Irritable Bowel Syndrome (IBS) is the most common intestinal disorder in the US – affecting 30 million Americans and 15 – 20% of people in the Western world. The majority of sufferers are relatively young and are female. Even though it is so prevalent, medical science does not yet fully understand the condition and does not know how best to treat it.
IBS damages the quality of life for those who suffer from it. IBS patients typically have recurrent bouts of diarrhea, constipation, or alternating bouts of both, any of which can trigger hemorrhoids. Bowel movements may contain mucous. Stomach pain, cramping and intestinal gas, including flatulence, cause ongoing discomfort. Interestingly enough, there are mood symptoms that often go along with IBS in up to 60% of IBS sufferers: fatigue, anxiety or depression, sleep problems, and reduced sexual desire. Because of this correlation, in times past IBS was thought to be primarily a psychosomatic condition.
Although the condition is not life-threatening, those suffering with it would be ecstatic if they could do something to get rid of the unpleasant and uncomfortable syndrome. The symptoms of IBS can be a deterrent from making and keeping plans, particularly when symptoms are active.
Going on a first date, for example, is a nerve-wracking experience, but the added element of potential for embarrassment caused by unexpected flatulence or diarrhea can cause IBS sufferers to decide that going out is just not worth it. The fear of having to wait in line to use the bathroom should an uncontrollable bout of diarrhea hit can make going to a concert or performance seem like a stressful and unpleasant event. Patients often complain that IBS hurts their sex life because the symptoms can make sexual intercourse uncomfortable. Finding relief from IBS is a high priority.
Symptoms and Diagnosis
As other, potentially-serious conditions have similar symptoms to IBS, it is important to seek medical advice to confirm the diagnosis, which is typically made only after ruling out other conditions including tumors of the intestinal tract, lactose intolerance, inflammatory bowel disease, celiac disease (or other malabsorption diseases), gallstones, parasites or thyroid disease. IBS is currently diagnosed by process of elimination and an evaluation of symptoms. There are no structural changes to the bowel that can be observed although alterations to gut motility (movements of the intestines) can sometimes be observed. To be diagnosed with IBS, intermittent symptoms will have had to persist for many months and tend to recur relatively regularly.
An experimental blood test is currently being tested, which appears able to assist in diagnosis and help to confirm the IBS diagnosis. This will be useful to differentiate IBS from other more serious bowel disorders such as Inflammatory Bowel Disease or cancer and provide useful information for medical professionals to outline the appropriate treatment plan. It will also useful for proving definitively that the symptoms are caused by a real condition and not just in the sufferer’s head.
Causes of IBS
Medical science has not yet figured out exactly what causes IBS, but there are several theories.
Research has shown that there may be a genetic element to a certain percentage cases of IBS. Patients with IBS with diarrhea as the primary symptom are more likely than those without it to show mutations in the genes the affect the number of serotonin receptors in the intestines. Having altered receptors or changes to the number of these receptors can cause the digestive system to get “over-excited”, resulting in diarrhea.
Having altered serotonin receptors could also explain two common symptoms of IBS: increased pain (in the absence of an apparent cause for it) and depression. Serotonin plays a role in both the perception of pain and depression. In fact, it has been shown that people with altered serotonin receptors are more likely than the average person to suffer from depression.
Another genetic marker has been observed in a subset of IBS patients. A defect in the SCN5A gene seems to cause a disruption in bowel function by affecting a sodium channel (that allows sodium ions to pass through muscle in the intestines).
Stress and Childhood Trauma
Stress has been shown to exacerbate symptoms in people with IBS. Studies have revealed that active stress management can improve IBS symptoms.
Doctors have wondered if stressful experiences can trigger the development of IBS because experiencing physical and sexual trauma during childhood had previously been shown to be correlated with the development of IBS during adulthood in certain patients. Because of this anecdotal link, Yuri A. Saito Loftus, M.D., a clinical researcher at Mayo Clinic in Minnesota conducted a study on 4,250 people by having them complete the Early Trauma Inventory Self Report. She determined that those participants with IBS had experienced more lifetime traumatic events such as sexual abuse, physical abuse, natural disasters or death of a parent, on average, than had the healthy participants in the control group.
