Addressing underlying hormonal imbalances could be the answer to IBS, says Marcelle Pick
When Caitlin came to see me, she was frustrated. Almost every day she dealt with gas, bloating, pain and cramping in her abdominal region. She never knew whether she would wake up with diarrhea or be completely unable to have a bowel movement.
“It’s not just the pain,” she told me. “It’s the roller coaster.”
She described how on certain days she felt fine—but that made waking up the next day with painful constipation almost more upsetting.
Caitlin had spoken with her physician several times about these uncomfortable symptoms and the way they seemed to be ruling her life. Her doctor had done a number of tests to rule out serious health conditions, and when they came up empty, he had finally diagnosed her with irritable bowel syndrome (IBS).
But what did that really mean?
He offered her a few medication options to manage the symptoms but no real guidance about how to find or eliminate the underlying root cause. He seemed to be telling her she just had to learn to live with it.
Caitlin isn’t the first client to come to me because the only solutions they’ve been offered are to take medications and learn to manage their symptoms. But that simply wasn’t good enough for her. She knew there had to be something behind the problem, and she wasn’t willing to endure these symptoms for the rest of her life. And she shouldn’t have to!
I asked Caitlin a lot of questions that she hadn’t been asked before, including about her stress levels—and whether she’d had her hormone levels tested recently. That’s because I know there’s an important (and often overlooked) connection between hormonal balance and symptoms of IBS.
Irritable bowel syndrome is a common health issue impacting approximately 15 percent of Americans and 20 percent of people in the UK. Its usual symptoms are exactly what Caitlin was experiencing: belly pain, cramping, gas, bloating and changes in the stool.
There are three types of IBS. With the first, you may have frequent loose stools, an urgent need to move the bowels and frequent cramps/pain. With the second, you may be constipated, have infrequent bowel movements and feel the urge to go but be unable to do so.
The third type, which Caitlin was diagnosed with, is a combination of the other two—alternating between diarrhea and constipation.
Increasingly, we’re also learning that IBS may lead to other, non-digestive symptoms. Research has shown that anxiety and depression are significantly more common in those with IBS than in those without,1 and many people with IBS also experience symptoms like fatigue.
Even though IBS doesn’t necessarily cause lasting harm to body systems on its own, it can take quite a toll on your physical and emotional health as well as on your social life. That’s why it’s important to talk to a healthcare professional if these symptoms linger for several weeks or months.
Irritable bowel syndrome is a diagnosis of exclusion. That means there isn’t a specific test that will confirm you have IBS. Instead doctors use testing, such as blood tests, stool tests, colonoscopy or endoscopy, to rule out other conditions, like infection or more serious disease. When no other conditions are found, your doctor may determine that you have IBS.
There is no single identifiable cause of IBS. In fact, it’s probably a combination of factors that impacts how your GI tract is functioning. These might include abnormal muscle contraction in the GI tract, hypersensitive nerves attached to the GI tract, and problems in the communication between the brain and the gut.2
The relationship between hormonal balance and digestive function is another essential one to consider—and one I wish more practitioners would dig into.
Women are twice as likely as men to be diagnosed with IBS, and often they experience flare-ups of IBS during their menstrual cycles. Here’s how different types of hormones can impact IBS.
Sex hormones. Research shows that there is a connection between symptoms of IBS and the balance of estrogen and progesterone.
In a review of literature in 2009, the authors concluded that GI symptoms that increased around the time of menses and early menopause happened when ovarian hormones were low or declining, suggesting that lower levels of estrogen or progesterone can impact symptoms of IBS.3
In a 2014 article in the World Journal of Gastroenterology, the authors concluded that clinical and experimental data strongly supports the idea that sex hormones play a key role in regulating the brain-gut-microbiota axis involved in IBS. They also reported that sudden changes in estrogen levels and complex interactions with neurotransmitters affected sensitivity to gut pain more than hormone levels alone.
The study finally concluded that androgens, male sex hormones such as testosterone, might play a protective role in modulating pain. It suggested testosterone has anti-inflammatory properties that could slow or stop greater sensitivity to gut pain from developing.4 This could explain why women are more susceptible to IBS than men.
Imbalanced sex hormones can also change the way your food moves through your digestive system. Hormones affect the speed of digestion and the severity of IBS symptoms, particularly at different times in the menstrual cycle and in different stages of life, such as pregnancy and menopause. This could help to explain the constipation that many women with IBS experience.
When estrogen decreases, pain can become more intense because estrogen raises the production of serotonin, a chemical in your brain associated with feeling good. That means a higher level of estrogen may reduce the pain you feel.
Imbalanced sex hormones can contribute to inflammation, too, which often makes symptoms worse.
More research is needed to really understand the way sex hormones and IBS are connected, but there is enough evidence available to indicate that balancing these hormones can decrease the associated symptoms to some extent.
Stress hormones. Stress is connected to almost any health condition in one way or another. We’ve learned so much about the impact of chronic stress on our bodies, and it’s clear that stress reduction is one of the most important steps we can take toward better health.
