1. IBS and Nutritional Therapy
IBS (Irritable Bowel Syndrome) is one of the most common gastrointestinal disorder, which can be resolved with the right Nutritional Therapy protocol. It affects a staggering 10-15% of the global population, mainly in the industrialized countries. IBS is defined by Rome III (classification system for functional gastro-intestinal disorders). It involves recurrent symptoms of abdominal pain, bloating and general discomfort, cramps and change in stool frequency, appearance and form. Before diagnosing IBS, more serious conditions need to be ruled out. These will be inflammatory bowel diseases, like Crohn’s and Ulcerative Colitis, but also cancer and diverticulitis.
There are three main differentiations within IBS: IBS-D, associated with diarrhoea, affecting 25.4% of the total sufferers; IBS-C, related to constipation and affecting 24.1% of sufferers; IBS-M, which presents a mix of the two, being the most common, affecting 46.7% of people diagnosed with IBS.
Some research found that loose bowels were present in those patients that had a much higher postprandial serotonin release. Patients with IBS-C showed a lower release. Serotonin is produced by the entero-endocrine cells of the stomach in response to food ingestion. Its function is to stimulate peristaltic movements. These movements are wave-like motions of the gut lining muscles that push food throughout our intestine. Disfunctions in the serotonin production or its re-uptake by the serotonin reuptake transporter, may be responsible of IBS-D. This may also explain why people on SSRI medications, may suffer with abdominal pain and diarrhoea.
thinking out of the box
Over the years, I have anyway personally developed the understanding that IBS itself is not a diagnosis at all. Let me explain.
If you have any of the symptoms named above your GP, without further investigations, may diagnose you with IBS. At this stage, the term IBS is just an umbrella tag. It only recognizes that there are some gastro-intestinal issues, which cause is still unknown. Finding out the triggering reason/s of these gut issues will be the actual diagnosis. Please carry on reading, so to gain some good insights of what these reasons may be.
2. Aetiology
The aetiology of IBS is never black and white, and it will vary from person to person. Some studies have reported a genetic causation. Others link IBS to dysbiosis (imbalanced gut flora), SIBO (small intestinal bacterial overgrowth). Food intolerances and sensitivities, most notably to dairies and gluten may also cause IBS symptoms. Just so that you know, you may undertake a test for coeliac disease, which comes out negative. This proves that you do not have an intolerance to gluten or allergy to wheat. This coeliac intolerance test is anyway not sensitive enough. In fact it doesn’t pick up on what the latest scientific data have discovered and named as “non-coeliac-gluten-sensitivity”. Scientists estimate that for every person with coeliac disease, there are nearly 10 with non-coeliac-gluten-sensitivity.
The problem with wheat containing products may be a consequence of the genetic modifications of this grain during the years. Also, modern baking practices and the amount of added gluten to accelerate the dough rising time may explain the gluten-sensitivity. If you would like to know more about the possible link between gluten and IBS, please read my article here.
more on aetiology
Some research has also identified the occurrence of persistent IBS type of symptoms following a “tommy bug”. Moreover, IBS symptoms may be a consequence of intestinal overgrowth of parasites, like the tiny pinworms or the huge tapeworms. The tapeworm can grow up to 80 feet in length and live in somebody’s digestive system for over 20 years. Also, infections from candida albicans, which belongs to the yeast family, may be responsible for different degrees of abdominal discomfort.
Other most probable IBS landmarks are low grade gut inflammation. When the gut is inflamed, mast cells activity increases. This may cause intestinal hyperpermeability (alias “leaky gut”) and dysregulation of the gut-brain axis. Consequently this may cause brain function impairment.
Put it this way, anything that has the ability to disrupt your gut ecosystem may potentially cause of IBS. This include excessive alcohol intake and antibiotics use, toxins in food and drinks, medications, contraceptive pill, stress, and much more.
These are just some of the causes and symptoms associated with IBS. The consequences of impaired digestive health may easily have a detrimental impact on the rest of the body.
3. Testing
Testing is the most accurate way to diagnose what may be at the root cause of the problem, but where to start?
Lactose intolerance
I would not spend time, money and energy in testing if you are lactose intolerant. I will simply eliminate all dairies from your diet anyhow or drastically cut them down. Humans are not meant to consume in adulthood the breast milk of a mother from a different species even, period. Human’s milk, not cow’s milk, is only needed to wean you off into solid food. In fact, your body stops producing the enzyme lactase, that breaks down the sugar in milk, lactose, around the age of 5. After this age you may become lactose intolerant, but simply because your body can not digest lactose anymore.
