Irritable Bowel Syndrome (IBS) is much more than just a gut disorder. It causes chronic discomfort, anxiety, social limitations (especially where food and drink is involved), and a decrease in quality of life. There are a variety of contributory factors leading to IBS including but not limited to altered bacterial microbes in the gut, inflammation from the immune system, inflammation of the bowels, stress: emotional and physical, food sensitivities, and chronic microbial infections (viral, bacterial, protozoan, etc).
Are you struggling with:
- Chronic bloating, even when you eat a seemingly healthy diet?
- Are you chronically constipated without the help of fiber supplementation or laxatives?
- Do you have pain and cramping in your stomach after eating?
- Are you chronically fatigued even after getting a “good night’s rest”?
- Do you suffer from anxiety and/or depression?
- Struggle with social eating, not knowing how your body will react to food?
IBS (Irritable Bowel Syndrome) is a gastrointestinal motility disorder of the intestines. IBS is defined as a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection. Common symptoms of IBS include: recurrent abdominal pain, change in bowel habits (constipation or diarrhea, or both), indigestion, bloating, weight gain/loss, nausea, chronic foul smelling gas, urgency of needing to empty the bowels, fatigue, difficulty sleeping, anxiety and depression.
Approximately 11% of the population are diagnosed with this condition by their primary care physicians, many suffer silently and go undiagnosed. There are self-help and support groups, popular searches relating to IBS, and general gut cleanses offered all over the web. We see patients frequently trying to control this condition on their own using different diets, oregano oil and probiotics, to no avail. Many people come to the conclusion that this is just their “new normal.” To the contrary, just because these symptoms are common in the general population, they are not normal!
IBS is a tricky condition to diagnose as there is no “gold standard” test. IBS is often a diagnosis of exclusion; meaning, you can rule out all the scary things like cancer, Crohn’s disease or internal bleeding, then what you are left with is a blanket diagnosis for a long list of digestive and systemic symptoms.
What Causes & Contributes To IBS?
- Microbiome imbalances: We’re talking gut flora.
- SIBO (Small Intestine Bacterial Overgrowth)
- Adrenal health/chronic stress. When the nervous system is in a dominantly sympathetic state it shuts down the rest and digest mechanisms. This leads to poor digestion and malabsorption, which in turn causes anxiety and moodiness from blood sugar swings.
- Blood sugar dysregulation will often cause oxidative damage to nerves in the gut and bowels further damaging digestive function and creating inflammation.
- Increased and decreased gut motility depending on the portion of the gastrointestinal system.
- Chronic infections/with biofilm. Often, this will happen after a bout of Gastroenteritis. In fact acute gastroenteritis accounts for 30% of all IBS cases.
- Food sensitivities.
- Stress: Both emotional and physical – History of abuse (physical, emotional, chronic, anxiety). We often see that the less support people have in their lives, the more severe their IBS can be.
- Visceral sensitivity aka rectal pain sensitivity – Perceived pain in the rectum – this pain is lower for patients in IBS. IBS patients notice more gas and discomfort in the bowels. IBS patients show changes in the brains esp in afferent pain signals in the brain.
Let’s look at some of these in greater detail:
- The Microbiome
Why is the microbiome, or the bacteria in your gut so important? Did you know that some of your neurotransmitters are made in your gut? That’s right, the bacteria in your gut can determine how well you break down and utilize your food, and even how happy you feel. Did you know that the enterocytes in the intestines are one of the main producers of serotonin (your happy neurotransmitter)? Having imbalanced bacteria can lead to symptoms of depression and anxiety. Furthermore, neurotransmitters in your gut regulate your perception of pain and digestive function.
You can read in more detail about small intestinal bacterial overgrowth (SIBO) here. SIBO in essence is having too much bacteria in your gut. With SIBO healthy foods, especially slow digesting carbohydrates actually feed the overgrowth of bacteria. This perpetuates symptoms like gas and bloating – especially as the day goes on and seemingly no matter what you eat.
The Immune System
The immune system is very important in the pathogenesis of IBS. Your immune cells, primarily Mast Cells, are important in the motility of your gastrointestinal tract. When these cells are activated, they cause inflammation in the gut wall affecting peristalsis (contractions of the gut wall moving food through the gastrointestinal system).
