Irritable bowel syndrome (IBS) affects 15 percent of Americans and is the second leading cause of work absenteeism (after the flu). Traditional treatment options focus solely on managing symptoms and are often ineffective. Only by identifying the underlying cause of IBS can you truly regain your health without taking countless unnecessary medications.
Irritable bowel syndrome is the most common functional gastrointestinal disorder worldwide, with prevalence rates ranging from 9% to 23% in different regions. Across the United States, irritable bowel syndrome accounts for 12 percent of primary care outpatient cases and causes $21 billion in direct losses and indirect losses from lost productivity and miners each year.
Symptoms of irritable bowel syndrome include belching, bloating, constipation, diarrhea, alternating constipation and diarrhea, and abdominal pain. These symptoms range from mild to severe.
So, what exactly is irritable bowel syndrome? In medical terminology, it is a diagnosis of exclusion (Diagnosis of Exclusion). This is a label given to a patient when other diseases have been ruled out. When you tell your doctor about your belching, bloating, and abdominal pain, she may schedule a series of tests to see if you have inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), diverticulitis, and other organic problems.
If all of these organic pathologies are ruled out, your doctor will evaluate your condition based on the Rome diagnostic criteria. This includes.
Recurrent abdominal pain and discomfort for more than 3 days in each of the past 3 months, and meeting more than two of the following three.
Relief of symptoms after a bowel movement
Change in the nature of the bowel movement
A change in the frequency of bowel movements
If you meet these criteria, you have been diagnosed with IBS and your doctor will prescribe the following, depending on your symptoms.
Anti-diarrheal medications. These include over-the-counter loperamide as well as bile acid binding agents such as abciximide and celebrex. (Ironically, however, many antidiarrheal medications cause bloating)
Anticholinergics or antitussives. These include scopolamine and dicyclomine, which are used to reduce intestinal spasms and pain. (Unfortunately, these medications can worsen constipation and may cause other symptoms, such as difficulty urinating. Also, these medications increase the risk of small intestinal bacterial overgrowth (SIBO), which is one of the potential causes of IBS – see below)
Antidepressants (SSRIs). These drugs can help reduce depression (associated with IBS) and can inhibit the activity of the nervous system to control bowel function.
IBS-specific medications. Alosetron, which reduces diarrhea by slowing intestinal motility, and Lubiprostone, which increases intestinal fluid secretion, thereby increasing intestinal motility. These drugs are often used as a last resort in the treatment of IBS, and alosetron can only be prescribed by physicians enrolled in a specific program, as it has previously been removed from the market due to side effects.
What are the problems with traditional treatment of irritable bowel syndrome?
Conventional treatments for IBS are only suppressing symptoms and not addressing the underlying problem. The medications mentioned above only focus on increasing or slowing bowel movements (reducing diarrhea or constipation) and reducing pain.
Even though some medications are effective in doing these things (but many don’t do much depending on the patient), many of them cause the same symptoms that IBS patients already experience – such as belching and bloating.
In some cases, medications can have serious complications and risks. Alosetron, a drug used for severe diarrheal IBS, had been temporarily recalled by Glaxo (a British pharmaceutical company) after cases of serious and fatal side effects emerged. These included five deaths and some cases requiring surgical treatment.
A better way to treat IBS: Address the underlying problem.
Given the failure of conventional medical treatments to be effective and the side effects and risks associated with drug therapy, patients need better treatment options.
Fortunately, irritable bowel syndrome can be successfully treated – and even cured – using a functional medicine approach. In functional medicine, we focus on the underlying cause of the health problem rather than just suppressing the symptoms, which allows for a lasting recovery and a true cure.
So what is the real cause of IBS? IBS is not a simple disease caused by a simple trigger. It is a syndrome – a series of indications and symptoms caused by many possible factors.
Both experimental studies and my clinical experience suggest that the following five pathologies are the underlying causes for many patients with IBS.
Traditionally, IBS is considered to be a ‘functional’ gastrointestinal dysfunction. This means that it is caused by abnormal function of the GI tract rather than by organic or biochemical abnormalities. This is true in some cases, but biochemical abnormalities (such as bacterial overgrowth) do exist in some patients.
It is important to understand this because for many years many patients have been told that their IBS is ‘in their head’. This seems to be saying that IBS is a disorder of mind and body caused by anxiety, depression and some unknown psychological problems.
Of course, IBS may include a disorder of the brain-gut axis, but we now know that it is primarily caused by biochemical or organic lesions in the gut. This important discovery removes the stigma of IBS as a “psychiatric disorder” and gives hope to the tens of millions of IBS patients worldwide.
Small intestinal bacterial overgrowth (SIBO)
Small intestinal bacterial overgrowth (SIBO) is an abnormal overgrowth of bacteria in the small intestine. One study showed that 84% of IBS patients had SIBO and 26 times more IBS patients had SIBO compared to healthy controls.
