Why You Probably DON’T Have IBSKeris Marsden •
We received an email this week from an individual asking if nutritional therapy would be helpful for Irritable Bowel Syndrome (IBS). After years of suffering from bloating and constipation, they had finally managed to obtain a diagnosis from their GP and could begin to seek treatment.
A diagnosis, like this, often provides a great sense relief because if you know what you’re dealing with it’s possible to put a plan into action, maybe a medication or dietary intervention can help.
The problem here, however, is that they often don’t provide a solution because disease states are multifaceted and the symptoms that manifest are usually the product of several integrated systems breaking down.
Both the body’s internal terrain and it’s external environment can contribute and drive symptoms, adding layers to an already complex situation.
This is most often the case with Irritable Bowel Syndrome, numerous factors need to be addressed yet the focus of mainstream medical interventions is symptom suppression which rarely brings a complete resolution of the issues.
My IBS Journey
I was diagnosed with IBS at the age of 22.
My GP suggested a gluten and dairy free diet and emphasised the need to implement some stress management strategies in my day as I’d observed a significant worsening of symptoms since starting my first graduate job.
He also suggested I cut back on running which was adding a mechanical stress to the gut.
The latter two were complicated so I got to work filling my cupboards with gluten-free pasta, millet cereal, soya milk, and yogurts.
Over the next 10 years, I pretty much-tried anything and everything I heard might help including antispasmodics (Buscopan), charcoal, peppermint, probiotics, digestive enzymes, laxatives when traveling, a low FODMAP diet, acupuncture and even colonics (never again!!)
None of the above worked.
Firstly, I was still avoiding those final two points – exercise and stress, however, the main reason was that all my efforts were directed towards symptom avoidance or suppression rather than tackling the root cause or addressing the processes driving my symptoms.
I’ve transformed my gut health finally with a combination of dietary changes, supplements and lifestyle adaptations.
Most days I’m symptom free, however, I can relapse or flare pretty easily, my gut will likely always be sensitive and I’ve established some key triggers, none of which are gluten and dairy, by the way, mine tend to be stress, intense exercise, eating too fast, too many vegetables, too many nuts, and legumes. My gut will tolerate a little of these but reminds me it has limits that I need to accept.
Reframing IBS and ill Health
The first discussion I have with clients who are informed they have any disease is to consider it as a blessing in disguise as it provides a continuous nudge in the right direction.
At times it’s VERY frustrating and you’ll find yourself looking at others, wondering why they don’t suffer like you and at worst envy the way they can take advantage of their body. You have to respect that your body has made a request for change and the great news is there’s a good chance these positive changes will transform the quality and longevity of your life.
Symptoms are feedback from the body that there’s some form of underlying dysfunction, One of your systems, be it digestive, reproductive, cardiovascular or musculoskeletal, is kicking off and needs to be fixed. The cause could be a nutrient deficiency, excessive stress, infection or chronic inflammation. Whatever the score DO NOT ignore them or quieten them down with medications, listen and respond.
What is IBS?
IBS can rarely be perceived as one single thing, in fact, there’s some discussion that it’s really more a diagnosis of exclusion.
This means you’ll be diagnosed not just due to the nature of the symptoms but because blood tests, stool tests or a colonoscopy have confirmed the absence of other gastrointestinal (GI) conditions including Crohn’s, colitis, coeliac disease, non-coeliac gluten sensitivity, infections, and cancer.
The symptoms tend to be abdominal pain that may move around different areas of the GI tract and is often relieved by bowel movements, plus any of the following:
- Altered bowel movements (constipation, straining, diarrhea or incomplete emptying of the bowel)
- Abdominal bloating/distention
- Symptoms which worsen after eating
- Mucus in the stool
GP’s will often ascertain details of symptom frequency, duration, and location plus inflammatory markers to make a diagnosis.
NOTE – Always mention any changes in your symptoms or new symptoms to your GP.
Blood or mucus in your stool must always be investigated thoroughly.
IBS is now divided into subtypes. Constipation dominant cases are referred to as IBS-C (constipation is classified as types 1 and 2 on the Bristol Stool Scale).
Whereas diarrhea dominant is referred to IBS-D (classified as types 6 and 7 on the Bristol Stool Scale).
You can check out the Bristol Stool Scale here.
There is also mixed IBS or IBS-M which is the most common subtype and defined as >25% of stools being loose and watery and >25% of stools being lumpy and hard to pass.
The Why Behind IBS
Put simply IBS is gastrointestinal dysfunction, which could be any of the following points below.