Conventional cow’s milk also contains inflammatory metabolites, growth hormones, antibiotics, mast cells, which may well exacerbate IBS symptoms. Production of cow’s milk is also damaging to the environment and goes against animals’ freedom, dignity and consent. I could carry on, but I will stop here, wishing you can hear me.
Gluten intolerance
You can test for coeliac if you have severe reactions when consuming wheat containing products, especially if you experience discomfort and pain within the lower part of your abdomen. But even here you can save your money and try one month on a 100% gluten free diet. Then see if symptoms improve, and if they do, you know what your next move should be. Please remember that as I have explained in my article, gluten sensitivity won’t be picked up by a coeliac test.
Faecal testing
There is other test you can request to your GP. This is a comprehensive digestive stool test analysis, to check for parasitic, candida and bacterial profile. Anyway, this test may be not pick up any pathogenic activity within the first part of the small intestine. It is a good place to start anyway.
Also, some simple diagnostic questions may be useful to understand what may be going on in your digestive system. For instance, candida may manifest itself with very specific symptoms like brain fog, fatigue, sugar cravings, white coated tongue. But also constant bloating and nail fungal infections. Parasites infestations may appear after travelling abroad, eating raw food, uncooked meat, using public toilette, having pets in your home. Symptoms of parasites infection may be itchy rectum, teeth grinding, fatigue, brain fog, sugar cravings and muscle or joint pain. In more severe cases vomiting and diarrhoea may occur.
Food allergies
A food intolerance test may also be beneficial. This will rule out any other allergens that may be impacting on your digestive health. Otherwise you can save your money and start a food and symptoms diary. You can thus track down what products and food types you may have a sensitivity or an allergy to. This will require a bit of mindfulness to what clues your body gives you after ingesting certain foods. You will have to look out for lethargy after food, sleepiness, abdominal cramps, bloating, flatulence, headaches, belching and fatigue.
Upper digestive system
I would also consider undertaking a breath test to find out if you have SIBO. Gut bacteria produce two types of gas, most notably hydrogen, produced by most of them, and methane, produced by a minority of bacteria. The results of this test can indicate which bacteria are most dominant and if there is an overgrowth.
A breath test may also be useful to rule out the presence of Helicobacter Pylori. This is a pathogenic bacteria that lives in our stomach. It can cause heart burn, stomach ulcers and other consequential problems further down the digestive system.
4. IBS and Nutritional Therapy
First and foremost, there will never be a “one size fit all” approach, considering the complexity of IBS causes. You also have to include the bio-individuality of every single human, with their past and present health and medical history. Emotions and personal believes, socio-economic status, ethnicity, family health history and genetic polymorphism, age, gender, religion are all to be accounted for as well.
In my clinical practice, my goal is to always find out and address the real underlining triggers and exacerbating factors of the problem, whilst modulating symptoms at the same time.
I am anyway confident to share the next few tips from my clinical experience. These may contribute to alleviate some gastro-intestinal complains:
FEW TIPS
- Listen to your body! Be mindful of the symptoms and bodily sensations before, during and after a meal. Look out for symptoms like low energy, headaches, abdominal discomfort, burping, flatulence, anxiety and low mood. Then link these back to what you have eaten, how much and how. This will allow you to make some connections and consequent adjustments.
- Eat in a relaxed state. Take time to eat, chew thoroughly and eat smaller meals, and always keep your weight in check.
- You should be cooking the food you eat. This will increase your gastrointestinal juice and enzymes secretion, so the food will be easily digested.
- Stress is also thought to be a trigger or mediator of IBS. If you feel stressed, please read my article on how to manage it here.
- Adopt an easy to digest diet, like soups, broths, minestrone, smoothies etc.
- Limit or avoid high sugar content products, including alcohol, fizzy drinks and refined carbohydrates.
- If you are constipated, please avoid all red and cured meats.
- Limit or avoid trans fats and everything deep fried.
- Drink good quality water. 1-1,5lt per day, a bit more if you exercise. Tap water mainly, but also plastic bottled water may contain fluoride, chlorine, hormones, pharmaceutical, micro-plastics and other toxins. Please take a look at these water filters to make sure you have the best drinking water in your household.
- Eat as much organic food as you can afford. Please read my article on the dangers of toxins and how to decrease exposure to them here.
- Avoid wheat, gluten and all dairies. Remember that cow’s milk is meant for baby calves, not for grown up humans!
This is just the tip of the iceberg
If symptoms do not improve with the above adjustments, my advice is to consult a Nutritional Therapist. His intent is to understand the underlining causes of your symptoms, through an accurate and thorough health and medical screening. Then he will create a personalized and easy to implement nutritional and lifestyle plan to meet your needs and goals.
