Irritable Bowel Syndrome Explained
Irritable Bowel Syndrome, (IBS), affects almost 20% of Australians and New Zealanders, occurs more in women than men, and is more commonly diagnosed in people less than 50 years of age. It presents with a cluster of gut symptoms, such as constipation, diarrhoea, bloating, and flatulence. Technically, the criteria for a diagnosis of IBS is;
Recurrent abdominal pain or discomfort at least 3 days/month in the last 6 months associated with two or more of the following:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with change in form (appearance) of stool
It is recommended that if you think you might have IBS, (and you haven't been already), that you go to your GP to get this assessed, to rule out anything more serious. If you have been diagnosed with IBS, then you will likely have been prescribed antispasmodics, anti-flatulents, anti-diarrhoeals and/or laxatives, depending on your symptoms. And none of these medications will be solving the root cause of your problems, your leaky gut.
THE ROOT CAUSE OF IBS - LEAKY GUT
For many people, the gut is a bit mysterious. Food goes in one end, something happens in the middle, and then something else happens at the other end. As long as we don't get any problems, we normally don't give things a second thought.
But your digestive system is much more than just a food processing network. Modern science is telling us that our gut health is crucial for many other aspects of our health, from depression to diabetes, autism, anxiety and auto immune conditions. What we are just beginning to appreciate is that the gut is registering a massive amount of information about our external (and internal) world each day.
We've really known this for a while though, that our gut feelings are an important part of our interactions with the world (ever heard the phrase - gut feel?). We now know that the gut is actually a sense organ - our main environmental interface, with more nerves than the rest of our peripheral nervous system put together. Your gut is also your primary immune organ - with the immune system in your gut making more immune-based decisions in a day than the rest of your immune system makes in your entire lifetime!
It's not surprising that there is so much sensory data coming in and out of the gut - as the gut is the biggest source of microbial and environmental antigens (bugs and potential toxins), and your body is very interested in monitoring this composition regularly. When there is an imbalance in this mix for whatever reason, (such as a junk food based diet, or a sustained increased level of stress), the vast amounts of immune cells in your gut sets off a huge inflammatory reaction, which can spiral out of control very quickly, causing pain and spreading throughout your body. We term this process, "Leaky Gut", and it is explained in the video below.
Leaky Gut can progress due to any one, (or combination), of the following;
- Stress - when you are in constant stress mode, "Flight/Fight" response, your digestive system becomes stressed as well. Check out our web page on "Stress" for a detailed explanation of how this occurs.
- Toxins - these can be external, (such as cigarette smoke, plastics), or internal, (such as hormones).
- Diet - sugar, dairy and gluten are common causes of leaky gut. In fact, eating gluten causes leaky gut in every single person! However, this does not progress to IBS in everyone.
- Drugs - antibiotics, whilst good at killing bad bacteria, will also wipe out your good gut bacteria as well. Certain pain killers can destroy your gut wall lining, leading to ulcers.
- Parasites - anything which normally should not live inside you, when introduced, could cause you problems, like salmonella and listeria.
- Good bacteria/bad bacteria balance - anything which throws out the balance of your normal gut bugs, puts you into a state known as "dysbiosis", which inflames your gut lining.
When any of the above occur, your gut will become inflamed, causing the cells lining your gut wall to "leak", or open up the gaps in between each cell. Then, the contents within your gut gets exposed to your blood stream, and immune system, setting up a chain reaction of inflammation , which can spread right through your body.
As you can see from the above diagram, leaky gut is responsible for many conditions, from liver disorders, skin conditions, food intolerances and allergies, autoimmune conditions, obesity, and even mental health conditions like depression, methylation issues and autism. It would make sense then fixing your leaky gut should be a high priority, beyond just addressing your IBS.
testing for ibs - why so many gp's get it wrong
If you've been to your GP to get your IBS investigated, they should have sent you for tests to rule out anything more serious. Chances are you may have had a referral to a specialist also, may be for a scope of some description, (putting a camera up your bum, or down your throat), or even for a special breath test. It is possible that you may have had a stool test done also.
