Introduction
IBS is a digestive condition that leads to a range of symptoms. These symptoms of IBS include bloating, abdominal pain and alterations in bowel patterns. For example, constipation and/or diarrhoea. Many people feel there is no cure for their symptoms.
IBS affects 5-10% of the general population and is more common in women than in men and has a significant impact on the quality of life in its sufferers. [Source: Pubmed]
To address IBS and cure the symptoms associated with IBS, understanding the underlying cause is important.
Research outlines many potential causes of IBS which include:
- Food intolerances
- Imbalances in gut bacteria
- SIBO
- Alterations in the gut-brain axis
- Vitamin deficiencies
- Low-grade inflammation
This offers an understanding of the causes of IBS. It is possible for IBS symptoms to improve significantly or resolve once these underlying factors are addressed. [Source: MDPI]
How is IBS diagnosed?
The criteria used for diagnosing IBS is the Rome IV criteria. This was developed by gastrointestinal disorder experts to offer a strict list of the symptoms that need to be present to provide a diagnosis of IBS.
The Rome IV criteria outline that certain symptoms need to be present for a diagnosis of IBS.
“Recurrent abdominal pain, on average for at least 1 day per week in the past 3 months, associated with two or more of the following: related to defaecation, a change in frequency of stool, a change in stool form; criteria must be fulfilled for the past 3 months, with symptom onset at least 6 months before diagnosis”
In addition to this, other causes of symptoms need to be excluded. This involves further testing into other conditions such as coeliac disease and inflammatory bowel disease. In the absence of these conditions, but in the presence of the symptoms listed above, a diagnosis of IBS will likely be given. [Source: Pubmed]
Once diagnosed IBS can be classified into 1 of 4 categories which are defined by the bowel movements and stool form.
| Type of IBS | Diagnostic Criteria |
| IBS with constipation | ≥25% of bowel movements of Bristol Stool Form types 1 or 2, and <25% of Bristol Stool Form types 6 or 7 |
| IBS with diarrhoea | ≥25% of bowel movements of Bristol Stool Form types 6 or 7, and <25% of Bristol Stool Form types 1 or 2 |
| IBS with mixed stool pattern | ≥25% of bowel movements of Bristol Stool Form types 1 or 2, and ≥25% of bowel movements of Bristol Stool Form types 6 or 7 |
| IBS unclassified | Patients who meet criteria for IBS, but do not fall into one of the other three subgroups according to Bristol Stool Form type |
Source: [Pubmed]
While these symptoms can describe how someone is feeling, resolving these issues by considering and addressing the underlying issue in the gut is important.
Causes of IBS
To cure the symptoms of IBS it’s important to understand the underlying issue (or combination of issues) that is contributing to the symptoms. Instead of seeing IBS as a disease with no cure, it can be seen as a sign of an imbalance or intolerance in the gut. By addressing this underlying issue it’s possible to significantly improve if not totally resolve symptoms of IBS.
There can be several underlying causes of IBS that we need to consider when working to cure the symptoms of IBS.
Post-Infectious IBS
In approximately 10% of those with IBS, it’s reported that symptoms started after a gut infection. This can be in the form of viral gut infections such as norovirus as well as food poisoning. Studies have indicated that the risk of developing IBS was increased by 4 times in the 12 months following an infectious event. [Source: Pubmed]
Following infection, there are changes in the gut that lead to symptoms continuing.
These gut changes include:
- Low-grade inflammation
- Microbiome imbalances
- Intestinal permeability
- Immune changes [Source: Pubmed]
Learn More About Post-Infectious IBS
The Gut Microbiome and IBS
Alterations in the balance of the gut microbiome have been implicated in the development of IBS symptoms. Factors that lead to imbalances in the gut microbiome have been associated with developing IBS.
