at the time, and over the years, I occasionally saw other gastroenterologists in multiple states.
Throughout this time, depression and anxiety began to worsen, but I did not realize until multiple years in that it was a problem. My family saw a change, but placed all blame on another rough personal experience I had around the same time the digestive issues began.
I probably saw at least 5-7 gastrointestinal (GI) doctors because I moved around a lot in my 20s. I still do, which is why telehealth works well for me, and the care I give to my clients now is the same high quality of care I gave when I started my business in person, because what I do never required hands-on or invasive analysis or techniques.
But through seeing all of those GI doctors, not one of them ever mentioned a correlation between IBS and mood instability, such as irritability, anxiety and depression. IBS is what inspired me to become a Naturopathic doctor. Naturopathic medicine has known for several decades that the mind and the gut are connected. Further explanation can be found in the following excerpt from an article titled, "Irritable Bowel Syndrome: Epidemiology, diagnosis and treatment: An update for health-care practitioners," from the Journal of Gastroenterology and Hepatology, published in 2010:
"The slow onset of IBS over weeks and months shows a strong correlation with stress disorders such as depression and anxiety...Diagnosis with consideration of stress disorders and explanation to the patient about the relationship between altered central nervous system (CNS) signaling and IBS development may aid in establishing positive health-care provider–patient rapport with consistently better clinical outcomes...The limbic system in conjunction with paralimbic structures connects the gut with the CNS through the autonomic nervous system in a bidirectional way. This allows transmission of emotional states from the CNS to the gut and perception of GI changes (pain, contractions, bloating) to the CNS. Independent of afferent connections from the CNS, the gut is able to release the neurotransmitters serotonin and acetylcholine as part of the enteric nervous system (ENS). The main neurotransmitter that regulates GI motility is serotonin (5-HT), which is released from enterochromaffin cells in the GI mucosa to stimulate acetylcholine release that initiates GI motility. The primary serotonin receptors involved in ENS transmissions are the 5-HT3 and 5-HT4 receptors, each with specific distribution patterns. While 5-HT3 receptors signal changes in intestinal motility to the ENS and serve as the main neurotransmitter for efferent nerves connecting to the CNS, 5-HT4 receptors are exclusively presynaptic and therefore serve as interneurons to transmit a signal to effector acetylcholine neurons. Serotonin signaling is terminated by a specific serotonin reuptake transporter (SERT) located on enterocytes within the intestinal mucosa. It has been shown that a decrease in SERT consistently leads to dysfunction of GI motility in animals and in humans through increased serotonin concentrations. Elevated serotonin concentrations then constantly stimulate 5-HT3 and 5-HT4 receptors leading to dysregulated contractions and dilations of the intestinal tract. Attenuation of this signaling cascade is employed for treatment of IBS and various other GI disorders."
Serotonin is a hormone and neurotransmitter that helps keep your mood stable. In addition to diet, stress management, exercise, and medications specifically for the GI tract, doctors may also prescribe anti-depressant medications to help with the mood instability.
As I mentioned, I was diagnosed in 2008. This article came out in 2010. This information was probably circulating amongst GI docs before 2010, and certainly was after. I saw GI docs before and after 2010. Reading the date of this article was very disturbing for me, because not one GI doc ever told me that my mood could be affected by IBS.
I as a Naturopathic doctor now focus on Prevention, Gastrointestinal disorders and Chronic Kidney disease. Through hearing the stories of individuals with kidney disease, a similar but more threatening-to-quality-of-life situation is occurring. The doctors are not being upfront with patients about how their kidney function is doing until they are at the point of stage 4 or 5 kidney disease and needing dialysis. Yes there are 5 stages, so that means from stages 1-3, doctors are not being upfront, or instead they are often saying things like 'It's not that bad.' This is why I am now an educational advocate for teaching people how to monitor their own kidney function through my E-book.
A separate notion that the medical field has about IBS is that it is not associated with inflammation, like Crohn's and Ulcerative Colitis which fit into the category of Inflammatory Bowel Disorders (IBD). The bloodwork and anatomical features customarily associated with inflammation are not found in IBS. Thus, the medical field confidently says it is not associated with inflammation. Through my personal experience, anything I used to reduce inflammation in my body over the years helped to reduce IBS symptoms. This does not signify that inflammation is the root of IBS or the ultimate solution for IBS, but just a component to not disregard because the science of 'today' does not have a mechanism to show it.
All of this to say, if you or someone you know has IBS, be aware that mood instability can be associated. I see it all the time with my clients with digestive disorders, and I saw it in myself. I was fortunate enough to track emotional symptom onset occurring shortly after I ate something my body did not agree with, and I teach my clients how to do the same, among many other strategies to help them feel much better and more in control of their digestive system than when they started to see me.
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