Ever since your doctor told you that your embarrassing symptoms are down to irritable bowel syndrome (IBS) your frustration has only got worse. You’ve missed parties and outings because you’ve been stuck in the bathroom. You feel bloated after a few bites of a delicious meal. All the medications you’ve tried have nasty side effects – and often they don’t even work! Your friend cured her IBS by eating yogurt – but it makes your own symptoms worse.
What if I told you that irritable bowel syndrome is made up? No, I’m not saying IBS is all in the mind: your symptoms and pain are all too real. But recent thinking and research shows us that IBS may be a catch-all diagnosis, gathering together many symptoms, caused by various root issues, that may differ from patient to patient. So if the medications your doctor prescribed for IBS aren’t working – and neither is your friend’s special probiotic yoghurt – you’re not alone. But how can you identify the culprit behind your IBS?
The Wide-Ranging Symptoms of IBS
IBS is a chronic condition that has a huge impact, on both your health, and the way you live your life. In theory, your doctor should use the Rome IV criteria to make a irritable bowel syndrome diagnosis, but most of the time in practice IBS is a diagnosis by exclusion. Diagnosis by exclusion means that when other illnesses and conditions are ruled out through tests, your symptoms are surmised to be IBS. But IBS symptoms are pretty wide-ranging!
Symptoms of irritable bowel disease include:
- Abdominal pain or cramping
- Mucus in stool
What I find interesting is the inclusion of both diarrhoea and constipation as symptoms – and sometimes a combination of the two. For diagnosis, the Bristol Stool Chart is often used to diagnose a specific subtype of IBS – with constipation, diarrhoea, or mixed IBS. But this is not an exact science – there are no biomarkers to test for IBS. And unfortunately the treatments available rarely work well enough.
Could the medical community be treating these symptoms in the wrong way?
IBS as an Umbrella Diagnosis
A recent paper by Benjamin Brown ND explores the diagnosis and treatment of IBS. Titled “Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not” – the review identifies the drawbacks in current treatments for IBS – and how a functional medicine perspective may help patients tackle the underlying issues.
The paper makes for interesting reading. With the controversy over how IBS is diagnosed, and the lack of exact biomarkers for easy diagnosis, IBS can be considered an “umbrella diagnosis” – where the underlying causes of certain symptoms are covered by the one classification.
An IBS umbrella diagnosis is flawed because symptoms can have many different causes within the body. No two people have the exact same biochemistry and gut health – and a treatment that may work for your friend may have no positive effect for you! A diagnosis of irritable bowel syndrome may also limit what you feel you can do to help yourself.
Studies show that focused identification of the underlying reasons for IBS ensures better treatment:
- One study found that 98% of patients previously diagnosed with IBS with diarrhoea had an alternative underlying reason for their symptoms.
- Another study focused on stool samples found that 94% of patients previously diagnosed with IBS had test results indicating an underlying diagnosis or underlying issue.
But how easy is it to figure out the root cause of your IBS?
Possible Underlying Causes of IBS Symptoms
Brown’s IBS paper investigates the underlying mechanisms of irritable bowel syndrome – and the list is pretty extensive. Once conditions such as inflammatory bowel disease (IBD) and celiac disease are ruled out, there are a number of potential reasons for your IBS symptoms.
- Disordered circadian rhythm – your circadian rhythm governs when you’re ready to go to sleep – and when you naturally wake up. Circadian disruption can result in symptoms of diarrhoea or constipation as it interferes with the natural rhythm of your gut – and can contribute to other issues such as leaky gut.
- Stress – your brain and gut are connected, but when you’re under stress it can affect your gut-brain axis – which can have an impact on your gut microbiome and movement, and cause you pain.
- Lack of exercise – if you have chronic constipation as part of your symptoms it’s likely you’ve heard the advice to be active. Yes, exercise can help bowel movements along, and reduce trapped wind and bloating.
- Pancreas not creating enough enzymes for digestion – If you’re unable to digest food properly in your stomach, it may cause food sensitivity in the gut, and diarrhoea after a meal.
- Low-level inflammation – Not to be confused with the high-level inflammation that is the source of IBD, low level inflammation in the gut can contribute to leaky gut and oversensitivity of the nervous system, causing food intolerance.
- Leaky gut – Otherwise known as intestinal permeability, leaky gut can lead to increased pain and discomfort.
- Bile acid malabsorption – When your stools contain too much bile, it can trigger leaky gut and diarrhoea.
- Long term constipation – Constipation can mimic IBS symptoms and share underlying mechanisms. Fecal retention, where bowel movements are incomplete, can often result in bouts of diarrhoea, contributing to classic IBS symptoms.
- Disrupted gut microbiome function – Changes in your gut microbiome can contribute to leaky gut and cause issues with the gut-brain axis.
- Small intestine bacterial overgrowth (SIBO) – When bad bacteria move from the large intestine up to the small intestine they cause discomfort and bloating through processing carbohydrates into gas.
- Parasite infection – Untreated parasites in your gut can disrupt your gut microbiome, cause an immune inflammatory response, and wear away at your gut wall, causing leaky gut.
- Gluten sensitivity – Non-celiac gluten sensitivity can cause damage to the gut wall, leaky gut, and trigger your immune system.
- Intolerance to certain carbohydrates – Fermentable carbohydrates may cause increased gas and bloating, while increasing the amount of water in your colon to excess – causing diarrhoea.
- Lactose intolerance – This food sensitivity can cause the same results as intolerance to fermentable carbohydrates, and diarrhoea is often a strong symptom.
- Food hypersensitivity – When your immune system is triggered by certain foods in the gut, it can cause several symptoms of irritable bowel syndrome.
- Vitamin D deficiency – A lack of vitamin D can have a hand in inflammation in the gut, changes in your gut microbiome, and can be one of the triggers between leaky gut.
What a wide-ranging and interconnected list! Suffice to say, with one or more of these mechanisms contributing to your symptoms, it’s unsurprising that conventional IBS treatments don’t always work!
The review paper underlines my general philosophy: your body doesn’t do anything for no reason! And just because you have a diagnosis doesn’t mean the thinking stops there – it should be where it starts. But even if the acute care model of medicine doesn’t have a drug or a surgery to cure you, this doesn’t mean you can’t be better or healthier than you are.
Functional Medicine for IBS
In order to reduce your IBS symptoms, you need to figure out the underlying mechanism. Functional medicine is an approach that allows us to look for the root cause. Clinical tests aren’t judged on an acceptable or unacceptable range – and all your test results are accessed together, not as singular figures on a chart. Your test results, health timeline, and individual symptoms reflect that you are an individual, deserving an individualised plan of treatment.
If you’re feeling intimidated by the list of possible reasons for your IBS – don’t be. My signature course, Foundations of Health guides you through the steps you need to take to improve your health from the foundations up – not just focusing on your diet and the health of your gut, but also on removing toxins from your lifestyle, improving your sleep, reducing stress, and focusing on self-care. The course is made up of private consultations and classes that you can attend from the comfort of your own home. Sick of the embarrassing and painful symptoms of IBS, and feel like you’ve tried all the medications and therapies? Now it’s time to take your health into your own hands by clicking here.