20 Dec Irritable bowel syndrome (IBS)
By Rana Habaishi
IBS (irritable bowel syndrome) was once thought of as a psychosomatic illness because IBS symptoms are very often accompanied by high levels of stress and anxiety. Many people will remember that around 20 years ago people presenting with IBS symptoms were told: “it’s all in your head”. Now we are beginning to see those with mental health symptoms being told “its all in your gut”!
We now know that up to 95% of serotonin, a neurotransmitter involved in feelings of happiness or depression, is made in the gut by certain gut bacteria.
Emerging research has revealed that serotonin has an important role in gut immune modulation, metabolic processes and gut inflammation. Serotonin in the gut even has a role to play in the development of osteoporosis, with a recent mouse study showing that the inhibition of serotonin in the gut assisted with bone formation and remodelling.
Serotonin is known as a gut “kinetic”. That means that it helps with the movement of the stool through the digestive tract. Too much serotonin and movement is excessively increased, too little and movement is excessively decreased.
Naturopaths have long known that IBS occurs due to dysbiosis in the digestive tract. Dysbiosis means there is an imbalance of gut flora making up the microbiome. In a dysbiotic gut, there may be an overgrowth of certain bacteria or yeasts or not enough of a particular beneficial bacteria in the digestive system.
Like many things that Naturopaths have known for a long time, this is beginning to be validated by modern research.
Do I have to live with IBS??
The short answer is NO!
The term IBS encompasses a range of digestive symptoms such as abdominal pain, bloating, gut spasms, excessive gas, diarrhoea or constipation. According to the ROME IV criteria for diagnosis, a patient needs to have had recurrent symptoms at least once per week for 3 months or more to be diagnosed with IBS. However, once diagnosed there is often very little treatment offered at the doctor’s office and many people are told to “just live with it”.
Unfortunately, with the rising popularity of the low FODMAP diet, many people are ill-advised at the doctor’s office (or by Dr Google) to avoid FODMAPs long term. I often see people that have walked out of a doctor’s office with a low FODMAP diet sheet or app, who have proceeded to spend many years avoiding FODMAP foods. This not only impacts severely on the patient’s ability to enjoy life; it also creates a further microbiome deficit. The clinical result of this is a patient with a severely restricted diet, a severely restricted life, and a more chronic set of symptoms.
FODMAPs are also known as prebiotic fibres. These are fibres that the body can not digest and what the gut bacteria use as fuel. When gut bacteria metabolise prebiotics they create a host of bi-products that can be either useful or harmful to the body. The kind of bi-product that is produced depends on the type of bacteria that is there. So, while reducing FODMAPs may be useful in the short term to reduce the available food to a dysbiotic gut, it also reduces any available food for beneficial bacteria to grow, which is highly detrimental in the long term.
How I treat IBS
There are four classifications of IBS;
IBS-D: Digestive symptoms with a predominance of diarrhoea
IBS-C: Digestive symptoms with a predominance of constipation
IBS-M: Digestive symptoms with mixed or alternating between constipation and diarrhoea
IBS-U: Digestive symptoms that are neither classified as constipation or diarrhoea
The treatment will vary according to the type of IBS and the presenting symptoms. However, from a naturopathic perspective getting the microbiome balance back is the primary focus in treating the root cause of IBS.
Up to date research has shown that the majority of IBS is caused by SIBO.
In the short term, I will try to reduce painful and debilitating symptoms. I may use soothing herbs such as aloe, marshmallow and slippery elm. Herbs such as chamomile and Lemonbalm are wonderful gut tonics that also help with symptoms of anxiety and nervous tension.
I may need to use bowel stimulants for IBS-C in order to help kick the bowel into motion. I may need to use digestive enzymes and bitter herbs such as gentian to stimulate digestion. I may use a low FODMAP protocol short term to reduce symptoms and identify the main triggers. However, at the same time, I will ALWAYS be attempting to address the root cause, by dealing with any SIBO, or gut infection and working to rebuild and rebalance the gut microbiome using probiotics and specific prebiotic fibres. There are particular fibres that I use such as partially hydrolysed guar gum (PHGG) that help to regulate and balance bowels. This helps with all IBS types.
There is often chronic nutrient depletion in cases of IBS, so supplementation of key nutrients like zinc, B vitamins, vitamin A and D is often needed until the digestive system is repaired and nutrient absorption is restored. Sometimes, gut microbiome testing is needed to stubborn cases.
I am now officially working with clients to help them to create a healthier and happier life, reduce stress, have more energy, and reach their health goals by dealing with their stress level and understanding their emotions.
I am supporting clients to make step-by-step, easily integrated food and lifestyle choices. I have always had an interest in holistic health and wellbeing, and enjoy sharing this knowledge with my friends, colleagues and family.
I wanted to increase these skills and learn, in a formal training program, how to live a better life through eating well and taking care of myself. And I have received very detailed and careful instruction on how to counsel others. It’s an exciting time!
My target market are people suffering from an emotional eating disorder (binge eating, weight management and fixing unhealthy lifestyle habits).
The reason I’m focus on this target market is that I was a victim of emotionally destructive eating habits from losing my dad which lead to imbalanced hormones and several tumours, that I got rid of once I fixed my eating habit after dealing with my emotions