Could I have undiagnosed IBS?
Prevalence and Symptoms of IBS
Statistics show that approximately 2 in 10 people in the UK have IBS. Many more people are thought to have IBS who have either not been diagnosed correctly or haven’t consulted a GP for a diagnosis. Many people think that IBS symptoms such as constipation, loose stools, going to the toilet less than once a day, wind or bloating is normal.
In terms of a healthy bowel movement, the gold standard is 2 to 3 times a day and doesn’t leave any marks on the toilet bowel or even on the toilet paper! Can you honestly say your stools are like that?
Common Treatments for IBS
IBS is commonly “treated” with medications such as Moviprol to relieve constipation or Immodium to stop diarrhoea. Proton Pump Inhibitors such as Omeprazole and Lansoprazole are prescribed to relieve symptoms of acid reflux and heartburn. All of which have side effects.
So, we are going to take a look at the side effects of using such medications. However, please consult a qualified health professional before making any decisions about medications.
Effects of Moviprol:
If you are taking Moviprol, have a look at the sodium content in it. It is very high and the wrong sort of sodium in the wrong sort of amounts can affect our cell health, blood pressure and heart health.
Effects of Immodium:
When we have loose stools, there is a reason the body is trying to eliminate so rapidly. We need to find out the reason, whether it is excess toxicity trying to escape or rapid transit time due to stress.
If we just ‘fix’ the symptom, then where will that toxicity go if we are stopping it from coming out? It goes deeper, where it can store itself in joints such as in arthritis, extra tissue such as endometriosis, or, even worse, in organs.
Effects of Omeprazole / Lanzoprazole and the Question of Stomach Acid Production:
Numerous research studies have indicated the dangers of Proton Pump Inhibitors. There have been links made in various studies between PPIs and an increase in mortality, stomach cancer and even neurological conditions such as dementia. Whilst I’m not suggesting you stop taking medication without talking to your GP, it does raise concerns that you might not have been aware of.
Not only do these medications have concerns surrounding their long term effects, but also stop a vital function of the body – they decrease the production of acid in the stomach. “But I’ve got acid heartburn”, I hear you say, “so why would I not want to decrease the production of stomach acid?”
Stomach acid purposes
Well to answer that question, let’s look at the main purposes of stomach acid production:
- The production of stomach acid actually triggers the tightening of the lower oesophageal sphincter, which prevents stomach acid from rising up into the oesophagus. So causes of acid reflux can actually include too little stomach acid. Conversely the treatment often dished out like sweets for acid reflux is the very thing that can cause reflux in the first place!
- Secondly, it is produced to break down proteins so that we can use them to regenerate our bodies. So when people don’t produce enough stomach acid, they can have impaired protein digestion and are not able to use the protein they take in to maintain optimum physical function. Instead it putrifies in the large intestine, causing toxicity.
- Thirdly, stomach acid has the effect of killing of any unwanted bacteria and prevents it from accumulating in the small intestines, a major cause of 60% plus of IBS cases!
Whilst some people do produce too much stomach acid, the majority of people actually produce too little. This is usually after use of antacids such as Gaviscon or PPIs.
I can hear you saying, well that’s all well and good Bee, but the symptoms of IBS are horrendous so what do I do? Well don’t worry, there are lots of natural alternatives. Most importantly naturopathic nutrition looks at addressing the root cause. So let’s take a look at some possible root causes of IBS. Our main focus is on the biggest known cause of IBS, SIBO.
Causes of IBS
Research suggests that one of the biggest causes of IBS could be something you have never even heard of! SIBO – small intestinal bacterial overgrowth. Studies have shown that 60-84% of people with IBS actually have something called SIBO which is causing their IBS symptoms?
But what is it? And is it curable? Well, we are supposed to have an abundance of certain bacteria in our large intestine, but not in our small intestine. SIBO is where bacteria have overgrown backwards into the small intestine.
Causes of SIBO
Poor gut motility
Poor gut motility is when food and bacteria aren’t being swept down through your digestive tract effectively. Gut motility is controlled by something called the migrating motor complex (MMC for short).
The functioning of the MMC can be impaired by illnesses such as gastroenteritis (gastric flu) or a severe bout of food poisoning (24 hrs or more). I can also be impaired by infections such as Lyme Disease or mould toxicity, and even an impact that has knocked or shaken the head. This is not as easy to address and may warrant ongoing treatment with natural prokinetics to keep everything moving through.
As discussed above, low stomach acid is obviously one cause. Other causes include impaired production of digestive enzymes, impaired production of bile and low secretory IgA which acts as an immune defence in the gut.
Causes can even be as simple as drinking with or close to meals (which dilutes your digestive juices). Or not chewing your food properly and eating whilst distracted (by our phones or the TV). Eating on the go, or eating under stress or whilst upset or angry can also cause poor digestion.
Stress shuts down our digestive system. With so many people under constant chronic stress, it is affecting their digestion all the time. Taking time to do some deep breathing or anything that calms you before every meal, helps switch your body into rest and digest mode.
Obstructions and abdominal adhesions
Adhesions are scar tissue that form after surgery, a perforated appendix or a haemorrhage. Obstructions can be caused by conditions such as endometriosis, diverticulitis and superior mesenteric artery syndrome.
Medications and stimulants
We have already discussed the dangers of anti-diarrhoea medications and PPIs above. Other medications such as opiates, narcotics, antispasmodics and even trycyclic antidepressants such as amitriptyline can all cause poor gut motility, as can cigarette and cannabis use.
For some people SIBO can reoccur throughout their life, depending on the cause, but for others it can be cured by addressing the route cause.