Subsequent studies on the correlation between SIBO and IBS have had mixed results. This may be partly because there is no consistent gold standard for the detection of SIBO, allowing studies to vary in the methods used to detect SIBO.
However, there is evidence that in some patients with IBS, SIBO is the causative agent.
Antibiotics used to treat SIBO – such as rifaximin and neomycin – are effective in patients with IBS.
For example, in a randomized controlled pilot study, IBS patients treated with rifaximin for 10 days were able to sustain recovery of symptoms for up to 10 weeks.
A recent meta-analysis of five studies found that rifaximin improved various symptoms of IBS and was more effective in reducing bloating problems compared to the control group.
II. Dysbiosis of the intestinal flora (also called microecological dysbiosis – dysbiosis)
The human gut microbiota is a very complex structure that includes over 100 trillion microorganisms. These gut microbes influence our physiology, metabolism, nutrition and immune function. Dysbiosis is associated with gastrointestinal problems, such as IBS and inflammatory bowel disease; at the same time, dysbiosis is associated with many extraintestinal diseases, including diabetes and obesity.
Studies have found that 83% of patients with IBS have abnormal fecal biomarkers and 73% have dysbiosis of the intestinal flora.
Many studies have shown that probiotics and prebiotics, which are used to regulate flora, can be effective in IBS. In addition, a low FODMAP diet (restricting certain carbohydrates that feed the intestinal bacteria) can be useful for IBS.
Third, increased intestinal permeability (also called leaky gut – leaky gut)
One of the most important roles of the digestive tract is to act as a barrier to prevent substances such as pathogens and undigested food particles from entering the internal environment.
Many studies have found that IBS is associated with increased intestinal permeability and that a cytokine called interleukin-22 is involved. Interleukin-22 affects intestinal permeability.
It is worth suggesting that the increased intestinal permeability is an organic change, which suggests that IBS is not always a functional disorder.
IV. Intestinal infections
Due to the protective effect of gastric acid, our intestinal tract is naturally less susceptible to pathogens. However, many ways in modern life compromise this immune role, such as chronic stress, poor diet, and long-term use of acid-suppressing drugs.
Many intestinal infections are associated with IBS. For example, 10% of cases in long-term IBS patients are associated with food poisoning caused by Campylobacter. Infections with intestinal parasites like human budding cyst protozoa, dinoflagellates, and Giardia lamblia are also relatively common causes of IBS. However, these etiologies are often underdiagnosed, even in developed countries.
V. Non-Celiac Gluten Sensitivity and Other Food Intolerances
Non-Celiac Gluten Sensitivity is a reaction to gluten, but is not an autoimmune (celiac disease) or allergic (wheat allergy).
Contrary to many media statements, non-Celiac gluten sensitivity is a condition that is recognized by the medical community and can lead to serious consequences.
In fact, I believe that non-Celiac gluten sensitivity poses a greater public health challenge than Celiac disease.
Patients with non-Celiac gluten sensitivity often present with symptoms of belching, bloating, abdominal pain, and changes in stool frequency and shape. These symptoms are indistinguishable from IBS.
These patients often have extraintestinal symptoms such as brain fog and fatigue, which are also common in patients with IBS.
Intolerances to foods, such as dairy products, eggs, peanuts, and seafood, are also common in patients with IBS. These intolerances may be food allergies (regulated by IgE) or chronic intolerances (regulated by IgG or IgA)
A recent study that evaluated 73 patients postulated that food allergies and intolerances – including reactions to wheat and gluten – should be considered as potential pathologies for IBS.
In my own clinical experience, I have found that both wheat/gluten sensitivity and food intolerance are the most common triggers of IBS.
It is worth suggesting that in most cases, food intolerance is caused by the other pathologies mentioned above. In other words, both IBS and food intolerance are symptoms of deeper problems such as small intestinal bacterial overgrowth and intestinal infections.
Summary and recommendations
As I wrote in the article, conventional treatments for IBS are not effective and carry potential risks. Simply suppressing the symptoms of IBS with medication without addressing the underlying problem is doomed to a lifetime of unnecessary medication and continued pain.
Thankfully, we now have a better understanding of what causes IBS. When these underlying issues are addressed, a complete cure is possible. In my clinical practice, I have seen patients who have had refractory IBS for more than 20 years who have recovered almost completely after addressing the underlying intestinal issues and changing their diet.
If you have been diagnosed with IBS, I recommend finding a functional medicine doctor (or a doctor willing to focus on the underlying cause) to find the root cause of your problem. You don’t need to get a diagnosis called ‘irritable bowel syndrome’ and you don’t need to spend endless hours fighting the disease.