Inflammation
Inflammation is a hot topic in research these days and it now appears that chronic, low-grade inflammation of the inner lining of the intestines is involved in the disease process of IBS.
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Find out what inflammation actually is and how it could be involved in the disease process of IBS, plus lots of different management strategies!
Find out more about the connection between inflammation and IBS...
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What is Inflammation?
Inflammation is your immune system's response to irritating, harmful or foreign stimuli. It's your body's way of recognizing and removing them and beginning the healing process.
This process causes many different substances to be released in your body, including hormones that irritate the nerves and cause pain signals to be sent to the brain. This is actually meant to help you, because if the inflammation hurts you will tend to protect the affected part of your body.
Inflammation can be acute or chronic. Acute starts rapidly, becomes severe in a short time and symptoms last for a few days. This type of inflammation is necessary to defend against bad bugs or to heal an injury, but it must be well controlled and finally resolved. If the inflammation isn't resolved it becomes chronic, lasting for several months or even years.​​​
Chronic Inflammation
Chronic inflammation can lead to tissue damage and inflammatory diseases. In fact, it underlies many of the big ones, ​including strokes, chronic respiratory diseases, heart disorders, cancer, obesity, inflammatory bowel disease (IBD), arthritis and diabetes. Connections are now being made between inflammation and neurological disorders like depression, Alzheimer’s and Parkinson’s disease.
Doing what you can to ease inflammation may not only help your IBS symptoms, it could also lessen the risk of other chronic diseases.
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This is an evolving topic and the processes of chronic inflammation are not completely understood, but exciting new research is high lighting communication between the gut, the brain and the microbiome. Sound familiar?
Inflammation and IBS
It now appears that chronic, low-grade inflammation of the inner lining of intestines is involved in the disease process of IBS. In the past tests were not sensitive enough to detect this low level of inflammation, as it can only be seen at a microscopic level.
The low-grade inflammation associated with IBS is different from the higher level of chronic inflammation of the gut and colon found in people with inflammatory bowel disease (IBD), although some overlap appears to exist between the two conditions.​​​
The Gut/Brain Axis
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IBS is a disorder of gut brain interaction. Things that get in the way of good communication between the gut and the brain or things that happen in the body as a result of bad communication between the gut and the brain could cause your IBS symptoms or make them worse.
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There are a number of ways that inflammation is linked to other drivers of IBS symptoms involved in communication between the gut and the brain. As per usual, everything is connected!
The Immune System
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Much of the communication between the gut and the brain happens through the the chemical messengers of the immune system. In fact, the majority of your body’s immune cells are found around the gut, since the digestive tract is constantly receiving substances from outside the body that could contain harmful bugs.
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​​If the cells that line your intestines receive inflammatory triggers, like damage to the tissue or aggressive bad bugs, this creates an inflammatory environment in the intestines. This can cause many other effects in your body, including the functioning of your central nervous system.
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​Normally your immune system would deal with the trigger and it's pro-inflammatory responses would stop, but your intestines are particularly susceptible to the development of chronic inflammation. They are constantly exposed to microbes (100 trillion bacteria, plus fungi and viruses!) that could continue to cause an inflammatory response if the relationship between your immune system and your microbiota is out of whack.
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Inflammation may be at the root of IBS caused by infection or other disturbances to the intestines or it may occur as a result of imbalances somewhere else in your body, like the gut microbiome or a dysfunctional stress response.
Intestinal Permeability
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If something is permeable, it will allow liquids and gasses to pass through it. Your gut is semi-permeable. The mucous lining of your intestines is designed to absorb water and nutrients from your food into your bloodstream, while keeping out everything else that doesn't belong.
Part of your immune system's inflammatory response to damage in the intestines is to make the cells lining the intestines more permeable. This allows more immune cells to get to the sight of infection or injury more quickly. But it could also allow undesirable things into your bloodstream that may cause pro-inflammatory responses in other part of the body.
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Immune cells that live in the gut walls then try to deal with these invaders, which can cause further inflammation in the gut walls. The immune cells also start to secrete large amounts of signal substances that make their way to the brain. This alerts the brain that something is up and could be felt as painful sensations in the gut.​
Gut Dysbiosis
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Dysbiosis occurs when the bacteria in your gut are out of whack. Perhaps there are too much of one type and not enough of another, or good bacteria die off allowing bad bacteria to move in and take over. It appears that people living with IBS have fewer different kinds and more unstable gut bacteria than people without IBS.