How Do I Know If I have SIBO
Consult a SIBO practitioner like myself who can carry out primarily a 3 hour lactulose breath test, possibly followed by a glucose test as well if necessary. It is important that the test is a 3 hour test and that it tests for both methane and hydrogen.
Methane & hydrogen are emitted by bacteria in the small intestine, before you have had chance to absorb your food. Causing the symptoms of wind, bloating, stomach cramps, iron deficiency, B vitamin deficiency, fatigue, etc! But a word of warning… There is a third gas, called hydrogen sulphide, that doesn’t show up on a standard test.
Leading expert in the field, Dr Mark Pimental, has recently developed a test for Hydrogen Sulphide SIBO. Unfortunately, at the time of writing this article, it is not yet available in the UK.
If however you have a flat line across the whole of your 3 hour breath test, it is possible that this is not in fact a negative breath test for SIBO, but in fact a positive indicator that you have hydrogen sulphide SIBO. So if you have previously been tested, as I was, and told that the test is negative because you had a flat line but you are still symptomatic, you may in fact need treating for Hydrogen Sulphide SIBO. A trained SIBO practitioner should be able to help you interpret the test and give you some indication of how long treatment might take.
I also order a stool test for my clients to see what possible causes of SIBO may exist. Lab tests I use include GI Effects from Genova Diagnostics and GI Map, depending on someone’s signs and symptoms.
Natural treatments for SIBO
The natural treatment for SIBO that I prescribe to my clients is herbal antimicrobials to kill off the excess bacteria, of a particular type and dosage. These should always be taken under supervision.
I also prescribe a 2 phase diet which can virtually eliminate symptoms within a couple of weeks in some people. However, this diet is not meant as a long-term strategy. We need to fix the cause, as opposed to just managing the symptoms with diet.
Phase 2 diet
The diet works by eliminating / reducing a group of fermentable carbohydrates called FODMAPs. Designed by one of the leading experts in the field, Nirala Jacobi, adapted from Alison Siebecker’s SIBO Specific Diet, the diet is specifically targeted at starving the bacteria to help with their elimination. It has also been designed to be as varied as possible, because restricting any food groups can cause disruption to the gut microbiome, the community of “normal” bacteria that are supposed to live in our large intestine and modulate our immune system, help us detoxify effectively, produce vitamins and in short keep us healthy.
If someone has Hydrogen Sulphide SIBO I tailor the diet, as hydrogen sulphide producing bacteria will thrive on different foods to hydrogen and methane producers.
Other strategies I employ include meal spacing, i.e. eating with four to five hour gaps in between. This can help the MMC to sweep excess bacteria out, so regular grazing can also be problematic.
I also, depending on someone’s stool test results, address any digestive issues with specific enzymes, address any leaky gut, inflammation or lowered gut immunity and assess whether someone needs to take hydrochloric acid in the form of Betaine HCl. I would also prescribe a prokinetic to ensure that motility is working as well as possible and possibly also a biofilm disruptor, as bacteria are known to create a biofilm around themselves to protect themselves.
There are also many natural treatments for symptoms such as bloating, reflux, constipation and diarrhoea. Take a look at www.siboinfo.com for more info.
I end my treatment with microbiome restoration, as the antimicrobials, although natural, and the restricted diet, do to some extent alter the gut microbiome. This can be done through prebiotic supplements and including prebiotic rich foods in the diet, but has to be done at the end of treatment, as it can otherwise make someone very symptomatic.
Probiotics, fermented foods, yoghurts such as Yakult, etc will not on their own be enough to recolonize our gut bacteria. Those bacteria need to keep being fed prebiotic foods in order to grow, thrive and survive.
Other Causes of IBS
Other causes of IBS can include;
- parasitic infections (almost impossible to pick up unless you use PCR testing to test for DNA and standard tests throw up a lot of false negatives)
- Coeliac disease (which your GP can test you for as long as you are still eating gluten)
- Non-coeliac gluten sensitivity (don’t think if you are not coeliac that gluten is fine as this could be you!)
- Disease causing bacteria such as Klebsiella Pneumoniae that produce endotoxins (linked with endometriosis in some cases), any of the individual causes of SIBO on their own
- Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis)
- Removal of gallbladder or part of the bowel
- Candida or other fungal overgrowth
- Food intolerances
- Salicylate or oxalate sensitivity
- Histamine intolerance
- Disrupted gut flora
- Or simply a poor diet.
I shall be diving deeper into some of these other causes in future articles.
Often removing highly inflammatory foods such as dairy, gluten and sugar can have a huge impact on someone’s digestion. Again, testing as part of my six step programme instead of guessing, can often get to the route cause of any of these, together with hydration, supplementation, lifestyle changes, clearing up the diet and detoxification.
If you would like help with any digestive issues, contact me for a free 15 minute chat to find out how I can help you.
Bharucha, A. E., Seide, B. M., Zinsmeister, A. R., & Melton, L. J. (2007). Insights into normal and disordered bowel habits from bowel diaries. The American journal of gastroenterology, 103(3), 692-8.
Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., … Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World journal of gastroenterology, 16(24), 2978-90.
Ghoshal, U. C., Shukla, R., & Ghoshal, U. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and liver, 11(2), 196-208.
Thomson, A. B., Sauve, M. D., Kassam, N., & Kamitakahara, H. (2010). Safety of the long-term use of proton pump inhibitors. World journal of gastroenterology, 16(19), 2323-30.
Treating IBS Course
We can run a course for you covering IBS, the causes and how to relieve the symptoms.
Contact me to get some more information on the courses/ workshops that I can run for you.