Irritable Bowel Syndrome, commonly known as IBS, is sub classified as diarrhea predominant (IBS-D), constipation predominant (IBS-C) or mixed. Symptoms of IBS include frequent painful gas and bloating, abdominal pain that is relieved with a bowel movement, and/or diarrhea and constipation. Usually the diagnosis of IBS is one of exclusion, meaning that other diagnoses like Inflammatory Bowel Disease, Cancer, Diverticulitis, or Celiac Disease have been ruled out. Common mainstream treatments for IBS are Metamucil or Benefiber to help bulk the stool and decrease transit time, or laxatives and stool softeners like Colace or Miralax. However even with medications, those that suffer with IBS often note decreased quality of life and anxiety.
The good news is that there is often a solution for those with IBS! Addressing underlying bacterial overgrowth/dysbiosis, poor digestion, nutritional deficiencies, food sensitivities as well as mediating gut lining dysfunction many with IBS are able to get relief. Here are our top 5 hacks for IBS!
Rule out SIBO
It is estimated that up to 80% of IBS cases are actually due to an underlying overgrowth of bacteria in the small intestine, commonly called SIBO. Essentially, SIBO means that bacteria have taken up residence along the small intestine where most of your food digestion and nutrient absorption takes place. As food passes into the small intestine, the bacteria then feed on carbohydrates, causing fermentation, gas and bloating and variable bowel movements. It has been hypothesized that one of the reasons SIBO occurs is that a food borne pathogen causes nerve damage in the small intestine, causing issues with the muscular contractions that sweep through the GI tract, thereby allowing bacteria to take up residence in the small intestine. Risk factors for SIBO also include being female, aging, and medication use (especially proton pump inhibitors, antibiotics, and drugs that alter intestinal motility like narcotics or anticholinergic drugs).
While SIBO is challenging and often multi-factorial, it is possible to diagnosis and treat. Treatment protocols center on eradication of the bacteria, restoring microbial balance and supporting digestion and proper motility. If you suspect that SIBO may be the underlying reason for your IBS, work with a trusted health professional that can help you with testing and treatment options.
Heal leaky gut
Normally, the intestinal lining is permeable enough to let fully digested food molecules and nutrients into the bloodstream for transport to cells and tissues. Leaky gut, or increased intestinal permeability, occurs when the lining of the intestines becomes too porous, allowing large food proteins, bacteria or endotoxins into the bloodstream where they cause immune system activation and widespread chronic inflammation in the body. Increased intestinal permeability is linked to IBS and IBD, food sensitivities, metabolic diseases like fatty liver, celiac disease and other autoimmune diseases like MS and Lupus. It’s been found that those with post infectious IBS and IBS-D have decreased barrier function and increased activation of mucosal white blood cells, indicating that a compromised intestinal lining is likely.
Leaky gut causes inflammation along the intestinal tract which can impact normal digestive processes and bowel habits. In a healthy GI tract, there is a mucus layer that contains immune proteins called immunoglobulins that bind pathogens and microbes and prevent contact with the inner layer of the intestinal lining. Without a healthy gut lining or functional mucosal barrier, microbes are allowed to interact with the inner lining of the intestinal wall which causes inflammation and tissue damage, further perpetuating the vicious cycle of leaky gut. Leaky gut can be caused by a poor diet (high fat/highly processed carbs), alcohol intake, nutrient deficiencies (especially Vitamin A, Vitamin D, Omega 3s and Zinc), gluten sensitivity/over consumption of gluten, overuse of antibiotics causing dysbiosis (an imbalance in the gut microbiome), taking NSAIDS long term and chronic stress.
Studies have found beta-glucan (a type of fiber found in oats), inositol (a member of the B vitamin family) and digestive enzymes are helpful in reducing symptoms of IBS. This may be due to the fact that increased inflammation or stressors in the GI tract cause decreased digestive capacity. Some of our digestive enzymes are made in the stomach and small intestine, but many are also made by the pancreas. There are different types of supplemental enzymes. Some are broad spectrum and contain a full array of enzymes, including supplemental stomach acid, the brush border enzymes made in the small intestine like lactase, sucrase and maltase, and the pancreatic enzymes lipase, amylase and protease. Some contain the plant-based enzymes bromelain and papain which help digest proteins. If your IBS is due to consuming foods that are harder for your body to digest, supplemental enzymes may help reduce gas and bloating. If you are taking antacid medications, make sure you work with a healthcare provider before starting to take digestive enzymes.
