Irritable Bowel Syndrome (IBS) is a condition which involves a wide variety of symptoms such as abdominal pain, diarrhea, constipation, gases, bloating, feeling of fullness, etc.
Diagnosis is normally given when at least three of these symptoms are present for three days per month during three months. Yes, lots of threes there!
Depending on the predominance of symptoms, one can find IBS-Constipation, IBS-Alternating Symptoms and IBS-Diarrhea. It should be noted that IBS-D can either happen after an infection or for other unknown reasons.
IBS prevalence in different regions.
IBS diagnosis does not refer to a particular disease, but rather to a series of symptoms which vary greatly from patient to patient. It is one of those imprecise diagnosis, together with fibromyalgia or chronic fatigue syndrome. This condition too often masks an underlying disease that hasn’t been well researched.
Therefore, is seems logical that an IBS diagnosis must have first gone through the some steps in order to rule out the following:
- Celiac disease: small intestine biopsy, genetic study and serum antibodies.
- Colon cancer: biopsy of the large intestine.
- Crohn’s disease, ulcerative colitis and other forms of inflammatory bowel disease (IBD): random serial biopsy from the large intestine through the terminal ileum, fecal calprotectin, and basic blood testing.
- Lymphocytic, collagenous or mastocytic colitis: random serial biopsy of the large intestine, looking out for subepithelial collagen bands, mastocytes and intraepithelial lymphocytes.
- Infections: study of serum and fecal antibodies for Giardia lamblia, Clostridium difficile, Yersinia enterocolitica, Campylobacter jejuni, Salmonella, Shigella and fecal parasites.
- Intolerances: fructose, lactose and food allergies.
If all the previous studies come back negative, one could then believe the problem is IBS. Conventional treatment consists of antidiarrheal agents such as loperamide. In the cases in which this works (not too many), symptoms resume as soon as medication is stopped. Therefore, although IBS is a condition with a very good prognosis, it definitely affects quality of life of the patients. An effective treatment is surely needed for this condition, which is suffered by 40% of population in the US.
The real causes of the disease, though not quite clear, seem to point towards:
- Non-diagnosed gluten sensitivity: normally solved by eliminating all grains (with the exception of white rice).
- Infections: treating underlying infection with antibiotics, anti-parasitics or supplements.
- Large intestine dysbiosis: it’s the most common and most difficult to treat cause. Deficit of butyrate production and higher levels of H2S (which precisely inhibits the process) are typically observed. Fecal transplants seem to be useful in these cases.
- Small intestine bacterial overgrowth: treated with antibiotics, digestive enzymes and supplements. Difficult to eradicate since normally comes back after discontinuing the treatment. Very restrictive diet might be needed in order to avoid relapse.
Diet: several diets have proved useful for IBS treatment. The famous FOODMAP diet, which eliminates all gas and fermentation causing foods is a good symptomatic treatment.
Also, Jean Seignalet treated hundreds of IBS patients with his ancestral diet, reaching remission of up to 90% of them. Other practitioners also attained similar results; such is the case of Wolfgang Lutz, who treated close to 500 patients with a low-carb diet. Even other diets out there such as the Specific Carbohydrate Diet, GAPS or Paleo also obtain similar results. All of them have a few things in common: eliminating grains, pulses, dairy and all types of fast-food. Some also cut back on all carbs. We recommend any of the following books, which you can get a hold of on Amazon by clicking on our library link below.
Vitamin D: 8 out of 10 patients with IBS have vitamin D deficiency. What’s more, patients actually improve when those deficiencies are solved. It should be recommended that all ISB patients test for 25-hydroxivitamin D, in order to discard possible deficiency. Should it be necessary, supplement until reaching serum levels of about 60-70 ng/ml. You can buy a good vitamin D supplement here.
Curcumin: three different studies have proved the effectiveness of curcumin of IBS treatment. In one of them, 60% of patients reached remission, whilst in the other two all patients improved their symptomatology. It is believed that the mechanism of action is linked to its anti-inflammatory, antibacterial and antispasmodic properties. Here you can buy a great Curcumin supplement, as it doesn’t include piperine (which increases intestinal permeability).
Boswellia: though there haven’t been any studies with Boswellia on IBS, it’s high effectiveness in other intestinal conditions plus its synergic effect with curcumin and its anti-inflammatory properties make it an interesting potential treatment for this pathology. You can buy Boswellia on Amazon by following this link.
Probiotics: a systematic revision of 1615 patients concluded that taking probiotics leads to an improvement in 70% of the cases. Though most of the studies have been conducted with lactic acid bacteria (such as the ones found in home-made kefir), the truth is that effectiveness of each strain varies greatly from individual to individual. Out of all of the probiotics out there, the following four are the ones with more science behind them:
Psyllium:Plantago ovata or psyllium is an excellent source of soluble fiber. Its usefulness for treating IBS has been measured in several studies and, though for IBS-D it doesn’t always seem to work, it does do so for IBS-C. You can buy psyllium fiber here.
Digestive enzymes: two studies have evaluated digestive enzyme supplementation for IBS. In both, taking this supplement obtained slightly better results than placebo. How results are obtained is still not clear. It may be due to better digestion in some individuals. Can be useful for IBS originated in the small intestine. Some we like, for example, are these ones.
Antibiotics: for those individuals whose IBS is caused by an alteration of bacterial flora, antibiotic treatment can be of use. Rifaximin is the drug of choice in most cases. However, it should be noted that symptoms often resume soon after stopping the treatment. Since rifaximin is a wide-specter antibiotic, the use of peppermint oil enteric-coated capsules is an interesting alternative, since it has great results without any secondary effects. You can buy them on Amazon here.
Intestinal anti-inflammatories: 5-ASA has been used in the treatment of IBS without much luck. However, all studies show that patients with and infectious IBS respond very well to this medication. Therefore, it should be recommended for post-infectious IBS patients. Taking increasingly smaller doses for three months seems to lead to higher rates of remission.
Fecal Transplant: without a doubt this is the star treatment for patients who suffer from dysbiosis originated IBD. Effectiveness reaches up to 70% both in IBS-D and IBS-C. The downside is it’s quite expensive.
Quick overview of science-based natural treatments for IBS:
- Hypoallergenic diet with special emphasis on eliminating grains, pulses and dairy.
- Supplementing with vitamin D until reaching serum levels of 60-70 ng/ml.
- Use ofcurcumin and boswellia in variable doses depending on symptomatology.
- Fecal transplant having specifically studied each individual case.
Other treatments suggested above should also be considered depending on individual circumstances.