From my personal experience and of many others, IBS can drastically reduce your quality of life. If it isn’t fatigue that is weighing you down, it will be anxiety.
Then there’s the bloating, the wind, the abdominal pain. Its safe to say that its hard to focus on the joy of everyday life when these things are on your mind.
Getting to the root of your symptoms is something conventional medicine often overlooks. Since these symptoms are your own, you know them better than anyone. By knowing the factors at play in IBS, you may be better equipped to make the choices to start improving your quality of life, I know you’ve got the motivation.
The more you know, the further you’ll go.
What Causes IBS?
There isn’t one clear cause of IBS, rather a matrix of factors.
- A leaky Gut
- Altered Gut – Brain interaction
- Impaired motility (Muscle contractions of Digestive system)
- Blunted secretion of digestive fluids
These form the pathophysiological underpinnings of IBS. In other words, the mechanistic functions of the body that have shifted. These change based on how you have been, and might still be interacting with your environment.
Factors which trigger these adaptations:
- Psychosocial stress
- Toxicity – pesticides, preservatives, additives
- Food contamination/infection
- Processed foods
Shifts in bodily function, the interaction with your inherent genetics, and the way they behave account for the symptoms of IBS.
IBS is famously characterised by either constipation, diarrhoea, or a mix of both. With these come a slew of symptoms. These include bloating, gas, abdominal pain, anxiety, depression and fatigue. We all know these to interfere with our quality of life.
Exciting new research has been highlighting the role of the gut microbiome and its effects on digestive health. Its composition and diversity has a far reaching influence on the health and function of the gut.
The role of the gut microbiota is diverse:
- Regulates immunity
- Is an intestinal bouncer – regulates the opening and closing of the gut wall
- Completes digestion of proteins and carbohydrates
- Synthesises the brain chemicals needed for healthy mood, memory and cognition
- Produce essential B vitamins and vitamin K used in many pathways throughout the body. In Energy production, immunity, cellular growth and repair.
Microbes are responsible for the breakdown of food particles, such as lactose and gluten. These we know to be a problem.
When certain microbes aren’t around to break them down, or there is an imbalance of beneficial:pathogenic microbes; gluten and dairy cause irritation. A poor balance of microbes can eventually cause damage to the gut wall, resulting in a ‘Leaky gut’. When the gut is damaged like this, the barrier that protects us from undigested food particles, toxins and viruses, actually leaks. These particles trip the immune system, which produces some of the symptoms of IBS and chronic inflammation.
The composition of the microbiome also dictates whether FODMAPS are well tolerated. Various stains of micro-organisms digest these specific carbohydrates. Its a possibility that the lacking composition of certain strains renders some of us ineffective at breaking down these foods.
FODMAPS is a popular dietary choice which provides some relief from persistent symptoms of IBS. But in some cases, the relief from symptoms is only temporary. Even when gluten, dairy and continual FODMAP avoidance is followed.
Interestingly, a FODMAPS protocol can actually deplete levels of Bifidobacteria, particularly over the long term. Since a wide range of plant fibres get excluded, some bacterial strains might be missing the essential fuel to grow and replenish.
This highlights the need to use FODMPAS as a transitional approach. Whilst doing FODMAPS, make sure to replenish gut microbes with probiotics and fermented foods. These increase bifidobacteria concentrations.
The Gut ~ Brain Connection
The gut and the brain are inextricably linked. This connection reveals the psychological and physiological complexity of IBS.
The gut ~ brain interaction is a two way street. What happens above affects what happens below, and vice versa.
This bidirectional relationship is influenced by food choices, environmental conditions, emotions and thought processes. This forms a feedback loop which can either support or undermine healthy digestive and mental health.
Interestingly through this connection, stress can actually alter the composition of the microbiome, affecting its function.
We see in the next image how the gut wall is affected by stress. How this triggers inflammation and how this inflammation damages the gut wall.
Ongoing chronic emotional background noise and stress eventually produces the symptoms of IBS. This happens through a leaky gut barrier and depleted microbes.
Because of these alterations, certain foods trigger inflammation via the immune system. This damages the gut wall, and creates inflammation of the brain, producing anxiety.
Its a two way street.
John R. Kelly, Paul J. Kennedy, John F. Cryan, Timothy G. Dinan, Gerard Clarke, and Niall P. Hyland. Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Frontiers In Cellular Neuroscience. 2015; 9: 392.
Anxiety and IBS share common ground. They almost unanimously co-exist. Chronic anxiety isn’t ideal for digestion.
Since the mind is perceiving a stress it cant escape/resolve, it is constantly warned to flee from danger. This activates the flight or flight response within the autonomic nervous system. Such shifts in physiology blunt digestive secretions, retards muscle contraction, and alters the composition of the microbiome.
If you are experiencing this stress often, eating and digesting food becomes problematic. The digestive organs and their secretions work together to break down, absorb and transport nutrients from each meal.
When stress is being perceived, this systems efficiency drops along with immune system activity. Because stress enables us to escape from danger, the resources the body needs for digestion get used to escape a threat.
What Are The Conventional Treatments?
Exclusion of FODMAP foods, gluten, dairy and refined sugar
These are among the recommendations given by dieticians and doctors. This may be a good short term strategy, but it doesn’t fully address the underlying cause of why these foods aren’t tolerated.
