If you suffer from IBS, there is hope

by Fanny Vandenhende, Naturopath N.D.

A common but difficult syndrome

While there are many disorders that afflict the digestive system, if there’s one you might already be familiar with, it’s probably Irritable Bowel Syndrome (IBS). Indeed, this digestive disorder is being diagnosed and discussed more and more, and currently affects 10-15% of the Canadian population, mostly women. It also happens to be the main reason people consult gastroenterologists in Canada [1].

Unlike some digestive disorders that cause lesions within the intestinal mucous, which can be spotted during a medical exam, IBS doesn’t cause visible damage, making it more difficult to diagnose. Identifying the condition relies heavily on the patient’s description of symptoms.

The principal manifestations of IBS have been classified and standardized according to the Rome III criteria, currently in use as a reference for diagnosis [2]. Irritability of the intestine often results in abdominal pain, bloating, gas, constipation, and diarrhea. It’s possible to experience one or more symptoms at the same time.

A profound personal impact

Beyond the physical symptoms, many people who suffer from the condition also experience all-too-real mental stress, often feeling anxious or depressed. Society still considers intestinal problems a taboo subject for the most part. This is why people often feel embarrassed, or misunderstood by their doctor and the people around them. Symptoms such as urgent bowel movements or abdominal pain complicate their daily lives and may lead them to avoid public spaces.

It’s not all in your head

Since there still are no discernable natural causes of the condition, some doctors still think their patients are exaggerating, faking, or that "stress" is the only culprit. While stress can most definitely exacerbate the symptoms, it’s not the root cause.

Recent studies have highlighted dysfunctions often present alongside this syndrome, in particular an intestinal motility disorder that causes contractions—either quick and close together or slowed down—which, in turn causes diarrhea and/or constipation.

The sensitivity of the nerves that aggravate the intestine can be exacerbated here, giving individuals with IBS a more pronounced sensation of pain than others. In brain scans of people suffering from IBS, these effects have been demonstrated visually; a research team inflated a small balloon inside each patient’s intestines and then monitored their brain activity. In patients with IBS, the emotional area normally responsible for dealing with unpleasant emotions was active, as opposed to healthy test subjects. This means that the people experiencing an irritable bowel perceived painful sensations without explanation [3].

Other related factors, such as intolerance to certain foods, an unbalanced diet, the repeated ingestion of antibiotics, and chronic infections of the digestive tract, like traveler's diarrhea, can influence symptoms.

To date, there still does not exist effective medical treatment for the symptoms of IBS, leading more and more people to turn to natural medicine.

SIBO: one of the main causes of IBS

The link between irritable bowel syndrome and SIBO (which stands for Small Intestine Bacterial Overgrowth) is now more and more acknowledged [4].

The small intestine and the colon, which form the intestines, do not contain the same amount of bacteria. Less than 20% of intestinal bacteria reside in the small intestine, while more than 80% reside in the colon. SIBO occurs when colon bacteria migrate to the small intestine, which then contains an excess of bacteria. This overgrowth modifies our digestive process.

According to Dr. Mark Pimentel, a SIBO research pioneer and author of A New IBS Solution, the symptoms of SIBO are very similar to those of irritable bowel. It’s possible to diagnose SIBO with a methane and hydrogen breath test, offered by some naturopaths and gastroenterologists.

The main cause of SIBO is an intestinal motility disorder (such as exists in the case of an irritable bowel), which hampers the movement of the food bolus and bacteria along the intestinal tract.

A recent study by Dr. Pimentel and his team showed that 78% of the 202 patients that tested positive for IBS were actually affected by SIBO [5]. The researchers administered antibiotic therapy to eradicate the bacterial overgrowth, and 48% of patients no longer had IBS after taking the drug.

Naturopathy offers many treatment options for SIBO. Natural antimicrobials represent a viable alternative, and could be equivalent to antibiotics in their effectiveness, according to a study released last year [6].

Individualized and effective care

The naturopathic approach aims to determine the causes of IBS by identifying a set of signs and symptoms and running associated functional tests such as the food intolerance test. Food intolerance is often implicated in the occurrence of IBS and can exacerbate symptoms. Temporarily cleansing the body of these foods helps reduce symptoms and calm inflammation in the digestive system.

The first step to an intervention in naturopathy is to examine and make changes to the diet. The therapist can then use plants, hydrotherapy, and certain supplements like probiotics or digestive enzymes.

The incredible FODMAP diet

There are several dietary approaches to alleviating digestive symptoms, such as gluten-free and dairy-free diets. On the other hand, the approach that has been clinically proven to achieve the best results is a diet low in FODMAPs. The acronym FODMAP stands for "Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols."

FODMAPs are part of a family of carbohydrates that are difficult for the small intestine to digest. The large intestine however ferments them easily, thus contributing to the digestive symptoms of IBS. The diet aims to ban foods rich in FODMAPs and reintroduce them gradually. Among these foods are apples, milk, wheat, onions, and legumes. Foods low in FODMAPs include tomatoes, avocadoes, berries such as blueberries, strawberries, raspberries and cranberries, citrus fruits, quinoa, etc.

Many scientific studies have shown the positive effects of this diet on patients who suffer from an irritable bowel. These studies report a marked reduction of the main symptoms of IBS [7][8][9].

Cultivating hope

Having been diagnosed with IBS myself, I am more than familiar with the frustration that comes with not understanding the causes of the syndrome. I also understand how discouraging it can be to think of your future with the symptoms of IBS. Identifying and eliminating the underlying causes of IBS with the help of a therapist who is familiar with the syndrome will allow you to regain some sense of control along with healthy digestion and optimal health.

References

[1] Caroline CanavanJoe West, and Timothy Card. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014; 6: 71–80.

[2] www.romecriteria.org

[3] Naliboff BD, Munakata J, Fullerton S, Gracely RH, Kodner A, Harraf F, Mayer EAEvidence for two distinct perceptual alterations in irritable bowel syndrome. Gut. 1997 Oct;41(4):505-12.

[4 ]Uday C Ghoshal and Deepakshi Srivastava. Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype. World J Gastroenterol. 2014 Mar 14; 20(10): 2482–2491.

[5] Pimentel M1, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000 Dec;95(12):3503-6.

[6] Victor Chedid, MD, Sameer Dhalla, MD, John O. Clarke, MD, Bani Chander Roland, MD, Kerry B. Dunbar, MD, Joyce Koh, MD, Edmundo Justino, MD, Eric Tomakin, RN, and Gerard E. Mullin, MD. Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Glob Adv Health Med. 2014 May; 3(3): 16–24.

[7] Molina-Infante J, Serra J, Fernandez-Bañares F, Mearin F. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows.Gastroenterol Hepatol. 2015 Nov 5. pii: S0210-5705(15)00221-6

[8] Mansueto P, Seidita A, D'Alcamo A, Carroccio A. Role of FODMAPs in Patients With Irritable Bowel Syndrome.Nutr Clin Pract. 2015 Oct;30(5):665-82

[9] Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG.A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.Gastroenterology. 2014 Jan;146(1):67-75.e5.

Fanny Vandenhende, Naturopath N.D.
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Fanny Vandenhende, Naturopath N.D.

Fanny Vandenhende, naturopath ND, is passionate about naturopathy, an alternative medicine that aims to restore health through natural methods. A graduate of ÉESNQ (École d’enseignement supérieur de naturopathie du Québec), she is currently continuing her training and also practicing at the Clinique Mille Mains, found in the Montreal neighbourhood of Villeray.

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