Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome, or IBS as it is lovingly abbreviated, affects nearly 50 million Americans. What is interesting about this syndrome ? you will note that it is not a disease ? its definition describes not what it is, but what it is not. IBS is not an anatomical or structural problem. IBS is not diagnosed by physical exam, imaging or by blood test. IBS is not cancer, nor will it cause cancer.
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Classically, people with IBS experience constipation, diarrhea, or a mixture of both that can be cyclical or random. Gastroenterologists are taught that IBS will be their most common diagnosis, and it typically is. Unfortunately, IBS can mimic a more insidious disease ? Celiac disease. Savvy doctors will make sure that they rule out this important condition.
So, if you have been diagnosed with IBS, and you don?t have Celiac disease, what does the diagnosis of IBS really tell us? IBS used to be considered a wastebasket diagnosis – after everything was ruled out, you received that label. Now, however, we know that there are two fundamental shifts in those with IBS: a dysfunctional enteric nervous system (the “second brain”, a huge plexus of nerves that governs nutrition) and an unbalanced microbiome.
The important thing to remember out IBS is that it can be multi-factorial, and is unique to the individual. Practitioners of integrative therapies will broaden their search for contributing factors towards symptoms of an irritable bowel.
The first item on the list to examine is food intolerances and sensitivities. This can be a confusing issue for people as some may have been tested for food allergies and told they were clear. If you have had the type of test where they inject things under the skin of the back or arms, you have had an IgE test. This type of test checks for life-threatening, anaphylactic reactions. This is NOT the only way to have a food allergy or sensitivity.
It is possible for the immune system to generate other antibodies to food, to generate inflammatory chemical messengers which activate the immune system and create symptoms, and to generate immune complexes which can be highly irritating to tissues. This type of sensitivity is measured by IgG antibodies in the blood.
Testing for food sensitivity is not perfect. A good general guide to follow is if you do have an IgG food allergy test, and more than 5-6 foods are listed as positive, you have an issue with the integrity of your gut wall that needs to be addressed. Another method of teasing out reactions to foods is doing an elimination-challenge diet.
During an elimination-challenge diet, common allergenic foods plus foods that you know you are sensitive to are eliminated for a period of weeks, then reintroduced one by one in order to assess your body?s unique reaction to each food.
Finding your body?s own unique sensitivities to food is going to be paramount in reducing your symptoms and even to achieve cure of IBS. It is important to consider that everyone is different, and everyone can tolerate or react to different foods. Here is a list of the ten worst foods for digestive health.
Those with IBS tend to do better on a low-FODMAP diet. FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These particular fibers and starches are highly fermentable to the disrupted gut flora, creating excessive gas, bloating, distension and spasms…a few of the common symptoms of IBS.
The next layers we want to begin to peel back at determining the root cause of IBS is to examine the overall health of the gut from a functional perspective.
Take the example of the very large population of bacteria that we have living in our gut. We have trillions and trillions of bacterial cells, representing 3-4 pounds of weight. These bacteria are so crucial to us that when they are out of balance, we can have body-wide effects.
The beneficial bacteria living in our gut serve many roles. They help balance the immune system, help us regulate peristalsis, which is that long, slow reflexive wave that our gut uses to get food from our stomach to finally be pooped out. You can imagine that this is quite relevant in the case of IBS. Our bacteria also protect us from bad, harmful bacteria, help us digest and assimilate food, and even help us make certain nutrients. Even though the idea of having 4 pounds of bacteria in us may be troubling to some, without it, we would not last very long.
For some people with IBS, issues with our beneficial bacteria can be a root cause or contributing factor. First, there may be bacteria present where they do not belong. The small intestine is largely unpopulated with bacteria, who live primarily in the large intestine. If, in some way, bacteria find themselves in the small intestine, that is a condition known as small intestinal bacterial overgrowth, or SIBO.
SIBO can be diagnosed with a simple breath test. Symptoms that can indicate that you have SIBO include excessive gas, bloating and distension ? especially with sugar, fiber, and carbohydrates ? all of which feed the misplaced bacteria, diarrhea, abdominal pain, fibromyalgia syndrome or other complex pain syndromes, restless leg, intolerance to probiotic supplementation, low stomach acid, and a history of use of antacids, proton pump inhibitors or H2 antagonists.
Treatment for SIBO is actually quite simple and can provide immense relief. Natural antimicrobial substances can be used, such as garlic compounds or oil of oregano. Some practitioners will choose to use a course of antibiotics concurrently or followed by probiotic supplementation. While this may seem counterintuitive, it is a larger priority to remove the rogue bacteria and replenish them in the right places than it is to take a staunch stance against antibiotic therapy.