Are offered as a means of calming the inflammation in response to trigger foods. Whilst these drugs provide relief from the symptoms, they provide no long term strategy to address the underlying cause of inflammation.
Such as rifaximin are administered to kill off overgrowth of pathogenic microorganisms within the microbiome. Whilst this can stamp out the bad, it effectively nukes the good bacteria in the gut. This can fail to address the issue of depleted beneficial bacteria.
Anti-spasmodic and smooth muscle relaxant drugs
Enable the passage of food through the GI tract, offering some respite from symptoms of IBS. However they are not without their side effects, and also overlooks the root cause of muscle spasms (stress is one).
To combat diarrhoea. Whilst an effective short term solution, Loperamide fails to deal with the root cause of diarrhoea. It is symptom management.
Since depression and anxiety are common passengers of IBS, these have shown to have an indirect yet beneficial effect on symptoms of IBS. Symptom reduction results through addressing the anxiety and depression, which may be a clue in how to combat IBS long term – establishing the psychological factors accounting for depression and anxiety.
Is a pathway some of you may take/have taken. Whilst this can prove useful for some, it is often an arduous and lengthy process for others.
Is There A Better Way?
Cognitive Behavioural Therapy
CBT has shown great promise in altering cognitions, emotions and behaviours. These constitute the attitudes, perceptions and beliefs that we hold about ourselves and the world. Shifts in perspective resulting from CBT can defuse the reaction to triggers that once set off the stress response, and even reduces inflammation.
In other words, CBT can help unearth the thought patterns that cyclically produce stress, anxiety and depression. These thought patterns can be broken, and retrained.
Yoga is one of the most effective treatments for IBS. It addresses a multitude of underlying mechanisms which account for IBS. A combination of stretching and focused breath work allows the release and relaxation of the muscles. Most notably those involved in digestion. Yoga unites the body and mind into a state of relaxation through calming a stressed nervous system towards a relaxed state. Yoga becomes a practice for many. The challenges physically open the mind to introspection mentally. Many who practice yoga find that they gain a more positive outlook and attitudes. These serve to defuse the stresses that once caused disruption of the gut brain axis.
Tai Chi, Qi Gong
Both mind, body practices – these two combine focused breathing, relaxation and moving meditation. Both bring a sense of calm to a stressed mind. Although more gentle practices than yoga, they still provide an array of psychological and physiological benefits. These include immune system renewal and increased activity of antioxidant enzymes within the body. A greater sense of mindfulness results through these practices, which defuses psychological triggers of stress. They even opening heightened states of consciousness.
Stress management techniques vary in there effectiveness from person to person. An epsom salt bath might do the trick. Maybe a walk in the woods. A weekend away. Writing your worries down so release them from your mind. Confronting something or someone that is causing you stress. Find what works for you.
Anxiolytic, Antispasmodic, Carminative Herbs
Herbs, whether you drink them in a tea or take them as an oil preparation can work wonders for calming stress, through relaxing the nervous system. They also act as muscle relaxants of the digestive system. known for their actions as antispasmodics, they facilitate the transit of food through the GI tract. Though easing of physical and psychological tension, cramps and spasms of the digestive system relax. As carminatives, they reduce flatulance by coordinating and regulating gut contractions soothing the gut wall.
Mindfulness & Meditation
Mindfulness meditation is a powerful long term strategy. By bringing awareness to your thoughts and gradually letting go of attaching to them, you can bring about some profound changes over time. These changes occur structurally within the brain as new neurones and pathways of thought emerge. A mindfulness practice such as meditation is a powerful ally. A practice allows you to reduce mental stress, stress arousal and increase positive states of mind.
Mindfulness training has shown great improvements in quality of life for IBS patients, whilst also increasing quality of life. This resulted from only one session a week over 8 weeks.
Essential oils offer up powerful benefits, particularly as antifungal, antiviral and antimicrobial agents. This is of particular interest when it comes to addressing dysbiosis, as some herbal preparations kill pathogenic strains of bacteria whilst sparing beneficial strains.
Involves the insertion of needles on certain points throughout the body which allows energy or Qi to flow freely. Through stimulating the flow of Qi, equilibrium is returns throughout the body from the flow of excess energy to areas deficient in energy. Accupuncture is has shown sufficient promise to warrant further study in addressing IBS.
Having a coach who provides the space for introspection, self discovery and awareness is a valuable resource. This is quickly gaining popularity across the UK and USA. A coach lays out actionable steps to induce behavioural change. Working with a coach can enable shifts in perspective. To identify triggers, address emotions, cognitions and behaviours that underpin symptoms (of IBS).
A targeted protocol which focuses on digestive healing goes a lot further than simply following a diet or eliminating foods. One such protocol is called the 4 R’s:
- Remove – Identify and remove poorly tolerated foods, stress and pathogenic microorganisms.
- Replace – Stimulate the production of bile, stomach acid and digestive enzymes either internally or introducing through supplementation.
- Reinoculate – replenish beneficial bacteria with probiotic foods and supplements and prebiotic foods.
- Repair – restore the lining of the gut wall with diet and supplements.
Read more about the 4 R’s here