IBS - Symptoms, Diet and Treatment
IBS, is the common slang term or abbreviation for Irritable Bowel Syndrome and may also be called spastic colon, irritable colon or spastic bowel. With an estimated 30 to 45 million Americans affected by this condition, it is one of the most frequent health complaints that a health care practitioner hears from their patients.
Irritable Bowel Syndrome is a condition that affects the bowels, otherwise known as the large intestine or colon. The area of the digestive system that stores and moves the stool to the rectum to be eliminated. Because diagnostic testing doesn't reveal any actual inflammation or damage to tissue within the colon, it is considered a functional gastrointestinal disorder. Meaning the problem lies in how the system functions and not an actual disease process.
The walls of the bowel are lined with muscles that contract and relax. This movement, which is called peristalsis, is what moves your food from your stomach and through the intestinal tract and out to the rectum to be emptied. In a healthy colon, these muscles work in a synchronized tempo and move smoothly through the process.
However, in IBS, the contractions of the muscles fail to work properly. They may be stronger than normal which results in food being pushed through the intestines too quickly, resulting in diarrhea and cramping or they may be slower than average and the food moves too slowly through the colon, which causes stool to dry out and turn hard, which leads to constipation and pain as it moves through the intestines.
The severity and impact of irritable bowel on the individual's life can range anywhere from a minor inconvenience to being completely debilitated. Statistics tell us it occurs more often in women than men, and usually presents before the age of 35, but I'm not sure I agree with this. I've known quite a few men with the condition and I think men are less likely to get diagnosed because they are embarrassed, so they hide it. Talking about the bowel is an uncomfortable subject for many, even women, so a lot of people tend to avoid it and suffer quietly. Additionally, because of the poor diet that most Americans eat, we are seeing what looks like IBS in many children, as well.
Although this condition can be quite painful and even disabling, it is considered less serious than other intestinal health conditions like Crohn's or ulcerative colitis and is not believed to increase the risks for colorectal cancer. However, people living with severe IBS may disagree, because with the extent of pain that is experienced it is hard to believe there isn't damage occurring.
Primary Symptoms of IBS
- abdominal pain and/or cramping
Other symptoms of IBS may include mucous in the stools, a feeling like you still need to have a bowel movement even though you've already had one, heartburn and feeling an urgency to go to the bathroom. It is often accompanied by a variety of other health conditions such as Fibromyalgia and chronic fatigue. There may be a wide variety of mental health symptoms as well like depression, anxiety, irritability, mood swings, OCD, or other psychological disturbances.
Symptoms vary from person to person and are usually unpredictable and disruptive. Some people have what is called constipation predominant, while others have diarrhea predominant, and yet others may alternate back and forth between the two. Symptoms often appear suddenly without warning which may interfere in everyday life, causing the individual stress, embarrassment and emotional distress.
For some people, their symptoms disappear for weeks or months at a time and then return and they experience no increase in severity, while other people report no reprieve and a consistent worsening of their condition over time. Some people experience spasms in the bowel as the muscles may contract suddenly and then return to normal just as fast. While others even have bowels that stop functioning completely for a period of time.
There are a variety of complications that can result with IBS, which although are not life threatening can lead to additional troublesome health conditions. The strain of constipation may result in hemorrhoids or anal fissures, which are tears in the canal of the anus, and when the stool sits in the colon too long then toxins are reabsorbed by the body.
With diarrhea, the body loses too much fluid and essential nutrients, which can lead to dehydration and the anus may become irritated from frequent evacuation. Additionally, changes in diet to avoid foods that trigger symptoms can also lead to nutritional deficiencies as the body doesn't receive all the nutrients it needs to function adequately.
Additionally, the symptoms of IBS are similar to or even overlap with many other bowel problems like Crohn's, inflammatory bowel disease or celiac disease, so it's important to rule out other possibilities.
Conventional medicine likes to slap a label on all health conditions and instead of looking for the root of the problem, they write a prescription for drugs that do nothing but merely cover up the symptoms, or even worse they will blame it on a psychological issue. While the main stream medical community seems to be at a loss for what causes IBS and has very little to offer for treatment, the alternative health field is a little more enlightened and offers a variety of explanations and treatment options.
IBS is usually multifaceted and the cause is often the result of several issues intertwined. It is believed that there may be an interaction that involves the brain, the gastrointestinal system and the nervous system that results in malfunctioning of the bowel.
