Irritable Bowel Syndrome (IBS)
IBS is often used as an umbrella term for bowel dysfunction, although it is a very specific condition with a psychological element affecting the gut. Sufferers often have chronic diarrhoea and/or constipation which are worse when they are stressed. Therefore, both the biochemical and psychological aspects of any case must be taken into account for true lasting success in my view.
Usually a combination of any of the following:
- abdominal pain
- altered bowel movement (ie, diarrhoea (IBS-D, constipation (IBS-C) or alternating between them IBS-M (mixed))
- mucus in the stool
- anxiety and depression
However, in severe cases of so-called IBS, people can also have extra-intestinal symptoms, including:
- chronic pain/fibromyalgia
- poor sleep/insomnia
- menstrual difficulties
- lower back pain
- chronic fatigue and
- restless legs syndrome (RLS).
What causes IBS?
There are loads of possible causes here and it depends very much on what type and pattern of symptoms a person has. Here are some thoughts to start you off…
Food Intolerance and Poor Digestion
The biggest cause I have seen over the years is food sensitivity and poor digestion, which is why the Gut Plan below targets that (and more) below. Removing the most common foods involved usually helps, so follow the Gut Plan first. If not, then these might be some other things to think about:
If you are the constipated type and especially if you have some of the symptoms in the more severe list, maybe look at levels of serotonin. Why? Well, people don’t realise that up to 90% of our serotonin (the happy neurotransmitter) is made in the gut and it is therefore termed not just a brain neurotransmitter, but an enteric – or gut – one. If you cut the nerves from the brain to the gut, the gut would still work!
Serotonin affects the peristalsis of the muscles in the gut mainly. So, if you have too little of it, you’ll slow up (constipation) and if you have too much of it, you’ll speed up (diarrhoea). That’s why serotonin meds like receptors and agonists are used in IBS cases. However, serotonin is also important in controlling chronic pain, and in what I call hypersensitivity illnesses like CFS, FM, multiple intolerance. So, you can see how it might be worth looking into.
Certainly, I have seen people use 5-HTP, a precursor of serotonin, quite successfully to increase gut movement. Useful herbs to decrease serotonin in diarrhoea cases include ginger and peppermint.
You can test serotonin levels using one of the neurotransmitter tests here.
Interestingly, you can boost serotonin levels effectively using meditation and relaxation techniques too, so do look at the Mind-Body medicine section and especially the Healing Plan if you have some of those illnesses. I wrote it for you! I’ve written some more about this in the Gut Plan below too.
I should imagine a lot of the key issues also comes down to poor absorption of nutrients. Magnesium is particularly key, not least because it is anti-spasmodic and the anti-anxiety mineral. Most of those conditions above are somehow connected to magnesium so check red blood cell levels (a standard test can be quite misleading). Interestingly, you also need magnesium as well as B6, B1 (thiamine) and folate for effective serotonin conversion and peristalsis in the gut.
Follow step 1 in the Gut Plan (below) to improve digestion and absorption and check your nutrient levels here.
Adrenals & thyroid
A sub-set of patients with IBS have symptoms such as palpitations, hyperventilation, fatigue, excessive sweating and headaches and I would be looking there first at food allergy/intolerance reactions, adrenals, thyroid and the magnesium level again to start with.
People with constipation should also look particularly at sugar intake. When glucose rises too fast, it slows down peristalsis in the colon.
FODMAPs, other ‘food issues’ and low enzymes
People with severe bloating and wind might look closely at FODMAPs and digestive ability. Often the bloating occurs because we can’t digest food down and especially fermentable carbohydrates (the FODMAP foods). Avoiding FODMAP foods and increasing digestion ability as per the Gut Plan below usually helps many. There is a useful FODMAPs primer here if you need one and do also read my post on it here:
There are many FODMAP diets. The most accurate one should be Kate Scarlata’s, because she keeps hers updated to Monash University where the testing is done. Her checklist is also here. It is being updated all the time and she specialises in the FODMAP diet. It can be quite difficult to follow though as she lists each part of FODMAPS separately, so also look here , here and here. There is a useful Monash University FODMAPs app for your phone here too.
