IRRITABLE BOWEL SYNDROME - 'JUST LIVE WITH IT' ?!?!

What is IBS?

IBS or irritable bowel syndrome affects around 11% of our population, of which only 30% seek medical attention. Because in medicine, no definitive investigation or biomarker has yet been established to diagnose IBS, it is a diagnosis of exclusion. Meaning that after running all pathological testing with normal structural results, doctors conclude that the presentation must be functional. However, unfortunately, up to this date, 25-30% of IBS cases are still misdiagnosed and therefore left untreated. Whilst IBS is yet poorly understood, many possible disease progression pathways have been identified and are currently researched [1, 2]. Natural Medicines aim to support a patient by understanding the symptomatology of IBS and investigating the underlying cause of the presentation. Nutritionists use investigation methods, that are not standardized in conventional medicine, which can give a more nuanced insight into the patient's presentation.

How does IBS present?

• Diarrhoea

• Constipation

• Altering Bowel Movements

• Bloating and abdominal distention

• Flatulence

• Reflux

• Cramping

• Abdominal discomfort

• Increased Urgency for BM

• Excessive fullness and Belching [1,2]

Possible Associated Symptoms:

• Fibromyalgia

• Joint Pain

• Muscle Pain

• Bladder Pain

• Fatigue

• Brain fog

• Anxiety

• Depression [1,2]

What's really happening in IBS?

Whilst IBS is a functional disorder, meaning no anatomical or physiological changes can be determined, many disease progression pathways have been suggested. Individuals experiencing IBS often suffer from multiple dysfunctional pathways in the digestive tract and other systems such as [2,3]:

• Compromised digestive enzyme production and function (especially bile salts)

• Hypersensitivity of the gut lining to triggers

• Compromised gut barrier integrity (leaky gut)

• The disturbed population of the beneficial bacteria and insufficient quantities

• Dysregulated muscular movements lead to impaired 'cleaning' of the gut

• Imbalanced neurotransmitter production and levels (serotonin)

• Dysregulated communication between the brain and the gut

• Miscommunication and activation of the immune system in and outside the gut

• Increased inflammation

• Altered pH in the large intestine

• Overactivation of your 'fight- and flight nervous system state, suppressing digestion

• Insufficient detoxification and clearance of toxins

What's causing IBS?

Whilst many aspects of IBS are still poorly understood, it is hypothesized that diet, lifestyle, genetic factors, previous infections (parasites and pathogens), nervous system disorders, food intolerances and allergies can lead to the development of IBS. As established, IBS is a multifactorial presentation, but a major contributing factor seems to be stress and dysregulations of the brain-gut axis, as well as inflammation and a compromised intestinal barrier function. To really understand what's causing an individual's IBS presentation, investigations and tests for pathology should be conducted, as symptoms alone are not sufficient to understand what's really happening for each individual [3].

Does it have to be IBS?

The answer is NO. Research has shown, that around one-third of IBS cases are yet misdiagnosed, and are in fact 'treatable'. The most missed diagnosis, that presents almost identical to IBS and is also missed, during routine investigations is SIBO. SIBO stands for small intestinal bacterial overgrowth and basically describes the migration of beneficial gut bacteria from the large intestine up into your small intestine, where they colonize. When bacteria species dislocate to the small intestine, they feed on the abundance of food particles, that they usually wouldn't get in touch with, causing them to over-ferment the food, leading to distinct symptoms such as bloating and pain. But also other gastrointestinal disorders, such as parasites, other 'harmful bacterial overgrowth, yeast overgrowth or general large intestinal overgrowth can mimick the IBS presentation. And even if all those 'differential presentations' are not present, you still can get a hang of your IBS presentation [2,3,5]!

How can you exclude all those differentials, such as SIBO?

As Nutritionists, we are trained to thoroughly investigate underlying factors and mechanisms that lead to symptoms. We connect the presentations in different body systems, with the patients' medical history, family history, and all other life circumstances to gain a clear picture of the possible pathways that are not working efficiently. In gastroenterology, however, symptoms often overlap and are impossible to distinguish, no matter how well we take a case. In those instances, we order further investigative tests to really deep-dive into the patient's individual biochemistry and gastrointestinal environment. Tests, like the SIBO breath tests, advanced blood tests and a comprehensive stool analysis give us great insight into the complex world of the gut and microbiome. Level of bacterial fermentations, populations, digestive enzyme efficacy, detection of pathogens- leaky gut - dysbiosis and inflammation, as well as risk for autoimmune disorders, can be picked up and assessed by those functional tests [2,5].

Can you treat IBS?

