IBS and Digestive Problems
What is IBS?
One of the most common reasons people seek out my services is due to Irritable Bowel Syndrome (IBS) or digestive problems. IBS is often a label assigned by medical doctors to people who are presenting with digestive symptoms with no known cause. Patients are understandably frustrated when they are told "there is nothing wrong with you" or "it’s all in your head". This condition always has an underlying cause and IBS is just a blanket term for a wide range of symptoms that affect the entire digestive system.
Sufferers routinely present with chronic, relapsing gastrointestinal problems, characterised by abdominal pain, bloating, and changes in bowel habit, alternating from constipation to diarrhoea, nausea, acidity, heartburn or a sensation of fullness soon after eating. An accumulation of food in the gastrointestinal tract may explain these symptoms.
Food allergies and intolerances
Food allergies and intolerances used to be recognised as the main cause and driver of IBS, and understandably so as approximately two-thirds of IBS patients have at least one food intolerance and many people have multiple intolerances. Foods that are usually reported to cause symptoms include refined carbohydrates, fatty food, coffee, alcohol and hot spices. The most common allergens are dairy, gluten, yeast, eggs, corn, soy, and peanuts. More recently, however, we have come to realise that there are other factors at play.
Stomach acid and absorption
Hydrochloric acid (HCL) is required for the digestion of protein, and for the stomach to empty correctly into the duodenum. Failure to do so results in gastro-oesophageal reflux disease or GERD as a back pressure of acid is created. HCL is also required to sterilise the stomach and kill bacteria and yeast that may be ingested in food. And most importantly HCL is required for the absorption of certain micronutrients, including calcium, magnesium, zinc, copper, iron, selenium, boron and B12. The implications of all this can lead to health problems such as bloating, indigestion, malabsorption of nutrients, food intolerances and much more. It is imperative to normalise stomach acid levels and eradicate reflux.
Gut flora imbalances and SIBO
Studies show that almost 80% of patients diagnosed with IBS have an underlying bacterial imbalance called SIBO (small intestinal bacterial overgrowth). Most of our gut bacteria should be in the large intestine but when the bacteria migrate backwards into the small intestine or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause symptoms, such as diarrhoea or constipation, gas, and bloating.
Parasites and candida
The role of parasites and candida or other yeast overgrowths should not be underestimated in their abilities to cause a wide range of undesirable symptoms including chronic diarrhoea, brain fog, insomnia, headaches, anxiety, depression, bloating and more. Nutritional therapists have access to sophisticated tests that can detect pathogens. An overgrowth or infection responds well to targeted supplements and some dietary modifications.
Increased gut permeability or ‘leaky gut’ is when the epithelial cells that line the gut wall become damaged and change from being ‘tight’ to ‘leaky’. This allows bacteria and undigested proteins and other food molecules to pass through directly into the blood stream which can lead to chronic inflammation. This is thought to be a major cause of increased gut pain sensitivity in IBS. Inflammatory immune cells are constantly exciting nerve endings in the gut tissue which is why the gut is so sensitive and painful. People with IBS often have allergic diseases such as eczema, asthma or hay fever and it is possible that anything that passes through the gut, including food or pollen, may pass through any gaps that have been created in the gut lining thus resulting in an increased risk of developing food intolerances and other allergies.
Psychological factors are an important aspect of IBS that need to be considered and addressed alongside any other suspected causes. Stress is widely accepted as an influence of digestive function and a vast amount of research in this area has linked stress to many of the major gut disturbances found in IBS including inflammation, increased gut permeability, pain hypersensitivity and changes in gastric emptying. Inflammation, pathogenic gut bacteria, increased pain perception and leaky gut can lead to an overactive nervous system resulting in increased physical and emotional stress. Stress often leads to a reduction in Hydrochloric Acid and digestive enzyme production which in turn can manifest itself into the symptoms associated with IBS such as bloating, dyspepsia, acid reflux etc.
When assessing a patient with gut problems I always take a solid case history and depending on the client I may recommend functional testing. Often the disease is due to interrelated factors so addressing just one area may not be of great benefit, and this is where functional testing can be of real benefit. Tests that I recommend include, organic acids testing, SIBO breath test, H. pylori stool/breath test and more, depending on the individual. The organic acids test is the single most useful test currently available and can save a patient a huge amount of time and money in the long run on wasted supplements and extra consultations. By assessing someone's metabolic markers, it allows me to see which imbalances may have initiated the disease. It also provides important information about areas in the body that need support, as well as obstacles that may be preventing someone from regaining their health. By rebalancing metabolic systems and removing obstacles, the body then has a fair chance to restore itself back to optimal health.
Brown, B. (2015) ‘The Digestive Health Solution’. Australia: Exisle Publishing.
Carnahan, J (2014). 6 Signs That SIBO Might be the Root Cause of Your IBS. Available at: http://www.jillcarnahan.com/2014/05/16/6-signs-sibo-might-root-cause-ibs/.