Irritable bowel syndrome and other functional bowel disorders

Those of you who have heard the term I.B.S. are probably well aware of what it is and how it can negatively impact quality of life.  For those of you who haven’t- I.B.S. stands for Irritable Bowel Syndrome. This means, from a clinical diagnostic approach, that a person has symptoms at least once a week associated with having a bowel movement (pain, bloating, gas, cramps, fatigue, etc) and has some change in bowel frequency and/or form (diarrhea, constipation, or both).  In plain English we could call IBS, “ApGI” or Angry/painful Gut Issues.

An interesting thing about IBS is that it is an official diagnosis. Often, people will go to their doctor with bowel complaints and leave with a diagnosis of IBS but no further workup or treatment.  When we think about a diagnosis we think about having answers and a treatment, right? Here’s the deal though, if we don’t know what’s actually causing the problem, how can we fix it?  For example: you go to the doctor with a sore throat, you are diagnosed with strep throat, you are treated with an antibacterial medicine to kill the strep and your sore throat goes away.  Say in a different scenario you step on a tack which gets stuck in your foot, you go to the doctor and are diagnosed with red painful foot syndrome and sent home.  Do you feel better?  Probably not.  In fact, you probably will not feel any improvement at all until you remove the tack and treat the wound.   IBS is a little bit like that.  And 10-20% of the population suffers from it!

So, what causes IBS and why is it not diagnosed as such?

IBS is different than Inflammatory bowel diseases like Ulcerative Colitis (U.C.), Crohn’s, Celiac disease and cancer in that there are no structural changes.  In all of the others, there is something that can be seen- ulcers, inflammation, growths, etc.  With IBS, often everything looks just fine.  So, often it’s something with the function that is not fine.  This is harder, especially from a conventional approach, to diagnose.  And there are a lot of potential causes.

Could it be your food? 

Absolutely.  It could be as simple as poor food choices.  Studies have shown that ~6-12 hours after eating fast food there is a marked decline in the good bacteria who live in and support the gut.  Or, it could be that your body has an allergy or sensitivity to certain foods. Allergies can be potentially life-threatening whereas sensitivities are not, but they are quality of life threatening.  These occur when the immune system gets confused and starts attacking food. 

Could it be your microbiome?  Also, what is a microbiome? 

Your gastrointestinal tract is full of bacteria.  In fact, you have ~10 times more bacteria living in your gut than you have cells in your entire body. This community of bacteria (mostly good) and some yeast is called your microbiome.  You get this from your mom as soon as you pass through the vaginal canal during the birthing process (ideally) and continue to build on it throughout life.  The foods you eat, the meds you take, the stress you experience, and other life exposures to animals, people and cultures all shape your microbiome.  Generally, the more you have and the more diverse the community is, the better.  Problems occur when this ecosystem is thrown off and the community becomes smaller, less diverse, overgrown by more yeast than bacteria, infiltrated by bad bacteria or the bacteria move to a place they shouldn’t be. There are times when good bacteria, who should be happily living in the large intestine travel North to the small intestine.  When this happens, they are doing just what they should be doing but in the wrong place.  If this happens, it’s called Small Intestinal Bacterial Overgrowth (SIBO).

What if it’s not your food and it’s not your microbiome? There are still lots of things it could be.  Maybe the stress you have in your life has signaled your digestive system to slow down.  If there is a fight or flight stress looming, the last thing you need is to go sit on the toilet. Maybe it’s a lack of digestive enzymes which can be the result of many things. Maybe it’s an inflammatory process targeted at the gut. Or maybe it’s one of the numerous other potential causes. 

Is there any good news here?  Yes, once the cause has been identified, it can be treated!  And once the cause has been treated, the symptoms go away.  Sort of like with red painful foot syndrome, once the tack is removed the healing begins.

 

- Dr. Laing 

Abby Laing