Introduction: What Is IBS?
Irritable Bowel Syndrome (IBS) is a frustratingly general disorder that can cause a wide range of digestive symptoms: constipation, diarrhea, gas, bloating, and general abdominal discomfort. In general, there are three basic types of IBS, classified according to the type of digestive problem involved. Patients with IBS-D suffer mostly from diarrhea; patients with IBS-C suffer mostly from constipation. IBS-M is a mixed type of IBS that includes both symptoms.
Although it’s incredibly common – approximately 1 in every 6 Americans has some IBS symptoms – scientists have not discovered any one clear cause or treatment, or even a reliable test for the problem. IBS is classified as a “functional disorder,” meaning that the symptoms aren’t obviously caused by any physical or metabolic abnormality. This makes diagnosis very frustrating: essentially, all doctors can do is rule out the possibility that you might have anything else. A doctor might test you for other digestive disorders with similar symptoms, like Celiac disease, Chron’s disease, or ulcerative colitis. Colon cancer is very rare but also a possibility. Anemia or other very severe nutrient deficiencies can cause digestive problems. You might also have an infection or a parasite – this might sound worse, but it’s actually not as bad: unlike IBS, infections and parasites are generally completely curable. If all of these tests come back negative, you’ll probably be diagnosed with IBS through process of elimination.
This lack of one clear cause implies that IBS is caused, not by any specific food or nutrient deficiency, but by a variety of interrelated diet and lifestyle factors that combine to do several types of damage to the digestive system. While treating such a vague problem can be frustrating and time-consuming, understanding your symptoms and learning about potentially problematic food groups can help you handle IBS without making your gut the center of your life.
Causes of IBS: Gut Flora Imbalances
There is no one cause of IBS. However, examining patients’ specific digestive problems can provide into the variety of different reactions and dysfunctions that can provoke IBS symptoms. One of these problems gut flora imbalance. Since gut flora play such an important role in healthy digestion, an altered or unhealthy pattern affecting these beneficial bacteria can cause severe digestive problems, and recent research has found that gut flora imbalances play an important role in all kinds of functional digestive disorders, including IBS.
Many different foods, lifestyle choices, and medications can disrupt your gut flora and create an imbalance. A healthy relationship with these bacteria goes all the way back to birth: babies born vaginally receive a starter colony of gut bacteria from their mothers, while babies born through C-section have no such advantage. Throughout your life, eating a diet free from toxins and high in nutrients will help your gut flora; eating junk food will harm them.
Another very common source of gut dysbiosis (the scientific name for gut flora imbalance) is antibiotic use. Antibiotics are commonly prescribed for everything from minor puncture wounds to tuberculosis; unfortunately, they’re also very dangerous to your gut. Although most antibiotics do a wonderful job of eliminating harmful bacteria, they aren’t choosy about what they attack, and they’re just as happy to kill the helpful gut flora that you need for normal digestion. Taking antibiotics reduces the number of strains of bacteria in your gut, and weakens the ones that survive. This can not only lead to the kind of gut flora imbalances that cause IBS, but can also leave you vulnerable to infection with even worse bacteria like C. difficile. Thus, antibiotics are another potential trigger for IBS symptoms, especially since your body is generally exposed to them when it’s already weakened by disease.
One particular imbalance strongly associated with IBS is Small Intestinal Bacterial Overgrowth (SIBO): this is a condition in which the bacteria in the small intestine grow too rapidly, causing general digestive symptoms like bloating, nutrient malabsorption, weight loss, and malnutrition. SIBO is found in 30-85% of patients with IBS symptoms; although scientists disagree about which condition is the cause and which is the effect, the two problems are clearly related, and treating one can only be helpful in treating the other.
Causes of IBS: Inflammation
Another digestive dysfunction strongly associated with IBS is systemic inflammation of the digestive tract. Inflammation is nothing but the body’s response to injury, so gut inflammation is a general sign that something is harming the lining of your intestines. This could be a certain type of food – for example, if you’re still eating products with gluten, or if you’re unknowingly eating something you’re allergic to, but gut inflammation can also be caused by injuries, diseases, stress, or any number of other factors.
