Irritable Bowel Syndrome (IBS) – 5 Things You Need To Know

“Research into Irritable Bowel Syndrome is making a lot of headway and there is a much better understanding today about the causes of this condition, the pathophysiological mechanisms involved and the interventions that can be used to effectively manage symptoms.”

Irritable Bowel Syndrome (IBS) is an extremely common, yet misunderstood condition that affects between 7 to 21% of the global population. Because other seemingly unrelated symptoms such as fatigue, hormonal imbalances, headaches often accompany IBS the condition can be difficult to understand and manage and can result in a significantly reduced quality of life (1).

I was never properly diagnosed with IBS but suffered from it for many years. Along with a host of other issues, I presented with the typical IBS symptoms of intense stomach pains, which had me break out into a sweat several times a day and diarrhea alternating with constipation. Doctors couldn’t find anything wrong with me and tests and colonoscopies came back clear, which left me with no choice but to figure out a way to manage my symptoms on my own.

While it was tough at the time, I credit this period of digestive distress with where I am today. My entire journey as a health & wellness practitioner has been motivated by a desire to understand IBS better, learn all about gut healing and share my knowledge and experience with the world so that others can avoid the suffering that comes with this condition. I delved deeper and deeper over the years and ultimately wrote my master’s thesis on the role of gut microbiota in IBS.

Fortunately, research into IBS is making a lot of headway and there is a much better understanding today about the causes of this condition, the pathophysiological mechanisms involved and the interventions that can be used to effectively manage symptoms.  It is a rapidly evolving space with new research data appearing frequently but here are some of the latest findings and research that are useful to know if you or someone close to you suffers from IBS.

1. The leading cause of IBS is food poisoning

For some people the immune imbalances and gut imbalances that are triggered by an episode of infectious gastroenteritis persist even after the infection is cleared. IBS symptoms may show up later, even quite some time after the infection has passed and this can be the reason that not everyone connects their IBS with a bout of food poisoning in their past. It is however thought to be one of the leading causes (2).

2. There are tests that can help you find out if you have IBS resulting from infectious gastroenteritis

For a long time, IBS has been a diagnosis of exclusion that involves a lengthy (and costly) process of ruling out other gastrointestinal diseases with endoscopies and colonoscopies and the use of certain diagnostic criteria. An IBS diagnosis usually implies that nothing much can be done and patients are often told that it may be stress related.

Fortunately, there is now a simple diagnostic test available for IBS patients whose symptoms are characterized by diarrhea (IBS-D) or alternating diarrhea and constipation (IBS-M). This blood test (or finger prick test for people outside of the U.S.) measures the levels of two antibodies that become elevated after exposure to certain bacterial toxins. The antibodies affect intestinal motility and as such contribute to the development of IBS symptoms.

3. There is a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in IBS patients (3).

Small Intestinal Bacterial Overgrowth (SIBO) is a condition that is characterized by the presence of abnormally high levels of bacteria in the small intestine. Symptoms include gas, bloating, abdominal pain and changes in bowel patterns. There are several causes for SIBO and one of them is impaired gastrointestinal motility, which can be caused by the elevated antibodies that are often seen in patients with a history of food poisoning. For patients who suffer from the type of IBS that is characterized by constipation (IBS-C), SIBO can play a role too (4). A special breath test can help identify if SIBO is contributing to your symptoms and inform a treatment plan.

4. There are treatment options available for IBS

Once it is clear what has caused your IBS and what the underlying imbalances are, a personalized treatment plan can be put into place.

There are pharmaceutical treatments to clear any lingering bacterial infection and to help restore motility, if needed. There are also herbal supplements and diet interventions such as the low FODMAP or low fermentation diet and probiotic supplementation. There are several research studies, including randomized controlled trials and meta-analyses that show a considerable improvement in IBS symptoms after a short-term low FODMAP diet for IBS-D and IBS-M patients (5) (6). The low FODMAP diet limits the intake of certain types of foods that are fermented by bacteria in the small intestine and as such contribute to the bacterial overgrowth.

5. The IBS gut microbiome needs rebalancing

The gut microbiome is the gut’s inner ecosystem that contains over 1000 different micro-organisms, which play a key role in many of our body’s biological functions. IBS population studies have shown that dysbiosis or disruptions in the composition of the gut microbiome are common in IBS (7).

Due to the large variations in gut microbiome composition between individuals it is difficult to pinpoint exact changes but probiotic supplementation with multi-species probiotics that contain Lactobacillus and Bifidobacteria species has been shown to have a beneficial effect on symptom improvement in IBS (8).

Multifactorial conditions such as IBS are best managed in a personalized manner, after a detailed assessment of a person’s health history and unique underlying imbalances. This is exactly why a functional approach is so effective in the management of IBS.

If you or someone you know needs help with IBS, please reach out to set up a free discovery session and let me help you figure out what to do next.

Be Well.

References:

1. Chong, P.P., Chin, V.K., Looi, C.Y., Wong, W.F., Madhavan, P. and Yong, V.C., 2019. The microbiome and irritable bowel syndrome – A review on the pathophysiology, current research and future therapy. Frontiers in Microbiology.
2. Lee, Y.Y., Annamalai, C. and Rao, S.S.C., 2017. Post-Infectious Irritable Bowel Syndrome. Current Gastroenterology Reports, [online] 19(11), p.56.
3. Takakura, W. and Pimentel, M., 2020. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Frontiers in Psychiatry.
4. Pimentel, M. and Lembo, A., 2020. Microbiome and Its Role in Irritable Bowel Syndrome. Digestive Diseases and Sciences.
5. McIntosh, K., Reed, D.E., Schneider, T., Dang, F., Keshteli, A.H., De Palma, G., Madsen, K., Bercik, P. and Vanner, S., 2017. FODMAPs alter symptoms and the metabolome of patients with IBS: A randomised controlled trial. Gut, 66(7), pp.1241–1251.
6. Rao, S.S.C., Yu, S. and Fedewa, A., 2015. Systematic review: Dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 41(12), pp.1256–1270.
7. Wang, L., Alammar, N., Singh, R., Nanavati, J., Song, Y., Chaudhary, R. and Mullin, G.E., 2020. Gut Microbial Dysbiosis in the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. Journal of the Academy of Nutrition and Dietetics, [online] 120(4), pp.565–586.
8. Ford, A.C., Harris, L.A., Lacy, B.E., Quigley, E.M.M. and Moayyedi, P., 2018. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, [online] 48(10), pp.1044–1060.