People with obesity struggle to lose weight, more so if they have associated medical or psychiatric/psychological problems. Here we discuss a common medical condition, which is Irritable Bowel Syndrome (IBS) and a very common mental health problem, depression which has an impact on body weight. Having one or both these conditions makes it difficult to lose weight. We also discuss the relationship between IBS and depression.
IBS and depression
Irritable bowel syndrome (IBS) and depression are very often discussed separately and rarely seen by us as coexisting conditions. When we think of irritable bowel syndrome we very often perceive it as a condition that exclusively affects the digestive system. We know that it appears as a range of purely physical symptoms. But we don’t often realise that it can also trigger the psychological aspects of our wellbeing and influence our emotions and feelings. It can have a huge impact on our mental state and is very often related to serious problems like depression.
Depression is a mental health condition that is associated with a persistent low mood, loss of interest or enjoyment or even aversion to activity. Other symptoms may also occur simultaneously and affect our quality of life and the ability to function and derive pleasure from life. It impacts our mood, thought, emotions, behaviour and motivation. It can also alter our appetite, sleeping pattern or the ability to concentrate and perform effective work. Thoughts of sadness, hopelessness, guilt, pessimism, dejection or even suicidal ideation may occur.
Depression is the most frequent mental health disorder diagnosed in patients with IBS. Research suggests that depression rates are higher amongst people with IBS than healthy people. Patients who struggle with IBS very often mention that depression affects their daily functioning as well as their thoughts, feelings and behaviours. They often suffer from the unpredictability of the symptoms especially in social situations. They also describe a feeling of loss of freedom or even fear and embarrassment with IBS and depression.
The chicken or the egg
The question very often is, which comes first and causes the other disorder to develop. Unfortunately, this is not such a simple case and this relation can work both ways. Some suggest that having IBS can lead to the development of anxiety and depression although the opposite can also be true. People with higher anxiety and depression can be at increased risk of IBS. These two conditions seem to go together. Sometimes, one condition can make the other one worse.
The correlation between IBS and depression
Take stress as an example. We can experience stress via many different feelings and emotions. But for some, stress can manifest as physical symptoms such as abdominal pain/cramps or nausea. Stress is one of the causes of IBS. Sometimes, low mood may affect the way we manage IBS symptoms and we might feel hopeless and discouraged to change our diet to alleviate the symptoms.
On the other hand, IBS can cause distress. Imagine having to deal with persistent symptoms and problems like pain, bloating, diarrhoea or similar. Imagine being worried about those symptoms all the time, having to plan your activities around them to try to avoid discomfort or embarrassment. This can affect work, school or other social situations. As a result, you may experience feelings of isolation and loss of interest in activities that you once enjoyed. You may feel restless or irritable. All of these are symptoms of depression.
People with IBS suffer from anxiety related to their gastrointestinal (GI) symptoms, and this anxiety can again worsen the IBS symptoms. Hence people struggle to overcome IBS as anxiety, depression and IBS develop into a vicious cycle.
Biological aspects
Research indicates that there is a mutual relation between our gut and brain. The neurotransmitter serotonin is important for the proper functioning of both. Serotonin plays a role in the functioning of the digestive system and is also very important for its communication with the brain. Researchers link low serotonin levels with depression.
Approximately 90% of serotonin is found in the enteric (intestinal) nervous system in our gastrointestinal tract, where it regulates intestinal movements. However, the central nervous system can also produce it. Now, if our gut’s cells and ecosystem get damaged by, for example, antibiotics, stress, sugar or toxins, serotonin will not be produced effectively. The functioning of our gastrointestinal system and the communication between the neurones in the gut and the brain will be disturbed. This may be why gastrointestinal symptoms and psychological symptoms occur simultaneously in IBS.
Obesity, IBS and Depression
People with IBS are sensitive to a number of food items, fruits, vegetables and may end up having energy dense snacks. As they struggle with bloating and indigestion they tend to avoid eating at normal meal times. This in turn may alter their hunger pattern and lead to craving for high calorie snacks, which they can tolerate.
Similarly people with depression have altered hunger pattern. In addition the antidepressants they have can increase appetite and lead to weight gain and lead to obesity.
Treatment of IBS and depression
How can we deal with such a complex problem?
There are a few ways that can help to manage IBS and depression and thereby prevent weight gain.
Balanced diet
It is important to stick to a balanced meal with increased intake of fermentable fibres to maintain the beneficial gut bacteria. Such fibres are present in leek, garlic, onion, asparagus, chicory, artichoke, wheat, oats, bananas or soybeans. It would also be helpful to limit intake of highly processed foods that are high in saturated fat, sugar and salt, as well as steering clear from artificial sweeteners. These can alter gut bacteria in a negative way and contribute to imbalance in blood sugar levels. Additionally, eat plenty of vegetables and fruits, wholegrain bread and legumes. Try to include nuts, lean meats, fish, chicken and dairy products in your diet.
Probiotics
A balanced population of the ‘good’ bacteria is necessary to keep our digestive system healthy. However, disturbances in this balance can lead to the ‘bad’ bacteria taking over and affecting our physical health and mental wellbeing. Probiotics are helpful live bacteria that we can find in fermented foods such as yoghurt, kefir or aged cheeses. These can positively affect the gut and subsequently the production of serotonin, helping with IBS and depression symptoms at the same time.
Anti-depressants
Healthcare professionals often prescribe these to people who struggle with IBS. They can help to minimise symptoms of anxiety and depression but they also have a beneficial effect on pain and gut functioning. This may be due to the effect of this kind of medication on serotonin and other neurotransmitters. Even people with IBS who don’t suffer from depression or anxiety can find antidepressant medication effective as it can help alter the way, in which brain processes pain.
Cognitive behavioural therapy (CBT)
CBT can help to alleviate the symptoms and improve the coping strategies for depression and IBS. Psychological therapies are often recommended as the first-line intervention for IBS for people with present or past experiences of anxiety or depression. It also teaches you how to recognise negative thoughts and feelings, and replace them with positive ones.
Relaxation techniques and exercise:
These can reduce stress and positively affect the IBS symptoms.
Regular exercise and the right amount of sleep can also be helpful in recovering from depression.
As we can see, there are many ways to manage IBS and depression. It is crucial to talk with your doctor to diagnose your problem and learn what the best options would be for you.
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