Very few of these are fully investigated in the process of diagnosis as mainstream medicine is yet to acknowledge some of them and some are still under scrutiny in terms of being an IBS trigger –
- Malabsorption possibly due to poor pancreatic function compromising digestive enzyme production, decreased levels of stomach acid, decreased bile acid production or damage to the gastrointestinal barrier and the villi which host brush border enzymes to further break down and absorb nutrients.
- Low levels of commensal (beneficial) bacteria that play a fundamental role in digesting food, synthesizing vitamins, signaling the immune system and protecting the GI tract from pathogens.
- Parasite infections including Cryptosporidium, Giardia, blastocystis hominis or dientamoeba fragilis.
- Bacterial infections including H Pylori, Campylobacter, E coli, Clostridium Difficile or Salmonella.
- Overgrowth of bacteria or fungi/yeast, especially in the small intestine, known as small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO).
- Damage to gastrointestinal tissues and increased intestinal permeability (often referred to as leaky gut).
- Structural or motor issues within the GI Tract. The digestive system requires continuous motility from mouth to anus which is governed by the nervous system and hormones. The different departments of the digestive system have different roles and are separated by valves which open and close. Some separate the acidic medium of the stomach from the oesophagus and small intestine. The Ileocecal valve separates the small intestine where food is absorbed from the large intestine where waste is accumulated. Bowel motility and the opening and closing of the valves are easily disrupted by nutrient deficiencies, hormone imbalances, nerve supply and even joint or soft tissue misalignment leading to many common digestive symptoms.
The complicated thing about IBS is it can be due to the presence of one of the dysfunctional components above and driven by lifestyle factors like stress, intense exercise, alcohol, nutrition.
The latter can cause the former and the former can mean the gut can’t cope with the latter. The takeaway here is it’s unlikely to be one thing and therefore the recovery and healing process needs to account for the complex nature of the gastrointestinal system.
It’s tempting to want to test all the above and get answers. However, increasingly I’m coming across new clients who’ve already spent thousands of pounds with practitioners and are none the wiser, maybe it’s because what they actually need is a new career, partner, living environment or just to eat slower (no really!)
Equally, I’ve observed client cases hosting a mixed community of bugs and parasites that we suspect to be pathogenic yet they have no GI symptoms as their immune system and happy outlook on life appears to be keeping everything in check.
How To Fix Your Gut Problems
1) Consider the Cause
I choose the word consider for a reason.
You may never actually establish the cause (and can drive yourself nuts trying to) and yet could still have great success with some nutrition, lifestyle and supplement interventions.
The reason I suggest contemplating what may have caused the problem is to prevent reoccurrence in the future and of course if it’s obvious it may provide some clues as to some key steps to recovery.
During the consultation process with a client, I usually aim to ascertain triggers and drivers of their gastrointestinal symptoms that will impair recovery or exacerbate symptoms.
A trigger is an event that may be linked to the onset of symptoms, with GI issues it’s often related to food poisoning, travel, medications, surgery, trauma (bereavement and divorce are common triggers).
Some common drivers for GI issues include stress, mould/damp exposure, excessive exercise, diet, caffeine, nutrient deficiencies, alcohol, eating too fast and all the dysfunctions (infections, enzyme insufficiency etc.) listed above.
2) Consider Testing Options
Again I have chosen the word consider for a reason.
Functional tests are not my first line approach. I’m aware of them all including different stool tests, breath tests (for SIBO) and urine analysis (helpful for identifying fungal overgrowth).
Initially, I use my clinical experience, conduct a thorough symptom analysis and obtain a comprehensive health history which almost always unveils some simple interventions that will begin to make a difference.
The reason I’m confident in this process is that the body fights to heal itself given the right environment, nutrition, and the opportunity.
If I had a penny for every client that told me their gut issues improved or completely disappeared whilst on holiday I’d have retired by now. So my first goal is to begin to assist clients with this process.
It’s easy to want to jump to more tangible, targeted gut interventions like a strict elimination diet, antibiotic treatment, antifungals or natural antimicrobials (garlic, oregano, berberine, coconut oil), however, the impact will be limited if the drivers detailed above are not addressed.
Clients often start out wanting tests because they want answers but acknowledge themselves that they struggle to pinpoint food triggers or explain the symptom patterns they experience because they can change frequently.
My concern is that tests take people down pricey rabbit holes that may not bring about the desired results. Again this is due to the fact the nervous system and hormones are influencing the mechanics of the digestive system all the time and that’s a little trickier to tackle.
