What’s Bugging your Gut? Causes of Irritable Bowel Syndrome (IBS)
Have you been told you have Irritable Bowel Syndrome or “IBS?” You are not alone! Did you know 7.5 million people in Canada are affected by IBS?
50% of our patients who come in with digestive complaints have been given this label by their medical doctor or gastroenterologist. But IBS is not really a clinical diagnosis. More accurately, this is an umbrella term for symptoms, and a temporary label when nothing else has been determined to be wrong with your gut. This is when other conditions like Celiac disease, IBD (Crohn’s disease, ulcerative colitis, etc.), acute bacterial infections/gastroenteritis, parasites, etc. may be the cause but have yet to be determined as such.
IBS is a frustrating “diagnosis” for many because the conventional medical system doesn’t have a lot of treatments for it. Patients may be recommended to take laxatives if you have more IBS-C (constipation), or advised to increase fibre if you have IBS-D (diarrhea), or be told that you need to work on stress management. But this is often inadequate – because the WHY to your digestive irritation has yet to be answered.
Symptoms of IBS
Irritable Bowel Syndrome, or IBS, conventionally is based on the following symptoms:
Recurrent abdominal pain at least 1 day a week in the last 3 months, with 2 or more of the following:
- Related to defecation (going the bathroom)
- Associated with a change in frequency of stool (how often you are having a bowel movement)
- Associated with a change in form (appearance) of stool
This has to be ongoing for at least 6 months, as IBS is identified by chronic changes in bowel habits.
IBS is usually a diagnosis of EXCLUSION – meaning, there are no other causes concluded by your doctor, and you continue to have digestive disturbances.
Main Types of IBS
There are 3 types of IBS that you can present with:
- IBS-C (Constipation)
- IBS-D (Diarrhea)
- IBS-M (Mixed – alternating constipation and diarrhea)
But the question for many patients remains: WHY is this happening?
ROOT CAUSES of IBS that we see in practice:
1. Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is a form of dysbiosis, an imbalance of bacteria in the gut. This condition occurs when abnormally high amounts of good bacteria are present in the small intestine. Due to a multitude of underlying factors, sometimes these good bugs back flow from the large intestine where they are supposed to be, and grow in abundance.
In the small intestine, these bacteria ferment the food we eat and produce gases which result in symptoms characteristic of IBS (hello bloating and changes in bowel movements). Common symptoms include: abdominal pain, bloating, flatulence, belching, acid reflux, diarrhea, and constipation.
The bacteria overgrowth can often result in nutritional deficiencies (specifically iron and B12) due to malabsorption, as well as inflammation and damage to the intestine. Studies have shown that SIBO may be the underlying cause of 50-85% of IBS cases, and eradication of the bacterial overgrowth can result in significant reduction in these symptoms!
Evaluating for SIBO is really important with chronic IBS pictures, because without killing off the excess bacteria, we won’t truly lead to resolution of our symptoms.
So I have highlighted that SIBO can be a root cause of IBS… but then what was the root cause to your SIBO?? There are so many factors!
Underlying factors that can cause SIBO
- Infectious gastroenteritis (aka food poisoning – bacterial toxins can compromise the integrity of the gut lining and its function)
- Compromised digestion (including H. Pylori infection, low stomach acid, lowered pancreatic enzyme and/or bile acid insufficiency)
- Neuropathic complications (in diabetes, Parkinson’s, and MS)
- Post surgery, post-concussion, and medication induced (like use of antacids, PPIs, antibiotics)
- Hormonal causes (like hypothyroidism, and birth control pills)
- CHRONIC STRESS! This is a big one.
So what can naturopathic doctors do for SIBO?
Firstly, we can test for the presence of the overgrowth of the bacteria (with a breath test). This test measures the amount of gas produced by the bugs in your gut (methane, hydrogen, and mixed). It is done so by essentially breathing into test tubes to measure the gases. Upon receiving a positive test result, treatment can begin! There a few phases of treatment that I find very successful if done in progression.
- Preparation Phase – supporting the body’s detoxification processes to reduce reactivity in the next phase; usually 2 weeks.
- Eradication Phase – either herbal or specific-spectrum antibiotic to kill all of the overgrowth; 2-6 weeks depending how many rounds of kill we need to do.