Identify Food Sensitivities, Food intolerances or FODMAP intolerances
Diet may have the most profound impact on IBS. Often, the standard American diet is to blame for tummy troubles. Highly processed, genetically modified, food-like substances have become the norm for many. When we eat this way, we eschew so many important plants and whole foods that contribute to a healthy gut. We also ingest more chemicals/preservatives, foreign proteins and toxins that may cause inflammation in the GI tract. Food sensitivity symptoms may show up as late as 72 hours after ingesting the protein making them hard to diagnose.
- FODMAP Diet
For some, FODMAP intolerances can be to blame. FODMAPS stand for Fermentable Oligo-, Di-, Monosaccharides and Polyols. These are classes of carbohydrates that may be difficult for some with IBS to digest. Since they are easily fermentable and usually foods that are higher in fiber, they can cause bloating, gas, abdominal discomfort and variable bowel movements. A low FODMAP diet has been found to provide symptom relief for those with IBS. However, it is restrictive and should not be attempted without guidance from a professional. They can help you round out your diet to contain the most variation and identify which kinds of FODMAPs may be an issue for you. Ultimately, there is often an underlying reason (like SIBO, dysbiosis or leaky gut) that may need addressed while on the low FODMAP diet.
- Gluten Free Diet
One study found that a subset of those with IBS experienced an improvement of symptoms while following a gluten free diet, suggesting that a sensitivity to gluten could be an issue for some. However, the reason why a gluten free diet is helpful is unclear. Improvements could be due to gluten sensitivity, agglutinins/lectins in wheat, or the fructans in wheat (a FODMAP). Increased gut permeability could also explain the gluten/wheat effects in IBS patients.
- The Dairy Connection
Another possible food intolerance that may mimic IBS is lactose intolerance. As we age, we produce less of the enzyme lactase, responsible for breaking down the main carbohydrate in dairy foods. Lactose intolerance causes gas, bloating, stomach pain and diarrhea when lactose is consumed. Therefore, it can be helpful to rule out lactose intolerance if you have IBS. A food sensitivity to dairy is due to a delayed immune reaction to casein or whey (the proteins in dairy foods). As a further complication, casein is similar to structure to gluten, meaning that it may cause a reaction if gluten sensitivity is present.
The bottom line is to work with a nutritionist or dietitian who can help you identify whether you have true food sensitivities or intolerances or whether they are due to compromised gut function! When it comes to food sensitivities, it can be helpful to test instead of guessing since they can be difficult to root out. Click here for more info.
Keep your good bugs happy
A healthy gut is the seat of health. If you have an imbalanced microbiome whether from stress, low fiber intake, yeast overgrowth, or antibiotic use you may be experiencing IBS type symptoms. The beneficial bacteria in our large intestine, commonly called probiotics, provide a multitude of benefits to us. They train our immune systems to recognize friend from foe, ferment dietary fiber into short chain fatty acids (SCFAs) that protect and nourish our colon cells, synthesize B vitamins and Vitamin K, regulate appetite, mood, hormones and metabolism, protect intestinal barrier function and so much more. You can see why replenishing our beneficial bacteria through probiotics, fermented foods and feeding them with prebiotic foods (asparagus, bananas, garlic, and resistant starches like cooked then cooled rice, potatoes or beans) is so important.
Not all probiotic supplements are created equal.There is still a lot of research to be done regarding many supplemental probiotics in regard to their efficacy, so proceed with caution. One brand we really trust is Microbiome Labs’ megasporebiotic because it has some solid research showing that it reconditions the gut and heals leaky gut, but we recommend getting advice from a professional before starting any kind of probiotic supplement.
As you can see, IBS and functional bowel disorders are often multifaceted. If you are dealing with unexplained GI symptoms or IBS and would like to work with us one on one, let us know! We are here to support you on your path to wellness.