Irritable Bowel Syndrome (IBS) is very prevalent in our modern world, affecting around 12% of the population worldwide (1). Symptoms vary widely, but can generally be described as altered bowel movements with abdominal pain or discomfort occurring regularly over a minimum 3-month time frame. Other symptoms can include diarrhoea, constipation (or both alternating), bloating, flatulence, nausea or indigestion. Diagnosis is made when your symptoms meet a set of diagnostic criteria (such as the Rome III Criteria) and further investigations have ruled out any underlying conditions causing your symptoms (2).
IBS is a complex, multi-factorial and variable condition that affects individuals in remarkably different ways. This often makes it frustrating and difficult for sufferer's to find effective treatments, and it makes an individualised approach to management the most logical. Some contributors to IBS can include:
Alterations to gut flora (dysbiosis) which can include infections or overgrowths of undesirable strains of bacteria, fungi or parasites. We each have a unique balance of bacteria and other organisms in our digestive systems, which control some of our reactions to food, our immune function and the way that our digestive system functions. This balance is in a constant state of change, depending on the types of food we eat, our stress levels and the pH of our digestive system. Antibiotics (natural or conventional), anti-fungals and anti-parasitical agents can also influence our gut flora dramatically. IBS occasionally starts following an obvious digestive system infection, such as traveller's diarrhoea.
SIBO (Small Intestinal Bacterial Overgrowth) is an emerging area of interest in association with IBS symptoms. SIBO is a condition in which abnormally high levels of bacteria are found in the small intestines. SIBO can involve the overgrowth of 'good' or 'bad' bacteria and has a similar clinical picture to IBS. It can be tested for through a Hydrogen Breath Test, although it's accuracy is variable. While it is still being determined whether SIBO is a cause or symptom of IBS, there is clear association between the two, with one research study showing that the eradication of SIBO eliminates IBS symptoms in 48% of the test subjects (3).
Intestinal inflammation and permeability which can be caused by alterations to gut flora, like overgrowths or infections, or IGE-mediated allergies to foods. An inflamed mucosal lining struggles to produce enough digestive secretions to break food down and can feed the cycle of dysbiosis. Bacterial overgrowths then produce large quantities of gases like hydrogen and carbon dioxide that can contribute to symptoms further. Breaking this cycle of dysbiosis and inflammation is important for normalising digestion for IBS sufferers.
Insufficient digestive secretions and enzymes such as hydrochloric acid, lactase and other carbohydrate digesting enzymes can also alter the balance of organisms in our digestive system by changing the acidity of the environment and the types of food available for these organisms to thrive on. Generally speaking, high levels of digestive secretions will foster better digestion by taking food away from pathogens more quickly.
Food intolerances or reactions to FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) can contribute greatly to IBS symptoms. A diet low FODMAPs, which are fermentable carbohydrates, has been shown to reduce symptoms in 75% of IBS patients (3). However, a recent research article in BMJ's publication Gut has confirmed that low FODMAP diets also reduce the levels of good bacteria, such as Bifidobacteria spp (4). This is because FODMAPs are prebiotics, meaning they providing food for both good and bad bacteria in out digestive system. A reaction to FODMAPs is usually indication dysbiosis or SIBO. A low FODMAP diet can be a great way of getting your symptoms under control in the short term, but should be combined with a longer-term treatment plan that identifies and rectifies the underlying cause of your symptoms. Other types of food intolerances can also contribute to IBS symptoms, such as IGG-mediated food reactions. These can produce delayed reactions that are hard to pinpoint. These can be tested for ELISA (Enzyme-Linked Immunosorbent Assay) tests, and can also play a role in the management of some IBS symptoms. IGG intolerances usually indicate intestinal permeability.
Sympathetic Nervous System function and stress also play a role in the development of IBS. This part of your nervous system controls the 'fight or flight' response , which redirects blood flow to vital organs and down-regulates bodily functions not vital for immediate survival. This can reduce digestive circulation and secretions, and even increase the perception of pain. Just as individuals have varying pain tolerances, we all perceive other sensations within our bodies differently. Patients with IBS generally have a heightened awareness of their gastrointestinal function, which can result from overstimulation of the sympathetic nervous system.
