Irritable Bowel Syndrome (IBS) is on the rise, especially in Western countries such as Canada and the US. According to the Canadian Digestive Health Foundation, more than 5 million Canadians suffer from IBS.
IBS is a diagnosis of exclusion; once other conditions such as Chron’s and Colitis have been ruled out a diagnosis of IBS is made. So, what is responsible for the rise in the number of IBS sufferers?
It’s all about the gut
Recent evidence tells us that the population of good bacteria that live in our gut has shifted. This recent article points to the rise in antibiotic use as a culprit. Another possibility has to do with the rise in sugar and simple carbohydrates in our North American Diet, or even the rise in c-section deliveries. Babies born via c-section do not receive the mouthful of bacteria upon birth that babies born vaginally receive. In addition to IBS, this may have implications for allergies, asthma and eczema as research suggests.
My approach is to address these key areas:
1. Gut Dysbiosis
Gut Dysbiosis refers to an imbalance in the population of “good” and “bad” bacteria that live in our gut. Small Intestinal Bacterial Overgrowth (SIBO) is a specific type of dysbiosis that has been associated with IBS symptoms. Studies such as this one are able to measure the kinds of gas produced by these bacteria and correlate its presence with symptoms such as bloating and diarrhea.
While antibiotics are a likely culprit, the rise in acid-suppressing drugs is another likely possibility. A number of studies have found an increased incidence of IBS among Proton-Pump Inhibitor (PPI) users. I have certainly found this to be true in my practice.
To treat dysbiosis and SIBO we need to use herbs with antimicrobial properties along with very high potency probiotics. Some dietary modifications also need to be made to support this shift in bacterial populations.
2. Food Sensitivities/Intolerances
Food sensitivities such as gluten, corn and dairy are frequently reported amongst IBS sufferers. There are currently no reliable tests to diagnose food sensitivities, but an elimination and challenge diet is a very effective tool to determine possible culprits.
More recently, a low-FODMAP diet has been found to help relieve IBS symptoms. Studies such as this one have shown considerable improvement in just 3 weeks. FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. Eating these fermentable foods can cause significant gas and bloating in sensitive individuals. I often incorporate a low FODMAP diet as part of correcting dysbiosis, and then guide people through a reintroduction and challenge phase to further refine the list of problematic foods.
A low FODMAP diet can be very helpful when used alone or in conjuction with a Dysbiosis treatment plan. But, not everyone needs to go this route so best to discuss with an ND.
3. Stress Management
Stress is a frequent “root cause” of any functional gastrointestinal disorder. This isn’t surprising given what we know about digestion and the stress response, aka the “fight-or-flight” response.
The “gut-brain-axis” is well known. When a person becomes stressed enough to trigger the fight-or-flight response, digestion slows or even stops so that the body can divert all its internal energy to facing the perceived threat. In response to stressors such as public speaking, the digestive process may slow or temporarily stop, causing abdominal pain and cramping. HCL (ie. stomach acid) and enzyme production and release can also be impaired.
Managing the stress response through deep breathing, acupuncture and herbal medicines can be an important part of any IBS treatment plan.
Many IBS sufferers have simply learned to live with the illness. They limit outings, meals away from home, and other circumstances which may provoke an episode. The goal of any naturopathic treatment is to restore normal function, which is often possible with the above approach. Many of my patients report a >75% improvement in all IBS symptoms within 3-6 weeks, greatly improving their quality of life.