Diseases can also cause this kind of inflammation, especially gastroenteritis. Gastroenteritis is an inflammation of the stomach and intestinal lining; it can be caused by a virus, a parasite, or a bacterial infection, and it produces symptoms similar to those of the stomach flu. After a bout of gastroenteritis, or any other inflammatory digestive disorder, you’re much more likely to develop IBS symptoms. Scientists speculate that the gut flora disruption and the systemic intestinal inflammation caused by acute gastroenteritis are to blame for this – and if you’re taking any kind of antibiotics to deal with the disease, that certainly won’t help. This development of IBS symptoms following an acute digestive illness is so common that doctors even have a special name for it: post-infectious IBS (PI-IBS).
Since the brain and the gut are so closely related, your mental health also has a huge effect on your gut function, and psychiatric illness is strongly correlated with IBS. Mental health problems don’t cause IBS on their own, but they can contribute to it. Specifically, elevated levels of cortisol (one of the major hormones produced by stress) interfere with a neurotransmitter called serotonin, which regulates not only feelings of happiness and depression, but also gut motility (how quickly you digest your food and how often you have bowel movements). People with IBS very often have abnormal levels of serotonin in the blood, indicating that chronic stress is a serious trigger not only for depression, but also for gut dysfunction. Since constantly feeling sick without a clear cause or treatment can be very stressful, having IBS can easily set off a chain of stress responses: chemical imbalances in the brain affect gut function, which causes gut inflammation, leading to inflammation and further hormonal problems in the brain.
Another common condition, leaky gut, causes both gut flora imbalance and gut inflammation at once; it’s strongly associated with IBS in general, and especially with IBS-D. If you have a leaky gut, your intestinal wall is abnormally permeable, meaning that molecules of food and other foreign substances can pass through the intestinal lining directly into your bloodstream. This provokes an inflammatory autoimmune response – your body knows that these molecules don’t belong in your blood, but in its attempts to get rid of the invaders, it also attacks itself. Scientists have found that this autoimmune response strongly contributes to intestinal inflammation and gut flora dysfunction, both conditions associated with IBS.
In general, anything that disturbs the balance of your gut flora or causes inflammation in the gut probably has something to do with IBS symptoms. While we would all love to know the precise relationships between all of these processes, we don’t need to know everything to understand what we can do about it: minimize anything that might cause leaky gut, inflammation, or unhealthy gut flora. A diet designed for overall gut health and recovery should be the first line of treatment against IBS – once you learn more about your particular symptoms, you can start modifying the diet to fit your situation.
Treating IBS Symptoms: Diet Recommendations
Since IBS symptoms have no one cause, it’s not particularly useful to embark on endless rounds of invasive tests and examinations to try to pinpoint the precise source of the problem. Instead, start by making a general effort to heal your gut from whatever problems are causing the gut flora imbalances and inflammation that lead to IBS. The wonderful advantage of this approach is that you can’t possibly go wrong: if one particular trial doesn’t eliminate your symptoms, you can rest assured that at least you haven’t done any harm and continue with your efforts. This is more than conventional doctors can say about antibiotics, antidepressants, and other conventionally prescribed IBS treatments!
First, cut out all the foods, medicines, and products that might be contributing to gut symptoms. Grains, legumes, and seed oils are harmful and inflammatory; for most people, so is dairy (even if you don’t think you have trouble with dairy, try eliminating it for a month as an experiment; if you don’t notice any improvement, you can add it back in). Some medication that you might be taking can also cause problems. NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) like Advil, Motrin, and Aleve prevent the stomach from protecting itself against the highly acidic digestive juices that it holds; this can cause bleeding in the stomach and digestive tract, and even ulcers. As discussed above, antibiotics can wreak havoc on your gut flora and general intestinal health. If at all possible, stop taking over-the-counter painkillers and antibiotics, and also make sure to get any antibiotic soaps and lotions out of your house.
