Irritable Bowel Syndrome
What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a common digestive complaint, suffered by about 15-20% of the population. Its symptoms include abdominal pain, cramps, bloating, flatulence and diarrhoea or constipation. A trip to the doctor or gastroenterologist is usually unsatisfactory as they can find no obvious cause with their routine clinical testing. It is estimated that 20-50% of people presenting to gastroenterologists suffer from IBS. The symptoms can persist for many years.
IBS can be classified as:
- Diarrhoea-predominant (IBS-D).
- Constipation-predominant (IBS-C).
- Alternating hard/soft stool (IBS-A).
- Post-infectious (IBS-PI). Sometimes an acute episode of IBS develops after an infectious illness characterised by two or more of the following: fever, vomiting, diarrhoea, or positive stool culture.
Symptoms of IBS
- Abdominal pain.
- Cramps in the lower abdomen.
- Diarrhoea and/or constipation.
- Mucus in the stools.
- Feeling that the bowel has not emptied properly after a bowel movement.
- Feeling full more quickly than normal during meals.
- Nausea or even vomiting after a large meal.
- Back pain.
- Frequent urination.
- Low energy, muscular aches and pains.
Triggers for IBS
- Certain foods and drinks affect some individuals. Keep a food diary to identify your own triggers.
Common triggers include:
"gassy" foods like legumes, broccoli and cabbage;
pasteurised dairy products;
sweet and sugary foods;
wheat and other grains;
high-fructose fruits such as pears and apples;
green and black tea;
- Gut infection.
Causes of IBS
- *** Impeded colonic bacteria. Antibiotics are the usual culprit here. A single course of antibiotics can
destroy the hundreds of different bacteria that it took a lifetime to build up. Processed food, excessive hygiene and cleanliness,
a lack of live cultivated foods, not being breast-fed, not having exposure to farm animals and birds as an infant, not having
exposure to healthy soil, compost, raw farm foods etc as an infant (and adult) - these are all contributing factors to having an
insufficient variety of gut bacteria.
A study (1) showed that 78% of people suffering from IBS presented with small intestinal bacterial overgrowth with high levels of harmful bacteria such as streptococcus, e. coli and clostridia. These bacteria caused fermentation in the small intestine which sometimes also led to fructose malabsorption.
There is a correlation between excessive gas in the colon, and the onset of IBS.
- *** Infection with a parasite. A wide variety of worms, bacteria, yeasts and protozoa can cause can cause
IBS-like symptoms. Some specialists say that IBS is commonly caused by infection with hard-to-identify protozoa such as
blastocystis hominis and dientamoeba fragilis.
Blastocystis comprises nine distinct species, living in the gastrointestinal tracts of animals as diverse as humans, farm animals, birds, rodents, reptiles, amphibians, fish, and cockroaches. Previously it was thought that only one strain of blastocystis infected humans, and it was called b. hominis. However, the other strains can also infect humans, and it is possible that people who suffer severe symptoms are infected with one of these other strains. In some less-developed countries such as Indonesia, up to 50% of the population may be infected with b. hominis, though most people show few symptoms. People who are infected as children tend to remain free of symptoms; those who get their initial infection as an adult tend to suffer more symptoms. In developed countries, up to 10% of the population may be infected. Usually infection is by faecal-oral transmission. Poor food preparation hygiene, drinking untreated well, bore or river water, eating unwashed food grown in contaminated soil / manure, and being licked by infected pets and animals are common sources. If your first symptoms arose after a bout of diarrhoea when travelling in a third world country, there is a likelihood of this type of infection. Many pathology labs are unable to identify these protozoa from a stool sample. Specialist pathology labs usually ask for three faeces samples, which must be provided in a container with a fixing medium. The fixing stops the protozoa changing after they are exposed to light and air. Note that the first part of a bowel movement usually shows no infection - the stools from the last part of the movement should be provided for the sample.
Getting rid of these parasites is extremely difficult. Most antibiotics are ineffective, and complex and potent cocktails of antibiotics have a limited rate of success. Regardless of their success, your existing gut flora will be decimated by such strong antibiotics. There is also a high risk that you will be re-infected, especially if you are living and traveling in the same places.
Some health practitioners claim to be able to rid these protozoa with a herbal treatment regime.
I recommend control of these parasites with probiotics, as detailed below. This is, after all, why millions of people in poor countries do not suffer their effects.
- Food intolerance, malabsorption or allergy. Often, food intolerance or malabsorption is caused by compromised gut flora (see above). Common types include gluten, fructose / FODMAPs and dairy. You can get tested for allergy to specific foods. Many intolerances are caused by a lack of the specific bacteria required to digest specific types of foods. A lack of variety in the diet can also cause intolerance. Keep a detailed food diary for a few weeks or months. Record the effects hours and days after eating every type of food.
- Diet. Dead foods - pasteurised, sterile foods. Lack of plant fibre in which bacteria can thrive in the lower colon. A high-sugar or high-grain diet encouraging protozoa such as blastocystis hominis rather than good bacteria. (Sugar and grain diets also encourage yeasts.)
- Bad eating habits. Overeating, eating large meals, insufficient chewing, drinking large quantities with food, drinking iced/cold drinks, eating whilst stressed or in a hurry.
Prevention / remedies / treatment of IBS
- Probiotics. See Cultured foods and other sources of probiotics.
- Fecal transplant (FMT). The introduction of colonic bacteria from a healthy donor.
- Diet - alkaline.
- Diet - gluten-free.
- Diet - low-fructose or low-FODMAP.
- Avoid GM foods.
- Psychological therapies, including meditation, yoga and hypnotherapy.
- Exercise - regular and pleasant.
- People who live the diet and lifestyle in my book Grow Youthful tend to have a good recovery from IBS.
- See details of remedies recommended by Grow Youthful visitors, and their experience with them.
1. Jacqueline S. Barrett, Kim E.K. Canale, Richard B. Gearry, Peter M. Irving, Peter R. Gibson.
Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome.
World Journal of Gastroenterology, 2008 August 28; 14(32): 5020-5024