Say goodbye to abdominal pain (& keeping one eye on the closest toilet) with our functional medicine approach to IBS...
Irritable bowel syndrome (IBS) is a disorder that is associated with abdominal pain or discomfort, and altered bowel habits (chronic or recurrent diarrhoea, constipation, or both).
Worldwide, it’s estimated that 5 to 10% of the population has irritable bowel syndrome.
A functional medicine approach to IBS can help.
At Coho Health, we’ve worked with many people with irritable bowel syndrome.
IBS can have a big impact on the quality of your daily life. We know it can be a frustrating health challenge, that a lot of people often struggle with for many years.
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One report suggested that four out of five people with IBS, reported pain as the most frequent factor contributing to the severity of their IBS.
What is IBS?
IBS is a ‘functional’ gastrointestinal disorder, which means that the bowel doesn’t work the way it should.
It can cause pain and cramping in the abdomen and changes in bowel habits – diarrhoea or constipation.
IBS symptoms can be mild, or severe.
Some people have only a few symptoms, while others have many.
IBS is one of the most common gastrointestinal disorders – it’s one of the most common disorders diagnosed by gastroenterologists.
IBS can occur at any age, but it is most common in adults under the age of 50.
Reported rates of IBS are higher in women (around 60-65% of cases) than in men (35-40% of cases).
The cause of IBS is not known.
However, it’s most likely caused by a combination of factors, including:
Symptoms can also result from a disturbance in the way the intestinal system, brain and nervous system interact.
There is no single cure for IBS, but there are strategies and treatments that can help relieve symptoms, including changes to diet and lifestyle, medications, and supplements.
Unfortunately, as we’ll discuss further below, the conventional medicine treatment for IBS hasn’t got very much to offer.
By assessing the root cause (or causes), the functional medicine approach to IBS can deliver life changing digestive health improvement.
Sign & symptoms of IBS
Symptoms of IBS include abdominal pain, cramping, bloating, diarrhoea, and constipation.
Some people with IBS find that their symptoms are worse after eating certain foods or drinking caffeine or alcohol.
Others find that stress makes their symptoms worse, which given the connection between the brain and the intestinal system, is no surprise.
The most common presentation of IBS is a change in bowel habits.
This can either be constipation or diarrhoea, or in some cases it is mixed – diarrhoea alternating with constipation.
However, other symptoms often present themselves.
The most significant symptoms of IBS include:
It is not uncommon for these symptoms to come and go.
They are often worse after eating and are relieved by going to the toilet.
The conventional medicine approach to IBS
Conventional medicine tends to focus to managing the symptoms of IBS.
For instance, medication might be prescribed to combat diarrhoea, abdominal cramps might be managed with anti-spasmodic medication, and laxatives might be employed to help with constipation.
The problem is that each of these strategies are designed to manage the symptoms that result from the problem, rather than identifying and treating the root cause, or causes.
While conventional medical advice has recently made some steps in making nutrition and lifestyle recommendations, it’s still a long way from the more in-depth, individualised functional medicine approach to IBS.
The functional medicine approach to IBS
The functional medicine approach to IBS focuses on identifying and addressing the root cause trigger (or triggers) of the symptoms.
Because this varies from person to person, and there may be more than one trigger at play, it’s critically important that we find the individual triggers in each case.
While there’s no ‘one size fits all’ test for diagnosing IBS, with the functional medicine approach to IBS, we start with an in-depth analysis of your health history.
Through this analysis, we often notice that IBS symptoms may have started after:
Together with paying close attention to the specific signs and symptoms that are being presented, this frequently helps us to form some ideas on potential triggers and root causes in a specific individual.
What's the root cause of IBS?
IBS can be triggered by a range of factors, and these can vary between individuals.
Which is why a functional medicine approach to IBS can offer some additional options when compared to conventional medicine approaches.
It’s also important for longer term health and wellness, to identify underlying causes and address them, rather than allowing repeated exposures to the trigger(s) that could be causing other problems.
Causes of IBS or undiagnosed conditions that may be associated with IBS symptoms, include:
Functional testing in IBS
For our clients presenting with IBS, we usually recommend a comprehensive gastrointestinal function test.
There are a range of ‘go-to’ stool tests in our clinics, and the most appropriate test for an individual would be recommended.
These advanced stools tests include an assessment of:
Imbalances in any of these areas can affect symptoms.
