“Irritable Bowel Syndrome – Naming is Not Explaining!” explains our Naturopath Amy
In a conventional medical setting, irritable bowel syndrome (IBS) is a diagnosis of exclusion, meaning that once serious pathologies have been ruled out, a patient who fits the Rome IV criteria (see below) will likely be diagnosed with IBS. As Naturopaths, we are trained to look beyond this ‘umbrella’ diagnosis, and understand that IBS more often than not has an underlying cause(s) that can be elucidated through a thorough case history and the use of functional testing where appropriate. Specific treatment differs according to the individual case and entails one or more of dietary, lifestyle, nutritional & herbal medicine approaches. While it is essential to rule out more serious pathologies eg. Inflammatory Bowel Disease through a GP or specialist in the case of chronic gastrointestinal tract (GIT) issues, the testing utilised is often ineffective at finding the underlying causes of functional GIT issues such as IBS.
Irritable bowel syndrome (IBS) is as a functional gastrointestinal disorder (as opposed to structural or inflammatory) and is estimated to effect 1 in 10 Australians at some point in their lives with a higher prevalence in females. (Boyce et al. 2006) The current diagnostic criteria, The Rome IV (updated in 2016) states that IBS is diagnosed by:
“Recurrent abdominal pain on average at least 1 day a week in the last 3 months associated with two or more of the following:
- Related to defecation
- Associated with a change in a frequency of stool
- Associated with a change in form (consistency) of stool.
Symptoms must have started at least 6 months ago.” (IBS Impact 2016)
IBS can effect someone’s ability to lead a normal life and cause considerable distress and discomfort, not to mention social isolation in some cases due to a persistent anxiety around the unpredictability of symptoms. Pharmaceutical medications for IBS tend to provide a ‘bandaid’ approach to treatment, doing little to address the underlying cause(s), and may have undesirable side effects especially when used in the long term.
A low FODMAP diet can be a useful tool to assist in reducing IBS symptoms for some, especially those diagnosed with frucose/sorbitol/lactose malabsorption. (Gibson et al. 2014) This diet is not designed to be restrictive in the long term, and often in clinic we see patients that have been on the diet with minimal reintroductions for extended periods which strongly suggests the need for further investigation and digestive support.
It is also important to understand that there are often overlapping contributers to GIT symptoms, for example, small intestinal bacterial overgrowth can cause fructose malabsorption, so in this case a low fructose or FODMAP may relieve symptoms but wouldn’t address the underlying cause.
Some potential underlying causes of IBS:
- Small Intestinal Bacterial Overgrowth – an overgrowth of bacteria in the small intestinal environment leading to a range of GIT symptoms, and non GIT symptoms also. Constipation or diarrhoea predominant or mixed. (Chow, Lin & Pimentel 2003)
- Large intestinal infections eg. parasites (Alaoui Delbac & Poirier 2012) & bacterial infections. (Grover 2014)
- Intestinal Dysbiosis – an imbalance of flora in the large intestinal environment, not considered an infection, but can be causative of symptoms. (Major & Spiller 2015)
- Food sensitivities/intolerances including non celiac gluten sensitivity, the symptoms of which often have a delayed onset as distinct from a ‘true allergy’ eg. peanut allergy. (Atkinson et al. 2004)
- Intestinal permeability – AKA leaky gut. This is often associated with GIT infections, SIBO & food intolerances, so there can be some overlap with other causes here. (Brummer et al 2016)
- Stress – it is possible that chronic stress is the main underlying cause for some, especially when there has been early life stress exposure – it has been shown that this can disrupt the stress response later in life. Stress can also be a trigger for the development of further GIT imbalances/infections as described above due its negative impact upon immune and digestive function. (Chang 2011)
From a Naturopathic viewpoint, we aim to find the root of a person’s ailments, and then treat accordingly. Some examples of Functional testing that may be utilised in assessing the underlying causes of IBS:
- Comprehensive digestive stool analysis which assesses the large intestinal environment for the presence of dysbiotic (imbalanced) flora, bacterial infections, yeast overgrowth and parasitic infections and provides other useful digestive health information.