The main contributing factors in IBS are poor diet, Candida overgrowth, bacterial overgrowth, parasites, food allergies or sensitivities, gluten intolerance, chemical sensitivities, an imbalance or deficiency of neurotransmitters, hormones and chronic stress. By addressing these issues many people are able to find some relief in their symptoms, and in some cases, eliminate them completely.Neurotransmitters
Neurotransmitters are chemical messengers that allow nerve cells to communicate with one another and reside in the brain and the gut. It is believed that neurotransmitters like serotonin, dopamine, GABA, norepinephrine and acetylcholine are involved in the regulation of the digestion process, including the contraction of muscles, absorption of fluid and secretion of mucus. GABA is of particular importance as the gut is loaded with GABA receptors and it is essential for contraction of the bowel. Insufficient levels of GABA can cause abdominal pain, constipation and a decrease in transit time.
Although there are a variety of prescription drugs on the market that a traditional physician may use to treat neurotransmitters, in the long run they only create more problems. Drugs only damage and create more of a deficiency in neurotransmitters. Balancing the neurotransmitters should be accomplished by making changes in the diet and lifestyle and supplementing the diet with amino acids and a variety of vitamins and minerals.Gluten Intolerance
With gluten intolerance, which is also called celiac disease, the individual has an autoimmune disorder that sees gluten, which is a substance found in wheat, rye and barley, as a harmful substance and prevents the body from being able to digest it. It causes damage to the small intestine and may result in symptoms like abdominal pain and diarrhea. Many people are unaware they have gluten intolerance and get misdiagnosed as IBS. Gluten intolerance or celiac disease can be identified with the ALCAT test.
However, gluten and grains in general, are inflammatory by nature. Our bodies are not genetically designed to consume them, so even if you don't have gluten intolerance, they can cause inflammation throughout the gastrointestinal tract.Grains and Legumes
Grains, including whole grains, and legumes contain a wide variety of anti-nutrients like lectins, phytates, saponins, and protease inhibitors that are destructive to the gastrointestinal tract and cause abdominal pain, cramping, gas, diarrhea, anxiety, etc. They can also contribute to leaky gut, mental health disorders, autoimmune disorders and much more.Food Sensitivities or Allergies
Many people have undiagnosed food sensitivities or allergies and one of the most common symptoms is irritation to the intestines when the offending food is eaten, which can result in diarrhea, cramping, pain, constipation, indigestion, heartburn etc. Some of the most common allergenic or offending foods are chocolate, dairy, wheat, corn, sugar and citrus, however any food at all can become an allergen. When the offending food is eliminated, the bowels will settle down. Hidden food sensitivities can also be identified quite easily with the ALCAT test.
However, it's important to note, that food sensitivities is not a condition in and of itself. It is a symptom of a problem in the gut. If there are a lot of food sensitivities, it typically means there is some type of organism like Candida, parasites, or bacteria present. The gut needs to be healed to address food sensitivities.Chemical Sensitivities
With chemical sensitivity, the individual experiences an allergic like reaction to low levels of common everyday chemicals found in the environment like perfume, cleaning supplies, air fresheners, pesticides, cigarette smoke, carpeting, cosmetics, laundry soap or fabric softener, etc. Any chemical at all can be a source of sensitivity. The toxins in these chemicals affect a variety of organ systems as well as the nervous system, endocrine system and immune system. The symptoms of chemical sensitivity are vast, but for many people, the colon is one of the primary organs affected. When they are exposed to these chemicals it results in pain and inflammation of the colon with bloating, constipation and/or diarrhea. Many people have undiagnosed multiple chemical sensitivity.
For example, in my own life in the past, cleaning supplies, perfume, dryer exhaust, hand cream, formaldehyde in department stores gave me excruciating pain in my colon, bloating and made me feel like I needed to go to the bathroom even if I didn't. The pain would be so intense I couldn't stand up or walk. A strong exposure to any kind of chemical could give me a bad bout of cramping and diarrhea.
In some severe chemically sensitive people, even natural odors from herbs, spices and natural vegetation like sage, peppermint, cinnamon, pungent flowers and pine trees can trigger IBS. Even natural things in the environment like mold and humidity can flare IBS. Before I moved to the desert where it is dry, when I lived in Ohio, damp moldy days would give me unbearable aching in my colon, bloating and a constant feeling of needing to evacuate. The top ten chemicals that people react to can be tested for in the ALCAT test that is mentioned above.Parasites
Although parasites are thought to be a problem that mostly occurs in third world countries, that is not the case. Many Americans have undiagnosed parasites that are picked up through contaminated food and water. Environmental toxins and an unhealthy diet cultivate a climate in our colons that encourages parasites to thrive, which can sometimes be a culprit of IBS symptoms.
Anyone with IBS should explore the possibility of parasites with parasite testing. If there is a lot of unexplainable pain in the colon, there is typically some kind of parasite present. The chances are very good, that if you have an irritable bowel, you have some kind of parasite. Abdominal pain and cramping are common symptoms of parasites.