These include:
- The use of antibiotics [Source: Pubmed]
- The use of proton pump inhibitor (PPI) medication [Source: Pubmed]
- Long-term dietary patterns [Source: Pubmed]
- Stress [Source: Pubmed]
Imbalances in the gut microbiome have been found in studies into IBS. This has found that certain changes in the balance of the gut bacteria are common in those with IBS. These changes include a low level of beneficial bacteria, in particular, Lactobacillus and Bifidobacterium and higher levels of less beneficial organisms such as Enterobacteriaceae and E coli. [Source: Pubmed]
For many, supporting the healthy balance of the gut microbiome is an important area to address for those with IBS. Some studies have reported that SIBO, bacterial overgrowth in the small intestine, is a common underlying cause in many with IBS.
SIBO (Small Intestinal Bacterial Overgrowth)
Several studies have found that an overgrowth of bacteria in the small intestine (SIBO) is present in those with IBS. The number of those with SIBO as the cause of their IBS symptoms may be as high as 78%. [Source: Pubmed]
SIBO is indicated by an increase in bacteria in the small intestine and this can result in many of the IBS symptoms. These include:
- Abdominal pain or discomfort
- Bloating
- Flatulence
- Changes in bowel patterns [Source: Pubmed]
To cure the symptoms of IBS and SIBO considering the factors that increase the risk of SIBO is important to help address these underlying factors.
The small intestine has several mechanisms that need to be taken place for a well-balanced small intestinal gut microbiome.
These factors are:
- Secretion of gastric juice and bile (these have an antibacterial effect to help balance the small intestine)
- Peristaltic movement prevents the adherence of bacteria into the intestinal mucosa.
- A balanced immune response in the gut.
- The production of beneficial and protective mucus inhibiting pathogenic bacteria.
- Gut antibacterial compounds being produced in the gut.
- A functioning ileocecal valve (prevents the backwards movement of bacteria from the colon to the small intestine. [Source: Pubmed]
These are required to be working optimally for the gut to be healthy.
There are also factors outside of the small intestine which can lead or contribute to bacterial overgrowth and the symptoms of IBS.
These outside factors include the use of medications and drugs that either alter stomach acid secretions (PPIs), the microbial balance (antibiotics) or small bowel motility (opioids) [Source: Pubmed]
As SIBO can be the cause of symptoms in many with IBS, understanding the factors that have led to SIBO development is important when working to cure IBS symptoms.
The Low FODMAP Diet for IBS
A low FODMAP diet is a diet that is frequently used for IBS to improve symptoms and quality of life. This diet is based on research into the fact that due to imbalances in the gut, certain foods can increase or trigger IBS symptoms.
The Low FODMAP Diet removes a wide range of foods that contain highly fermentable carbohydrates. These are contained in foods such as beans, lentils, garlic, onion and apples.
Also Read: Low FODMAP Diet – Everything You Need To Know
While these foods are considered healthy if there are imbalances in the gut, these foods can trigger symptoms of IBS.
This is commonly due to alterations in:
- How these foods are absorbed
- How these foods are fermented
- The sensitivity of the gut lining [Source: Pubmed]
This diet was found to be helpful in reducing symptoms of IBS and increasing the quality of life in those with IBS. Some report that this improvement may be seen in up to 86% of those with IBS who follow the Low FODMAP Diet [Source: Pubmed]
The improvement in symptoms was seen at similar levels between the various sub-types of IBS. For example in those with IBS with diarrhoea and those with IBS with constipation. [Source: Pubmed]
While the Low FODMAP diet may improve the symptoms of IBS for many, it is not addressing the reason why these foods are triggering symptoms. It may also have negative effects on the gut if followed long-term.
Without addressing the underlying issue symptoms can often return when the high FODMAP foods are reintroduced into the diet. Therefore, avoiding these foods may help to manage symptoms but does not necessarily offer a cure.
Is the Low FODMAP diet forever?
The Low FODMAP Diet is intended as a short-medium term diet to assess for triggers and manage symptoms. This is an important part of the process to calm IBS. However, it is not intended to be used as a long-term diet as there may be negative aspects to this.
