“Irritable Bowel Syndrome” (IBS) – I regularly meet clients at my practise in Sydney, and often meet people from all walks of life who have been labelled with IBS at some point in their lives. Many people these days appear to be experiencing some sort of digestive discomfort, and are either diagnosed with IBS or have come to their own conclusion that they ‘experience’ IBS, either occasionally or constantly.
They typically have nagging symptoms which don’t appear to be life-threatening or suggestive of anything considered more serious such as inflammatory bowel disease (IBD), but which are seriously uncomfortable and impacting their quality of life. Some of these symptoms may include:
– Chronic constipation
– Alternating constipation & diarrhoea
– Chronic Bloating
– Abdominal cramping & pain
– Excessive flatulence
– A sense of incomplete bowel evacuation
It’s basically a constellation of symptoms which are an obvious sign that your digestive system is not functioning properly. You feel sluggish, you know your digestion isn’t the best, and you know that there must be something wrong or imbalanced.
Throw in a bunch of food intolerances with no idea what the culprit foods are, and there is clearly something not quite right with your digestive system.
But apparently there is nothing specifically wrong with you. You have general blood tests and other investigations done, and apparently you should be fine. At this point a diagnosis of IBS is usually handed out – when there is nothing conclusive that points to a specific disease that is detectable
It is considered a “diagnosis of exclusion”- a medical term used for when a diagnosis is reached based on simply ruling out other conditions. In the case of IBS, this would include Coeliac Disease, parasites, colorectal cancer, IBD and Gastro-oesophageal Reflux Disease (GORD) to name a few.
So IBS is not a ‘disease’ as such, which is why it’s called Irritable Bowel ‘Syndrome’ – a group of signs and symptoms that occur together and characterise a particular abnormality or condition. But you don’t have to have all of the symptoms associated with IBS to be diagnosed (similar to Polycystic Ovarian Syndrome).
This can leave patients that are ‘diagnosed’ or guessing that they have IBS feeling deflated for a number of reasons, because if we take a step back and look at the bigger picture:
1) The name Irritable Bowel Syndrome can be misleading as it simply indicates an issue with the bowels, but it is much more than just a bowel issue – those with IBS can also experience significant anxiety and/or depression, poor sleeping patterns, joint pain, hormonal imbalance and gastro-paresis
Isolating IBS to simply being a bowel issue is a typical reductionist approach which doesn’t consider the many inter-related body systems that are involved such as the gut-brain axis
Patients may be offered medication to relieve constipation or diarrhoea, or even painkillers. Clearly this is a band-aid approach
2) IBS is considered to have an ‘unclear aetiology,’ i.e. it is not known exactly what causes it. When you’ve been cleared of more specific diseases, being lumped into the category of ‘generally unknown’ can be frustrating and leave you even more stressed about your symptoms
Since IBS is a constellation of symptoms that vary from person to person, it is a situation where each person must be treated individually. There are in fact many possible causes that are all intricately connected, which can be targeted when we take a whole-body and whole-person approach. The conventional medical approach is generally focused on a single cause with a one-drug approach, which IBS does not really fit into
3) Many patients and physicians alike are aware that stress can significantly affect IBS and exacerbate symptoms. Many patients have been left with the impression that it is ‘all in their head’ since there is no obvious organic cause of their IBS, and that they need to just ‘stress less’.
While stress management and nervous system support are an important treatment strategy, there are in-fact underlying physiological mechanisms at play that are related to the symptoms they are experiencing. Stress is an important factor, but it’s not just in your head.
I remember having gut issues and getting the regular eye-roll from physicians, waiters and other people when trying to explain my digestive discomfort and need to avoid particular foods. It’s already an uncomfortable topic to bring up, and even more humiliating and disheartening when you are immediately shut down and made out as if it’s not a big deal.
So what are these possible underlying causes I keep referring to?
