IBS: achieving digestive comfort by addressing root causes

IBS symptoms

Wondering what irritable bowel syndrome is, or what the symptoms of IBS are? The diagnosis of IBS is given to those with 2 or more of the below symptoms persisting over 3 months or more:

• Bloating, cramping
• Diarrhoea, or loose stools
• Urgency
• Constipation, or dry, irregular bowel movement
• Reflux
• Fluctuating diarrhoea and constipation
• Pain on defecation
• Visceral pain/hypersensitivity to abdominal areas
• Migraines or headaches can sometimes accompany other symptoms

‍‍‍How is IBS diagnosed?

The symptoms identified come from a list titled the Rome IV criteria. They are:

Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria*:

• Related to defecation
• Associated with a change in the frequency of stool
• Associated with a change in form (appearance) of stool

*fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Often when a patient is assessed for IBS, the practitioner may also consider inflammatory bowel diseases (IBD) Crohn’s disease and Ulcerative Colitis. Irritable bowel syndrome symptoms differ from IBD, which are characterised by chronic inflammation throughout the digestive tract and are generally diagnosed by endoscopy, colonoscopy or sigmoidoscopy. IBS is often diagnosed when other conditions such as IBD have been ruled out.

What are the different types of IBS?

IBS is broken into 5 major subtypes:

• IBS-C – characterised by constipation
• IBS-D – characterised by diarrhoea
• IBS-M – characterised by fluctuations of diarrhoea and constipation
• IBS-U – refers to unspecified or undetermined – generally applied when symptoms don’t fit the other subtypes
• Post-infectious IBS – which often occurs after an infection, or following antibiotic treatment

What causes IBS?

The exact cause of IBS is unknown, however, it is believed to be related to a combination of factors, including gut-brain communication issues, stress, diet and more recently gut microbiota imbalances.

More research will help illuminate all of the precise irritable bowel syndrome causes, however so far, research has identified that a disturbed microbial make-up, or dysbiosis of the microbiome, can be a feature of IBS. Chronic stress, anxiety or mood disorders are known to alter digestive function, which can disrupt the pH of the microbiome, affect the function of bile acids and compromise fat and carbohydrate absorption. These changes can alter species of bacteria in the small and large intestines, the numbers of microbiota and the diversity. The resulting reduction of short-chain fatty acid producing bacteria such as Roseburia and Eubacterium rectale can have an impact on the inflammation of the colon, and contribute further to the severity of symptoms of irritable bowel syndrome.

Alongside strong connections to stress and anxiety, other physiological causes include pathogenic parasites, disorders of gut-brain interactions (DGBI), low stomach acid SIBO (small intestinal bacterial overgrowth) and intestinal hyperpermeability (AKA leaky gut).

Food sensitivities or intolerances such as FODMAPs can cause or exacerbate symptoms, and in some cases, intestinal permeability can create further intolerances to foods that were not previously known as triggers. This can create a confusing cycle of symptoms and a growing accumulation of intolerance to foods that were previously well tolerated.

Other contributing factors to IBS

Allergic reactions and poor clearance of histamine can trigger an immune response that can further exacerbate or trigger symptoms. In perimenopause and menopause, the reduction in the protective effects of oestrogen and progesterone can prevent the effective clearance of histamine produced by mast cells in response to an allergen. This can in turn create more food and environmental allergies (pollen, dust, animal dander etc.) which can trigger or exacerbate IBS symptoms.

SIBO or small intestinal bacterial overgrowth is also commonly found with IBS, where some microbiota species such as Enterococcus, E. coli, and Klebsiella which are usually found in the large intestine, have migrated to occupy the small intestines. As a consequence, both IBS and SIBO can share a myriad of symptoms such as abdominal pain, bloating distention and diarrhoea.

