What Are The 5 Warning Signs Of Severe IBS?

In this article we’ll look at the 5 main warning signs and symptoms of IBS, because a lot of patients get left on their own here by the doctor and are not sure if they have IBS or what to do.

In fact, can you guess what percentage of people these days are believed to have IBS, both globally but then also specifically in western countries, like the US, Canada, UK and Australia?

It’s super fascinating and not what you think, we’ll get to that below but consider what you think that number might be.

1. Garlic and Onion Cause Digestive Symptoms

Garlic and onion IBS symptoms

Have you noticed this is true for you?

And it can be a bit deceiving because it’s not just literal garlic and onion pieces in your food.

It can be garlic or onion in a sauce or dressing you always eat, it can be powder in a seasoning you’re using, it can be labelled as ‘spices’ on the ingredient list of sandwich or soup or pasta you eat.

There are so many ways that high concentrations of garlic and onion can be in our diet that we don’t realise, especially if you occasionally eat food that you didn’t prepare yourself from scratch.

Which is basically all of us right, when you get lunch at work, when you go out to a restaurant, when you get yourself a little treat at Starbucks.

Now, why is this happening?

The problem is the FODMAPs – which are a group of carbohydrates found naturally in foods like onion and garlic – these FODMAPs can ferment in our gut and cause symptoms like bloating, excessive gas, and diarrhea.

Now you may be wondering, “I thought garlic and onion were healthy for us!?”

And that is correct, they are healthy for us, in those who are not sensitive. But for those who are – typically IBS patients – we can have a negative reaction that far outweighs any nutritional benefits. I hope that makes sense.

It’s a bit like how spicy chili peppers are good for us if you tolerate them, they’re vegetables after all, but they wreak havoc on your guts if you’re sensitive.

There are so many ways that high concentrations of garlic and onion can be unknowingly in our diet, especially in food that isn’t prepared from scratch.

Garlic and onion in all forms i.e. as pieces, in sauces, dressings and powder or mixed ‘spices’ cause digestive symptoms.  

FODMAPs – which are a group of carbohydrates found naturally in foods like onion and garlic – can ferment in our gut and cause symptoms like bloating, excessive gas, and diarrhea.

In general, garlic and onion are a healthy option, but for IBS sufferers can cause a negative reaction that far outweighs any nutritional benefits.

Summary: FODMAPs in foods like onion and garlic can ferment in our gut and cause digestive symptoms in those who are sensitive to them. 

2. Recurrent Diarrhea On Most or All Days

Recurrent Diarrhea On Most or All Days

This one is pretty straight forward and so I won’t spend a lot of time on this one, but I needed to mention it because of my duty of care as a Dietitian.

If this point speaks to you, make sure you get the proper tests and scopes first from the doctor to get the all clear on anything more sinister, shall we say.

That’s not to take anything away from just how severe and life-changing IBS can be by the way, but the IBS diagnosis should only be given when the doctor cannot find anything else physically wrong in your digestive system.

The other thing you need to know here is that recurrent diarrhea left unmanaged leads to other major issues like nutrient deficiencies and fatigue, and so it’s a big problem I’m gonna talk more about that at a later point in this article.

Summary: Recurrent diarrhea is a sign of IBS once serious gastrointestinal issues have been ruled out by tests and scopes.

3. Bloating that requires you to wear pants that are 1-2 sizes too big

Severe bloating in IBS pants size

Nobody talks about it but there are so many people that do this…

They need intentionally wear pants too big because otherwise the bloating literally means their pants won’t fit or close after eating.

And while slight stomach distension is normal after a big meal of course, regular severe bloating to the extent of needing different sized pants is not normal.

Unfortunately it’s becoming increasingly common and is a warning sign.

Remember at the start when I asked how many people are thought to have IBS?

Well the answer is it’s 11% of the global population.

However, in Western countries it’s over 20%, that’s 1 in 5 people! And about double the rate of the rest of the world.

Was it always like this and we are just reporting it more now and that’s why rates are higher?

Or is it because of our modern food systems, or our modern lifestyles?

It’s a topic for another article, if that’s something you want covered let me know in the comments. I’d love to hear what you think.

If you’re interested, I’ve written a full guide on how to overcome bloating here.

Summary: Many with severe IBS have to wear pants that are 1-2 sizes too big because of how severe their bloating is after eating. Stomach distension is normal, but not that extreme.

4. Chronic Lethargy and Daytime Fatigue

Chronic lethargy and daytime fatigue

Of course there can be many reasons for this, here’s what I believe as it relates to IBS which I touched on earlier.

If you regularly have diarrhea, like you have many loose bowel movements per day, your body is not absorbing all the nutrients that you eat as it doesn’t have time.

So food is passing through the digestive tract far too quickly, and so the intestines where the main nutrients are absorbed don’t have enough time to take what your body needs.

It’s like trying to catch rainwater in a bucket that is full of cracks and holes, everything just leaks out. The nutrients you eat are leaking out of your system before there is a chance to absorb them into your bloodstream and cells.

I believe this is a major problem nobody is talking about, that even if we eat a nutritious diet and we supplement and all the rest, if we have severe IBS our body is not absorbing what we think (or what it says on the nutrition label), we’re operating in a state of nutrient deficiency and it causes chronic fatigue and lethargy, among other issues.

Summary: If you are not absorbing all of the nutrients that your body needs, it can cause chronic lethargy and daytime fatigue.

5. Anxiety and Stress Cause Symptoms To Become Much Worse

Stress and anxiety severe IBS

The fifth and final sign of IBS may be the most overlooked and least understood by all of us.

And before I reveal what it is I want to share this quick story with you to see if you can guess what it is.

So a client of ours, Sue, she had severe digestive symptoms that began to take over her life.

The GI doctor had said its IBS and recommend she start increasing fiber, taking probiotics, and to follow a low FODMAP diet. This went on for 10 years, nothing was helping properly.

And when we met her there was one question we asked that flipped everything on its head

Because the problem was she had an executive level like stressful job, always thinking about work, business travel regularly, always “on”.

And so this was the question, “When you’re on vacation – where your lifestyle and diet and environment completely different from regular routine – what happens to your symptoms?”

She thought about it for a moment, and she said, “Well last Christmas I was on vacation and my eating was less structured and certainly not healthier, but symptoms were way better!”

Isn’t that so fascinating?

This happens because of the vagus nerve, which is the main nerve connecting the brain to our heart, lungs and digestive tract.

It’s the reason we get butterflies in our stomach when nervous or that pit in the stomach feeling when you get bad news or realised you left your wallet on the bus.

Research shows this vagus nerve can become hyper-sensitive in those who’ve experienced trauma, chronic stress, anxiety, or depression, and it makes our gut hyper-sensitive to what we eat, especially FODMAP compounds.

This is what had happened to Sue. When she was on vacation that sensitivity in her vagus nerve subsided a lot.

The good news is the scientific community knows more about treating this than ever before.

Summary: The vagus nerve connects the brain to the digestive tract. It can become hyper sensitive in those who’ve experienced trauma, chronic stress, anxiety or depression, and it makes our gut hyper-sensitive to what we eat, especially FODMAP compounds.

If you’ve finished reading this and felt like at some point, “Yes this is me you’ve described, what do I do about it?”

I invite you to read this article or watch this video I made which recommends the next steps for IBS sufferers to actually treat the issue properly.

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About Joe Leech, Dietitian (MSc Nutrition & Dietetics)

Joe Leech is a university-qualified dietitian from Australia.

He graduated with a Bachelor's degree in exercise science, followed by a Master's degree in Nutrition and Dietetics in 2011.

Learn more about him on the About page