The recommendations above would be useful for everyone, even people with a perfectly healthy digestive system, but some foods that are otherwise perfectly healthy and normal parts of Paleo can be harmful to people with chronic gut dysfunction. IBS can cause your digestive system to become hypersensitive, or intolerant to foods that otherwise wouldn’t cause any problems. While you’re in the first stages of gut recovery, try eliminating nuts and seeds, nightshades, and eggs. Nuts are inflammatory due to their high levels of Omega-6 PUFAs, nightshades (like eggplant, bell peppers, and tomatoes) can exacerbate autoimmune problems, and eggs (especially egg whites) can be irritating because they contain anti-microbial compounds as part of their natural defenses. These proteins are designed to protect the growing egg from microbes and viruses, but they can also harm your digestive system. Fruits are not normally dangerous, but if you have trouble with SIBO or other gut flora imbalances, the fructose they contain can provide a delicious food source for the bacteria that are already too numerous, making the problem even worse.
IBS can also cause you to react very poorly to a group of foods high in several varieties of carbohydrate known collectively as FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). Foods high in FODMAPs include several fruits and vegetables like apples, onions, and cauliflower. The problem with these foods isn’t that they’re naturally toxic; it’s that an unhealthy digestive system just isn’t up to them. FODMAPs aren’t easy to digest, so they linger in the small intestine while your gut flora ferment them. This extended digestive process can cause abdominal pain, gas, bloating, and constipation or diarrhea
Eating to cure digestive problems can seem like an endless list of foods to eliminate, but in fact, the foods you do eat are just as important as the foods you don’t. It’s crucial to get enough micronutrients while your body is healing itself, especially since malabsorptive digestive disorders like IBS often rob your body of nutrients. Make sure to get enough vegetables, preferably very well cooked (this makes them easier to digest). An easy way to do this is to just throw them into a slow-cooker with your meat for a delicious and tender meal that takes almost no time to prepare.
You’ll also want to eat plenty of bone broth at this stage: bone broth is very soothing to the digestive system, and it contains a wealth of vital nutrients extracted from the bones. Many people with IBS or related problems (like leaky gut, poor gut flora, or gut inflammation) find that bone broth is extremely helpful in restoring and maintaining normal gut function. Fermented foods will help restore your gut flora to healthy levels. A probiotic can also help – research into various types of therapy for the gut flora has indicated that both prebiotics and probiotics can be helpful, depending on the specific case. You might want to be cautious with your probiotic use if you have a problem related to overgrowth of gut flora (Candida or SIBO), though, since this might just feed the bacteria you don’t want. Some people find that taking digestive enzymes also helps relieve IBS symptoms.
It’s important to be very strict about your diet at first, to get the clearest possible picture of what you do and don’t react to, and to give your body the best possible change to recover. After your gut has healed, you can start experimenting with “grey area” foods that you may or may not have a problem with.
Treating IBS Symptoms: Healing the Gut
IBS is marked by two major physical problems: gut inflammation and an unhealthy pattern of gut flora. To treat the symptoms, you need to address both of these. Since inflammation is nothing but a response to injury, to heal your gut you need to stop injuring it: eat a clean, healthy diet as outlined in the last section, avoid toxins and stress as much as possible, and make sure to get plenty of micronutrients.
Eating a proper diet will avoid injuring your gut, and the inflammation will eventually subside, but healing your gut flora can take a more intensive effort. First you need to handle any bacterial overgrowth problems, like SIBO and Candida. This, unfortunately, can be harder than it seems. One of the reasons why bacteria are so resistant to your body’s natural defenses is that they have natural shields called biofilms, which protect them from your immune system. These biofilms are built from the same minerals that you eat to nourish yourself (especially iron, calcium, and magnesium), so they present you with a dilemma: if you starve the bad guys, you’re starving yourself along with them, but if you feed yourself, you’re feeding the bad guys, too.
In the case of iron, one way around this is to supplement with Lactoferrin or Apolactoferrrin, two proteins that bind to iron and help deliver it to your cells instead of to the bacteria that want to steal it. Limiting calcium in the short term won’t cause serious damage, as long as you make sure to eat a calcium-rich diet when your gut has healed. Magnesium is trickier: there is no equivalent of Lactoferrin or Apolactoferrin for magnesium, and intentionally creating a magnesium deficiency while attempting to heal your gut is a very poor strategy, since magnesium is one of the most important micronutrients for healthy digestion. Don’t go out of your way to take magnesium supplements, but the benefits of magnesium restriction are generally not worth the drawbacks.
