IBS or irritable bowel syndrome is a chronic illness of the gastrointestinal tract. It causes a range of symptoms like diarrhea and constipation or both, bloating, gas, abdominal pain and cramping, feeling like the bowels cannot be emptied, constant stomach discomfort, and additionally, mental health issues such as anxiety and depression. Further, IBS can affect social, romantic and work life.
Since there is no IBS test, diagnosing IBS starts with an evaluation of the medical history. While IBS is not genetically passed, it can run in families. After physical examinations then moves on to testing to rule out other conditions that cause similar symptoms like celiacs disease and cancer.
These tests can include a colonoscopy and endoscopy, stool and breath tests for bacteria and scans and labwork. Once other illnesses are ruled out, comes the diagnosis of IBS.
It’s important to note that there are different types of IBS, classed by bowel movement.
IBS with diarrhea (IBS-D) Stool is frequent, or watery.
IBS with constipation (IBS-C) Stool is infrequent or hard to pass.
IBS mixed (IBS-M) Stool alternates between constipation and diarrhea.
IBS unsubtyped (IBS-U) Stools vary and do not fit any of the other three patterns.
In addition to not having an IBS test, there is no cure. The acronym IBS is an umbrella term for the group of symptoms with no definitive cause after ruling everything else out. So, a diagnosis of IBS, does not mean that the journey gets easier. Since IBS describes a collection of symptoms, the following root causes should be considered.
Small intestinal bacterial overgrowth (SIBO) which occurs when bacteria populates the small intestine, an area which should be free of harmful bacteria. This causes digestive symptoms like bloating and diarrhea to more visible symptoms like rashes and rosacea. Some associated complications due to SIBO include malnutrition, anemia and kidney stones. SIBO itself can be caused by prescription medications or conditions like diabetes and celiacs disease.
Leaky gut occurs when the tight junctions lining the intestines become loose or compromised, allowing particles like food and toxins to pass through the gut lining. This is otherwise known as intestinal permeability.
Food intolerances occur when the body does not tolerate a specific food or food group causing a physical and biological reaction often in the form of digestive disturbances. These offending foods vary from person to person and this is not the same as an allergic reaction, which can be immediately life threatening.
Candidiasis, the overgrowth of the yeast Candida albicans which is normal in small amounts in certain parts of the body like the mouth and intestines.
Heavy metal toxicity can be due to excessive exposure to heavy metals in food, medication and environmentally including soil, water and air. These metals include mercury, cadmium, arsenic and chromium. This exposure can affect the body’s normal function.
Gut-brain interference has long been considered a root cause of IBS. According to the Mayo Clinic, “Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in issues like pain, diarrhea, or constipation.”
The journey from experiencing these very real symptoms to convincing your Dr to take you seriously that something is wrong can be a long and frustrating one. It’s believed that a startling 75 percent of people who have IBS, are undiagnosed. Many report not being taken seriously by health care providers when presenting with numerous symptoms with no obvious cause, even being told that it may be a mental issue.
While IBS can affect mental health and likewise IBS is common in those with mental illness, the gut-brain connection is real, IBS is not in your head. Current conventional treatment for IBS is purely to ease the worst of the symptoms. These include psychotherapy and medications to manage symptoms like diarrhea. However alternative treatments have been shown to be more effetive in addressing the root cause of the issue.
Alternative Treatment
This can include seeking out a health coach or functional medicine practitioner. This type of practitioner specializes in finding the root cause of chronic illness and creating individualized health plans. In terms of IBS, this means more extensive testing that conventional practitioners do not typically use. These include:
Lactulose/mannitol test – Check for leaky gut.
Microbiome testing – Assesses the diversity and composition of microbes in the gut
Fecal elastase – Checks pancreatic enzymes
Fecal calprotectin – Looks for inflammation in the stool
Secretory IgA (sIgA) – Assesses digestive immune function
C-reactor protein (CRP) – Checks for inflammation in the body
Motility tests – Assesses muscle activity in the GI tract
The benefit of having a health coach for IBS is to provide education around managing IBS through lifestyle, diet and supplementation. Options for supplementation depends on the type of IBS.