Or, it could be a true lactose intolerance, a histamine issue or fructose intolerance, for example. See here for more on those.
Maybe people have SIBO (small intestine overgrowth) instead of in the colon where bacteria are over-growing and having a fermenting party?
I regularly ask patients what are they not digesting, what are they holding on to or not letting go of? What can’t they wait to get rid of? Amazing how that elicits some lightbulb moments!
I would even go so far as to suggest that IBS may well be a true anxiety disorder in some people. Sometimes, you don’t know if you’re anxious because of the symptoms making you feel naffed off or whether it’s the condition of anxiety causing the IBS in the first place. Who cares really, lower the anxiety anyway. That’s why meditation and the mind-body medicine stuff works in IBS cases very often. Please do it as well as the physical stuff above.
Massage of the colon correctly using a tennis ball can also work wonders for constipation, as can sitting on the loo properly. See my constipation factsheet here.
Diagnosis of IBS
Is usually made after ruling out other functional gut disorders like Crohn’s, colitis or diverticulitis. Many sufferers never see their GP and just put up with symptoms, which is a shame. That said, it is still probably the most common gut disorder seen in general practice. If nothing else is found and there are indicators such as bloating, pain with frequent bowel movements and a relief of pain when you do pass a stool, then it is normally thought of as IBS.
IBS can mimic other conditions, though, so it is worth getting checked out.
For example, if you mostly have loose stools, you should check out coeliac disease, amxiety and poor absorption problems like pancreatic insufficiency or even a bacterial infection. If you are more constipated, look at wheat intolerance, depression, hypothyroid or get even that there are no mechanical issues like a blockage.
Tests are important with a condition such as this as IBS can be caused by or be contributed to by so many different factors as we’ve seen. Once you know what’s involved, you can then target the problem much more effectively and hopefully solve it once and for all.
First, check the gut itself obviously. Check the Gut Tests Overview for current recommendations of the best overall gut tests.
Then, if necessary, think about these:
Inflammatory bowel disease (like Crohn’s and colitis)
Gut dysbiosis (an upset bowel bacteria balance) including SIBO
Nutrient deficiency especially of magnesium, the anti-anxiety and muscle spasm mineral!
Over the years, I have seen many people with a diagnosis of ‘IBS’ which turned out to be caused by one of the factors above. Food intolerance is the leading cause I’ve found, followed by stress and candida. For constipation, wheat intolerance and thyroid issues come up a lot.
Once you have ruled out acute problems such as bacterial infection (say, picked up on holiday) and coeliac disease (a clue is constantly low iron levels and/or feeling tired all the time), if the problem is chronic, you should take steps to eliminate it rather than continue to suffer.
I favour a two-pronged approach to this to tackle the physical and emotional elements of the problem.
Do the Gut Plan below to sort out digestion and absorption, common allergens and a liver and gut MOT which sorts out most issues.
But don’t forget the mental and emotional side of IBS too. We found in-clinic that doing hypnotherapy and/or meditation was also a big part of people getting better. They don’t say the gut is the third nervous system or the second brain for nothing!
Check out the Mind-Body Medicine section here and choose an audio download to help you. Do it daily and it will make a huge difference.
Are you fed up with bloating, wind, acid, mushy erratic stools and constipation?
Too many people continually put up with these symptoms which really drag down your quality of life, don’t they? Draining bloating, embarassing uncontrollable wind, burning acid, rushing to the loo or sitting there for ages bunged up. Not nice.
You need the Gut Plan. Hop over here to read all about it and start getting rid; these are actually quite simple to solve once you know how. The Gut Plan is based on over a decade of specialising in this area and I wrote down what I find works for the vast majority of people with this type of gut problem.