Low Grade Infection & Inflammation
Ever had a parasite? Montezuma’s Revenge? Mononucleosis (Also known as Epstein Barr Virus)? Chances are you still have it! We like to refer to these as subclinical chronic infections. The reason for that is you might not be experiencing swollen lymph nodes and fever, but maybe you are chronically fatigued, or your digestion hasn’t been quite right since the initial infection. This can be an indication that though you don’t have an acute infection, you might have a low grade and chronic infection. These infections can create biofilms that make them virtually untouchable by your immune system. Without breaking these biofilms down, these pathogens continue to wreak havoc on your immune system and gut. Biofilms can be attributed to lingering symptoms like chronic gas and bloating, diarrhea and constipation, chronic fatigue, and poor immune function.
Food sensitivities are not an allergy. Though they do not create a life-threatening, immediate response like a true food allergy, they stimulate and up-regulate your immune system, creating symptoms like bloating, gas, diarrhea, acne, fatigue, blood sugar swings… the list goes on. The only way to control these symptoms is to eliminate or minimize the foods creating these symptoms to allow your body to heal and regulate. The tricky part can be figuring out which food(s) are the triggers. Simply eliminating one suspect food might help dampen your symptoms, but if there are multiple foods triggering you, your symptoms will not completely go away; leading many to the conclusion that that wasn’t their food sensitivity and continue eating it. For this reason elimination diets like the Whole30 have been designed to cut out the most common food sensitivities to “reboot” your system in a sense, and then slowly reintroduce said eliminated foods.
The most common food sensitivities for the majority of the population are gluten (sometimes all grains), eggs, dairy, soy, corn, and seafood. However, because everyone is so individual, even a healthy food like bananas or sweet potatoes might be creating your symptoms. If you find an elimination diet is not doing the trick, it could be because you are still eating something you are sensitive to. Always start with the foods you are eating most frequently. This might be the culprit. Diet diaries are also a great way to track your eating habits. In our office we highly recommend food sensitivity testing – these tests help cut out the guesswork and also identify foods that might be cross-reactiving in your system.
If you aren’t familiar with leaky gut, it is when the wall of your intestine becomes compromised and permeable, allowing for particles of food to get into your bloodstream, thus activating the immune system to respond to the alien “invader.” Over time you can become sensitive to more and more foods. Making you reactive to foods that you were once not sensitive to. As you restore your gut wall, many of these new sensitivities will resolve.
Stress is all to common among our society. From traffic jams to long office hours while raising a family. It can be hard to find time for yourself, period. Forget simple self care like meditation, exercise, breathing, you’re lucky to get a shower in 4 days a week. Sound familiar? Stress has a huge impact on your physiological processes. It slows and makes your digestion less effective (perpetuating IBS), causes inflammation and blood sugar swings and lets not forget anxiety, insomnia, depression and pain. Practicing techniques to help your body adapt and calm down from stress are incredibly important. Taking breaks from drinking stimulants like coffee and substituting adaptogenic herbs like Ashwagandha, Reishi mushroom, and Maca can be incredibly beneficial.
How We Treat Differently from the Traditional Model
Much of what is commonly done for IBS in the Traditional Medical model is symptomatic relief. More and more this is changing, which we Love to see! However, where antibiotics, laxatives, anti-diarrheal (or antispasmodic medications) and long-term elimination diets fail, we do our best to pick up the slack.
We use functional medicine to evaluate your blood work. We use different values than the standard to evaluate for optimal health and see where your body might be starting to struggle. Through this model we find we get to the root cause of the issue to resolve symptoms rather than treat the symptoms.
- After blood work confirms the presence of infection/co-infections we will treat the pathogen(s) PLUS eliminate biofilms
- After blood work confirms any and all food intolerances, or leaky gut, we will treat the permeability of your Small Intestine as well as recommend which food or foods to avoid or substitute.
- Elimination diets
- Lifestyle changes
- Exercise regimens
- Identifying stress factors, and how to properly adapt
- Treating depression and anxiety through supplementation and exercise
- Detoxifying your system and supporting your microbiome
- Reset your metabolism
- Manual modalities such as Visceral Manipulation to decrease pain and inflammation
IBS can be a tricky condition to tackle on your own, as there are typically several variables contributing to your symptoms. If you don’t figure out all of the variables, you will have a difficult time eliminating your symptoms for good. With all of these factors adding to IBS, having a little guidance can be incredibly beneficial.