Berberine
Helpful for: IBS-D
Berberine is an alkaloid found in many plants, like goldenseal and barberry. It has been shown to decrease inflammation in the gastrointestinal tract.
Magnesium
Helpful for: IBS-C
Supplementing with magnesium increases water in the intestines and relaxes the muscles, which helps initiate peristalsis (the wavelike motion that moves fecal matter through the intestines). Magnesium used for constipation include magnesium chloride and magnesium citrate. When taken in higher levels, magnesium citrate acts as a natural laxative for severe constipation.
Peppermint Oil
Helpful for: IBS-C
Peppermint oil has intrinsic properties that may benefit patients with IBS. It contains L-menthol, which blocks the calcium channels in smooth muscle. This produces an antispasmodic effect in the gastrointestinal tract. Burning sensations, pain, and bloating can be relieved with peppermint oil by dulling pain receptors and relaxing the muscles in the colon.
Psyllium
Helpful for: IBS-C, IBS-D
Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms. Long-chain, intermediate, viscous, soluble, and moderately fermentable dietary fiber, such as psyllium, results in low gas production and the absence of the symptoms related to excessive gas production. The effects of this type of fiber has been documented in the management of IBS, and it is known to improve the overall symptoms. Fiber helps bulk up stool for persons with diarrhea and can also help “move things along” for those with constipation.
Probiotics
Helpful for: IBS-C, IBS-D, IBS-M
The right probiotic that contains the right strains and species for the individual can help repopulate good bacteria in the gut to help crowd out the bad.
L-Glutamine
Helpful for: IBS-C, IBS-D, IBS-M
L-glutamine is the most plentiful amino acid in the body and supports intestinal health because it helps maintain and build the intestinal lining.
Digestive Enzymes
Helpful for: IBS-C, IBS-D, IBS-M
Digestive enzymes refer to a broad category of enzymes that include pancreatic enzymes, plant-derived enzymes, and fungal-derived enzymes. They help turn macronutrients (carbs, proteins, and fats) into more easily absorbed particles.
Remember, any supplement should be taken under the approval and supervision of a healthcare provider.
Dietary Approaches
Persons with IBS will find relief by avoiding high-FODMAP foods (i.e., apples, garlic, asparagus, etc.), but since many high-FODMAP foods are full of fiber and prebiotics, this should be done cautiously. The most effective way to approach diet for IBS is to keep it very individualized as different forms of IBS will require different approaches.
Some diet protocols that can help with IBS include Ayurvedic, Gluten- and grain-free, Mediterranean and Paleo. As always, special diets and food choices ultimately come down to bio-individuality. Individuals with IBS should consider consulting with their doctor and/or a dietitian when adopting a therapeutic diet or making modifications to their existing diet.
Foods Commonly Recommended for IBS
Healthy fats from foods like avocado, coconut oil, olive oil, omega-3s (salmon, sardines, walnuts), and organic and grass-finished meats.
Stocks and broths both vegetable and animal-based
Meats with no added hormones or antibiotics; organic and grass- finished whenever possible
Low-FODMAP fruits and vegetables like leafy greens and berries
Low-FODMAP grains like rice and quinoa.
Soothing herbs, like rosemary, thyme, and basil
Foods to Avoid
Gluten and grains are high in insoluble fiber and can trigger symptoms.
Conventional dairy due to the high fat content. Opt for low or no fat.
Processed foods, their high fat, sugar and numerous additives are difficult to digest.
Fatty, greasy foods
Caffeine stimulates the GI tract, triggering symptoms like pain.
Artificial sweeteners and processed sugars
Corn and other foods with a high chance for GMOs (soy, canola oil, sugar beets, apples) can increase sensitivity in the bowels
Alcohol irritates the digestive tract
Potential foods to avoid include eggs, nuts, nightshades, FODMAPs, and red meat. This is because they can be highly inflammatory for many due to various individual properties (albumin, lectins, etc.)
Authors: Shawn Regis, Certified Health Coach | U.S Army Veteran and Alison Regis, Nutritionist | Master Gardener