Catchy headlines poke fun at the gluten-free ‘fad’, and many GPs still do not believe non-celiac gluten sensitivity could be affecting their patients. But many people are finding that they feel better when they avoid gluten. So what does the research tell us? In case you didn’t know, gluten is a family of proteins found […]
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!
Many people have suffered for years, whether diagnosed or not, and can end up eating a very restrictive diet making eating out and socializing difficult. After a while, this can give rise to anxiety and stress and is often associated with brain fog. It’s so important that we can get you eating a diverse range of foods that support your gut, but first we need to find out what is causing your gut issues.
The Diagnosis Criteria
The Rome IV Criteria is commonly used to diagnose IBS and so if you meet this criteria, IBS is likely:
Rome IV Criteria
Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
Doctors call IBS a ‘functional gastrointestinal disorder’ which means the gastrointestinal tract doesn’t show any physical abnormalities but functions abnormally.
As the underlying cause isn’t often known by a GP, their only option is to treat only the symptoms using drugs or surgery, or you may be told there is nothing that can be done, or to eat more fiber or Metamucil.
But this is NOT the final answer. Most of these options aren’t effective as they don’t address the underlying causes of your IBS.
If you take one thing away from this post, I want it to be the hope and understanding that it’s 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 well-being 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, parasites, slow digestion, food intolerances, gluten disorders, small intestinal bacterial overgrowth (SIBO), high stress, and carbohydrate maldigestion. These issues then tend to be associated with imbalances of bacteria in our gut, a overly reactive immune system and ‘leaky gut’.
In some people,IBS all started with an infection, such as food poisoning.
Remember that time years ago when you were travelling and got sick after eating something?
The toxins released during an infection may have damaged nerves in the gut. Now, when you are stressed, there is an abnormal muscular contraction of the bowel causing digestive discomfort. In this case, the brain can then become overly sensitive to signals of pain or bloating sent from the gut, and it feels like your gut has become overly reactive.
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, diarrhoea, 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, particularly bloating within 120 minutes of eating, it may make sense to test for SIBO.
If SIBO is found, anti-biotics are an option. But many people prefer an approach that is less damaging to the gut bacteria. This approach involves dietary and habit change, and targeted supplements.
A successful approach should always look at the underlying cause of SIBO itself. For instance, a build of methane producing bacteria, associated with constipation, may have been caused by a slow transit time of food (how long it takes to pass through the gut). If that’s the case, steps should be taken to speed up the digestive process, else SIBO is likely to return.
Testing Option: SIBO Breath Test
Parasites, Bacteria and Yeast Overgrowths
For some people, there may be an overgrowth of particular microbes in the gut. For example, the yeast Candida is a normal resident in our gut but can become overgrown and be problematic. Parasitic protozoa (essentially supercharged bacteria) such as Blastocystis Hominis and Dientamoeba Fragilis, and bacterial overgrowth such as Chlostridia can also cause IBS type symptoms.
When the immune system becomes overly reactive, we lose oral tolerance, and we can find ourselves with an increasing number of sensitivities to foods. This may be associated with ‘leaky gut’.
To read more about the processes behind food sensitivities, you might want to look at my detailed article here.
Food sensitivities are not true allergies but low-grade reactions to foods that may not be seen until hours or days after eating. The British medical journal, Gut, found that eliminating trigger foods identified through IgG food sensitivity testing resulted in dramatic improvements in IBS symptoms in the study’s participants.
Testing for food sensitivies is a bit of a minefield and I suggest you work with a practitioner such as myself to guide you. An elimination diet that removes likely trigger foods from your diet for 4 to 8 weeks can be useful. After that time, foods can be re-introduces and reactions to the foods closely monitored.
When working with someone, I always start with diet, and consider removing the possible trigger foods and / or high FODMAP foods (see below). Common trigger foods may include gluten, dairy, added sugar, soy, corn, oxalates or foods containing high levels of histamine or food additives.
Testing Options: IgG Food Sensitivity
There is considerable research showing the effectiveness of a low FODMAP diet to remove symptoms and associated inflammation of 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.
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 most of the eliminated foods.
Gastro-Intestinal System Questionnaire
This questionnaire can be used as a guide to help you identify where in your GI tract may be your greatest priority.
PS/ If you submit this form, I’ll get back to you with some feedback/advice..
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, as well as working on the gut-brain connection with a practitioner such as myself.
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.
- Trial quality probiotics. I recommend a combination of Sacchromyces Boulardii, Lactobacillus Bifidobacterium blend, and a soil based probiotic. This triple probiotic therapy tends to be the most effective.
- Try taking digestive enzyme, apple cider vinegar, 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 that 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 the root causes of your gut issues. A practitioner can help you identify which tests, if any, are appropriate. They will also be able to help identify your root causes by taking a detailed health history and symptoms analysis. For stool testing, I often recommend the GI Map test or the GI 360 test.
- Work with the brain It always helps to pay attention to the brain and gut-brain connection. This can involve a variety of approaches and modalities, ranging from activation of the rest and digest part of the nervous system (parasympathetic – vagus nerve), stress reduction, exercise, blood sugar balance, acupuncture, counseling, NLP, or hypnotherapy.
- Repair the gut once the drivers of IBS has been removed. Repopulate with good bacteria and prebiotics. Repair any increased intestinal permeability (leaky gut) and balance the immune system in your gut.
For a more detailed overview of the steps to fix your gut health, have a look at this article.
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.