Irritable Bowel Syndrome
Bloating, gas, cramping and poor elimination plagues about 20% of Americans.
If you’re struggling with these symptoms, you may have IBS, or irritable bowel syndrome. It’s the most common digestive problem facing Americans, second only to heartburn.
Women are most commonly affected, especially in menstruating women, and those with a family history of IBS as well as people with anxiety and depression.
Long considered a “waste can diagnosis", patients have been told it’s all in their head, and that there’s nothing to do for their irritable bowels but take an anti-depressant.
While these symptoms can be depressing, there are many contributors to IBS and new understanding and solutions are emerging (SIBO). Let’s take a closer look.
What are the triggers for IBS?
- Diet: There are many mechanisms by which the food we eat may contribute to IBS, and we explore them all in our functional approach. The SAD diet (Standard America Diet) is full of refined and processed “food products”, sugar, bad fats, chemical additives and preservatives, and excess alcohol and coffee.
- Various foods may trigger the immune system to create antibodies in an effort to bind and eliminate them from the system. Early stage celiac disease, where antibodies form to proteins in wheat (gluten/gliadin) can mimic IBS.
- Eating highly fermentable carbohydrates (FODMAPs) like milk, beans, broccoli, onions and garlic can play a significant role. (see my article on FODMAPs).
- Other food reactions, such as lactose intolerance or lectin reactions can create similar symptoms.
- Hormones: The monthly hormonal changes in women seem to play a role, triggering increased bloating and either constipation and/or diarrhea. The exact mechanisms by which hormones influence IBS have yet to be determined, but women with IBS are wise to clean up their diets, stay hydrated and lay off the coffee and alcohol the week prior to the onset of their period. All these measures add up.
- Stress: While stress definitely plays a role in exacerbating IBS, is not its sole cause. Serotonin is a “calming” neurotransmitter that helps stimulate “peristalsis”, the muscular contractions that propel food through the gut. In fact, 95% of our body’s serotonin is in the gut. Some drugs were developed to regulate gut serotonin levels but have been withdrawn from the market due to serious side effects. Until this relationship is more fully understood, I recommend daily meditation, yoga and other therapies that bring balance to the neuro-hormonal system.
- Infection: Some people with IBS recall having a severe bout of food poisoning or gastroenteritis that seemed to mark the beginning of their IBS. Now a definitive new test has been developed to identify bacterial toxins, which can then guide an effective treatment plan.
How is IBS diagnosed? For the past several decades, IBS has been a diagnosis of exclusion: a thorough medical workup is done (physical exam, parasitology, and perhaps an endoscopy or colonoscopy) and if no physical abnormalities are found, it is concluded to be irritable bowels. The cause is then assumed to be stress and the patient is given an anti-depressant (which rarely resolves the symptoms).
As a naturopathic doctor, I do a “functional workup”, which includes testing for food reactions, a Comprehensive Digestive Stool Analysis to assess microbial balance, the presence of parasites, digestive enzyme output, as well as markers of inflammation or past infection.
But the biggest recent breakthrough in our understanding of how to approach IBS is to run a “breath test” to check for Small Intestinal Bacterial Overgrowth (SIBO). (See my article for more on SIBO). Thanks to the pioneering work of LA gastroenterologist, Dr. Mark Pimentel, who first recognized and studied SIBO, we have new insight into another primary cause of IBS.
What is SIBO? Small Intestinal Bacterial Overgrowth occurs when the bacteria that normally live in the large intestine, migrate upstream to proliferate in the small intestine. Here, they ferment the starches we eat before we can digest them, causing gas, bloating, heartburn and other symptoms of IBS.
But beyond discomfort, these bacteria can damage the delicate small intestinal lining, leading to nutrient malabsorption, intestinal hyper-permeability (“leaky gut”), and altered motility. Once diagnosed, both antibiotic and herbal protocols can be used to reduce populations of bacteria living in the small intestine and
How is IBS treated? Successfully treating IBS involves a thorough work to identify and address the root cause. A range of dietary shifts, including an elimination diet, low FODMAP diet, digestive enzymes, anti-microbials and probiotics are all utilized. I’ll host a webinar soon to connect all the dots!
See other posts including:
- Heartburn and GERD
- Small Intestinal Bacterial Overgrowth
- Leaky Gut Syndrome (Intestinal Hyperpermeability)
- The Seven Factors that Influence Digestion
- Tour of the GI Tract