Could that cramping abdominal pain be IBS?

Did you know that since 2016, April was designated as I.B.S. (Irritable Bowel Syndrome) Awareness month?

Funny since if you have Irritable Bowel Syndrome, you are anything but aware that you have it!

Yet many people don’t know that their digestive woes are not reflective of a normal functioning digestive tract.

On the world stage, IBS affects 10% of the population or over 779,000,000 people.

In the U.S. up to 20 percent of the population experiences the symptoms associated with irritable bowel syndrome. That translates to about 50 million adults. Children are affected too but rarely diagnosed.  

To honor this awareness month, I’d like to share more about IBS.

IBS 101

Irritable bowel syndrome (IBS), formerly known as spastic colon, is a chronic condition that can interfere with a person’s daily life since symptoms are often unpredictable. People can go months symptom-free and then an unknown trigger can set them into days, weeks, or months with a flare-up.

If living with the symptoms weren’t bad enough, having them rear their ugly head when we least expect it, can severely impact the person’s quality of life. This is an often-forgotten consequence of this syndrome.

How is IBS diagnosed?

Over the years, the criteria have evolved, but IBS is now defined as recurrent abdominal pain at least three days per month in the previous three months. It is also associated with two or more of the following:

• Improvement or relief of symptoms with elimination
• Symptoms started with a change in stool frequency (less or more “productive” trips to the toilet)
• Symptoms started with change in stool consistency (start to have loose or hard stools)

The “work up” before you get the diagnosis of IBS should include screening for gut disease, like Celiac, Inflammatory Bowel Disease, or GI cancers. If findings from tests shows no physical evidence of disease, often the diagnosis of IBS is made.

What is a Functional Gut Disorder?

The lack of findings of physical changes within the gut has led IBS to be labeled as a functional disorder. IBS is characterized by several functional changes and include:   

• altered motility (things go too fast (loose stools) or too slow (constipation or hard stools) through the digestive tract)
• the nerve endings in the GI tract are hypersensitive to expansion from eating and pressure incurred when foods are broken down known as “visceral hypersensitivity”
• lining of the gut becomes “thin” allowing things to leave and enter without our consent = compromised mucosal function
• impaired immune function (heightened immunity can result in food sensitivities)
• imbalances of gut bacteria (or an increase in opportunistic bacteria over our usual and welcome bacteria in the gut)
• Gut-Brain communication which can impact our moods and gut motility (called Gut-Brain axis)

Symptoms associated with functional GI disorders can range from difficulty swallowing, to heartburn, to nausea, to constipation.

When a person has IBS, they typically have abdominal discomfort and changes in bowel habits. They usually have diarrhea, constipation, or a mix of both.

It turns out that our historical understanding of functional GI disorders was misguided. Over the past decade plus, what makes a healthy gut has been turned upside down by research on the gut’s microbiome.

What’s the Microbiome?

Here’s where the science nerd in me gets excited! Did you know that humans are mostly microbes? Here are some cool facts:

• There are over 100 trillion microbes in our body with the majority living in our gut
• Humans have 10 times more bacteria than human cells in the body
• More than 1,000 different strains of bacteria live in human intestines
• The microbiome may weigh as much as five pounds. Remember that when you step on the scale!
• The microbiome includes bacteria, fungi, protozoa and viruses and they all live on and inside the human body

The microbiome has several jobs. Here’s a short list:

• help us digest food
• regulates our immune system (estimated that 70% of our immune system is found in our gut)
• protects us against other bacteria that cause disease
• Produce vitamins including B vitamins B12, thiamine and riboflavin
• Produce Vitamin K needed for blood clotting

The microbiome was not officially recognized until the late 1990s. Microbiome research shows that those with IBS do have detectable and measurable changes in the microbiome of the gut. This type of research expands the definition of functional gut disorders.

Bacterial imbalance in the gut is called dysbiosis. This condition signals that changes in the composition, diversity, or the metabolites of the bacteria has moved from a healthy pattern to one associated with symptoms and can lead to disease.

What causes IBS?

The latest research shows that a number of factors can lead to IBS symptoms such as:

• An imbalance of bacteria in the gut (dysbiosis). This may be a result of poor food choices, daily stress, antibiotic use and other lifestyle factors. As many as 73 percent of cases of irritable bowel are associated with a bacterial imbalance in the small intestine.
• Exciting hot-of-the press research shows that an episode of food poisoning may cause between 5% and 32% of IBS cases. This is called post-infectious IBS and often occurs six months after the food poisoning.
• A breakdown of the lining of the gut (AKA “leaky gut”) have also been found in people with IBS.
• Allergy-related diseases, such as asthma, in childhood increased the risk of having irritable bowel syndrome at age 16.
• SIBO, or Small Intestinal Bacterial Overgrowth. SIBO means there is bacteria in the small intestine, where it doesn’t belong.
• Gut infections are another lesser-known cause of IBS. Many studies have confirmed a link between a single episode of bacterial gastroenteritis and future development of IBS.

SIBO may be present in up to 78 percent of IBS patients. A simple at-home breath test for gases released by certain bacteria in the gut can help diagnosis SIBO.

Treatment for IBS

While prescribed medications are available that target symptoms; specific diets, supplements and lifestyle tweaks are often more effective to manage this condition.

First, treatment for IBS must be customized. Receiving a handout of foods to avoid is not an effective treatment plan. The timing of the onset of symptoms and how long they last are clues to a functional dietitian. This along with health, life and living habits, are the foundation for creating a comprehensive plan for treating IBS.