- Recovery Phase – diet modification, prokinetics (either nutraceutical or prescription, to stimulate the movement of the intestine transit again) and gut healing supplementation; 2 months.
- Remission Phase – reinoculating with proper probiotic dose and form, and aiding with other supporting digestive components to prevent recurrence; 1 month.
2. Post-Infectious IBS
This stems from a past experience of gastroenteritis from food poisoning or travelling. A significant volume of research shows a clear link between food poisoning and IBS, specifically diarrhea-predominant IBS (IBS-D). A 2017 45 study review conducted at the Mayo Clinic showed that 1 in 9 patients who experience food poisoning develop IBS.
3. Yeast Overgrowth
Candida is a type of yeast that is part of the normal gut flora. However, Candida is opportunistic by nature, meaning that it will overgrow when allowed, such as after antibiotic use or with immunodeficiency. When yeast overgrows in the intestines and overtakes the good bacteria levels, this leads a yeast/candida overgrowth causing symptoms such as diarrhea, constipation, and excessive bloating. It may also sometimes increase susceptibility for developing recurrent vaginal yeast infections in women.
4. Nervous System Overactivation
Anxiety, stress, and adrenal dysfunction are all major contributors to nervous system overactivation.
5. Dysbiosis or Lack of Probiotics/Good Bacteria in the Gut
The microbiome in our gut, specifically the large intestine, is really important for a multitude of functions in the body. Nearly 70% of the immune system is located in the gut, and these good probiotics help our immune system function properly and maintaining that healthy mucosal layer.
A good dose of probiotics helps fight off any bad guys that enter our body at any time. The skin is also an outward presentation of our gut, so supporting gut health and microbiome supports skin health (eg: eczema, psoriasis, acne, etc). Mental health is another aspect well supported by probiotics, as a lot serotonin is produced in the gut – so anxiety and depression can be remedied with restoring proper gut levels.
6. Food Sensitivities
Food sensitivities and lactose intolerance are an immune response to foods we are putting in our body. This is different than a true food allergy (mediated by IgE antibodies, causing swelling/itching/hives/wheeze etc). Food Sensitivity reactions are IgG mediated, and do not have an anaphylactic reaction.
Sensitivity symptoms can include abdominal pain, reflux, bloating, constipation, diarrhea, weight gain, as well as eczema, headaches, joint pain, and fatigue. The timing of the reaction can be delayed up to 72 hours after ingestion so it is sometimes difficult to determine what food caused your digestive symptoms .
These all lead to chronic inflammation and overactivity of the gut, ultimately causing intestinal hyper-permeability and irregular bowel habits. With our immune system over-activated, this can then lead to issues with absorbing nutrients in the gut – our essential vitamins and minerals!
How to Determine the Cause of Your IBS
The list above is not exclusive, but by determining if you fall into one of the categories above and treating it, there can be significant improvement. Comprehensive testing run by a naturopathic doctor can determine the root cause of your irritable bowel, and help get things resolved or greatly reduced to improve the quality of your life.
Functional Medicine Testing
The following testing options are offered at Mind Body Soul Integrative Clinic:
- SIBO Lactulose Breath Test – a take home breath test where we measure the amount of gas produced by the bacteria in your small intestine
- SIBO TRIO Test – brand new and release in Canada just this year 2022, for stubborn SIBO cases.
- Microbiology Stool Profile – a take home stool test that measures the amount of good and bad bacteria, and yeast present in the stool – specifically the large intestine
- Adrenal Function Profile – a take home salivary test that evaluates when cortisol is spiking or dropping at 4 points in the day, to evaluate your adrenal glands and stress hormones
- Serum Candida Profile – an in-office blood draw to evaluate for candida/yeast antigen presence in the body
- Serum Food Sensitivity Testing – an in-office blood draw to evaluate which foods your body is mounting an immune response to, causing digestive complaints
Treatment Options for IBS
So now what does treatment look like once you are diagnosed with one of the above conditions via testing? Treatment can range from specific anti-microbial herbal therapies or antifungal herbs, antibiotics in some cases, specific strained probiotics, food elimination diet plans, and herbal and nutrient adrenal support. A comprehensive treatment plan is always given after we get you the concrete answers for your chronic IBS!
Book in today to have your IBS investigated to get you back to normal digestive health!
Courtesy of Dr. Shannon McGuire, ND