WTF is IBS - irritable bowel syndrome types, causes, treatment (natural remedies)
Confused about your IBS diagnosis? You’re not alone.
IBS is a troublesome condition that many of us face. And luckily, naturopathic therapies are going to be your best friend.
Let me tell you a little bit about it first. Irritable bowel syndrome is classified under The Rome IV criteria. It requires patients have recurrent abdominal pain on average at least one day per week during the previous three months, that is associated with two or more of the following:
Related to defecation (meaning the pain may increase, of be unchanged by a bowel motion)
Associated with a change in stool frequency
Associated with a change in stool form or appearance
Four bowel patterns have seemed to arise, including:
IBS-D - meaning diarrhea predominant
IBS-C - meaning constipation predominant
IBS-M - meaning mixed diarrhea and constipation
IBS-U - meaning ‘unclassified’
So.. pretty vague, huh?
Other symptoms that have been reported include gas, wind, bloating, nausea, anxiety and depression.
pathophysiology
Let me explain the diagram pictured below quickly. Originally, there seemed to be a two part theory, including altered gastrointestinal motility and visceral hypersensitivity, however the underlying mechanisms for this is suggested to be due to disorders of the gut-brain axis, diet, genetics, infections, dysbiosis, inflammation, immune activation, abnormalities in serotonin metabolism, and last but not least… altered intestinal permeability (Holtmann et al., 2016).
the gut-brain-axis
The hottest topic of 2018, the (quite-dated) phenomenon that psychological manifestations can influence the gut, and gut manifestation can influence the brain. The microbiota (make-up of the gut) and the brain communicate with each other via various routes, such as the immune system, tryptophan metabolism, the vagus nerve and the enteric nervous system, involving microbial metabolites. The gut-brain axis is always changing, as many factors can influence it. An exhaustive list of factors in fact, which include the way that you were born (vaginally or cesarean), infections, use of medications such as antibiotics and the oral contraceptive pill, environmental stressors, physical stressors, physiological stressors, diet, age, and genetics. It can control gut inflammation, response to acute and chronic stress, and also effect the behaviour, making it an attractive target for disorders relating to mental health, cognitive function, inflammatory bowel disease, and IBS (Cryan et al, 2013).
diet
The role of diet in IBS is huge. Unfortunately, we are faced with many foods that are causing detrimental effects to our health. This is because of the over-processing, over-consumption, reduced quality, and chemical and toxin plagued food that we are exposed to. Alcohol, caffeine, transfats, low fiber, high fiber (say what!), dairy, and sugar are all linked to IBS (Cozma et al., 2017). I’m sure you’re probably aware of the low FODMAP diet, which is quite beneficial in some cases of IBS. Basically, the FODMAP diet restricts the dietary intake of the poorly absorbed short chain fermentable carbohydrates that are naturally present in foods. This includes fructans, fructo-oligosaccharides, galacto-oligosaccharides, fructose and polyols. Basically, it’s a very restrictive diet and I highly recommend doing this under the guidance of a practitioner, as there are also specific protocols with various herbs and nutrients to take at different times.
genetics
I won’t bore you with the specific genes, but there is a genetic link. Genetics don’t define you, so don’t be disheartened. You can optimise the health of your genetics by minimising harmful toxins and chemicals, reducing your stress response, identifying allergies and intolerances, and ensuring you’re getting appropriate nutrients by eating a clean and wholefood diet.
infections and dysbiosis
Did you go overseas and end up with gastro, and have never been the same since? Don’t worry, you’re not alone. Infections, whether bacterial, fungal, or viral, could be contributing to your IBS picture. You may be suffering from a chronic infection, or a ‘stealth pathogen’, which are changing the make up of your microbiota. Pathogens can alter their environment to make it more desirable to them, in turn producing inflammatory mediators, and leading to the elevation, or reduction, of different bacterial species (known as dysbiosis).
inflammation and the immune activation
Ah, a key player in functional gastrointestinal disorders! IBS patients have been shown to exhibit significant increases in immune cells of the colonic mucosa compared with healthy subjects, and also experience low grade inflammation. Why? Great question. Inflammation can be caused by pathogens, dysbiosis, stress, allergies and intolerances, nutritional deficiencies, and a pro-inflammatory diet (i.e our western fast foods, pastries and pies!). The microbiome is thought to modulate inflammation, and act either directly or indirectly through microbial metabolites (NG et al., 2018). Dysbiosis promotes inflammation and should be considered as a main causative factor in IBS.
serotonin
Psychological factors are strongly implicated in IBS, with studies finding childhood abuse and PTSD are associated with adult IBS. Stress stimulates proinflammatory cytokines (such as IL-6, IL-8) and NFKB, which upregulates enzymes in the tryptophan and serotonin pathway, which contributes to the abnormal 5-HTP functioning. The ‘hyper-responsive’ HPA axis (the stress response), is correlated with visceral hypersensitivity (pain), seen in IBS (NG et al., 2018).