5. In depth Nutritional Therapy Management for IBS
Bloating
Bloating is a functional mechanism, most possibly related to food fermentation in the bowel. The by-product of fermentation is gas. Bloating is ranked as the most bothersome symptom in people with IBS-C. Sometime abdominal distention, due to bloating, can reach up to 12 cm. Bloating can be a consequence of candida and parasites overgrowth, dysbiosis, food allergies. A great remedy for functional bloating is activated charcoal. This has greater absorption ability compared to normal charcoal, binding to toxins and excessive gas within the gastro-intestinal tract.
IBS-D
With IBS-D I use a specific non-colonizing friendly yeast strain of probiotic called Saccharomyces Boulardii. SB may also be used to re-balance intestinal microflora due to production of lactic acid and B vitamins. They are important organisms to improve gut lining cells health. I may want to bulk up their stools too and use a fibre product without FOS. This product contains a combination of soluble and insoluble fibres. FOS are fructooligosaccharides, a type of complex sugars. Although, they are very beneficial for the gastro-intestinal tract, they may cause some bloating in sensitive individuals.
IBS-C
If my clients suffer with constipation, I definitely will want to improve their bowel motility with and different type of probiotic, containing high doses of Lactobacillus, but also Bifidobacterium strains, as this last family of bacteria is mostly prevalent in the bowel. You can use a different type of fibre from chicory root, called inulin, to support friendly gut bacteria proliferation and consequent bowel motility and health. I will advise starting at a very small dose with this product as it may cause some bloating, and increase dosages gently, until you find the dose that works for you.
I may also want to add some magnesium in the form of hydroxide to enhance motility further and introduce an omega 3 to lubricate the digestive track, but mainly to modulate low grade gut inflammation, a landmark in IBS. With functional constipation I may also introduce a broad-spectrum digestive enzymes formula, because due to IBS causing mechanisms, the digestive system function may not be 100%, which may lead to undigested food sitting in the intestinal track, which may constipate.
Candida
If I suspect that my client is infected with candida, which anyway deserves an article of its own, I may try with a product that may have antifungal properties, alongside Saccharomyces Boulardii. When cleansing, always make sure that you empty your bowel at least once a day, if you are already slower than this, please consider enhancing your bowel motility prior the cleansing with some magnesium and inulin. Please note that candida is a tough pathogenic organism and its eradication may also need an anti-candida diet (no sugar or refined carbohydrates, no fermented food like sauerkraut, no alcohol and others) and loads of patience and commitment.
Parasites
I do a parasite cleanse myself once or twice a year anyhow, because it is so easy to pick them up and although I have a strong immune system I just want to make sure no worms live in my digestive system. If you suspect or found out that you have a intestinal parasites infection you can try with a parasite cleanse, but please note that this product contains nuts! When cleansing, always make sure that you empty your bowel at least once a day, if you are already slower than this, please consider enhancing your bowel motility prior the cleansing with some magnesium and inulin. During cleansing you may also want to include insoluble fibre to physically engulf and trap dying or dead parasites for readily elimination.
For what concerns allergies, SIBO and H. Pylori, in depth considerations are needed, for which I will have to write individual articles, but please feel free to ask me any questions in the comments section below.
6. Next stage
There are two other steps I consider finishing off with, once all the IBS symptoms have improved and these are: liver support, but also repairing any possible gut lining damages that inflammation, toxins, allergies and pathogenic organisms may have caused. For what concerns liver support and cleansing you can read my article here. For enhancing gut function and its repairing mechanisms you can investigate an all-around gut health supplement with high glutamine levels, which I highly recommend.
7. Final thoughts
IBS is one of the most common gastrointestinal disorders, affecting people mainly in the industrialized countries. Its pathophysiology is very complex and involves different aspects like dysbiosis, food allergies and sensitivities, SIBO, pathogenic infections and anything else that may impact on the gastro-intestinal environment and ecosystem. Testing may be beneficial to find out the possible triggers, but otherwise an elimination diet and diagnostic questions may result beneficial as well. A Nutritional Therapy approach to IBS will look into the present and past medical and health history of the person, dietary and lifestyle habits, plus others, in order to understand the probable triggering and exacerbating factors of the problem/s, whilst modulating symptoms at the same time.
Remember that you only have one body to get you through life. Take good care of it.
Author, Cristiano Percoco, BSc (Hons) Nutritional Therapy
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References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773304/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225338/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095723/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324800/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707740/
https://www.ncbi.nlm.nih.gov/pubmed/21181303
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