Irritable Bowel Syndrome

Most of the people I see in my clinic have IBS.  They’ve been told by their well-meaning Doctor to self-manage the condition.  To avoid triggers but the reality the triggers are rarely known.  It can be especially confusing when the healthier the food on the plate, the worse bloating and pain.

IBS impacts the lives of around 17% of the UK population.  A higher percentage is actually seen in women than in men.  This, however, might be the result of women being more likely to seek help for their symptoms.

Most of the people with IBS say it’s having a significant impact on their quality of life as well as their social life.  Although, it’s not seen to increase the risk of other serious diseases those with IBS may be at greater risk of surgical procedures such as hysterectomy and cholecystectomy.  It also plays a role in being one of the main reasons for people taking time off work.

The bloating, altered bowel habits, pain, and the anxiety that can come along with these symptoms can truly be debilitation.

From my clinical work, I have come to see that the symptoms of IBS almost become normal.   When things become normal we feel as though there’s less we can do about it.

But is IBS a real diagnosis?

Diagnosis of IBS

IBS will be diagnosed by the Rome IV criteria which directly relate to digestive symptoms but goes no further into investigating what could be the cause.  Bloating, altered bowel habits, pain, they all tell us how we might be feeling but now why.

Once more serious digestive issues have been ruled out then IBS is often diagnosed.  This leads some to believe that IBS is the lack of a diagnosis rather than a diagnosis in itself.

In reality, a wide range of factors can be contributing to the symptoms. 

We can think of IBS as an umbrella term that covers the symptoms.  The discomfort and pain and perhaps even the anxiety that often comes with digestive issues.

Many people reach my clinic when feel they feel they’ve come to the end of the road after being told to self-manage your symptoms but today we know a lot more about what contributes to IBS than we did even 12 months ago.

Does that mean IBS is curable?

Can IBS Be Cured?

When we talk about gut health and the symptoms, we may be experiencing it’s important to remember that IBS isn’t a condition like diabetes or heart disease. In these conditions, there is a clear understanding of how they develop and how to test for them. In IBS things are less clear.

IBS is diagnosed on symptoms alone. The presence of bloating, cramping and altered stool patterns tell us a lot about how we’re feeling. However, they don’t get us any closer to understanding why we are experiencing them and more importantly what to do about them.

This ‘why‘ can be different for each individual but by understanding the gut we can work through the possible reasons and help to bring things back into balance.

Woman holding stomach due to IBS and bloating

Underlying Causes of IBS

The multiple factors that contribute to IBS have recently been explored in a peer-reviewed article entitled “Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not”.

This title is not suggesting that IBS is made up in our heads but it focuses on the fact that there can be many issues that combine to contribute to the gut being sent out of balance. 

When things go out of balance there is disruption, and this is what is leading to the symptoms.

So, in order to ‘cure’ IBS, it’s vital to identify which issues are most relevant to each person and their individual version of IBS.  It’s by addressing these underlying issues that we can bring the gut back into balance.

The Underlying Factors

The underlying issues fall into 3 categories:

  1. Lifestyle & Environment (eg. stress, poor sleep)
  2. Nutritional Factors (eg. vitamin deficiencies, food sensitivities)
  3. Functional Imbalances (eg. gut bacteria imbalances, infections)

Within each of these 3 categories, there are a number of aspects that contribute to a disrupted gut. Some examples are listed above but in fact, the research identified 17 factors that have the potential to contribute to IBS.

This may be why medication can be so hit and miss as it can only address one aspect at a time.

Treatment & Therapy

Rather than living on a restricted diet forever, there is another way. By identifying and addressing the underlying issue we can bring about lasting change.

Treatment and support include:

Short term elimination diets to assess for food sensitivities
The aim is rarely to find the single dietary culprit that’s causing the digestive issues.  It’s more about supporting and rebalancing it so it’s more resilient and better able to tolerate what we put into it.  However, short term elimination diets can be helpful to take a weight off the digestive system as the underlying issue is addressed.

Strain-specific probiotic supplementation
Probiotic supplements can play a wide range of roles in the gut.  They can strengthen the gut lining, reducing inflammation, and support digestive processes.  It’s important to choose the right strain with the appropriate research behind it.

Targeted nutritional supplementation
As well as probiotics a wide range of supplements are available to support the gut.  I like to think of these as scaffolding.  We erect the scaffolding while we repair.  Once the structure is stronger and more resilient we can take the scaffolding down.

Testing to assess the gut bacteria
Common tests are SIBO breath tests and microbiome analysis.  Both have their pros and cons.  Definitely a topic for another article.

Supportive lifestyle recommendations
Lots of stress, exercise and even the times we eat our meal can impact our digestive system.  Research even indicates that yoga is as effective as a low FODMAP diet.  This is a very restrictive diet that removes fermentable fibres, often a trigger for IBS symptoms. 

Conclusion

So, in order to ‘cure’ IBS, we need to see it as a disease. In reality, it needs to be seen as a sign that something is out of balance somewhere. The job at hand is to understand why the symptoms are there.  By supporting that underling issue we can restore the health of the gut.


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