There are some fundamental steps that have to been taken initially which will bring symptom relief and provide an indication of where the dysfunction lies, otherwise any testing, supplements, and treatment can all be an expensive waste of time.
If I do decide testing is needed I use Invivo Clinical’s GI Map, Great Plains Organic Acids Test and blood chemistry including complete blood count, vitamin D, and inflammation markers.
3) Try a Guided Elimination Diet
One of the reasons we made our online transformation plan Fitter 16 a guided elimination and reintroduction process is to help folk personalise their nutrition and establish what really works for them.
The only way to do this (the gold standard in my opinion) is an elimination diet as it’s a highly individual process.
I NEVER recommend or endorse food intolerance testing as there’s no scientific validation and there’s a good possibility of false positives or false negatives.
Again the elimination diet is not necessarily the solution for IBS.
Many people are reluctant to even do them fearing they may have to part ways with their favourite foods, men especially seem to have an intimate relationship with beer and bread, I am often met with a look of horror when I detail what ‘yeast free’ really means.
However, it’s simply part of the healing process and not necessarily a long term intervention, there’s a good chance many of these foods can be reintroduced (in moderation) yet some may always be problematic.
Without a structured elimination process, it’s difficult to establish.
I use elimination diets not just to establish food triggers but also because they can be hugely supportive in restoring gut function. Moving back to a wholefood, Paleo-ish approach and minimising processed foods (including flour), additives, preservatives, sweeteners, alcohol, caffeine, fast acting yeast and refined sugars provides the building blocks needed to heal the gut. I’ve observed great results across my client base and the research is beginning to support an ancestral approach to addressing a number of gut issues here and here.
4) Increase Nutrient Density Of Your Diet
Like all cells in the body, those that make up the gastrointestinal system require nutrients to functions. Cells are busy doing stuff, parietal cells produce hydrochloric acid to break down protein, pancreatic cells produce digestive enzymes, enterocytes line the gastrointestinal tract creating a safety barrier whilst also absorbing and breaking down nutrients.
Cells have fundamental needs, they’re made of protein and make both functional proteins or some like goblet cells secrete carbohydrate compounds called mucin to protect the intestinal barrier.
The building blocks of all cell membranes are fats and proteins, what I’m explaining here is that meeting your basic macronutrient requirements is vital (carbohydrates included) for optimal cellular function and therefore digestive health.
The batteries of the cell (mitochondria) are powered by vitamins and minerals especially B vitamins, iron, magnesium, zinc, manganese, and copper.
Cells work hard for us, each doing their specific jobs and they require cleaners (antioxidants) to come in regularly and mop up the mess (free radicals) before their workspace gets trashed and unusable and REMEMBER cell dysfunction will eventually cause system dysfunction.
Therefore antioxidants are incredibly important, way beyond the anti-aging effect they are well known for, they PROTECT function in the body and are sourced through nutrition, yet many people struggle to name more than a couple and rarely consume any.
Many clients I work with like to keep their cells busy yet have low iron/ferritin, B12, low red blood cell count, low vitamin D, low protein intake, insufficient essential fatty acids especially omega 3’s and increasingly low intake of preformed vitamin A as intake of animal products is decreasing.
All of these nutrients are vital for a healthy digestive system, in fact, any system in the body.
5) Perform A Lifestyle Audit
How you think, how you eat (the pace and environment) and the quality of your sleep has a huge impact on your digestive health.
They also tend to be linked, when you’re stressed you eat quicker, relax less (no time to rest and digest) and sleep is less and lighter. You can easily find yourself in a vicious cycle that impacts GI motility and absorption.
As research unravels the neuro-immune-endocrine system it’s clear that how we think impacts our health including inflammatory processes in the body and hormone regulation so peppermint tea really won’t cut it here.
There’s likely a need for you to go upstream and start to challenge your response to stress and the pressures you place on yourself and make some key changes there.
6) Get Some Professional Support
Sometimes it’s hard to figure all this out yourself, you’ll find yourself cherry picking from the information just like I did or worse still promising to start once the summer is over, it’s important NOT to delay.
If you find yourself doing this outsource the task of fixing your gut to a professional.
The longer you delay the more systems begin to impact one another.
Hippocrates apparently claimed that “all diseases begin in the gut” it’s not a bad shout because if you can’t digest and absorb nutrients it’s likely your mood, joints, energy, performance, strength and immune system will be next on the list to head downhill.
If you’re ready you can make a start today with Fitter 16 and it’s elimination guidance or please do contact us about 1:1 nutritional therapy options. Just promise me you’ll take action TODAY!
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