As anyone with Irritable Bowel Syndrome already knows, IBS is a condition that can severely limit what you can eat, what you can do, and can strike at any time!!.
You should start with your GP to rule out certain conditions. But many people find their GP isn’t able to identify the root cause of your IBS. After a few months or years with IBS, you may come to believe that there is little that can be done to help you. That it’s not possible to find out what is causing your symptoms. If you have had IBS for a while, you know what I’m talking about, and I really do feel for you!
This belief may have started when your GP told you that little can be done. And this makes sense from a GP’s point of view: Doctors call IBS a ‘functional gastrointestinal disorder’ which means the gastrointestinal tract doesn’t show any physical abnormalities but functions abnormally.
A doctor usually gives an IBS diagnosis using a process of exclusion. This means that once all their tests come back normal but symptoms persist, the diagnosis is given. As the underlying cause isn’t known, a GP can then only treat the symptoms using drugs or surgery or you may be told there is nothing that can be done or told simply to eat more fiber or Metamucil.
But this is NOT the final answer. Most of these treatments don’t work well, because they don’t address the underlying causes of your digestive disorder.
If you take one thing away from this post, I want it to be the hope and understanding that is possible to improve your IBS. You can increase the diversity of foods you eat. It is possible to lessen the constant worry about your digestion and improve your wellbeing and quality of life.
What is causing my IBS?
As a Functional Medicine practitioner, I aim to get to the root cause of health issues. This is important! Only by finding the root cause, can we weed out the health issue for good. Imagine you are pulling a tough weed out of your garden. The weed breaks and leaves the roots behind. By addressing only the symptoms, it’s as if you are pulling this weed out of your garden. When the roots remain, the weed will grow back. It’s better (essential!) to remove the weed by it’s roots.
Some of the possible causes of IBS include bacterial and fungal overgrowth, possible parasites, slow digestion, food intolerances, gluten disorders, small intestinal bacterial overgrowth (SIBO), high stress, and carbohydrate maldigestion. In some people, toxins released during an infection, or food poisoning, may damage nerves, which in turn can cause abnormal muscular contraction of the bowel, especially when stressed. The brain can then become overly sensitive to signals of pain or bloating that are sent from the gut.
Small intestinal bacterial overgrowth (SIBO)
We normally have about 1.5kg (3 lbs) of bacteria, about 500 species, in our gut. Usually, most of these bacteria live in our large intestine and our small intestine is relatively sterile. But bacteria can also become abundant in our small intestine and then SIBO develops. These bacteria ferment food in the small intestine causing bloating, gas and belching, diarrhea, and constipation.
Significantly, up to 80% of people with IBS, have SIBO. That’s far more than in the general population. Therefore, in people with symptoms, it may make sense to test for SIBO. The most common test is a breath test which measures gas production by the bacteria in the small intestine. However, in some cases, when working with clients, testing isn’t always necessary and treatment is sometimes based on symptoms alone.
If SIBO is found, anti-biotics or diet, anti-microbials, and probiotics maybe used to resolve it. This is great news for people with IBS! A natural approach may also focus on increasing motility (i.e. the speed at which food passes through the small intestine) to clear out the bacteria in the small intestine. Proper digestion is also important. Digestion requires enough digestive enzymes and stomach acid. Eating mindfully in a low-stress environment (not at your desk) also helps, as the body enters a more relaxed state, digestive juices are more readily released and energy is directed to digestion within the body.
Parasites and Overgrowths
But unfortunately, the causes of IBS in everyone aren’t the same. Candida is a normal resident in our gut but can become overgrown. Parasitic protozoa (essentially supercharged bacteria) such as Blastocystis Hominis and Dientamoeba Fragilis, and bacterial overgrowth such as Chlostridia can cause IBS type symptoms. The GI Map test can be used to test for these and other parasites.
Another major cause of IBS is food sensitivities. These are not true allergies but low-grade reactions to foods that may not be seen until several hours or days after eating. British medical journal Gut found that eliminating foods identified through delayed food allergy testing (IgG antibodies) resulted in dramatic improvements in IBS symptoms.
When working with an individual, I may start with diet, removing the possible trigger foods for IBS. This can include trigger foods such as gluten, dairy, added sugar, oxalates or histamine containing foods.
There is a lot of research around the effectiveness of a low FODMAP diet for IBS. FODMAPs are types of sugars that are fermented by our gut bacteria and this may cause bloating and IBS type symptoms in some people. Monash University, one of the pioneers of the low FODMAP diet, say the diet should be used for 2-6 weeks and not for life. After the elimination phase that removes high FODMAP foods from the diet, the re-introduction phase monitors your personal response to the re-introduction of a high FODMAP food so that you can find out which foods are affecting you.
But even when trigger foods are identified, I’m still looking to find out why that person has an issue with that food. FODMAP foods tend to be healthy, fibre rich foods, that feed our good gut bacteria, and so we work towards being able to re-introduce these foods.
So overgrowth of bacteria in the small intestine and food intolerances are two major causes of IBS but there are others: These include poor digestion, parasites, stress or previous trauma…
What if I’ve looked at these causes, and I still have IBS?
In many cases of IBS, our guts have become overly sensitive. Certain foods or a build-up of gas (bloating) affect us more than in other people, even when eating a healthy diet and doing all the right things.
If you have improved your diet, ruled out food sensitivities, and parasites, then your IBS likely involves disturbed neural functioning of the gut-brain axis. In which case, you may need to work with the brain as well as the gut (see what do I do next?). Hypnosis and the Dynamic Neural Retraining system ca be helpful, and I also offer NLP health coaching.
What do I do next?
In most cases, it is possible to identify your personal causes of IBS – It doesn’t have to be just a label attached to untreatable symptoms. Solutions can be found if you look at the underlying causes and address them.
- Try taking digestive enzymes or Hcl stomach acid with meals to help break down food while your gut heals. Also, eat in a mindful way to reduce stress and aid digestion. Once healed, eating bitters, or some apple cider vinegar or lemon in water, before eating will stimulate the release of these enzymes and stomach acid without a supplement
- Try an elimination diet for 30 days such as a Low FODMAP diet, or a diet which removes the common triggers of gut issues: dairy, gluten, added sugar, alcohol, yeast, eggs, corn, soy, and peanut. Dairy, gluten, added sugar and excessive alcohol are the most important triggers to remove. After 30 days, re-introduce foods systematically one by one to isolate which foods are causing your symptoms.
- Test for SIBO, food sensitivities, parasites or other gut issues through a practitioner to help identify your root causes. A practitioner can help you identify which tests, if any, may help you. They will also be able to help identify your root causes by taking a detailed health history and symptoms analysis. I often recommend the GI Map test.
- Work with the brain If no cause for the IBS can be found in the previous step, then pay attention to the brain. This can involve a variety of approaches and modalities, ranging from activation of the rest and digest arm of the nervous system (parasympathetic), stress reduction, exercise, blood sugar balance, acupuncture, counseling, NLP, or hypnotherapy.
- Repair the gut once the cause of IBS has been removed through repopulation with good bacteria and repairing increased intestinal permeability (leaky gut) and the immune system lining your gut
By taking steps such as these, and seeking out the underlying causes of IBS, you can really improve your health and finally overcome your digestive disorder. For a detailed overview of the four steps to improve gut heatlh, refer to this article.
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Stephen Ward (MSc) is trained in assessing the root cause of chronic health issues through Functional Medicine.
He uses nutrition, lifestyle changes, and nutraceuticals (targeted supplements) to help you achieve your goals and improve your health.