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Even low levels of inflammation can significantly affect the bacteria in your gut. Under inflammatory conditions, fewer types of bacteria want to live there and the bacteria that do typically do more harm than good. These bad bacteria have been shown to be pro-inflammatory, which increases the probability of continuing pro-inflammatory immune responses in the intestines, which in turn negatively affects the gut microbiome. And so on, ultimately perpetuating low-grade chronic inflammation.
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Gut microbes produce or help produce neurotransmitters and hormones that convey messages between your gut and brain. Dysbiosis and inflammation of the gut have been linked to several illnesses, including anxiety and depression,
The Nervous System
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Immune cells are also in direct communication with neurons. Inflammation in your intestines is communicated to your enteric nervous system (your gut brain), which may then send inflammatory signals to your central nervous system via the vagus nerve. The vagus nerve is an essential part of the gut/brain axis and plays an important role in the regulation of inflammation.
​Inflammation could also come from the top, as psychological stress could make gut inflammation worse by modifying neurons in your gut brain. Anxiety and mood disorders are risk factors for IBS and research is showing that anxiety and depression are linked to inflammation in the brain and in the gut.
The Neuroendocrine System
The Hypothalamic Pituitary Adrenal (HPA) Axis
The main function of your HPA axis is to release cortisol (a glucocorticoid, or steroid hormone) through a chain reaction of hormones. This kicks off short-term bodily changes that allow you to respond to stress. It does this in response to signals from your autonomic nervous system.
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The HPA axis is meant to have a fine-tuned negative feedback loop. The cortisol in your body actually tells your hypothalamus to stop sending stress hormones, ending the stress response. But experiencing frequent or intense stress or not managing your stress can cause dysfunction with your HPA axis.
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This dysfunction could lead to lots of problems, including increased inflammation throughout your body and mood and anxiety disorders.​
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​HPA axis activation is also able to affect the composition of the gut microbiota and increase gastrointestinal permeability.
Serotonin
Serotonin is a neurotransmitter that can act like a hormone. It can influence many things your gut, including the immune system and inflammation, motility and visceral sensitivity, and in your brain, including anxiety and depression.
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Emerging evidence suggests that a particular form of serotonin may be crucial for communication between your body, microbiota and environmental factors like diet. It may also be involved in the process of chronic intestinal inflammation.
Histamine
Histamine is also a neurotransmitter that can act like a hormone. In the gut it can affect many things, including inflammation, motility and your pain response.
Normally histamine sends its message to the gut and then gets cleared away. Research is showing that people with IBS might not have enough of the enzyme that gets rid of the histamine. This build up could be the cause of abnormal inflammation and pain.
Management Strategies
The good news is that the management strategies for easing inflammation are very similar to most management strategies for IBS and for overall good health in general. Which actually makes sense, since inflammation underlies so many chronic diseases as well as IBS.
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In this section you'll find out why a particular strategy could ease inflammation, as well as some links to other sections for practical tips.
Stress and Inflammation
Stress is a broad concept that includes challenging or difficult circumstances (stressors) or the physiological or psychological response to such circumstances (stress responses). One of the systems that responds to challenging circumstances is the immune system.
Stress can activate an inflammatory response in your brain or other parts of your body. If the source of stress is not dealt with, then inflammation could become chronic. More and more evidence is showing that stress-induced chronic low-grade inflammation is linked to a wide variety of chronic diseases. The gut may be particularly affected by stress via the gut/brain axis.
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Poorly managed stress can negatively affect other drivers of chronic inflammation as well, including intestinal permeability, the gut microbiome and the nervous system.​​​​​​
Stress Management
Psychosocial Therapy
Psychosocial therapies are classified as mental health interventions, including different forms of psychotherapy and support groups.
Studies have shown associations between the functioning of the immune system and psychosocial factors such as life stress, negative emotions, and social support. Studies have also shown that psychosocial interventions can significantly reduce inflammation and enhance beneficial immune system function.
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Mental health is health and nothing is ever "just in your head". The mind-body connection is a two-way relationship where the mind influences the body, and the body influences the mind. If you need more than the stress management strategies above, check out some other options.​
Psychosocial Therapy
Diet and Inflammation
Diet can affect inflammation in a number of ways, including influencing your body's immune response and the bacteria in your gut.
