IBS, Chronic Fatigue Syndrome, and Mental Health: The Common Link- Part 1

The Complex Relationship Between IBS and Chronic Fatigue Syndrome

Have you ever wondered what the link is between Irritable Bowel Syndrome (IBS), Chronic Fatigue Syndrome (CFS), and mental health? This 3 part series starts with a brief overview of each condition, its symptoms, and how it's diagnosed. 

What Is IBS?

IBS is a common gastrointestinal disorder characterized by many symptoms that can significantly interfere with one's ability to function in everyday life. It can be classified as IBS with diarrhea predominantly, IBS with constipation predominantly, or a combination of both. 

It is estimated that IBS impacts around 10-15% of people worldwide, and up to one-third of these individuals also experience a mental health condition such as depression or anxiety. One study found that 39% of individuals diagnosed with IBS experienced anxiety, and 29% experienced depression. This brings us back to the well-known gut-brain connection, which we will explore in part 3.

What Is It Like To Live With IBS?

Mornings may start with abdominal pain, nausea, and a desire to eat but feeling unable to eat. If you do eat, it may lead to a trip to the bathroom for the first time. Abdominal pain may still linger, nausea may still linger- breakfast is done. 

You may perk up around midday and find it productive, try to get work done, maybe exercise, or catch up with a friend. You need to pace yourself, as pushing too much too fast can leave you tired and unable to move. 

Many people with IBS suffer from social isolation and fear of going out. Always needing to know where all the bathrooms are in case they need to dip out quickly due to unpredictable bowel movements. Other symptoms such as abdominal pain, bloating, or constipation have others feeling sick and not in the mood to socialize. It can be mentally exhausting, and the stress and anxiety add to the gut-brain disruption and worsen symptoms. 

This can affect the ability to hold a job and perform simple daily activities, leading to social isolation, depression, and even suicide.  

How Is IBS Diagnosed?

Providers typically diagnose IBS by excluding other potential causes when symptoms are present without a clear explanation. This means structurally, the gastrointestinal (GI) tract is normal; however, something is causing a disruption leading to IBS symptoms.

The diagnosis is made by asking a series of questions to assess symptoms fully, and providers utilize the Rome Criteria. This asks a few questions and assesses for symptoms that include abdominal pain or discomfort for at least three months, having a change in frequency or consistency of stools, and pain/discomfort related to moving bowels. I recommend finding a GI or holistic provider to help make this diagnosis if you are dealing with any of these symptoms.

Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)

According to the Institute of Medicine (IOM), ME/CFS is described as a condition marked by severe fatigue, cognitive issues, sleep disruptions, autonomic symptoms, pain, and various other symptoms that worsen with any form of exertion, significantly limiting patients' ability to lead their regular lives.

While this condition needs to be better understood, it is estimated that ME/CFS affects around 2.5 million Americans; however, many individuals remain underdiagnosed as many clinicians either do not think the condition exists or do not know how to go about diagnosing or treating it. Women are more affected than men, and children can be affected as well.  

Symptoms mainly include unrelenting fatigue that does not improve with rest. People with ME/CFS often experience extreme fatigue after physical or mental exertion, cognitive impairment (called "brain fog"), and sleep disturbances. Ongoing research regarding ME has suspected potential causes, including but not limited to infectious, genetics, immune conditions, sleep abnormalities, and more.

Diagnosing CFS/ME

There is no specific screening test to assess ME/CFS. The diagnosis takes time and effort. Before making the diagnosis, providers must rule out other treatable conditions, effectively making it a diagnosis of exclusion.

The Institute of Medicine (IOM) recommends providers utilize the Canadian Consensus Criteria and other questionnaires. The IOM states that 3 of the following must be present to make the diagnosis:

1. Severe reduction in ability to engage in pre-illness activities such as work, school, personal or social interactions. This inability to function must have a duration of more than six months, associated with fatigue of a definite onset (not lifelong), and this fatigue is not improved by rest. 
2. Moderate to severe malaise (feeling unwell) after exertion (which occurs more than ½ the time). This can be physical or cognitive exertion that was previously tolerated but is now not.
3. Moderate to severe unrefreshing sleep more than ½ the time plus either of the following:

1.  Cognitive impairment that is moderate to severe more than ½ the time. This would include confusion, poor attention, impaired concentration, difficulty finding words, and poor memory.
2. Orthostatic intolerance, inability to regulate the body's internal autonomic nervous system, such as dizziness, postural orthostatic tachycardia syndrome (POTS), intolerance to exercise, abnormal sweating, and digestive problems, to name a few. 

 If you have any of these symptoms and are concerned about ME/CFS, seek guidance from a holistic professional with experience in diagnosing and treating this condition.  

Stay tuned for part 2, discussing the mental health link between IBS and CFS.

1. _{Bested, A. & Marshall, L. (2015). Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Reviews on Environmental Health, 30(4), 223-249.}
2. _{Institute of Medicine. (2015). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. National Academies Press.}
3. _{Mayo Clinic. (2023, May 12). Irritable bowel syndrome - Diagnosis and treatment. Mayo Clinic. Retrieved October 18, 2023.}
4. _{Staudacher, H. M., Black, C. J., Teasdale, S. B., Mikocka-Walus, A., & Keefer, L. (2023, June). Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management. Nature Reviews Gastroenterology & Hepatology, 1-15.}