Dr. Saito Loftus, along with others in the medical community, believe that experiencing trauma is one possible cause or risk factor for the development of IBS.
Infection and Food Poisoning
Gastroenteritis, an irritated or inflamed stomach condition causing nausea, diarrhea and/or fever, and commonly known as the stomach-flu, can be caused by bacteria, viruses or parasites. After the underlying cause of the gastroenteritis has resolved, up to 32% of people will develop long-term gastrointestinal symptoms that are eventually diagnosed as being IBS.
Evidence is mounting that IBS commonly occurs following a serious gastrointestinal infection (post-infectious IBS or “IBS-PI”) or bout of food poisoning.
It has been shown that having taken a course of antibiotics can predispose some people to developing IBS.
Imbalances in Gut Bacteria
Dysbiosis is a disturbance with an individual’s gut flora in which the microbes found in the gut are out of balance from what would typically be found in a healthy state – where health promoting probiotic species and numbers are reduced, and unhealthy microbes may be increased from normal levels.
The human gut is awash with trillions microbes – both bacteria and fungi. If you were to weigh the gut microbes of an average adult they would total more than 4 pounds. In a healthy state, the gut microbiome (mix of microbes found in the human gut) performs valuable functions for its human host including aiding in digestion, aiding the human immune system and modulating its responses, synthesizing vitamins and amino acids necessary for health, maintaining a healthy weight and moderating mood.
Recent research has shown that in some patients IBS is associated with either an increase in number of bacteria found in the small intestine (Small Intestinal Bacterial Overgrowth or “SIBO”) or in changes to the types of microbes found in the digestive tract.
Whether the IBS is a factor in causing this dysbiosis or whether the dysbiosis is a cause of the IBS has yet to be objectively determined.
It is interesting to think about the fact that gastroenteritis is known to alter to the composition of microbes in the digestive tract and that IBS often follows bouts of gastroenteritis and its subsequent dysbiosis. Additionally, antibiotics, which can be used to treat severe cases of SIBO as well as gastroenteritis or food poisoning, are also known to create disturbances to the gut microbiome. This seems to suggest that the alterations to the gut microbiome often come before the onset of IBS.
Chronic stress is a common cause of dysbiosis – even in people without IBS. As mentioned above, depression and anxiety are commonly associated with IBS. Alterations to the gut microbiome are also commonly associated with depression and anxiety. It has been shown that levels of anxiety and depression can be reduced by bringing the gut microbiome back to a healthy state. Treating dysbiosis (an unhealthy gut microbiome) may help an IBS patient’s anxiety and depression, even if it does not cure the underlying IBS itself.
The link between disturbances to healthy gut microbiome development of IBS is a fertile area for ongoing and future research.
IBS and the Gut Microbiome
IBS is a poorly understood condition with multiple triggers or causes. Because of the different potential causes, there does not appear to be one treatment that can help all IBS sufferers. Additionally, traditional western medicine does not have a particularly effective treatment for this disease, although antibiotics can provide relief for some patients. Many of the potential IBS causes, other than IBS caused by genetic mutation, seem to be associated with the health of the gut microbiome i.e. having unhealthy gut bugs.
Antibiotics are a known disruptor to the gut microbiome as well as being a known trigger for IBS.
Food poisoning or the stomach-flu are known to affect the mix of microbes in the human gut and some scientists believe that food poisoning is the most common trigger for IBS. Taking antibiotics for any reason, including for the treatment of gastroenteritis, is another known cause of disruption to gut bacteria (dysbiosis). For those patients who develop IBS after having had the stomach flu or food poisoning, or have it arise after taking a course of antibiotics, a disruption to the microbes living in their guts is a likely culprit.