Second, methods such as food diaries and elimination diets typically are used to identify potential trigger foods. To reduce diarrhea or alleviate constipation, a mix of diet and supplements can be a stand-alone plan or an addition to prescribed medications.

Since constipation is a very common symptom in IBS, increasing fiber intake has been shown to improve this condition. Ironically, for those with diarrhea, adding the right type of fiber can reduce this challenging symptom too.

The key to symptom control is using the right type of fiber for the condition.

Finally, we can’t forget the impact of stress, exercise, and sleep have on the health of the digestive tract. 

What diet is best for IBS?

Decades ago, it wasn’t uncommon to hear a doctor say “diet won’t make a difference for IBS symptoms.” Thank goodness we now know better! Food choices have a huge impact on triggering symptoms of IBS.

Yet one woman’s poison is another’s elixir of wellness. Finding the foods and meal pattern for someone with IBS can be a moving target if the potential root causes for the symptoms are not identified.

There are a handful of diets that have been shown to reduce symptoms and move toward creating a healthier gut. These diets are based on research showing that eating the right type and amounts of fibers and temporarily limiting certain types of carbohydrate-type foods can reduce or even eliminate symptoms.

Hail the FODMAP diet!

The most popular diet for control of IBS symptoms is the Low-FODMAP diet. Created by Monash University in Australia, the low FODMAP diet is designed to treat IBS symptoms.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

Foods that are high in FODMAPs include wheat, garlic, onions, honey, apples, milk, and cashews. Common symptoms 1-2 hours after eating these foods are bloating, distention, gas, and even diarrhea.

The research shows that up to 75% of individuals with IBS find relief using a low FODMAP diet. This success rate is greater than any prescribed medications for IBS.

Food truly can be the best medicine! 

Other diets shown to help with IBS are:

• Specific Carbohydrate Diet
• SIBO Bi-Phasic Diet
• Gut and Psychology Syndrome (GAPS) Diet
• Cedars-Sinai Diet

In my practice, I often start with my “gentle” low FODMAP diet. This short-term diet is not as restrictive as a full low FODMAP. This often provides immediate symptom relief. This first step also provides a bridge for test results. Once they are available, the fine-tuning of the diet can occur.

The first phase of the low FODMAP diet is eliminating high FODMAP food for 4-6 weeks. The second phase, the re-introduction, carefully crafted to allow one category of high FODMAP containing foods. This is where the identification of specific high FODMAP foods can be detected.

The third and last stage combines the patterns of tolerance to create a customized meal plan. Sounds like a lot of work? It’s easy to do with the help of a functional dietitian fluent in the FODMAP diet.   

Supplements for IBS

I believe real food (not powders or capsules) is the backbone of a healthy diet. With plant-based foods as the star player when it comes to gut health.

Food, especially food with various types of fiber, is always my first strategy for restoring the gut. But prebiotic and probiotic supplements can be the lynchpin when digesting fiber is a challenge due to a damage gut.

Using a pre or probiotic in capsule or powder form provides a targeted way to feed the gut with the “food” that bacteria need to create helpful gut components without taxing the gut with the digestion of fiber.

Pre and probiotic supplements can improve our ability to process fiber. Plus reduce the digestive distress that comes from imbalanced bacteria and a damaged gut microbiome.

My caveat is that the hype around probiotics is somewhat ahead of the science. The marketing machinery has created a message that unless you take a probiotic you are doomed.

I don’t believe that every ill can be fixed with a probiotic. This is especially true IF a low fiber, low plant containing diet is part of the individual’s daily diet.

The question then is, what type of probiotic to take? The science has been able to show us which strains can help with diarrhea, constipation and other symptoms of IBS.

The science shows that taking a multi-strain supplement versus one type of probiotic is more effective for gut restoration.

Beyond Probiotics

There are many types of supplements that ease and even stop common IBS symptoms. From digestive enzymes to herbal teas; to home remedies of acid cider vinegar.   

Herbs have a powerful place in IBS especially when SIBO is the cause. But in order to have success, you have to make sure you’re taking the one that works for each situation.

Here are several other supplements that help with various digestive symptom:

Activated Charcoal – great for bloating and helps with abdominal pain and diarrhea

Magnesium Oxide – this type of Magnesium can help with constipation

MegaIgG – this brand of powder heals the gut lining through improving immunity, can be helpful with diarrhea

Ginger Root – superpower is to quell nausea (also helps with that feeling that food is sitting in the stomach) 

Bitters – a mixture of plants and herbs that are helpful to combat acid reflux and also helps with general indigestion

The best way to ensure that the supplements you take for IBS are right for you is to review them with a functional dietitian nutritionist.

Also, using bacteria-busting herbs takes longer than traditional prescribed special IBS/SIBO antibiotics. Many time’s it takes more than one bottle and as your gut changes, there may be the need for additional supplements like “binders” to remove those hard-to-get to bacteria.

What’s the next step …

In closing, if you’re living with IBS, know that you’re not alone. Also, know you don’t have to learn to live with these symptoms.

Struggling with IBS is an option not inevitable conclusion!

My IBS was diagnosed over 45 years ago. I spent decades struggling before science discovered the microbiome and the FODMAP diet. These discovery’s coupled with learning how herbs and plants contain the natural remedy for relief of the common symptoms of IBS, has made me the master of my digestive universe.  

To learn how you can reduce unpleasant digestive symptoms and get back to enjoying life, click here to schedule a complimentary consultation. You can tell me your biggest gut challenge and I’ll share the first step to take to get closer to that happy gut!