Parasites also contribute to food sensitivities, because they destroy the lining of the gut.Hormones
The role of hormones in relation to IBS is not fully understood, but what we do know is that many women, perhaps as many as three quarters of women with IBS, see a significant increase in symptoms during their menstrual cycle. Women on hormone replacement therapy have an increased risk of developing IBS, indicating that hormones have some impact.
The stomach and small intestine have estrogen receptors which respond to fluctuating levels of hormones and may be responsible for some symptoms, while menstrual cramping that takes place in the uterus can also expand to the muscles in the gastrointestinal system.
I can give testament to this fact completely. Before I went through menopause, during some months, my menstrual period would bring on completely debilitating IBS symptoms. However, it didn't happen every month. It seemed to occur when something really upset my hormonal balance, like a pesticide exposure.SIBO and IBS
Norm Robillard, author of Fast Track Digestion, cites a variety of studies that indicate SIBO (small intestinal bacterial overgrowth) can be a root cause of IBS. SIBO is a condition where the bacteria that typically reside in the large intestine invade the small intestine, where numbers of bacteria are generally low. When these bacteria are present in large numbers, they produce a lot of toxins, gases, and enzymes that can impair digestion and produce a great deal of gastrointestinal discomfort. In severe cases, they can damage the small intestine and result in weight loss, failure to thrive, anemia, malabsorption and autoimmune conditions. Some of the most common symptoms of SIBO include gas, bloating, acid reflux, abdominal pain and cramps, nausea, and fatigue, as well as numerous psychological disturbances.
Additionally, other studies Robillard mentions, demonstrate that people with irritable bowel have an overgrowth of a particular bacteria called firmicutes and a decrease in microbial diversity in the colon. Diversity of microbes is important to keep one particular type of bacteria from becoming dominant. Firmicutes feed predominantly on starches and fiber in our diet,(including resistant starch) and produce byproducts which result in gas, cramping, diarrhea, constipation, anxiety, depression, etc. when in excess. If a lot of starches and fiber are consumed, they can encourage proliferation of these organisms.
In one study it was that 84 percent of the individuals with IBS had SIBO and other studies have demonstrated that small intestinal bacterial overgrowth is found in more than 50 percent of the individuals. Additionally, successful eradication of SIBO results in a 75 percent decrease in symptoms associated with irritable bowel.Candida and IBS
Candida is an opportunistic yeast that usually lives in harmony in our body, but poor diet, sugar, antibiotics and environmental toxins allow it to grow out of control and wreck havoc on our body and mind. It thrives throughout the gastrointestinal tract and causes a variety of GI problems. Once it takes up residence in the body, it is very difficult to eradicate.
Some of the most common symptoms of Candida are abdominal cramping or pain, bloating, gas, indigestion, constipation and diarrhea. As we see, these are also the most common symptoms of IBS.
Additionally Candida is a crucial factor because when it is present it also contributes to food allergies, bacterial imbalances and overgrowth, chemical sensitivities, hormonal and neurotransmitter imbalances. When yeast burrows into the intestinal wall, it leaves microscopic holes which is then called leaky gut. Leaky gut is is the cause of food allergies or food sensitivities.
One of the main toxins Candida releases is acetaldehyde and this puts an excessive burden on the liver and other detoxification systems of the body, which contributes to chemical sensitivities. Additionally, yeast overgrowth wreaks havoc on hormones and neurotransmitters. It mimics estrogen in the body and binds to progesterone, which leads to hormonal imbalances and it interferes in the production and function of neurotransmitters.Chronic Stress
Like most health conditions, IBS symptoms may become exacerbated by stress. Chronic stress can kill off friendly bacteria in the gut that are needed to keep Candida and bacteria that can contribute to gastrointestinal issues from proliferating. Additionally, when we are under stress digestion is practically shut down.
Why do so many people have IBS? Because the average American diet is not conducive to a healthy environment for the colon. The standard diet that most people eat is not nutritious and it damages the colon. This leads to malfunctioning of the colon and makes it a breeding ground for opportunistic pathogens like yeast, bacteria and parasites.
There's a lot of conflicting information out there on what is the best IBS diet to follow and this can be very confusing. That's because there isn't a one size fits all diet that everyone should follow because each individual may have different sensitivities and allergies. Different things work for different people.
For example, someone with IBS-D may tolerate a variety of different foods than someone with IBS-C. This is because some foods are more likely to cause diarrhea, while other foods are more likely to lead to constipation. Someone with predominant diarrhea is not going to want to eat foods that will speed up the digestion process, while someone with predominant constipation is not going to want to ingest foods that slow down the digestion process. You have to find what works for you and your situation.
