With 1 in 5 Australians having this condition at some point in their life, IBS is the most common gastrointestinal (digestive) condition. It is more common in females and may come and go throughout life.
IBS is characterised by:
Some other symptoms often reported by people with IBS, include:
It is important to note that symptoms vary between people and may change over time.
The diagnosis of IBS is generally considered based on presenting symptoms and when all other possibilities have been ruled out. There are many conditions that have similar symptoms to IBS, including, but not limited to: inflammatory bowel disease, gastrointestinal infection, diverticulitis, sugar or food chemical intolerances, malabsorption diseases and cancer. It’s possible that some of these conditions may even cause IBS.
The Rome diagnostic criterion for the diagnosis of IBS is a follows:
Recurrent abdominal pain or discomfort** at least 3 days/month in the last 3
months associated with two or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance) of stool
* Criterion fulfilled for the last 6 months with symptom onset
at least 2 months prior to diagnosis
** “Discomfort” means an uncomfortable sensation not described as pain.
In pathophysiology research and clinical trials, a pain/discomfort frequency of at least
2 days a week during screening evaluation is recommended for subject eligibility
The frustrating part for people who have IBS is that there is no consensus on what causes the condition. There are some theories, including: gut infection, food intolerances, medications, poor diet, dysfunctional microbiome, and emotional stress. However, it is not clear whether these are actually the root cause of IBS or just contributing factors or some may even just be a symptom of IBS. However, what all of the above theories have in common is that they can all directly or indirectly lead to gut damage or negative changes in the composition of the microbiome.
Gastrointestinal infections seem to be a major contributing factor with studies showing a 5 to 6 fold increase risk of developing IBS following an acute gastrointestinal infection with a further 4-fold increased risk if antibiotics are used to treat the infection. More specifically, this suggests that an acute negative change in the composition of the microbiome can result in a significantly increased risk of IBS. Therefore, in my opinion, it is probable that IBS is caused by damage to the gut, often, but not always, due to an altered microbiome (dysbiosis). One theory is that this damage to the gut causes a hypersensitivity of the nerves in the gut and this is what actually causes a lot of the symptoms associated with IBS.
Therefore, based on the evidence of gut damage and dysbiosis linked to IBS, our treatments involve:
At the core of our naturopathic approach is to take a detailed case history and this provides the best chance of identifying the potential root cause/s and confirm if it is in fact IBS. Often the root cause is not obvious, but we always strive to at least understand the potential causes for the person’s IBS. If we can treat the cause then we have the best chance of successful treatment and prevention of future recurrence. However, we also understand that often the damage is already done (antibiotics etc) and there’s no way of reversing that damage, but we can still absolutely provide treatment. Some tests may be required to rule out other conditions or to assess for gut infections etc.
It’s important to investigate what foods may be contributing to the IBS symptoms. If we don’t stop the gastrointestinal irritation then we don’t stop the inflammation and any other treatments are therefore unlikely to be as successful as they should be. We asses for food allergies (including intolerances) using an Elimination Diet. Elimination Diets are the gold standard in assessing food allergies and they are very cost effective. There are certain foods that tend to be more problematic in IBS, but it’s good to keep an open mind and investigate objectively. A diet diary prior to the Elimination Diet can give some good information as to where to start. In my opinion, food allergies are likely to be secondary to gut damage, rather than the root cause of IBS….what’s causing the food allergies?
Once food allergies have been assessed and offending foods removed, the next step is to start healing the gut wall and restoring the microbiome balance. The good news is that an appropriate diet and microbiome restoration will likely go a long way to healing the gut because we have down-regulated the inflammation and associated tissue damage. Current evidence suggests that diet, prebiotic supplements and particular strains of probiotics are the most effective at improving the composition of the microbiome. These three interventions have also proven to be beneficial in reducing the symptoms associated with IBS.
The above treatments should offer symptom relief for the majority of people. However, IBS symptoms van vary significantly among people so an individualised approach is important, as it is with all conditions. Not every treatment works for everyone so it’s always a matter of trial and error to see what treatments work. For example, peppermint oil has good evidence in reducing IBS symptoms, but peppermint is high in salicylates so it wouldn’t be effective in someone with a a salicylate sensitivity. Dealing with any psychological and emotional issues is also important because there is a strong bi-directional link between the gut and the brain, often termed the gut-brain axis.
IBS can be successfully treated by following a logical and systematic investigation and treatment approach, based on available evidence and presenting symptoms.
Rick has a special interest in IBS so give us a call today…first consultation is FREE.
Rick Hallion is a nutritionist located in Coffs Harbour, NSW. Rick has a special interest in treating irritable bowel syndrome (IBS) because it is a common condition and is totally treatable. Rick uses a holistic naturopathic approach which he truly believes is the only way to treat chronic and complex health conditions, such as IBS.
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