Anxiety, depression and increased stress are all known risk factors for developing IBS. And this stress doesn’t even have to be current. Some studies have shown that childhood abuse or stressors from many years prior also predispose people to developing IBS later in life.5
IBS patients report many more negative events in their lives than patients with other stress-induced conditions, like peptic ulcers. In two-thirds of IBS patients, mental illness episodes or situations that cause anxiety precede or exacerbate symptoms.6
In one study, individuals with IBS tended to wake up with a higher cortisol/DHEA ratio than those without IBS, and it was highest when they were under prolonged stress. The authors concluded that the “cortisol effect” may be dominant in individuals with IBS who deal with chronic stress.7
Cortisol levels also have an impact on other hormones, as they are all interconnected.
Gut hormones. Gut peptides, or chains of amino acids, contribute to proper regulation of gastrointestinal functioning, but not much is known about how gut hormones are secreted in patients with IBS.
A study in 2008 evaluated concentrations of several peptides in 40 patients with IBS and 15 control patients. It found that levels of some peptides were higher in patients with IBS, while others were significantly lower. The changes in these peptide levels could play a role in the manifestation of IBS.8
The gut-brain connection—similarities in the nervous systems of the brain and the gut and communication between them—is well established. The gut manufactures 95 percent of the serotonin in our bodies. The main role of serotonin in the gut is to stimulate movement and contraction of the intestines. Foods that cause a serotonin spike (often refined carbs) may also trigger an IBS episode.
The relationship between the gut and the brain is complex but worth considering when thinking about IBS.
With the hormonal connections that exist, it makes sense that keeping all the essential hormones in your body balanced can help reduce symptoms of IBS.
Drug treatments simply mask symptoms, so while they might make you feel better temporarily, they’ll do nothing to prevent symptoms from returning. Healing the underlying causes will go much further in improving your quality of life.
Here are some tips for creating natural balance and healing.
Eat well. One of the best ways to keep hormones well balanced and keep uncomfortable symptoms at bay is to make your diet as balanced and nutritious as possible. That means avoiding processed foods, excess caffeine, alcohol, sugar and trans fats as often as possible.
A healthy diet is not a boring diet, though. Fresh organic produce is delicious and filled with all the nutrients your body needs. Eating a wide variety of fruits and vegetables is important; that’s why I always tell clients to “eat the rainbow.”
Lean protein, healthy fats and fiber are also important components of a healthy diet.
Because IBS symptoms often crop up after meals, you should pay close attention to what you’re eating that triggers these symptoms. Try keeping a food journal for a week before changing your diet so you can identify any hidden food sensitivities.
Finally, don’t forget to stay well hydrated. Water, herbal tea (both hot and cold) and seltzer are all good choices. Try to avoid caffeinated beverages and sugary drinks as often as possible.
Manage stress. Stress has a huge impact on hormonal balance,9 so it’s essential to find ways to reduce stressors and relax, especially if you’re experiencing uncomfortable symptoms. Multiple factors will help reduce stress levels, and each one matters.
It’s always important to address emotional issues, especially those that have lingered for a long time. Practicing mindfulness and learning to be present in each moment can help you let go of old hurts.
Spending time outside is a great way to relieve stress. Even a quick walk around the block can give you a new perspective. Self-care is nonnegotiable if you want to feel your best.
Whatever your needs are, it’s critical that you know them and tend to them, giving yourself the same attention you give to everyone else.
Finding an activity that you love, that allows you to forget everything else while you’re doing it, can work wonders. For me, that’s dancing, but it’s different for everyone. It isn’t what you do that matters—it’s the joy you feel while doing it that makes a difference.
Take time to breathe deliberately. There are many methods you can try and apps that will walk you through breathing techniques. Learning to breathe deeply and fully will calm your nervous system and let stress slip away.
Exercise. Keeping your body moving will help keep all its systems functioning well, but there’s no need to overdo it. Trying to squeeze hours of exercise into an already crowded life just causes more stress.
Even small doses of regular exercise, such as five or 10 minutes of stretching when you wake up or 20 minutes for a brisk walk around the neighborhood at midday, can make a big difference in your hormonal balance.
Try supplements. Because it’s tricky to get all the nutrients you need no matter how healthy you’re eating, I always recommend a high-quality daily multivitamin.
I also think a probiotic can aid everyone in maintaining good balance in the gut.
Other targeted supplements can be helpful depending on your unique situation. It’s best to work with a functional medicine practitioner to devise a plan that will work for you.
Don’t let IBS rule your life—you have more control than you think. Taking steps to address the underlying hormonal imbalances tied to IBS can help you get back to all the activities you once enjoyed.
Remember Caitlin? When she spent some time working on hormonal balance, her symptoms subsided—and they haven’t returned. That’s because she now understands how much her lifestyle choices impact her health.
Now, she doesn’t have to hold back. She’s back to all the activities she used to love, including long hikes in the woods. You can take your life back as well.
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