Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by abdominal pain, bloating and gas. There is usually associated diarrhea or constipation but occasionally some people afflicted with IBS will experience alternating diarrhea and constipation.
The diagnosis of IBS is usually made by excluding other gut disorders that can result in similar conditions such as celiac disease and inflammatory bowel disease (IBD) including Crohn’s disease and Ulcerative Colitis.
Top Causes of IBS
- Small Intestine Bacterial Overgrowth (SIBO)
- Food sensitivities/allergies
- Candida overgrowth
- Dysbiosis of the large bowel
Small Intestine Bacterial Overgrowth
Bacteria are found abundantly on our skin and in our digestive tracts. In most instances, this bacteria is beneficial to our health and well-being. However, when a large amount of bacteria overgrow in the small intestine, this can result in a syndrome known as Small Intestine Bacterial Overgrowth (SIBO).
SIBO is thought to be involved in over half the cases of IBS; in fact, one study suggests that this number may be closer to around 84% of individuals with this condition! The same study found a 75% reductions in IBS symptoms with SIBO treatment.
Symptoms of SIBO
The bacteria that overgrows in SIBO include both anaerobes (Bacteroides, Lactobacillus, and Clostridium) and aerobes (Streptococcus, Escherichia coli, Staphylococcus, and Klebsiella). These bacteria produce both hydrogen and methane gasses which cause the typical bloating and flatulence associated with the condition. Often the volume of gas produced by the bacteria is sufficient enough to result in significant abdominal pain.
Hydrogen and methane gas also have an effect on motility within the bowel; hydrogen gas typically causes diarrhea whereas methane gas typically causes constipation. An individual with bacteria that produces both hydrogen and methane gasses will often experience alternating constipation and diarrhea, the typical presentation for people with IBS. The volume of gas produced is typically correlated with the severity of the symptoms of the disease.
The small intestine is where all of the nutrients from our food are absorbed into the bloodstream. Bacterial overgrowth in the small bowel will also typically impair digestion and absorption of nutrients, occasionally leading to secondary disorders such as anemia.
Testing for SIBO
The hydrogen and methane gasses produced by the bacteria that overgrow in the small intestine are not produced by human cells. These gasses, rather, are a metabolic byproduct of fermentation of carbohydrates by the bacteria. We are able to detect these gasses using a breath test; if there are elevated levels of either methane or hydrogen gas using breath testing, you have SIBO.
Food Sensitivities vs. Food Allergies
Most severe, immediate allergy symptoms are a type I hypersensitivity reaction meaning that it is mediated by immunoglobulin E. These reactions tend to manifest within minutes to hours of ingestion and can be life-threatening such as anaphylaxis. These reactions can be tested for by either an allergist or a naturopathic doctor.
There is evidence that in addition to immunoglobulin E, there is a second immunoglobulin that is responsible for food reactions, called immunoglobulin G. Immunoglobulin G reactions are much more common and are involved in 80% of all food allergy or sensitivity reactions. The reactions are a lot harder to elucidate because symptoms will typically manifest within hours to days after eating the offending food. This type of delayed reaction is more common in food intolerances or sensitivities. IgG reactions are testable through your naturopath but not an allergist as allergists focus on the more severe IgE reactions.
Symptoms of Food Sensitivities
- IBS: constipation, diarrhea, bloating, pain
- Itchy skin
- Tiredness and fatigue
- Joint pain
- Respiratory problems
Testing for Food Sensitivities
The elimination diet involves removing the most common food sensitivities for a period of time and the patient self-monitors for improvements in his or her symptoms. Foods are then re-introduced one at a time and if symptoms arise on reintroduction, then a food sensitivity is suspected.
The top food sensitivities I see in my practice are to dairy, eggs, gluten, red meat, peanuts, tree nuts, soy and corn. These foods and other suspected allergens are typically strictly eliminated for up to 6 weeks during an elimination diet.
The major advantage of an elimination diet is that there is a high level of patient involvement with their health and they can become more self-aware of their bodies. The most frequently discussed problem with the elimination diet is that it does involve (at first!) quite a restricted diet that can be expensive due to having to purchase egg-free, dairy-free and gluten-free specialty foods. The diet may also not eliminate all potential sources of allergens.
Food Sensitivity Testing
The second way to check for food sensitivities is to run a food sensitivity panel which is a blood test that is analyzed by specialized labs to assess for IgG reactions to foods. These antibodies are produced for several hours or days after exposure to an allergen.
The benefit of running a food sensitivity panel is that it provides a clear outline of food sensitivities as well as the severity of the sensitivity. The panel also tests for a wide variety of commonly consumed foods and therefore may detect sensitivities that would never be determined using an elimination diet. The major disadvantage for most people is that this test can be expensive and tested foods must be consumed within 3 weeks prior to the test for accurate readings. People taking immunosuppressant medications such as prednisone and azathioprine cannot run a food sensitivity panel as false negatives often occur.
The food sensitivity panel I use also checks for antibodies to the yeast, Candida albicans. Yeast overgrowth within the gut can mimic the symptoms of food sensitivities and ruling out yeast overgrowth as a contributing factor is essential to the proper treatment of the gastrointestinal tract.
Dysbiosis is a term doctors use to describe a microbial imbalance within the digestive tract. There are normally trillions of bacteria within the bowel that are present to help us digest food, maintain our weight, and prevent disease.
After an illness or antibiotic use, the levels of these healthy bacteria may decline and pathogenic bacteria and yeast levels may start to rise. When this happens, we may experience difficulty in digesting food and symptoms such as bloating, diarrhea and constipation.
A Comprehensive Stool Analysis can be used to determine the overall state of health of the gut. This stool analysis checks how well your body digests different foods such as starches, fats and proteins. In addition to checking for inflammation markers, the test also cultures the stool to check for overgrowth of pathogenic bacteria and yeast. It will also detect healthy bacterial levels to ensure that you have enough of the good guys present within your large bowel.
This comprehensive test will provide me with the information I need to make a full customized treatment plan to optimize your digestion.
The IBS-B Gone Program
The IBS-B-Gone Program is customized to you to determine what is causing your digestive woes. After taking a full history, I will recommend testing for one of the above conditions that I believe is at the root cause of your case. From there, a personalized plan will be developed based on the four R program of gut healing:
This may involve removing allergenic foods or pathogens including any abnormal bacteria, yeast, parasites and viruses depending on what I believe is going on in my patient. This step may involve testing for SIBO, food sensitivities, or candida overgrowth.
As the body ages, secretion of essential substances that digest food such as stomach acid, bile, or pancreatic enzymes may diminish. If there are any suspected deficiencies, then I work with my patients to help their body increase secretion of these substances.
If there is dysbiosis (a microbial imbalance) present, then the third step in gut healing is implemented where the digestive tract is reinoculated with healthy bacteria. This can be achieved with high dose probiotics, fermented foods and in extreme cases, a stool transplant.
The last step in the four R program is to repair the gut lining. Weaknesses in the intestinal wall can result in intestinal hyperpermeability (AKA “Leaky Gut”) that can predispose you to multiple allergies and autoimmune diseases. Gut repair may involve decreasing intestinal inflammation and providing nutrients to help the enterocytes (the cells that line the gut) strengthen and heal.