Whilst Nutritionists usually avoid the word 'treating', we like to educate our patients about the management of gastrointestinal issues, especially IBS. As previously discussed, IBS is not well enough understood to give a definitive answer for the best or golden standard treatment practice. However, by understanding the underlying drivers for the initial activation, as well as the current state of the presentation, holistic health professionals can work on addressing the underlying triggers as well as prescribing supplements to overcome acute symptomatic challenges. Thus very well support the eradication and management of symptoms. Clinical research has also shown that nutritional and herbal supplements can assist in the management of IBS symptoms such as pain, bloating, relieve constipation and diarrhoea and abdominal cramping. So the answer is YES, you can manage IBS and don't have to live with severe symptoms, that determine the quality of life for the rest of your life 1,2,4]!

Would I, as a Nutritionist recommend dietary changes for IBS?

This question is hard to answer for a whole population group, as each individual has different nutritional requirements, different disease manifestations, and reacts differently to the same changes. However, in my clinic, I start to see dietary patterns, that contribute to the initiation, as well as the progression of IBS, which can be easily adjusted on a daily basis. Summarizing those patterns and translating them into a few general dietary changes, will be beneficial to all individuals suffering from IBS:

• Limit or avoid caffeine (1 cup of coffee can be fine for some people)

• Reduce your intake of animal fat (i.e. fatty cuts of animal meat such as lamb chops, chicken thighs etc.)

• Limit and avoid any added and processed sugars, carbohydrates and fats

• Avoid artificial sweeteners, colourings and preservatives

• Avoid eating late at night (finish your dinner latest at 7 pm)

• Avoid constant snacking (ideally leave 4h eating windows between meals)

• Chew your meals thoroughly and practice mindful eating

Therapeutic elimination diets can be greatly beneficial to relieve gastrointestinal symptoms. IBS diets such as the low FODMAP diet, the Elimination Diet, the Bi-Phasic diet, the High Fibre diet, a low fibre diet, the gluten - and dairy-free diet, have been trialled and shown great effects on symptom management in conjunction with adequate functional testing as well as nutritional and herbal supplementation. Therapeutic dietary eliminations are used to reduce exposure to certain triggers on the gastrointestinal and immune system, thus supporting the healing of possibly inflamed and irritated structures, giving your practitioner the time and angle to address the problem further with holistic tools [6]. Eating restrictively is a short term therapeutic approach only, that should always be used with the proper re-introduction of nutritional whole foods afterwards [4]. Which diet suits you needs to be assessed by a Nutritionist, based on your symptoms and should not be attempted by a patient himself, as this can lead to severe nutritional deficiencies, hormonal imbalances and disordered eating.

What you can do when you are suffering from IBS and how a Nutritionist can help you:

Seek help from a Holistic Nutritionist or Naturopath that are trained in assisting to navigate you through your challenges. Chances are, that you feel like you have 'tried everything' and you have done 'all the tests' but chances are that your medical doctor still has not searched for your underlying cause that's re-triggering and exacerbating your condition. Working with a Nutritionist will help you to get to the bottom of your IBS issues, whilst helping you to manage dietary intakes, correcting nutritional deficiencies, giving immediate symptom relief and supporting you to choose better lifestyle practices to support the other treatment.

If you would like to work with me, please book via my contact page on my website and get in contact with me. I am passionate about all gastrointestinal issues, as they are the key piece to overall health and they can limit people greatly in their daily lives. What and how we eat matters and I made it my mission to support as many individuals suffering from gut issues as possible.

References:

[1] C. Canavan, J. West, and T. Card, ‘The epidemiology of irritable bowel syndrome’, Clin. Epidemiol., vol. 6, pp. 71–80, Feb. 2014, doi: 10.2147/CLEP.S40245.

[2] U. C. Ghoshal, R. Shukla, and U. Ghoshal, ‘Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy’, Gut Liver, vol. 11, no. 2, pp. 196–208, Mar. 2017, doi: 10.5009/gnl16126.

[3] G. J. Holtmann, A. C. Ford, and N. J. Talley, ‘Pathophysiology of irritable bowel syndrome’, Lancet Gastroenterol. Hepatol., vol. 1, no. 2, pp. 133–146, Oct. 2016, doi: 10.1016/S2468-1253(16)30023-1.

[4] M. E. Werlang, W. C. Palmer, and B. E. Lacy, ‘Irritable Bowel Syndrome and Dietary Interventions’, Gastroenterol. Hepatol., vol. 15, no. 1, pp. 16–26, Jan. 2019.

[5] D. Poon, G. R. Law, G. Major, and H. J. N. Andreyev, ‘A systematic review and meta-analysis on the prevalence of non-malignant, organic gastrointestinal disorders misdiagnosed as irritable bowel syndrome’, Sci. Rep., vol. 12, no. 1, Art. no. 1, Feb. 2022, doi: 10.1038/s41598-022-05933-1.

[6] B. E. Lacy et al., ‘ACG Clinical Guideline: Management of Irritable Bowel Syndrome’, Off. J. Am. Coll. Gastroenterol. ACG, vol. 116, no. 1, pp. 17–44, Jan. 2021, doi: 10.14309/ajg.0000000000001036.