Irritable Bowel Syndrome (IBS) is the most common gastrointestinal disorder worldwide. It is estimated that around 11.3million people in the UK, and up to 1.9 billion people worldwide suffer with IBS. These figures help to explain why around 50% of visits to general practitioners relate to gastrointestinal health. Sadly, the economic burden on the healthcare system is enormous and in my opinion this is largely the result of ineffective treatment.
The Rome Foundation, an independent organisation dedicated to support the diagnosis and treatment of IBS, published its most current guidelines in 2016. These guidelines set out in the Rome IV criteria include that IBS can only be diagnosed six months after the onset of symptoms. Symptoms have to include recurrent abdominal pain on average at least one day a week for the last three months. This has to be coupled with changes in frequency of stool and changes in appearance (form) of stool.
IBS is then further categorised into diarrhoea predominant (IBS-D), constipation predominant (IBS-C), mixed type, alternating between diarrhoea and constipation (IBS-M), and unclassified (IBS-U). There is also post-infectious IBS (PI-IBS), where the acute onset develops after an infectious illness.
A number of other comorbid conditions can often occur in people with IBS. These conditions include gastro-oesophageal reflux, fibromyalgia, Genito-urinary symptoms, irritable bladder, headaches and psychological symptoms. This can often muddy the water and lead to an initial misdiagnosis.
The key symptoms of IBS
- Abdominal pain
- Inconsistent bowel movements
- Intermittent diarrhoea/constipation
Conventional treatment options for IBS
The current conventional treatment options can vary and often depend on the severity of symptoms and also who is diagnosing it. I often see clients diagnosed by their General Practitioner (GP) who have received very little support or guidance. Diagnosis made by the gastroenterologist can often be more supportive in terms of treatment plan, but is still very generic. In large treatment options include:
- peppermint oil
- antispasmodic medication
- support for constipation IBS-C or IBS-M
- antibiotics for the those with PI-IBS
- low FODMAP diet
The low FODMAP diet
Monash University devised the low FODMAP diet to provide relief for people suffering with IBS. If used correctly, the FODMAP diet is an incredibly powerful tool and can significantly improve IBS. Sadly, in my experience, this is NOT the case. Clients are not getting adequate support on how best to navigate and use the low FODMAP diet.
The focus of the low FODMAP diet is to exclude specific food groups for a maximum period of six weeks. After six weeks the food groups are reintroduced to avoid negatively impacting levels of good bacteria in the gut. This can hamper the immune system and overall health. The focus of the low-FODMAP diet is to establish which FODMAP category might be problematic for the individual.
What your doctor might not be telling you about your IBS!
The word ‘syndrome’ within IBS indicates that the etiology of the condition is not fully understood. As a result, treatment options can be limited. IBS can be the result of various health factors and very often some of the key triggers get overlooked within the conventional medical system.
A large majority of people deal with IBS symptoms daily and for some these symptoms can be very debilitating. Fear of leaving the house and engaging in social activities can play a big part in people with IBS.
IBS is not a diagnosis for life. In fact, the good news is that you can change this!
You do not have to live with these symptoms for the rest of your life. IBS no longer has to control your life and impact your social activities, holidays, family time and work. You can actually significantly improve your IBS. In fact, providing you establish the root cause and resolve the underlying factors, you can free yourself from IBS.
In Functional Medicine we strive to understand where it all started. IBS, like all other conditions, diseases, syndromes have a root cause. There are many possible causes, however I will only cover five of the main causes below. There are many more, so it therefore important to work with a Functional Medicine Practitioner to establish the root cause of your IBS.
Causes of IBS
Parasitic infections are very often at the root of IBS. Unfortunately, the standard stool tests available through the National Health Service (NHS) do not always detect some of the key culprits. Furthermore bacterial, fungal or yeast infections all play a role in IBS. This is one of the many reasons I always encourage my clients with any gut issues to do a Comprehensive Stool Analysis before we start work on their gut.
Small Intestinal Bacterial Overgrowth
Around 60-70% of all IBS cases may in fact be the result of Small Intestinal Bacterial Overgrowth (SIBO). Consequently, I am seeing more clients presenting with SIBO. I suspect one reason for this is that thanks to Dr. Siebecker and Mark Pimentel, we now have a better understanding of the condition. Diagnosis is made by hydrogen or methane breath test. This can be challenging to obtain through the NHS. Furthermore, I believe the standard time on the NHS for a SIBO breath test is two hours, and that not all hospitals offer a 3-hour test. Potentially this could impact the results for those presenting with methane dominant SIBO.
Low pancreatic elastase, something I personally struggled with, is a big driver for developing IBS and SIBO. Insufficient digestive enzymes can impact normal digestion and lead to maldigestion and malabsorption. This may present as typical IBS symptoms. It can also lead to a host of other symptoms, such as anaemia, fatigue, indigestion, muscle pains, headaches, mood and hormonal imbalances and more.
Low stomach acid is a very strong contender for both IBS and SIBO. In fact, this is definitely one of the reasons why I got SIBO in the first place. The pH levels in the body play an important part and especially in the gut. Low stomach acid results in creating an environment for opportunistic pathogens to come and reside. This is NOT something your doctor will investigate or consider. If you are not sure whether you have too little or too much stomach acid then I recommend reading this blog post.
Intestinal Permeability/Leaky Gut
The intestinal epithelial lining is the largest mucosal surface in the human body. It provides an important interface between the internal and external environment. It is made up of a single layer of epithelial cells and intercellular junctions, known as tight junctions. Illness, bacterial infection and/or antibiotic use can damage this lining. This can result in toxins, bacteria and antigens getting into the lumen and the blood. The result is IBS. At present conventional treatment plans ignore the possibility of leaky gut. IBS symptoms could improve on a low-FODMAP diet, but unfortunately symptoms could return at a later stage unless some effort is made to ‘heal’ leaky gut and protect the gut lining.
More concerning to me is the fact that if left unsupported/untreated, leaky gut can trigger a whole host of other more serious health conditions, such as autoimmunity.
Other possible causes
As mentioned earlier, there are many other triggers for IBS. These include: imbalance in beneficial bacteria, hormonal imbalance, stress, motility, diet, food intolerances, frequent infections, antibiotic use, several surgical procedures and more.
How can Functional Medicine help?
Addressing IBS can take anywhere from three-six months and in some complex cases it might take a little longer. The process requires some dietary and lifestyle changes whilst working through the 5R protocol. You can read about the 5R protocol here.
Based on my own results, having suffered with IBS/SIBO for years and those of my clients, the time and money invested is no comparison to the quality of life gained. Many clients come to me having suffered with IBS for up to 20 years without much support from their doctors. A little effort, dedication, discipline to address the underlying cause is no comparison to the benefits of having a healthy and symptom-free life.
If you have IBS, hopefully the information provided will reassure that it is not a diagnosis for life. You have the power to change it. Get in touch if you would like guidance and support.
Happy Wednesday all.