What next? If you suspect you may have IBS and you haven't been diagnosed you should see you doctor. They may wish to do some blood tests, or even a colonoscopy if your symptoms might indicate other digestive conditions. If you have an IBS diagnosis, consider working with a Naturopath to come up with an individualised Natural Health Plan. When an client in my clinic presents with IBS, I help them focus on the steps below.
Control your symptoms especially if your symptoms are drastically impacting on your quality of life. This may involve a short-term low FODMAP diet while other underlying causes are investigated. Symptomatic relief may also be achieved through herbal medicines such as peppermint, chamomile, fennel, globe artichoke, turmeric, slippery elm or psyllium depending on your specific symptoms.
Get your diet right for you by considering the role of food reactions, allergies or intolerances. Depending on your symptoms, this may include IGE or IGG testing, a temporary elimination diet or a 2-week food diary to draw connections between foods and your reaction. Eat a varied diet of whole foods that you tolerate, focusing on nutrient dense foods.
Have further testing if required such as a CDSA (Comprehensive Digestive Stool Analysis). These tests are performed in the privacy of your home, and sent away for testing. The results reveal a wealth of information about your individual digestive function and balance of organisms within it. Hydrogen breath testing may also be useful to identify lactose or fructose malabsorption and to diagnose SIBO, although CDSA's can also give an indication of SIBO. These results help treatments to be targeted to you as an individual, and can be an important part of finding underlying causes of your IBS.
Treat any dysbiosis or overgrowths that may have been shown in your CDSA. Natural treatments may include citrus seed extract, oregano oil, saccharomyces boulardii (a therapeutic yeast), berberine containing herbs, coconut oil, wormwood or pau-darco depending on the specific organism being treated.
Repair your mucosal lining so that you can improve your tolerance of foods over time (including FODMAP's) by increasing digestive secretions and the colonisation of beneficial bacteria. Glutamine can be useful for achieving this, which can be found in nutritional supplements as well as dietary sources go gelatine, such as homemade Broth or my Gummy treats. Zinc and Vitamin A are essential nutrients for mucosal repair, and you may benefit from a supplement containing high does of these nutrients for a period of time.
Encourage good bacteria growth by eating FODMAPs to your tolerance after treatment of dysbiosis or overgrowths. Also include a source of good bacteria in your daily diet, such as a high-quality probiotic or fermented foods like my Super Kraut, other fermented vegetables, kefir or home-made yoghurt. Probiotic sources are also individual, so find one that works for you. Find a fibre source that suits your digestive system.
Stress management and relaxation are also important for managing your symptoms. Simple relaxation techniques, such as the 4-2-6 technique can help. It involves breathing in for 4 seconds, pausing for 2 seconds and breathing out for 6 seconds. It is then repeated for an increasing amount of time as you get used to the process. Smiling Mind also has a free app that has short meditations for adults and children. Exercise has been shown to improve IBS symptoms, so find an activity that you enjoy and make it a weekly habit. Improve your sleep quality, by going to bed before10:30pm and ensuring your digestive system also gets a rest by not eating any food a minimum of 3 hours before bed.
The key to treating IBS symptoms effectively is finding out what underlying causes are the most relevant to your digestive system. Breaking the cycle of dysbiosis, inflammation, intestinal permeability and food intolerance requires the careful co-ordination of natural treatments, but it is possible.
1. Halverson, HA et al (2006). "Postinfectious irritable bowel syndrome - a meta-analysis ". Am J Gastroenterology 101: 1894–9.
2. Hechtman, L (2012). "Clinical Naturopathic Medicine". Elsevier Australia.
3. Pimentel, M et al (2000). "Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome". Am J Gastroenterology 95: 3503-3506.
4. Halmos EP, et al (2015). "Diets that differ in their FODMAP content alter the colonic luminal microenvironment". Gut (BMJ) 64:93–100.
This blog post is for your general information and is not intended to be medical advice. Please see your healthcare professional for more information on the safe treatment of your specific health conditions.