intestinal permeability
Our friend, the mucosal barrier. The barrier that separates our insides from the outside. A friend indeed. The intestinal barrier consists of a vascular endothelium, an epithelial cell lining, and a mucus layer, where digestive secretions, immune molecules, cytokines, inflammatory mediators, and antimicrobial peptides are found, thanks to cells called the Paneth cells. Impaired intestinal permeability is a common finding in IBS patient, and the effects are detrimental. The suggested culprits that lead to this malfunction include dysbiosis, bile acids, inflammatory foods, allergies and intolerances, stress, and poor nutrient status.
what else could it be?
It’s important to remember that there are many other disorders that are similar to IBS. It is important to find a practitioner to help you with relevant testing. Some examples could be
SIBO - small intestinal bacterial overgrowth. This is a common culprit driving IBS
Gastroenteritis
Parasites
Stress and anxiety
Allergies and intolerances: such as to gluten and dairy
Celiac disease
what can you do?
Firstly, I want to stress the importance of not treating yourself. There are so many factors that can contribute to IBS, and I highly recommend following the advice of a practitioner. Why? Because your safety is paramount, treating yourself is expensive (trust me, I’ve been there!), and there may be other underlying or comorbid issues going on. So, that being said…
find yourself an experienced practitioner
Do you think you have IBS? Head over to my bookings tab, and book in to see me.
clean up your diet
Reduce your intake of processed, refined, and sugary foods. Basically, ditch the fast food, shop at a wholefood market, and avoid all the middle isles in the supermarket!
Identify any food allergies and intolerances. Most common allergies include gluten and dairy, so try and cut them both out for a month to see if you improve.
Make sure you’re eating a variety of colours and foods, of all food groups, to maintain your macro and micronutrient intakes.
Have a strong focus on antioxidants, found in berries, cacao, dark chocolate (my favourite), and nuts and seeds (if you can tolerate it).
Increase your intake of dietary antimicrobials. Think FRESH GARLIC (again, if you can tolerate it!). It has to be fresh, otherwise the constituent is destroyed. Also think about your other herbs and spices, such as rosemary, thyme, oregano, cloves and cinnamon.
Make sure you’re staying adequately hydrated by drinking the recommended 2L of water per day. If you are suffering chronic diarrhea, consider electrolyte replacement therapy.
look after yourself
IBS is a debilitating disorder, and can greatly affect your mental health. Ensure you have appropriate self care strategies. Reach out to your friends and family, and check in with other support networks.
Treat yourself to a ‘pamper’ activity, once a week or whenever you can. This could include getting a massage, going for a bush walk, getting your nails done. Whatever makes you happy.
Get a healthy dose of sun and nature each week.
Download mindfulness apps, or set aside 20-30 minutes each day to focus on yourself. Activities could include reading, yoga, or going to a light walk.
key herbs
Commonly prescribed herbs include
Phellodendron
Oregano
Clove
Nigella
Myrrh
Garlic
Ginger
Chamomile
Fennel
Gentian
Meadowsweet
key nutrients
Commonly prescribed nutrients include
Pomegranate husks
5-HTP
NAC
Glutamine
Vitamin C
Zinc
Psyllium, slippery elm
Probiotics
Digestive enzymes
references
Cozma-Petruţ, A., Loghin, F., Miere, D., & Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!. World journal of gastroenterology, 23(21), 3771–3783. doi:10.3748/wjg.v23.i21.3771
Cryan, J. F., O’Riordan, K. J., Cowan, C. S. M., Sandhu, K. V., Bastiaanssen, T. F. S., Boehme, M., … Dinan, T. G. (2019). The Microbiota-Gut-Brain Axis. Physiological Reviews, 99(4), 1877–2013. doi:10.1152/physrev.00018.2018
Lehrer, J. (2019). Irritable Bowel Syndrome. Retrieved from https://emedicine.medscape.com/article/180389-overview#a1
Ng, Q. X., Soh, A. Y. S., Loke, W., Lim, D. Y., & Yeo, W.-S. (2018). The role of inflammation in irritable bowel syndrome (IBS). Journal of Inflammation Research, Volume 11, 345–349. doi:10.2147/jir.s174982
Sinagra, E., Pompei, G., Tomasello, G., Cappello, F., Morreale, G. C., Amvrosiadis, G., … Raimondo, D. (2016). Inflammation in irritable bowel syndrome: Myth or new treatment target?. World journal of gastroenterology, 22(7), 2242–2255. doi:10.3748/wjg.v22.i7.2242