A slightly more controversial therapy is chelation. This has mostly been tested in animal and test tube models, but it does show some promise for destroying the biofilms that protect bacteria from your own natural defenses. On the other hand, chelation therapy isn't without its risks: talk to your doctor before you decide one way or the other.
To supplement your body’s natural defenses, some mainstream doctors recommend antibiotics for gut flora imbalances, especially problems like Candida or SIBO, where you have too many of the wrong kind of bacteria. This is not an ideal treatment option, since antibiotics can actually contribute to gut flora imbalance and gut inflammation. Unless you have no alternative, stay away from antibiotics and focus on helping your own immune system handle the problem - or try more gentle antibacterial substances. For example, one of the most common natural antimicrobials is garlic, which is available almost anywhere and tastes delicious on all kinds of foods.
Another helpful natural treatment is peppermint oil; other herbal remedies include turmeric extract, Arrowroot, and artichoke leaf extract. It’s important not to go overboard with these supplements, though: if your diet is sound and you have your stress levels under control, you shouldn’t need a shelf full of pills in addition to your diet.
Treating IBS Symptoms: Mental Health
What you put in your mouth can go a long way towards healing your gut. But since the brain-gut axis is such a significant factor in the health of your digestive system, it’s important to also treat any mental health problems that might be causing IBS symptoms. Minimize stress and anxiety in your life as much as possible – if you can’t eliminate a stressor, make a plan for dealing with it productively, instead of allowing it to keep you worried and tense. Get 8 hours of sleep every night, and more if you need it: nothing will make you anxious and depressed like a chronic sleep debt. If you have more serious mental health concerns, consider finding a therapist or psychiatrist to help you work through the issue.
This connection between stress relief and fewer IBS symptoms isn’t just common knowledge: doctors studying treatments for IBS have found that an integrated mind-body approach typical of Eastern medicine can be very effective. Depending on your symptoms and personality, you might want to look into alternative mental health approaches like meditation, hypnosis, or cognitive behavioral therapy (CBT). This type of treatment is especially useful because it doesn’t involve any invasive procedures or harsh drugs.
When you have IBS, eating can seem like a minefield, with your gut ready to react at the slightest provocation. Every new study recommends that you avoid a different food or group of foods, and cooking is not much fun when a simple grocery trip requires an encyclopedic list of forbidden foods and precisely specified supplements.
While it can be a challenge to play meals around an ever-changing grocery list, living with IBS doesn’t mean that you have to subsist on nothing but ground beef and vegetables. You can eat a Paleo diet without eggs, FODMAPS, nightshades, or nuts, and still enjoy your meals! This pork roast recipe makes a delicious entrée with plenty of leftovers to grab for a quick breakfast or a cold lunch. For a lighter meal, try a shrimp and mango salad or cinnamon chicken (just leave out the onions if you’re eliminating FODMAPs foods). This tuna steak recipe even calls for garlic, a helpful natural antibacterial. For a rich side dish on long winter evenings, try some roasted acorn squash: this would be a delicious accompaniment to a roast chicken or a nice, juicy steak. Kale chips would make a great snack in the place of unhealthy crackers or cookies.
As you learn more about your specific triggers and intolerances, you’ll be able to add more different types of foods into your diet – after all, if you don’t react to something there’s no reason to avoid it. Everyone’s gut issues are unique: experiment in your own kitchen, and find a way of eating that works for you.
Although doctors continue to research potential treatments for IBS, so far it remains a vaguely defined collection of digestive symptoms classified by elimination: if it isn’t anything else that your doctor can recognize, it’s probably IBS. The very general nature of the problem demands a very general treatment: maximize your gut health as much as possible by reducing inflammation and healing your gut flora, and identify your trigger foods so you can avoid them in the future. Someday, you might wake up to a New York Times headline about the cure for IBS, but until then, healing and supporting your gut as well as you can is your best bet for controlling IBS symptoms, so you can look better, feel healthier, and move on with your life.