- Ubiome explorer stool test – a very in depth view into the large intestinal bacterial environment using DNA sequencing to provide a greater depth of species information – useful in assessing dysbiosis.
- Breath testing using lactulose & glucose to test for the presence for elevated hydrogen and/or methane to assess for SIBO. Testing involves a specific preparation diet followed by administration of lactulose/glucose sugars prior to taking breath samples to assess small intestinal gas levels over a 3 hour period.
- Assessment of stress/adrenal hormones can be performed with a simple salivary test taken at multiple occasions over one day, or with dried urine samples also taken over one day. Questionnaire based depression & anxiety scales such as the DASS (Depression & Anxiety scales) can be utilised in clinic to assess mood alterations.
- Stool testing, breath testing and hormone testing can be performed in the comfort of ones home, and always come with detailed instructions to ensure the most accurate test results.
- Food sensitivity testing can be be performed with a finger blood prick in clinic or a blood draw at a pathology centre depending upon which test is utilised.
Your Naturopath will be guided by a thorough case history to ascertain the most suitable testing based upon your individual signs and symptoms.
Commonly utilised strategies for IBS such as dietary changes eg. low FODMAP diet and probiotic therapy can be helpful in some cases of IBS, but if you have been unresponsive to these therapies, had a worsening of symptoms or have only found minor improvements, consider seeing a Naturopath for further assessment to find the underlying cause, and be provided with a specific treatment strategy.
By Amy Castle BHSc (Nat)
1.Alaoui, H Delbac, F & Poirier P 2012. ‘New Insights into Blastocystis spp.: A Potential Link with Irritable Bowel Syndrome.’ PLoS Pathogens vol.8 no. 3 viewed on February 25th 2017
2.Atkinson, W, Shaath, P, Sheldon, T & Whorwell P 2004 Food Elimination Based on igG Antibodies in Irritable Bowel Syndrome.’ Gut vol. 53 pp 1459-1464
3.Boyce P, Burke, C, Koloski N & Talley, N 2006, ‘Epidemiology of the functional gastrointestinal disorders diagnosed according to Rome II criteria: an Australian population-based study.’ Internal Medicine Journal vol. 36 pp.28–36 viewed on February 24th 2017
4.Brummer et al. 2016 ‘Human Intestinal Barrier Function in Health and Disease Clinical and Translational Gastroenterology,’ vol 7 viewed on 23rd February 2017
5.Chang, L 2011 ‘The Role of Stress on Physiological Responses and Clinical Symptoms in Irritable Bowel Syndrome,’ Gastroenterology vol. 140 no. 3 pp. 761-765
6.Chow, EJ, Lin HC & Pimentel, 2003 ‘Normalization of Lactulose Breath Testing Correlates with Symptom Improvement in Irritable Bowel Syndrome: a Double-blind, Randomised, Placebo-controlled Study’. The American Journal of Gastroenterogy, vol. 98 no. 2 pp.412-499 viewed on Februaury 25th 2017 <http://www.nature.com/ajg/journal/v98/n2/abs/ajg200397a.html>
7.Gibson et al. 2014 A Diet Low In FODMAPS reduces Symptoms of Irritable Bowel Syndrome,’ Gastroenterology vol. 46 pp. 67-75 viewed on February 24th 2017
8.Grover, M 2014 ‘Role of Gut Pathogens in Development of Irritable Bowel Syndrome,’ Indian Journal of Medical Research vol 139 pp. 11-18 viewed on February 24th 2017
This article is intended to be informational only and represents the opinion of the author. It is not intended to be used as medical advice and does not take the place of advice from a qualified health care practitioner in a clinical setting. Please check with your healthcare practitioner before embarking upon any of the treatments discussed.