IBS is defined as ‘a very common syndrome of abdominal pain and disordered bowel habit for which there is no organic explanation’ – meaning there is no underlying unifying theory of its causation. IBS symptoms include abdominal pain and spasms, bloating, gas, and diarrhoea alternating with constipation. Bowel movements usually relieve discomfort. The condition affects 15-20% of the population in industrialised nations, providing between 25-50% of patient referrals to hospital gastroenterology.
The descriptors of IBS indicate that it is a disorder of motility (throughput) and/or inflammation. It is commonly associated with anxious/depressed personality, food intolerance (such as lactose or gluten) and acute gastrointestinal infection, and it can be triggered by antibiotics. Key factors are likely to be bacterial imbalance or overgrowth, stress, gut motility, digestion and absorption of foods.
Structural considerations
The cells of the digestive tract are replaced every 24-48 hours. Several different layers lubricate, protect, secrete enzymes and hormones, and facilitate absorption, and house immune system cells, glands, blood vessels, lymph vessels and nerves, plus muscle to enable food transit, and tissue securing the gut to the peritoneum.
Neurological considerations
Little research has been done on the interaction between the local (enteric) nervous system in the gut, and the systemic (body-wide) sympathetic/parasympathetic nervous system acting on the gut through the vagus nerve – but it is known that dominance of any one of these can result in digestive disturbance. The enteric nervous system makes use of many neurotransmitters such as dopamine and serotonin3, with serotonin levels impacting both food transit muscle action (peristalsis) and secretions: it is increasingly believed to be capable of altering mood via the central nervous system.
Immunological considerations
Up to 70% of the body’s immune system is located in the gut mucosa (inner lining). Secretions here neutralise microbes and food antigens, and it houses the lymphocytes and plasma cells. Gut flora help to activate these immune cells whilst inhibiting overstimulation. If the immune system is reacting strongly and producing antibodies to normal dietary antigens the gut microflora can balance that immune response.
Digestive considerations
Starch breakdown and neutralisation of bacteria begins with the enzyme amylase and other substances in the saliva. Food is then sterilised and protein broken down by hydrochloric acid and pepsin in the stomach. Bile and pancreatic juices to digest the food are added into the duodenum where most nutrient absorption takes place. Final stage protein digesting enzymes (maltase, sucrase and lactase) live in the lining of the small intestine (ileum) and are critically important as any undigested proteins (e.g. in coeliac disease) can cause severe diarrhoea. Water is absorbed in the large intestine (colon), where multiple bacteria, including the most prevalent E. coli, feed on the indigestible fibre waste.
Microbiological considerations
Bacteria contribute to digestion, immune support and overall cellular health in the digestive tract. This gut flora is regulated by diet, gut motility, genetic characteristics, acid-alkaline gut environment and fermentation products of the bacterial species present. Alterations in bacterial colonisation and activities can have profound effects on the gut mucosa and the immune response.
Options for treatment of IBS
For digestion to function optimally the structural, neurological, immunological, digestive and microbiological factors above all need to be in good working order.
- Probiotics – L. acidophilus, B. bifidum, B. infantis
It is clear that dysbiosis plays a part in IBS, and recent clinical trials of increasingly specific targeted probiotics with higher dosages and longer duration have shown promising results.
2. Digestive enzymes
Chronic poor digestion and fermentation of food in the gut have been implicated in IBS, for example in coeliac disease the enzymes that break down specific food molecules are absent. Supplementation with enzymes, particularly those that break down disaccharide sugars or proteins may be helpful, especially in cases of food intolerance.
3. Nervous system support
Assessments of IBS sufferers have shown them to have higher anxiety levels and a greater feeling of depression. In addition overall stress levels may be high where there is a general imbalance between parasympathetic and sympathetic nervous systems, resulting in muscle signalling disruption. Peppermint, fennel, cardamon and chamomile can help relieve colonic muscle spasms, gas, cramp, and regulate gut muscle contractions. Ginger aids digestion and improves gut motility, while a diet high in sugar has the reverse effect. Yoga, meditation, mindfulness, nature, fresh air and sunshine, exercise, joy and a natural wholefood diet can all help to calm anxiety.
4. Food allergies and intolerances
The connection between IBS and food allergies has been well established. Approximately two thirds of IBS patients have at least one food intolerance, and some have multiple intolerances. In one study 40-44% of IBS cases were intolerant of dairy and 40-60% intolerant of grains. Only prostaglandin mediated (IgG) response testing, not often carried out by the NHS, will reliably pick up these intolerances. Many patients have noted marked clinical improvement when using elimination diets. Supportive gut-healing supplements include N-acetyl glucosamine, glutamine, vitamin A, zinc and butyric acid.
Extracted with thanks from a professional update by BioCare, one of our favourite suppliers
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