If you have IBS, these test results will come back as either;
- There is nothing wrong with you
- You are fructose intolerant
I'll let you in on a little secret, if you have read this far, then;
- There is something wrong, the test just can't find it
- "Fructose Intolerance" is not the issue, all it's telling you is that your gut bugs are out of balance
So many times, our patients come to see us under these circumstances. And so often, we have to explain, that your GP and/or specialist is looking at your IBS the wrong way.
You don't have a "disease", you have a loss of digestive function. To examine what is contributing to this, you need to have your gut bugs properly assessed. The best way to do this is with a special stool test, called a Complete Digestive Stool Analysis, (CDSA). Different labs have different versions of this test, and it is important to get the right advice from your health care practitioner about which test you will need. Our testing partners include Bioscreen, Doctors Data, Nutripath and Clinical Labs, and these laboratories offer a range of tests which are fantastic at giving us a very clear picture of exactly what is happening inside your gut.
If you think you have an issue with gluten, then watch this video to learn more about the right testing you need.
Naturopathic and nutritional medicine solutions for IBS
Parasite Removal - if you have had a parasite confirmed via a stool test, then you need to get it out, period! Certain antibiotics may be useful for this, but often antimicrobial herbs will do the job. Garlic, wormwood, berberine, uva ursi, oregano oil, thyme oil, and clove oil all exert anti-parasite properties, depending on the type of parasite. A CDSA will determine which anti-microbials will be most effective at destroying the parasite identified.
Gut Healing - as well as addressing the offending bugs/parasites themselves, healing the barrier of your gut lining is equally important. A good, healthy gut wall lining will promote the right balance of your normal gut bugs. Nutrients vital for gut healing include zinc, glutamine, Vitamin A, Vitamin D. Useful herbs include tumeric, bosweilla, larch, and aloe. Certain strains of anti-inflammatory probiotics, such as Lactobacillus plantarum 299v.
Elimination Diet - often certain foods will be aggravating your leaky gut. One way to determine whether this is the case is by trialing an Elimination/Rechallenge Dietary plan. This normally involves the removal of a certain food group, such as dairy foods, for a period of time, (normally 2 weeks), and then re-introducing them to see if you get a reaction. For example, you may eliminate all dairy containing foods from your diet for 2 weeks. At the start of the 3rd week, you start the day with a glass of milk, or tablespoon of yoghurt, and do that again around dinner time. The following 2 days you don't consume any dairy foods. On the 4th day, you reintroduce the dairy foods again, and then again eliminate them for the following 2 days. During this process, you note down any symptoms. You may find that you can tolerate a certain amount of these foods, and adjust your diet accordingly.
FODMAPS Diet- the FODMAPS diet, (invented by Australian Dietitian Dr Sue Shepherd), is a version of an elimination diet. “FODMAP” is the acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, a group of short-chain carbohydrates and sugar alcohols (polyols). These nutrients are everywhere in our diets. The key FODMAPs are:
- Oligosaccharides, such as fructans/fructo-oligosaccharides (found in grains and vegetables) and galactans/galacto-oligosaccharides (found in legumes)
- Disaccharides, such as lactose (found in milk)
- Monosaccharides, such as fructose (found in fruit)
- Polyols, such as sorbitol (found in sweetened products
Susceptible people can experience intestinal symptoms from ingestion of FODMAPs for a number of reasons.
- The carbohydrates are not well absorbed into the body and remain in the digestive tract for longer periods.
- FODMAPs draw water into the intestines, which can increase bowel motions and promote diarrhoea
- These carbohydrates can be metabolised by the bacteria that normally reside in the bowel, producing gas, bloating and wind.
To determine if FODMAPs might be contributing to your symptoms, the most effective strategy is to eliminate all FODMAP-containing foods and observe your symptoms. Following the elimination of all FODMAPs, the next step is to complete systematic rechallenge one-by-one of each FODMAP to help determine the tolerable doses and types of FODMAPs for you.
Please note; It is not generally recommended that you follow a low FODMAP diet for life, (unlike the advice given by some health professionals!) Restricting your dietary intake of a wide array of foods should generally be avoided if possible to reduce you risk of nutrient deficiencies. FODMAPs are a normal part of your diet and have benefits for health, such as providing fibre and prebiotics for gastrointestinal health.
If you would like some more information about how to trial the low FODMAP diet, please fill in you details below.