There is no specific anti-inflammatory diet, but researchers have identified certain foods and eating patterns that can increase or help to control inflammation. ​
Food to Ease Inflammation
Exercise and Inflammation
Research is showing that regular exercise is anti-inflammatory, especially the kind that gets your heart and lungs working like brisk walking.
But researchers are still trying to find out why. Exercise actually works as a stressor, both during and after, and it can cause acute inflammation. But it appears that once the acute inflammation is resolved, exercise creates an anti-inflammatory environment in your body. These effects may also be caused by a reduction in visceral fat (around your organs) which contains substances that can promote inflammation.
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Moderate exercise or vigorous exercise with appropriate resting periods seems to be the best for fighting inflammation. Intense, long exercise seems more likely to lead to higher levels of inflammation.​
Get Moving for IBS
Sleep and Inflammation
Sleep deprivation is a condition that occurs when you don't get enough sleep, or enough good quality sleep. Research has found that sleep deprivation is associated with markers of inflammation and proper sleep reduces inflammation.
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There may be a number of reasons for this association and research is ongoing. One theory focuses on blood pressure. During sleep, blood pressure drops and blood vessels relax. When sleep is restricted, blood pressure doesn't decline as it should, which could trigger cells in blood vessel walls that activate inflammation. Not enough sleep might also affect the body's stress response system. Other research shows that disrupted sleep can impact immune stem cells, causing them to over produce immune cells. This overreaction can lead to inflammation.
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​​Unfortunately poor sleep and inflammation (and the pain that often goes with it) can create a vicious cycle. When you’re not sleeping well, getting adequate REM sleep, and waking up refreshed, your inflammation is harder to manage, and you may feel more pain, stress, and anxiety. This may make it harder to fall asleep the next night, and so on.
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Managing stress, a better diet and exercise could all contribute to a better sleep, so check out the above sections. For more on sleep follow the link below.
Sleep Hygiene
The Gut Microbiome and Inflammation
Inflammation in your body can promote an inflammatory environment in your gut microbiome and dysbiosis can lead to inflammation in your gut and the rest of your body. So it's important to do what you can to keep your microbes happy.
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Your gut microbiota can be affected by many things. Everything is connected, so you will find some links to strategies above. Unmanaged stress and diet can have a huge impact. Moderate exercise has been shown to have positive effects. Sleep can have an effect on the gut microbiome and vice versa.
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For more on the gut microbiome, check out the following section.
The Gut Microbiome
Weight Management and Inflammation
Obesity is a complex disease associated with an increase in several markers of inflammation, leading to low-grade chronic inflammation. Adipose tissue (white body fat) is not only for energy storage. It also contain hormones and many different types of immune cells. Obesity causes some of these immune cells to release pro-inflammatory substances.
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I'm a weight neutral dietitian, so you won't find anything on this site about losing weight. But I do believe in trying your best to have a healthy life. Focusing on weight often leads to stress and unhealthy behaviours. Instead, try some strategies that will improve your overall health and help you find your healthy weight.
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Since everything is connected, you'll find links to some strategies above. Stress can impact weight in many different ways. Moderate exercise helps to balance energy intake. Good sleep habits can help, as there is an association between sleep loss and obesity. Gut dysbiosis could alter production of certain neurotransmitters involved with hunger feelings and energy balance, leading to overeating and weight gain.
Food and drink are also important, but how you eat may be as important as what you eat. For more on healthy eating, energy balance and mindful and eating, check out the following sections.
Tips for Healthy Eating
Mindful and Intuitive Eating
Alcohol and Inflammation
Alcohol, especially if it's consumed regularly and in larger amounts, can cause inflammation in your intestines that can lead to inflammation throughout your body.
​​Many interconnected mechanisms are at play, including changing the composition and function of the gut bacteria, increasing intestinal permeability and negatively affecting the functioning of the immune system, both inside and outside the GI tract.
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Alcohol is also a gut irritant, so cutting down could be a good option.
Smoking and Inflammation
Smoking may cause whole body inflammation in a number of ways, including via the gut microbiome.
Research is showing that chronic cigarette smoking could lead to dysbiosis, increasing inflammation in the body by creating an environment favouring pro-inflammatory bacteria.
One more reason to try to quit!​​