With March, and Colon Cancer Awareness month behind us, the focus in April is on irritable bowel syndrome or IBS.
The International Foundation for Functional Gastrointestinal Disorders designated April as IBS Awareness Month in 1997 to bring attention to this very common, yet overlooked disorder.
IBS is estimated to affect 10% to 15% of the population yet many people remain undiagnosed and unaware that their symptoms indicate a medically recognized disorder. Only 40% of those with IBS seek medical attention.
Canadians are particularly at risk.
We’re not sure why but the percentage of Canadians affected by IBS is a little higher than the world average.
Some 13-20% (or about 6 million on average) are affected at any given time and the lifetime risk for a Canadian to develop IBS is a staggering 30%.
This vitamin D nerd knows that vitamin D status is involved in gut health and is a risk factor for many digestive-related disorders AND as a northern country. Canadians have limited opportunities to make vitamin D from the sun which, for sure plays a role in higher rates of IBS in the True North.
What is IBS?
Changes in bowel habits may include symptoms related predominantly to either diarrhea or constipation, but may also include a mixed sensation that alternates between diarrhea and constipation (2).
IBS is unlikely to increase the risk for the development of cancer or inflammatory bowel disease (3).
What causes IBS?
The exact cause of IBS is unknown but there are many associated conditions and risk factors for it including:
- Prior intestinal infections including food poisoning [food borne illness] & small intestinal bacterial overgrowth or SIBO
- Traveller’s diarrhea
- Gastrointestinal surgeries
- Changes in diet
- Antibiotic use and other over-the-counter medications
- Intestinal bacterial, hormonal & neurotransmitter imbalances
One or more of these risk factors can negatively impact gut function and lead to:
- Gut dysmotility (changes in intestinal contractions/peristalsis)
- Gut hyper-sensitivity (heightened sensitivity & pain)
- Gut-brain dysfunction (disruption in the normal cooperativeness between the gut and the brain, each affecting the other, a.k.a. ‘gut-brain axis’)
- Gut barrier dysfunction (a.k.a. ‘leaky gut”)
The symptoms people living with IBS experience vary from person to person but may include any of the following; highlighted in orange are most common:
- Gas, bloating, cramps, abdominal pain related to bowel movements
- Irregular bowel patterns
- Diarrhea or constipation or alternating between both
- Mucus present around or within the stools
- Heartburn, nausea
How do I know if I have IBS?
Contrary to what many people think, IBS is not simply a ‘catch all’ diagnosis for symptoms other than those caused by inflammatory bowel disease – IBD (Crohn’s or ulcerative colitis), intestinal cancers or celiac disease after they’ve been ruled out. Unfortunately there is no blood test, X-ray or other imaging, or scope to diagnose IBS given that it’s a functional disorder but a set of specific criteria, known as the Rome IV criteria, has been developed to help diagnose IBS:
- 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 frequency of stool
- Associated with a change in form (appearance) of stool.
Types of IBS
There are four subtypes of IBS. Each subtype relates to the type of bowel movement most often experienced (4):
- IBS-D: Diarrhea-predominant
- IBS-C: Constipation-predominant
- IBS-M: Alternating between diarrhea and constipation
- IBS-U: Unspecified, for people who do not fit into one of the above categories
Another subtype, known as “post-infectious” IBS has also been suggested for people who develop the disease following a gastrointestinal infection. This subtype may apply to as many as 25% of people with IBS (5).
How is IBS managed?
We’ve come along way in the management of IBS.
I’ve been practicing long enough to remember that all we offered patients was “work on stress reduction, eat more fiber, watch your intake of caffeine/chocolate and fried/fatty foods”. Wow, how things have changed – for the better.
The gastrointestinal tract is a VERY complex system.
It is not simply an organ of elimination. It has muscles, tons of neurons, a living ecosystem inhabited by trillions of microorganisms (microbiota), is influenced by hormones and neurotransmitters and it takes a lot of abuse.
Everything we eat, drink and ingest passes over the surface of it from tip to tail; it is very susceptible to damage & irritation, and is exposed to nearly countless ingested microorganisms, pathogens and tons of food-related antigens (proteins that the immune system has to deal with).
There are also plenty of medications that negatively impact both the lining of the gastrointestinal tract and its function too.
Strategies to help IBS
Management is best achieved by working with a team of practitioners including a nutrition professional with a focus on integrative & functional nutrition to go beyond just identifying food triggers. A comprehensive management approach will include much of the following:
Bowel habits & routine, stress level, sleep duration and sleep quality, activity and leisure
Food triggers, intolerance & sensitivities, fiber, supplement use and recommendations
Low FODMAP diet, Specific Carbohydrate Diet (SCD), Small Intestinal Bacterial Overgrowth (SIBO) assessment and treatment
Indication for probiotics, review of food preparation, alcohol use, caffeine, certain food additives and more
Stress reduction, psycho-social counselling, pelvic physiotherapy
Antispasmodics, antidepressants, anti-diarrheal, pain management, prosecretory, antiflatulents, and anti-microbials
Do probiotics help with IBS?
A lot of research has investigated how probiotics might be used to treat and manage IBS.
IBS symptoms have been linked to certain changes in the gut flora.
Also, up to 80% of IBS patients experience SIBO which can lead to many of their symptoms (6).
Probiotics may improve symptoms by (10):
- Inhibiting the growth of disease-causing bacteria
- Enhancing the immune system’s barrier functions
- Helping fight inflammation
- Slowing down bowel movements
- Reducing gas production by balancing the gut flora
- Reducing the gut’s sensitivity to gas buildup
However, not all probiotics are alike. In fact, the term “probiotic” is covers many different strains and types of bacteria and yeasts. Probiotics are categorized by their genus, species and strain. It is at the strain level where probiotics have their health effects depending on the type.
Best probiotic for IBS
Different strains of probiotics have been studied in IBS. While not an inclusive list, the best research supports the following:
- Digestive Care Daily Probiotic
- Genestra Brand
- HMF Forte
- IBS Relief
- Ultra Probiotic Care by GNC
- Ultra Flora Intensive Care
IBS is a chronic condition but successful management of it is possible, it’s not something you ‘just have to live with’.
Treatment is highly individualized, there’s no one-size-fits all.
Many find significant relief of symptoms with huge improvements in their quality of life. Others will continue to experience some symptoms to varying degrees but the good news is that symptoms typically do not get worse.
With successful treatment, up to one-third (33%) of patients become symptom-free.