– a term that translates to ‘altered GIT microflora.’ The trillions of bugs that colonise our gut need to be in a delicate balance, which you will commonly hear as being imbalanced in favour of ‘bad bugs,’ as opposed to ‘good bugs’
-Patients with IBS have increased expression of inflammatory markers in the body, which suggests that low-grade inflammation is present. It is theorised that mild inflammation of the gut mucosa (lining) is what can disrupt neuromuscular function, i.e. GIT Motility
Altered GIT Motility
– i.e. altered bowel habits. We all know the frustration and pain of having alternating bowels that may also be super uncomfortable, unpredictable and leave you having to know where all possible public toilets are in case of an emergency
Motility means movement – we should experience smooth, wave-like muscular contractions of our bowels that gently move food through our gut, allowing it to be digested and absorbed properly. Being constipated means our gut motility is under-functioning, and experiencing diarrhoea is a sign of more rapid gut motility.
There are many potential reasons for having poor gut motility – as already mentioned it could be due to dysbiosis and low-grade inflammation, but could also be due to Small Intestinal Bacterial Overgrowth (SIBO), Gastro-paresis, medication side-effects and hypothyroidism to name a few
Visceral hypersensitivity –
this refers to an “enhanced intestinal perception of pain.” A phenomenon in IBS patients is experienced where pain is experienced due to underlying dysbiosis and low-grade inflammation. You may not necessary bloat or have gas more than others, but when you do experience bloating it may exacerbate pain and discomfort due to underlying inflammation and hypersensitivity
HPA Axis Dysfunction –
a fancy term for describing an imbalance of stress hormones due to prolonged and unmanaged stress, trauma and significant life events. Stress may not only exacerbate your symptoms, but you may find that you have a much lower stress tolerance.Chronically elevated stress hormones impact our digestion by reducing digestive enzyme function, disrupting GIT motility and affecting the balance of our GIT microflora (explained in further detail here)
These are the key underlying factors on a physical level that we must address, and that complementary medicine can help you with
Here are my foundational tips for reducing the uncomfortable symptoms you are experiencing, and begin healing the gut at a root level:
– getting to the root cause is important, but relieving symptoms along the way is important too! My favourite tools for improving digestive function and eliminating uncomfortable symptoms are:
– Iberogast: a liquid herbal digestive formula that has stood the test of time in alleviating IBS symptoms in adults & children, that conventional Dr’s even recommend to their patients. It can be found at health food stores, pharmacies, naturopaths or online.
A brilliant tonic for quick symptom relief and when taken 2-3 times per day consistently, reduces low-grade inflammation
When you decide to work with a naturopath & herbalist, a herbal medicine tonic can be compounded to your own unique presentation.
-Digestive Enzymes: a great supplement to take with each meal to reduce bloating and gas. We should be making our own digestive enzymes but may not be due to the underlying factors that drive IBS. Over time with the correct treatment plan, you shouldn’t need them anymore. A good quality practitioner-grade brand is best.
-Chamomile, Lemon Balm & Licorice Tea: are all gentle anti-inflammatory herbal teas that help reduce GIT cramping, gas and abdominal pain
-Low FODMAP Diet: “FODMAPs” are short-chain carbohydrate containing foods which are incompletely absorbed in the gastro-intestinal tract of IBS patients and lead to being excessively fermented by bacteria, which causes bloating, cramping and gas. They are not ‘bad’ foods either – they are mostly from a range of healthy fruit and vegetables
Removing high FODMAP foods in the short-term will help reduce symptoms while trying to restore any gut dysbiosis and low-grade inflammation. It should not be a long-term diet as many of the FODMAP containing foods are prebiotics, so you are essentially starving your microbiome. Working with a practitioner, you can figure out the best dietary approach for you whilst restoring your gut microbiome with probiotic, prebiotic and anti-inflammatory supplements.
