Irritable Bowel Syndrome: Natural approaches to treatment

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Irritable bowel syndrome, or IBS, is a common disease. Some papers have cited a whopping 20% of the population has IBS (1). While we still don’t know the cause of IBS we are learning more and more about every year. Recently a paper was published looking into these different aspects, or underlying factors, that may be contributing to or cause irritable bowel syndrome. Today we will review the findings and discuss them in the hope that it sheds some light for anyone struggling with IBS symptoms. 

But first let’s cover the basics. If you’ve been following along then you’ll know that IBS is a diagnosis of exclusion. This sounds more complicated than it actually is. Basically what this means is that you must first rule out all other factors that could be causing your symptoms. Many times doctors seem to jump straight to an IBS diagnosis without proper screening. We can’t be too hard on them, they are overworked and not given enough time to properly evaluate a patient. It’s a broken system.

This is why it is important to understand the possible alternative to your IBS diagnosis as it will help direct your approach to healing.

So let’s cover them, in no particular order.

  • Food sensitivities and allergies – These may include but aren’t limited to dairy, gluten and fructose. You may have an egg allergy or even a potato intolerance.
  • Intestinal parasites – Much has been written in the scientific literature between IBS symptoms and parasites. Things to screen for would include Blastocystis sp, Giardia duodenalis, Entamoeba histolytica, Helicobacter pylori and a number of other parasite infections
  • Inflammatory bowel disease – As we will cover later there seems to be an overlapping of underlying processes occurring here, predominantly inflammation and altered transit time. IBD also includes an immune dysregulation component involving autoimmune processes and a loss of self-tolerance to the gut flora.
  • SIBO – as mentioned in this article small intestinal bowel overgrowth can and does overlap with IBS. Be sure to rule out SIBO before settling on your IBS diagnosis.

New Perspectives on IBS

Now let’s move onto the more recent findings that may underpin irritable bowel syndrome. The two factors discussed in an article published in World Journal of Gastroenterology include low-grade inflammation and intestinal permeability. Lets cover them in more depth.

Number one is Inflammation

It has been argued that inflammation is at the root of all chronic disease so it should be no surprise that we are finding it in our investigations into IBS. One review summarised the findings of inflammation in irritable bowel syndrome notings inflammatory cells, mainly mast cells, in the end of the small intestine and the colon. This may help explain the dysmotility as well as the visceral hypersensitivity, or pain, found in IBS.

They list a few underlying causes that may be contributing to the low-grade inflammation. Some of them match the list above and some are new. They include:

  • Previous infections (infectious enteritis)
  • Genetic factors
  • Food allergies
  • Changes to the intestinal microflora

The post-infective IBS model is interesting with IBS occurring in people that had been infected with certain bacteria like Salmonella, Shigella, and Campylobacter.

If, as it appears, low-grade inflammation is an underlying process occurring in IBS we can then turn our attention to anti-inflammatory interventions. The same review notes a number of different pharmaceutical drugs like corticosteroids to help to address the inflammation. They also consider antibiotics and mast-cell stabilisers. I think there are more gentle options for treating inflammation.

Number two is Intestinal Permeability

We have been exploring the link between intestinal permeability or leaky gut and a range of chronic diseases for awhile now. While there is still conflicting results and we can’t generalise that all IBS cases have increased intestinal permeability (4) there have been a range of studies referenced here that show an increase in intestinal permeability in a number of IBS cases. There may be a certain subset that has elevated levels of permeability. They are still working on that one.

It is important to note the interplay between inflammation and intestinal permeability. Inflammation has been shown to increase intestinal permeability (5) which then goes on to stimulate and maintain the pro-inflammatory state that lead to increased permeability in the first place (6).  

The review covers a range of different interventions that have been assessed for leaky gut and IBS including glutamine, probiotics and pharmaceuticals.

Glutamine and Intestinal Permeability

As I’ve written about before the results are mixed with glutamine’s ability to heal and seal the gut. Some have found success others have not. Further studies are needed to really nail this one down.

Probiotics in IBS

Probiotics have been assessed as an intervention for IBS many times. So many times that there are a handful of systematic reviews, each with a with meta-analysis, the top level science we have.

Now here is the rub. Each one of these systemic reviews compiled all of the probiotic trials in IBS that met their criteria. This type of information gathering and assessing works when you are looking at one particular intervention.  Homogeneity is the term they use here. Probiotics on a whole are extremely wide and varied. We have our Bifidobacteria, Lactobacilli, our soil based organisms some yeasts like Saccharomyces cerevisiae variety boulardii, even the beneficial Escherichia coli Nissle 1917. One excellent researcher and a wealth of knowledge on the subject Jason Hawrelak has been writing out the differences between different probiotics and even the strains within the same species for some time now.

‘As mentioned in my previous article, strains of bacteria can be likened to different breeds of dogs. All dogs belong to a single species ie Canis familiaris. Within this one species there is great diversity in size, shape, strength and other physical characteristics — ranging from the German Shepherd to the chihuahua. A similar division occurs within species of bacteria’
Jason Hawrelak from Probiotics: Choosing The Right One For Your Needs

The point being made here is that if you take all the trials assessing different probiotics in the treatment of IBS you are going to get a whole range of different results. Concluding that probiotics aren’t suitable for use in IBS is misleading. Thankfully the paper we are reviewing today does mention this.

‘…the heterogeneity of the studies of probiotics in IBS impairs the value of meta-analyses. The use of different bacterial strains and different mixtures of these strains, as well as different dosages, may be the main factors contributing to this heterogeneity’

Wrapping It All Up

We have noted a few newer findings in irritable bowel syndrome. Low-grade inflammation has been observed in a number of different studies and points to an underlying process that may be increasing intestinal permeability or leaky gut. This in turn goes on to feed the inflammation. First it is important to rule out any underlying issues including food intolerances, infections and SIBO. Working with your health care provider to minimise inflammation and decreasing intestinal permeability may help to resolve your irritable bowel symptoms. 

Now I want to hear from you. Have you had any success in treating your IBS symptoms? Share your insights below.

References and Resources

  1. Review article: irritable bowel syndrome
  2. New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond
  3.  A role for inflammation in irritable bowel syndrome?
  4. Intestinal permeability and irritable bowel syndrome.
  6. Intestinal mucosal barrier function in health and disease
  7. Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials
  8. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome.
  9. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review.
  10. Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?
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