Other risk factors of IBS include:

• A genetic predisposition
• A suboptimal diet
• Lifestyle behaviours (overuse of recreational substances, lack of exercise)
• Use of antibiotics
• Stress or trauma
• Anxiety or depression

IBS treatment – conventional treatments

Once diagnosed, the conventional approach to IBS involves dietary modifications such as the FODMAP diet, counselling to help reduce the effect of stress on the gut-brain connection, and pharmaceutical treatments for the suppression of symptoms. Drug therapies can include antispasmodic, antidiarrhoeal or laxative treatments that may have undesirable side effects such as mineral deficiencies or, in severe cases rendering the colon incapable of peristalsis. More recently, IBS treatments including psychological therapies such as CBT (Cognitive Behavioural Therapy) are becoming popular to improve stress-related IBS symptoms.

IBS symptoms can become worse over time if not treated effectively, and avoidance of some food/nutrient groups can lead to malnutrition if the person is not under the supervision of a nutrition expert. Haemorrhoids and anal fissures can also occur if IBS is left untreated.

Many people find their IBS symptoms don’t subside with these approaches, partly because the broader range of underlying factors aren’t widely understood in the conventional medicine space. Thankfully, IBS functional medicine natural treatment has been shown to have greater symptom management and higher quality of life outcomes for IBS patients.

IBS functional medicine testing considerations

Functional testing can provide insight into the causes or contributing factors of IBS, and along with a detailed case history, can deliver a more targeted, effective approach to solving your digestive concerns. Our functional medicine practitioners will analyse your test results to determine factors contributing to IBS.

Testing may include;

• Nutritional sufficiency
• SIBO
• Testing for pathogenic microbes  such as E. coli, Giardia, Salmonella, or Shigella
• Food sensitivities or food intolerances
• Microbiome health and diversity
• Mould & mycotoxins
• Organic acid testing
• Standard blood chemistry from your GP

IBS treatment – the functional medicine approach

At Melbourne Functional Medicine, we seek to establish the root cause, or causes, of IBS, and focus treatment strategies on resolving these underlying issues.

Via thorough investigation, our IBS specialists will consider:

• your personal health history
• history of antibiotic use
• your family health history & genetic predispositions
• diagnostic test results (with a functional medicine view)
• current and historical medications
• other conditions
• and, your symptom picture

We’ll walk you through our holistic understanding of your particular case, explaining the factors we’ve identified as contributing to your IBS using the most up-to-date scientific insights.

Your IBS treatment may include a range of science-backed strategies depending on the factors influencing your condition to ensure your success. They may include:

• Improving stress resilience with strategies, such as mindfulness or meditation practices, breathwork or Shinrin-yoku (forest bathing)
• Specific dietary or nutritional changes to eliminate aggravating foods i.e. low histamine, low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, gluten-free, while adding in nourishing foods, specific to your case, such as the Mediterranean diet
• Precision antimicrobials, prebiotics, and probiotics, specifically targeted to your symptom picture
• Vitamins, amino acids and mineral supplements to ensure necessary cofactors for healing

One of our Melbourne IBS specialists, Mark Payne says “The gut is the seat of all health”, and helping to restore digestive function can provide relief for symptoms that may seem unrelated such as mood disorders, depression and anxiety, pain, skin conditions and more.

At Melbourne Functional Medicine, we pride ourselves on innovative delivery and clinical excellence, designed to empower and educate you to restore your health. In addition to working with a functional medicine practitioner, you’ll also have the ongoing support of a health coach. Your health coach will help you implement your personalised treatment plan, and provide you with the encouragement and support you need to be well again.

We’ve helped people just like you to be well, and symptom-free. Have a look at our patient success stories.

See how our approach helps our patients achieve better health and richer lives.

This case study follows Lola’s journey through the healthcare program. Her aim was to regain control of her persistent skin conditions, hormonal imbalances, and gut health issues that had been impacting her daily life.

‍

Ready for a personalised, natural functional medicine treatment?

Our unique model of care was designed with you in mind. Find out how, then book a call today