– Focus on Omega-3 rich foods such as wild salmon, sardines, ground flaxseeds, flaseed oil, hemp seeds, hemp seed oil and ground chia seeds. Supplemental EPA/DHA from fish oil or sourced from algae is popular as anti-inflammatory strategy if you find it difficult to eat enough Omega-3 rich foods, especially if you’re on a strictly plant-based diet
– Turmeric is an incredible anti-inflammatory herb that has shown a significant reduction of IBS symptoms in clinical trials. It not only provides symptom relief but reduces low-grade inflammation in the gut, and is also fantastic for mood support
– Eat plentiful fruit and vegetables!
3.Restore Your GIT Microbiome
– Partially Hydrolyzed Guar Gum (PHGG): a low cost prebiotic powder that promotes the growth of beneficial bugs in the gut and is a brilliant tool for regulating bowel motions (for both constipation and diarrhoea). This is an important long-term strategy for addressing dysbiosis in the gut so stock-up! Simply add it into water or into smoothies.
– Probiotics: these live micro-organisms can be found in fermented foods such as yoghurt, sauerkraut and kefir, or in supplemental form. Fermented foods are a great addition to your diet for gut health, whilst supplements have a long history of success in treating IBS.
The efficacy of probiotics is strain-dependent. While many people try different broad-spectrum products with much success and noticeable improvement in their digestion, others notice no benefit or even a worsening of symptoms. This can be a sign of a more significant underlying issue such as Small Intestinal Bacterial Overgrowth (SIBO), or if you don’t notice any benefit you may need a more specific strain or strains of bacteria. Working with a practitioner can help you get the best out of probiotic therapy
– Eliminate Gluten & (Possibly) Dairy– I don’t follow a particular dietary trend or recommend my clients all exclusively eliminate particular foods or food groups, but in the case of chronic and persisting digestive symptoms the majority of clients i see notice a significant reduction of symptoms when eliminating gluten-containing foods their diet. Many clients also notice a significant reduction in symptoms when removing dairy from their diet due to lactose & casein sensitivity.
Note: Calcium is easy to get from plant-foods! Dairy is not all it’s cracked up to be…
Removing foods that drive alot of digestive systems gives the gut a rest and creates an environment for inflammation to resolve. If the idea of removing these foods stresses you out about what you can eat, work with a nutritionist who can help you.
Clinically I have seen the best results using Food Biocompatibility Testing – it takes the guesswork out by removing foods that you are incompatible with, which optimises cellular function and reduces inflammation
4. Stress Management
– As you are well aware, having IBS is already stressful enough, and stress worsens your symptoms. This vicious cycle can be difficult to deal with especially in modern times when we are all so busy and feel like we barely have time to stop and nourish ourselves
– Committing to self-care practises and putting yourself first is a crucial part of overcoming chronic gut issues. Whether it’s breath-work practises, yoga, meditation, counselling, seeking help with a practitioner – take the small but necessary steps of making these a priority in your life. It may require some initially uncomfortable changes, but the pay-off is worth it. Trust me! You don’t have to be perfect, but investing in the skill of relating to stress in a healthy way is a game changer for health overall
– Magnesium is a superstar mineral that not only helps relax the bowels but is great for supporting the nervous system during times of stress, also helping with improving sleep quality. Magnesium citrate is my preferred form GIT conditions
Hopefully this article has in someway been helpful for you to begin healing the root cause of your IBS and finally getting some symptom relief.
At my naturopathic practise in Sydney I help my clients with extremely thorough and holistic treatment plans, where we have the opportunity to work a bit deeper on their presenting health concerns, on all levels.
For clients who still seem to be struggling despite all of the foundational healing tips provided, further testing is usually necessary to rule out conditions such as SIBO and more severe dysbiosis – a combination of breath-testing (for SIBO) and comprehensive digestive stool analysis are game-changers for anyone with chronic gut symptoms, and can give as valuable insight into what’s really going on within the gut ecosystem.
Yours In Health,
Sydney Naturopath & Nutritionist