Bloating, gas, stomach pain, cramping, and altered bowel movements plague at least 1 in 5 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 as well as those with a family history of IBS, which is also associated with anxiety and depression. (1)
Long considered a “waste can diagnosis", patients have been told that IBS is all in their head, and there’s nothing that can be done 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. Let’s take a closer look.
THE 8 IBS TRIGGERS
DIET: There are many mechanisms by which the food we eat may contribute to IBS, and we explore them all in a 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.
IMMUNE RESPONSE: Several common foods contain antigens that can trigger the immune system (2) to create antibodies in an effort to bind and eliminate the allergens from the system. Cow’s milk, wheat, fish and shellfish, peanuts, tree nuts, soy and many others may play a role. Early-stage celiac disease can mimic IBS, where antibodies form to the proteins, gluten and gliadin, in wheat.
FODMAPs: Highly fermentable carbohydrates (acronym FODMAPs) like milk, beans, broccoli, onions and garlic can contribute to excessive gas, bloating and cramping. My next blog post focuses on this subject, so stay tuned.
ADDITIONAL FOOD REACTIONS: These include lactose intolerance or lectin sensitivity can create similar symptoms and should be considered.
HORMONES: The monthly hormonal changes in women 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. New drugs have been introduced to regulate gut serotonin levels but seem to have little effect.
VAGUS NERVE: The Vagus Nerve, or the 10th cranial nerve, is the longest nerve in the body, running from the brainstem through the entire gut. It is the “information superhighway”, that forms the gut brain-connection. The vagus nerve is part of the parasympathetic nervous system, which operates when we are relaxed. To promote proper function of the vagus nerve and address the role that stress plays in its dysfunction, practice 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 (3) 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, as well as testing for SIBO, or Small Intestinal Bacterial Overgrowth.
SO, WHAT’S SIBO?
Small Intestinal Bacterial Overgrowth occurs when the bacteria that normally live in the large intestine, migrate up into the small intestine to proliferate. Here, they ferment the starches we eat before we can digest them, contributing to gas, bloating, cramping, heartburn and other symptoms of IBS.
SIBO is believed to be a leading contributor to IBS.
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.
HOW DO I KNOW IF I HAVE SIBO?
When excess bacteria inhabit in the small intestine, they ferment the starches we eat, and in doing so, generate gasses that can be captured through a simple and inexpensive breath test at home.
The tubes are then sent to the lab and results graphed out: if there is a rise in hydrogen, methane or hydrogen sulfide gasses, then SIBO is suspected. It is important to be tested before treating, as there are obviously a number of other contributors to IBS that may need to be addressed to ensure complete resolution.
SIBO TREATMENTS
Two different protocols have been proven to eradicate SIBO (though it may take more than one course of either). The first employs a special antibiotic that is active only in the small intestine; it is not absorbed systemically nor does it kill the good bacteria in the large intestine. The other is a botanical protocol that was studied by a gastroenterologist at Johns Hopkins, which demonstrated a very similar remission rate.
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.
While you connect with an experienced functional medicine doctor who can support you in this workup, consider using my Happy Belly Bundle of products available here.
This set of the highest quality nutritional supplements includes Sun Fiber, a SIBO-safe fiber, which promotes intestinal health, aids in the transit of food through the intestines, promotes the absorption of essential minerals and helps control the glycemic index of foods.
Thorne’s Advanced Digestive Enzymes is a comprehensive blend of digestive enzymes that support good digestion. A digestive enzyme supplement can be beneficial in circumstances when less than optimal amounts of digestive enzymes are being produced in the body – like during the natural aging process or after periods of extreme stress or gallbladder removal.
GI Revive is my go-to product to support a healthy intestinal lining, so it can not only absorb nutrients but also prevent toxins, allergens, and microbes from gaining access to the bloodstream. This product is formulated for those looking to support the GI mucosal lining.
If you are looking for something at home to help soothe your gut, consider nutrient-rich bone broth. Bone broth contains nutrients that are healthy for gut flora and the intestinal lining and may also have anti-inflammatory effects that can help ease abdominal cramping and diarrhea. Try making your own bone broth with my colleague, Dr. Trevor Cate’s recipe.
The truth is that resolving IBS can be a challenge, but know that there is hope to manage IBS and SIBO. You’ve taken the first step by understanding the variables involved and that protocols, supplements, and strategies are available to you to help you work though the challenges and associated symptoms.
References
1 https://medicine.missouri.edu/news/irritable-bowel-syndrome-patients-suffer-high-rates-anxiety-and-depression#:~:text=This%20study%20looked%20at%20more,found%20in%20those%20without%20IBS.
2 https://journals.physiology.org/doi/full/10.1152/ajpgi.00207.2012
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969781/