Irritable Bowel Syndrome (IBS) is a common complaint as many of my readers and patients can attest. Many websites exist describing the clinical signs and symptoms of IBS which adequately describe common work-ups and traditional treatments. Additionally several medications, laxatives, and anti-depressants have been used to treat symptoms with varying success.
I would like to impart some clinical experience and perhaps give food for thought as to alternative therapies and theories as to why this troublesome condition occurs. As always, I prefer to seek the cure not stop at focusing on symptoms.
First off, IBS is a diagnosis of exclusion. Simply put, just because you have bowel cramping, diarrhea, alternating constipation or bloating, IBS isn’t always the cause. Diagnosis of exclusion in medical circles means that numerous other possible diagnoses should be ruled out before settling on the IBS diagnosis.
In my experience people often receive the diagnosis and prognosis for IBS without a complete evaluation for other possibilities.
Here are a few key features that would weigh against the diagnosis of IBS:
1. Specific food triggers
2. Bloody show in stools
3. Black or Tarry stools
4. Green or Mucus coated stools
5. Fevers, vomiting, or significant weight loss
5. Age > 50 years old at onset
6. Poly-pharmacy (Consuming 3 or more prescription medications routinely)
Any of the above symptoms would suggest a more different diagnosis.
If your IBS symptoms are caused by specific foods such as: dairy, wheat, cereals, spices, sodas, sugars, etc, you must first try eliminating these foods for a minimum of 2-3 weeks to assess your resulting bowel function and motility changes. In my clinical experience dairy, wheat, corn, and soy elimination resolves a huge portion of IBS symptoms in a large majority of these patients. Remember, preservatives, dyes, artificial sweeteners. If you notice some improve at 3 weeks, but not complete resolution, continue eliminations x 3-6 months. I often see steady improvement with complete elimination of offending foods given enough time.
So what if you’ve tried that? After all, everybody knows about gluten sensitivity, lactose intolerance and similar conditions. Consider more specific testing such as ALCAT testing. I have no financial affiliation with the company or labs which perform this type of testing but I often use this simple blood test to give me specific details about food sensitivities. Routinely patients removing food sensitivities identified this way improve dramatically. (Incidentally, I’ve seen it work for allergies, asthma, and migraines too)
Dysbiosis refers to the development of imbalance between good and bad bacteria in the gastrointestinal tract. Dysbiosis has many
causes most of them induced by diet and doctors. Highly processed, refined sugar diets shift bacterial cultures towards harmful species which lead to mal-digestion, bloating, flatus, and poor absorption….which functionally mimics IBS.
Doctors trigger dysbiosis by indiscriminate or frequent antibiotic usage often triggers imbalances in bacterial flora in the intestinal tract. Use antibiotics only when necessary! Imbalances can occur for months after a single round of antibiotics. Other common drugs like NSAIDS (Advil, Aleve, etc.) also can affect proper balance inside out digestive system. Routine usage of these medications and those similar can affect our gut lining, bacterial cultures and ultimately trigger dysbiosis.
Other common medication/drug offenders include nicotine, caffeine amphetamines, and narcotic medications. Each of the aforementioned can effect bowel motility in different ways leading to changes in bowel bacteria flora or gut motility characteristics.
I like to treat dysbiosis with probiotics. Probiotics include specific species of bacteria designed to replenish balance in the intestines, thereby restoring proper digestion. A classic example of probiotics includes: lactobacillus acidophilus.
Taking a probiotic routinely in many cases relieves IBS due to the correction of dysbiosis.
Clearly IBS has connections to emotional states. Many individuals with IBS suffer mood disorders, anxiety, and even panic disorder. I’ve read that serotonin (an extremely important neurotransmitter in the brain important for mood stability) is found in very high concentrations in the nervous system of the bowels. Logically if someone suffered serotonin imbalances causing mood instability, those same imbalances likely explain the commonality of IBS in patients suffering from mood disorders.
THE MIND IS CONNECTED TO THE BODY. THEY ARE NOT SEPARATE.
…..just ask anyone who’s ever had “Butterfly’s in their stomach!”
Focusing on stress reduction goes a long way treating refractory cases of IBS. Some doctors believe that IBS may actually originate as a manifestation of suppressed subconscious rage or emotional baggage too painful to verbalize consciously. (Abuse, neglect, childhood trauma, insecurities, etc.) These types of treatments require a diligent and committed patient but offer another frontier to explore when seeking IBS cures. (See Dr. Sarno’s work)
In many cases, focusing on one mind, spiritual, and physical technique for stress reduction often improves IBS.
Top Ten Recommendations for IBS:
1. Eliminate Dairy (Includes milk, cheese, cottage cheese, etc.)**
2. Eliminate Wheat (Cereals, breads, pasta, crackers, etc.)**
3. Stop all alcohol (Beer, wine, liquor)**
4. Eliminate caffeine, stimulant drinks, and high fructose corn syrup from your diet**
5. Avoid fast foods and prepackaged foods as much as possible
7. Stress Reduction (Top 10 recommendations)
8. Seek Work-up if not already performed to include: CBC, CMP, TSH, ESR, Stool Blood test, stool culture, Stool O&P, ALCAT testing, and colonoscopy
9. Consider medication or medication interactions as a cause of symptoms. (Trial off potential offending medications–with your doctor’s supervision)
10. Consider detoxification programs, water sources, heavy metals, and other environmental toxicities
**Eliminate minimum 2-3 weeks to gauge basic effectiveness. If beneficial continue elimination minimum 3-6 months. In some situations those foods will always cause IBS-like symptoms. You will simply need to avoid them for best health.
This list is not exhaustive but the point is to start somewhere and stay consistent.
My best outcomes with IBS have come from Food eliminations, digestive enzymes, probiotics and a combination of stress reduction techniques.
I encourage feedback on this important and common problem. I welcome comments, questions, and stories of success….or failure!