Irritable Bowel Syndrome
Different sources will report different numbers, but one thing is clear: Irritable Bowel Syndrome affects a vast amount of people. Statistics vary between 8-25% of the world population suffering from IBS, with numbers in the higher range in Western countries. Having IBS is annoying, uncomfortable, sometimes painful and simply no way to go through life. IBS is not the same as Inflammatory Bowel Disease (IBD), which includes ulcerative colitis and Crohn's disease. Diagnosis of IBS is one of exclusion, usually given by physicians simply by evaluating a patient's symptoms. Some people may get tested to rule out parasites or anemia, or potentially given a colonoscopy to check for malignant polyps or IBD. Technically, IBS is a condition with abdominal pain and a change in bowel habits, but with an absence of structural abnormalities.
Symptoms can range from chronic annoyances to very severe problems, greatly affecting one's life. It can affect anyone at any age, and children often feel the symptoms more acutely. IBS is often associated with diarrhea, but people can exhibit symptoms of diarrhea and constipation, or exclusively constipation - particularly in women. The condition is further divided into symptomatic categories:
- IBS-C (or C-IBS) = Constipation dominant
- IBS-D (or D-IBS) = Diarrhea dominant
- IBS-A (or M-IBS - mixed) = Alternating between the two
For people who are suffering, you know how horrible this can be. It can limit social functions, travel and even work. I suffered from IBS for years and simply felt toxic. The good news is that it does not pose permanent harm to the actual intestines, so you can heal eventually, but malabsorption of essential vitamins and minerals will undoubtedly contribute to other health issues, so it's important to figure out what is triggering your IBS before it causes a cascade of other problems.
- Diarrhea, may be severe
- Constipation, may be severe
- Abdominal Pain; may be relieved by defecation
- Pellet-like bowel movements
- Incomplete 'eliminations'
- Foul gas
- Mucus in the stool
- Anxiety & depression
- Weight gain
- Weight loss
- Urinary pain/frequency
- Symptoms may come and go
- Occasional loss of appetite
- Skin problems
- Bad breath
- Food allergies & intolerances - usually # 1 issue
- Stress & anxiety - very powerful in IBS
- Low serotonin levels
- Parasites & infection
- Lack of exercise
- Large meals, spicy food
The causes of IBS remain clinically undefined. It's extremely important to rule out parasites and bacterial infections. You can do this with your doctor or a health practitioner who can order tests. Your doctor may even want to do an edoscopy or colonoscopy. There's a small chance you'll receive medication, but there has yet to be an effective prescription drug for IBS.
There is an increasing amount of research that proves food sensitivities and allergies may be the culprit. Personally, this was the biggest game changer for me. The most common dietary provocateurs in IBS sufferers are dairy and grains, but you must understand what works for one person may not work for you. The grains people are most sensitive to are those containing gluten: wheat, triticale, rye, barley, spelt and semolina; some people do much better eating gluten-free. There are many "IBS diets" out there and they may be a waste of your time, as one person's remedy is another's poison. Next time your doctor says, "eat more fiber," think twice about adding All Bran or Fiber One bars. These products are filled with 'non-foods' and contain ingredients that you may be sensitive to. If you've struggled with eliminating foods in the past, consulting with a nutritionist is an excellent way to feel less frustrated and overwhelmed, and to determine your sensitivities. Eliminating them may provide long term relief, and while I know it's hard to believe, you'll find ways to eat without your trigger foods. Check out my in the kitchen page.
There is no specific test that can pinpoint IBS, the diagnosis is one of exclusion. Doctors should assess all of your symptoms according to the Rome III criteria, which utilizes standard medical testing to rule out other diseases. Some of these tests may include:
- Colonoscopy: camera used to examine the entire length of the colon
- Flexible sigmoidoscopy: examines lower part of the colon (sigmoid) with a flexible, lighted tube
- Computerized tomography (CT) scan: scans the abdomen and pelvis to rule out other issues
- Lactose intolerance test: to find out if lactose intolerance is the cause of symptoms
- Blood test: rules out celiac disease
If other diseases are ruled out, conventional treatment options for IBS may include
- Fiber supplements such as psyllium seed. May cause constipation in some people
- Anti-diarrheal medications (loperamide - aka Imodium). May cause constipation in some people
- Eliminating high gas foods including carbonated beverages, raw fruits and vegetables and salads. Eliminates nutritious fiber sources from diet
- Anticholinergic medications (ANS) drugs that control the painful bowel spasms. May exacerbate constipation
- Antibiotics in the case there is a bacteria or parasite. Antibiotics kill off healthy flora; must reinoculate gut with a probiotic. Unbalanced gut flora can actually be the main cause of IBS.
- Zelnorm to increase serotonin levels. Pulled from the market because of increased risk for heart attack and stroke
- Antidepressants: for diarrhea and stomach pain. May cause drowsiness and constipation
- Lubiprostone (Amitiza): Used for IBS-C. Increases fluid secretion in the small intestine. Side effects include nausea, diarrhea and abdominal pain.
As you can see, traditional IBS treatments are not always effective and tend to be medicines that target symptoms, not the underlying imbalances that are causing your problems. It is not a disease, but a condition with a collection of symptoms, so why we are attempting to treat specific targets, instead of the root of the problem? What should be addressed are the imbalances associated between the gut and the brain, as well as dietary intervention. Something is provoking your body to react, and instead of treating the symptoms, you should be removing the provocateur(s).
The Institute for Functional Medicine defines functional medicine as personalized treatment that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. It is a science-based field of health care that follows a set of principles; focusing on each person's biochemical individuality.
A functional assessment will look at your particular system and review your medical history. Have you taken many rounds of antibiotics or anti-depressants? These can very seriously compromise your beneficial gut flora and you must restore what they have diminished or destroyed. Make sure to pay attention to all side effects of any drugs you may be taking, or have taken in the past. Some symptoms can be a result of medications. Do you have undiagnosed food allergies, or have you ever attempted or completed an elimination diet? Have you kept a food diary before? Do you know if you're deficient in any vitamins or minerals? You can get to the bottom of these questions with the assistance of a nutritionist or health professional. You and your nutritionist may decide to use a Comprehensive Stool and Digestive Analysis test, which can help you determine the root of your problems. The CDSA and an elimination diet may be two most powerful tools you can use to understanding your IBS.
Once you've determined what's contributing to your IBS, you'll need to heal the damage done to your gut. It's a fruitless endeavor to try to heal something unless you've removed what is triggering your IBS, so you must be vigilant. Meet with a professional to get you on a protocol that eliminates food intolerances, sensitivities and allergies, and to thoroughly review your health history.
IBS is commonly associated with leaky gut, and will require a similar protocol to heal. Strictly following the 4 R Protocol is imperative to eliminate IBS symptoms and help rebuild a healthy digestive tract, particularly if you have Leaky Gut symptoms. Working with your nutritionist, figure out a specific diet plan that caters to you and your lifestyle; for some people this means following a gluten-free and/or dairy-free diet. Some people have success on the Specific Carbohydrate Diet, others on a fructose-free diet. At least for a period of time, include therapeutic supplements that can help you get back on track. This is important - healing is impossible without removing the provocateurs, but removing them alone may not necessarily give your body what it needs to rebuild the digestive tract. These supplements may include probiotics, digestive enzymes, essential fatty acids, amino acids and powerful yet soothing herbs. Check out my healing page for more detailed support.