The long-term use of a low FODMAP diet may result in nutritional deficiencies as well as changes to the gut microbiome. Certain changes in the microbial balance appear when following a low FODMAP diet that may have a long term negative effect on the gut. [Source: Pubmed]
Due to the restrictive nature of a low FODMAP diet, concerns have been raised about its use in those with eating disorders. This can lead to increased anxiety around foods, reduced calorie intake and potentially the reluctance to reintroduce high FODMAP foods leading to an increasingly restrictive diet.
While the elimination phase of the Low FODMAP diet (which is then followed by a reintroduction phase) is to be followed for 4-6 weeks, a study found this was followed by many for longer. A 2018 study found that when patients were seen again by the clinician several months after the first consultation (between 2-40 months later) 38-64% of them were still following the Low FODMAP diet for most or all of the time. This was in spite of them being provided with guidance around the reintroduction process. [Source: Pubmed]
While The Low FODMAP diet may reduce symptoms, it does not cure them.
Best supplements to fix IBS?
When addressing the underlying causes of IBS to cure the symptoms there are key tools that can be considered. One group of these are evidence-based supplements with a range of options being considered depending on the approach required.
Several types of gut supplements can be used at the same time or in isolation to address the underlying causes of the IBS symptoms.
The supplement that can be considered for IBS call into 4 categories.
- Probiotics
- Prebiotics
- Herbal medicine
- Postbiotics
The recommendations for gut health supplements can be made based on factors such as the specific symptom someone is experiencing, if there was an event (such as food poisoning) that triggered the onset of the IBS symptoms as well as test results.
Probiotics for IBS
Probiotics have been researched to address IBS and improve the symptoms. Rather than probiotics simply adding more bacteria to the gut, their benefit is understood to stem from their ability to interact with the gut lining.
By doing so, they support factors such as the immune response, and the production of antimicrobial compounds and as well as stimulate the bodies own anti-inflammatory processes.
Probiotics with clear evidence for improving symptoms of IBS include B.coagulans and L.plantarum. [Source: Fronteirs]
Prebiotics
Prebiotics are fermentable fibres that encourage the growth of specific bacteria that are already in the gut. Various types of prebiotics are available which can support specific factors in the gut.
A study using the prebiotic galactooligosaccharide was found to improve a range of IBS symptoms such as:
- Improved stool consistency
- Reduced flatulence
- Reduced bloating
It was also founded to reduce symptoms of anxiety which can often be present along with gut issues.
It was noted that this prebiotic encouraged the growth of bifidobacteria, a key regulator of the gut microbiome. [Source: Pubmed]
Herbs for IBS
Herbal medicines have been studied for their beneficial effect on symptoms of IBS.
Peppermint oil has been found to improve symptoms of IBS, in particular symptoms of abdominal pain. This is understood to be due to its properties such as its anti-inflammatory and antimicrobial effects as well as its ability to reduce visceral hypersensitivity [Source: Pubmed]
Antimicrobial herbs have been shown to improve symptoms of IBS. This is likely due to imbalances in the gut microbiome contributing to symptoms.
Herbs that have been studied and shown benefit in IBS include:
- Oregano oil
- Ginger
- Berberine
- Chinese skullcap
- Sage leaf [Source: Pubmed]
Postbiotics in IBS
Postbiotics are compounds that are produced naturally in the gut as a consequence of beneficial fermentation. They produce an energy source for beneficial bacteria (through a process known as cross-feeding) as well as providing an energy source for the cells along the gut lining.
Butyric acid is a postbiotic that provides up to 70-80% of the energy requirements for the cells along the digestive tract. This means it serves a role in helping cells regenerate to keep the gut lining healthy as well as reducing inflammation.
It has also been shown to improve the balance of the gut microbiome to improve symptoms and quality of life in those with IBS.
Conclusion
Rather than seeing IBS as a disease that needs a cure we encourage our patients to see it from another angle.
IBS is a sign that there is an imbalance or intolerance in the gut. So in order to cure IBS, we don’t want to suppress the symptoms but to identify and address the underlying issue in the gut. In many cases, this can involve a combination of dietary approaches, supplements and lifestyle modifications.
If this underlying issue is addressed then it is possible to live a life free of IBS symptoms.