However there are a few basics that everyone can follow. The goal of any IBS diet is not only to relieve symptoms, but it is also to encourage a healthy colon that improves its functioning.
- no alcohol
- no caffeine
- no white sugar
- no refined foods
- no carbonated beverages
- restrict fiber and starchy carbohydrates
- no artificial sweeteners
- no legumes or grains (including whole grains)
- drink plenty of water
- no milk or soft cheese (yogurt may be okay for some because it is lower in lactose. Butter, ghee and cream, are okay too, unless you have a dairy intolerance. Check my dairy page for more info on this.)
- eat organic food
- don't overeat
Some health practitioners suggest that people with IBS should not be eating meat, because it's high in fat. I disagree. If you don't eat meat, several things happen. One, you're not getting adequate amino acids and fat in your diet, and if you don't get enough amino acids and fat, then your neurotransmitters don't function adequately. Two, when you're not eating meat then you'll have to eat a diet that is high in carbohydrates which will only aggravate and encourage Candida, bacteria or parasite overgrowth. Three, if you're not eating meat and fat, you can't keep your blood sugar stable. However, your meat should always be grass-fed, organic, hormone and antibiotic-free. Fat is not your enemy; it is crucial for a healthy mind and body.
It is my opinion that a low-carb version of the Paleolithic diet is the best diet for IBS, however some aspects will vary somewhat from individual to individual and may even vary within the same individual on different days or months. Some people may have a particular food that triggers their IBS symptoms on every occasion, while for others it may not be consistent. For example, you may find that you can't eat a particular food during your menstrual cycle, but you don't have trouble with it during other times of the month or perhaps your symptoms will flare if you eat a particular food on a damp, moldy day, but on a dry, sunny day you're symptom free.
Becoming aware of your unique idiosyncrasies will help you to manage your diet more effectively. If you're just starting out on your learning journey, it would be helpful to keep a journal so you can take note of any foods that seem to trigger symptoms and observe the patterns that set them off.
The goal is to design a diet that will eliminate, or at least reduce, symptoms and yet you don't want to deprive your body of essential vitamins, minerals and nutrients. Try and strike a balance that allows you to ingest the maximum amount of essential nutrients while providing relief at the same time.
The best IBS treatment incorporates a healthy diet that we discussed above with a variety of other steps that together will encourage a healthy colon.
- Follow a low-carb Paleo diet and combine it with a low FODMAPs diet. Research has found as much as 75 % of people with functional gut disorders can achieve significant improvements by eliminating or reducing FODMAPs. FODMAPs are foods that feed bacteria like firmicutes, which we mentioned earlier can be present in excess in the gut of the individual with irritable bowel.
- Find healthy ways to manage stress such as regular exercise, meditation, deep breathing exercises, yoga, mindfulness visualization, communing with nature or other activities that relax you.
- It is essential to get some form of daily exercise for a properly functioning colon, but not too much.
- Avoid laxatives, as they may damage your intestines further and cause you to become dependent on them.
- No smoking. Among other things, nicotine has a detrimental effect on the gastrointestinal system.
- Get enough sleep. Sleep has a profound impact on all the body systems and organs, with particular emphasis on neurotransmitters and hormones.
- Explore a couple colon cleansing practices.
- Some people have found that acupuncture is helpful in improving bowel function and reducing muscle spasms.
- A variety of herbs like peppermint, ginger, slippery elm, and chamomile have also been helpful for some people seeking IBS in soothing the digestive tract, discouraging muscle spasms, reducing inflammation and improving the function of the muscles in the intestine.
- The regular use of mindfulness meditation can be an excellent pain reliever.
However, it's important to note, that you should always consult with a knowledgeable physician, because herbs are just as powerful as prescription drugs and can have side effects of their own, and if you take any prescription drugs there can be drug interactions.
Additionally, in some people, pungent herbs can actually be a trigger for irritable bowel symptoms rather than an effective IBS treatment. So, if you notice a flare in response to a particular herb, then naturally it should be discontinued.
There should also be some focus on soothing the autonomic nervous system. If the sympathetic nervous system is dominant much of the time, as it is for many people, then digestion is impaired.
IBS is a complex and difficult condition to live with that may, and probably will, have an impact on the quality of your life. However, with awareness and a proactive approach that enforces a few simple changes in diet and lifestyle you can find a way to manage it effectively and experience relief.
Educate yourself about your condition as much as possible and take an active role in all aspects of your treatment path. Being informed about all aspects of your condition will not only enable you to make the best choices for yourself, but it reduces feelings of powerlessness and helplessness.
If you feel isolated or alone, seek out others with your condition through support groups or the Internet where you can find support, empathy, and understanding.