Depression and anxiety are closely associated with IBS – up to 90% of IBS sufferers also have depression and or anxiety symptoms. Increasing levels of depression and anxiety are associated with a worsening of IBS symptoms. Treatments to reduce anxiety have been shown to correspond with reduced IBS symptoms. Improving the health of the gut microbiome has been shown to decrease unhealthy levels of anxiety and depression (that aren’t linked to triggering life events). Therefore, no matter whether IBS is either caused by or worsened by stress, or whether stress / anxiety are instead symptoms of IBS – improving the health of the gut microbes may have the added benefit of preventing or reducing IBS symptoms in IBS patients that have anxiety / depression symptoms.
People with IBS who have taken antibiotics, have had a bout of stomach-flu or food poisoning, or who have other risk factors for dysbiosis, such as alcohol consumption, excessive or chronic stress, or an unhealthy diet, might consider taking steps to improve their mix of gut microbes.
Probiotics as Treatment for IBS
Probiotics, microbes that provide benefit to their host when they are given in adequate amounts, support gut health by preventing harmful microbes from multiplying in the gut and by reducing inflammation in the body. Although traditional treatments have failed to provide consistent relief to IBS sufferers, studies have shown that probiotics can benefit many people with this condition with few side effects.
Taking a multi-species probiotic supplement has been shown to improve symptoms for participants with IBS when administered in clinical trials.
The probiotic supplement VSL#3 was used in two double-blind, placebo-controlled studies. VSL#3 it contains the following live microbes: Bifidobacterium (B. longum, B. infantis, and B. breve); Lactobacillus (L. acidophilus, L. casei, L. delbrueckii ssp. bulgaricus, and L. plantarum); and Streptococcus salivarius ssp. thermophiles. VSL#3 can be purchased commercially.
A different, small, placebo-controlled clinical study examined the effectiveness of SCM-III, a probiotic supplement containing three probiotic strains: L. acidophilus, Lactobacillus helveticus, and Bifidobacterium sp. Researchers found that it improved IBS symptoms significantly.
Other studies evaluating different probiotic combinations (most often including Bifidobacterium, Lactobacillus, and Streptococcus) in 772 patients have shown significant improvement in IBS symptoms for sufferers.
Administration of B. infantis alone in high doses has also been shown to be effective for decreasing IBS symptoms.
There is need for larger, randomized, controlled studies in this area. Although results have been promising, the studies have been flawed or quite small. Additionally, effectiveness of probiotic treatment seems species specific, so multiple strains and doses should be tested.
Improving Gut Health to Treat IBS Symptoms
Eating probiotic rich foods (preferably); taking a good-quality, multi-strain probiotic supplement that includes B. infantis; and eating a diet rich in fiber and low in preservatives to improve probiotic gut health to improve the health of the gut microbiome may have the added benefit of improving IBS symptoms.
Supplementing with B. infantis has been identified as being the front-runner in available treatments for IBS currently. Not all probiotics are equally effective for IBS – therefore it is important to read the label to understand which microbes are included in any supplement. As there are more well-controlled studies of probiotics undertaken to compare different strains of bacteria and doses, additional probiotic recommendations will likely become available.
Fecal microbiota transplants have been shown to provide relief from IBS symptoms for patients with severe IBS. Fecal matter is biologically active – it contains living microbes. As fecal transplant involves taking fecal matter from a healthy individual and transplanting directly into the large intestine of a patient, this is regulated by the FDA and can only be performed by a licensed physician. With fecal transplants, it has been shown that the microbes from the healthy donor can multiply and improve the health of the microbiome in the recipient – often reducing symptoms.
Probiotics are generally deemed quite safe and well-tolerated by most individuals. However, those with impaired immune systems, such as people with immune deficiencies or those receiving cancer therapy, should avoid taking probiotics or eating probiotic rich foods. As with any change to life-style, please consult with your doctor about adding any supplements, including probiotics, to your health routine.
There is lots of anecdotal evidence that probiotics have greatly improved the quality of life for many with IBS. We really would like to hear from you (add comment below) if you have any personal experience, beneficial or not, with trying to improve your bacterial mix (from food or from a supplement or otherwise) and IBS.