The second issue that can involve our beneficial bacteria and contribute to IBS symptoms is an imbalance of beneficial bacteria. This is called, quite simply, dysbiosis. Whether we like it or not, even the healthiest bacteria populations have some bad guys lurking in there. The good guys keep the bad guys in check. If something happens, such as years of inappropriate food intake, chronic stress, overuse of antibiotics, antacids or other drugs, trauma or injury to the gut, the delicate balance of the gut bacteria can be shifted away from the good and towards the bad. Unlike the good guys, who we live in harmony with and need for our health, the bad guys have their own agenda and can wreak havoc on our system.
Testing for gut dysbiosis is quite simple and can be done by a simple stool test. Symptoms that you may have gut dysbiosis include seasonal or recurring diarrhea, frequent or recurring colds, frequent or recurrent kidney or bladder or vaginal infection, abdominal cramps and toe or fingernail fungus. Management of dysbiosis typically includes the use of natural antimicrobials, HCl if indicated and therapeutic doses of probiotics. Unlike SIBO, pharmaceutical antibiotics are less commonly used to treat dysbiosis.
Next on our list to tackle is the issue of some pathogen setting up shop in our gut where they do not belong and through their very presence create, contribute to or exacerbate IBS symptoms. Perhaps the most famous two examples falling in this category is candida and parasites.
Several years ago, a candida wave swept the natural and integrative health industry. Every ailment, it seemed, could be pinned to candida overgrowth. Everyone was diagnosing yeast overgrowth, to the extent that it got over-diagnosed. After a few years of this, the pendulum swung the other way, and candida was dismissed completely, with people who discussed it were mocked. Enter 2012, where we understand that while candida/yeast overgrowth is not present in everyone, in some people it most certainly is.
Candida is a yeast that is ever present in our world and guts, but kept in check by our good bacteria and a good diet. If allowed to flourish, such is the case with chronic antibiotic use, which kills our friendly bacteria but not yeast, yeast will certainly take us up on the opportunity and grow. The life cycle of yeast actively inhibits the growth of friendly bacteria, and includes a myriad of IBS and other symptoms. For more information on Candida, check it out.
Parasites, as much as we would like to not think about them, are present here in the United States. We tend to think of parasites as little critters that live in far away, dirty lands, but this is not the case. There are several common protozoan parasites here in the US, including Giardia, Blastocystis, Cryptosporidium and Entamoeba.
There are also parasites that are worms, which are even less appealing to think about. Hookworms, roundworms and tapeworms are all found in the US. Symptoms include diarrhea, constipation, weight loss, rectal itching and even blood loss. Hookworms feed on blood.
Parasites and yeast overgrowth can be detected by a complete stool analysis. By this point, you should be thinking that if you have IBS, you would really like to have a stool analysis done so you can pinpoint exactly what is going on in that delicate, disturbed gut of yours!
Treatment for yeast overgrowth can be a bit more involved than treating for the other functional disturbances we have outlined this far. Anti-yeast natural compounds or prescription products like Nystatin or Diflucan may be used, along with a fairly specific low-sugar diet to begin to starve the yeast. In cases of yeast overgrowth, parasites or dysbiosis, repeating the stool analysis in 3-6 months will help you gauge if treatment was effective.
Lastly on our list of things to consider for IBS root causes and management is the nervous system. Our digestive system has a mind of it?s own, and it is called the enteric nervous system. It is also known as the second brain. What this means is that the gut is able to be fully operational without any input at all from the brain. The process of breakdown, digestion and assimilation marches on without any input at all from the brain.
Interestingly, this second brain is so elegant and complex that there are actually more nerve cells from the esophagus to the anus than there are in the entire central and peripheral nervous system. That is more nerve cells than your brain, spinal cord and peripheral nerves all combined.
It is not a far leap, then, that if this system is disrupted or perturbed that one may experience unpleasant symptoms around the motility and function of their gastrointestinal tract.
If you have no food sensitivities, SIBO, dysbiosis, yeast overgrowth or parasites, pampering your second brain may be in order. How do you do this?
The enteric nervous system loves serotonin. In fact, there are more serotonin receptors located in the gut than there are in the brain. The same can be said for many so-called neurotransmitters. The place we begin first is thus calming and soothing serotonin. Using serotonin boosting nutrients and amino acids like 5-HTP, tryptophan, St. John?s wort, SAME and the like can help calm and tone an irritated belly. Next to consider are GABA-boosting nutrients and compounds such as glycine, l-theanine, taurine, valerian root, skullcap, and kava kava.
Reframing stress, choosing a positive attitude, showing love, practicing gratitude and appreciation, deep breathing, walking, exercise and laughing can also begin to calm and soothe the second brain and lesson IBS symptoms.
Irritable bowel syndrome does not have to rule your life. Doing some detective work into the root causes of this functional problem can yield great insight and thus offer significant relief for sufferers and in some cases, a permanent cure.
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