Stool tests performed by conventional doctors do not provide nearly as much detail as these comprehensive stool tests (but conventional medicine testing can be helpful in some cases, e.g. if you just want to rule out inflammatory bowel disease by checking calprotectin levels).
Understanding precisely what the underlying imbalances are, and therefore where support is required, means that a tailored protocol can be designed, resulting in fast, sustainable symptomatic improvements.
Some examples of functional gut testing reports that are identifying imbalances:
Test result example: low pancreatic elastase
In these results we see a very low level of pancreatic elastase – a marker for the digestive enzymes produced by the pancreas. This person is likely to have maldigestion that can result in IBS symptoms.
Test result example: multiple IBS factors
This test result summary page shows a need to support digestion (low levels of pancreatic elastase), reduce inflammation (secretory IgA – the ‘first line of defence’ of gut immunity is slightly raised), and support metabolic balance by reducing the high levels of beta-glucuronidase, an enzyme produced by some bacteria that interferes with normal detoxification processes.
Test result example: dysbiosis & digestion
This summary page shows a high need to support digestion and dysbiosis. Dysbiosis is a bacterial imbalance, that in this case means there is a higher level of methane producing bacteria that can cause constipation, and an overgrowth of commensal ‘friendly’ bacteria that may be causing symptoms of abdominal bloating.
Test result example: parasites
In this result, we see an infection with the parasite, Blastocystis hominis. Common symptoms of infection with Blastocystis include watery or loose stools, diarrhoea, abdominal pain, anal itching and excess gas.
Test result example: additional bacteria
These results show a presence of five ‘additional’ bacteria at higher levels, that have the potential to correlate with symptoms. Many of these bacteria are commonly found at high levels in individuals with reduced digestion, constipation or small intestinal bacterial overgrowth (SIBO).
Test result example: low pancreatic elastase & low SIgA
In this test result we see a low level of elastase (a marker for the digestive enzymes produced by the pancreas) and a low secretory IgA. IgA is the primary immunoglobulin in the intestinal mucosa and represents a ‘first line of defence’ in response to ‘bad’ bacteria or food intolerances. A low secretory IgA suggests that the gut immune system is suppressed by underlying factors such as chronic infections, chronic stress or being immunocompromised. We would expect this client to have a ‘sensitive’ gut who feels like they are reacting to multiple foods.
Test result example: high H. pylori
Whilst Helicobacter pylori is common and the bacteria is present in around 50% of humans, for some of us, at high levels, the bacteria can cause issues. H.pylori in the below results is high and two of the virulence factors are positive, suggesting that h.pylori may be more of a problem in this individual and could be associated with inflammation, increased duodenal ulcers, and increased gastric cancer risk. H.pylori can result in low levels of hydrochloric acid (HCl) which is necessary for digestion.
Test result example: high calprotectin & bile acids, low pancreatic elastase
The stool test results below show a high calprotectin level – a protein that at high levels, correlates with bowel inflammation and Inflammatory Bowel Disease (IBD) risk. Bile acids are synthesised in the liver and assist in the digestion and absorption of dietary fats. Bile acids are a marker of fat malabsorption and metabolic conditions. A high level of bile acids can present as increased bowel frequency and urgency, night-time bowel movements, excessive flatulence, abdominal pain and incontinence of stool.
Test result example: SIBO in IBS
SIBO was found to be present in 78% of patients with IBS, in a study published in the American Journal of Gastroenterology, and once the SIBO was eradicated, IBS was resolved in 48% of the patients. There are signs and symptoms that would prompt your practitioner to consider the presence of SIBO and whether it could be a factor in your IBS symptoms.
The below SIBO breath test report hydrogen and methane SIBO.
Test result example: hydrogen dominant SIBO
The below SIBO results are suggestive of hydrogen dominant SIBO (a rise of more than 20 ppm (parts per million) of hydrogen gas from baseline, within 120 minutes).
Test result example: hydrogen and methane SIBO
The below results are suggestive of hydrogen and methane SIBO.
Nutrition interventions for IBS
IBS sub-types based on the dominant type of stool that is produced, influences the nutritional strategies that are applied.
IBS sub-types are:
Comprehensive gastrointestinal testing enables us to understand the root causes to your symptoms.
These symptoms would be addressed through tailored, highly individual nutritional, supplement, and lifestyle interventions to optimise intestinal function.
Coho practitioners provide bespoke details on what foods may be causing a problem, and which foods to increase that can support symptom improvement.
Whilst there is no ‘one diet’ for each type of scenario, nutritional principles from some common dietary models may be taken and then adapted for the individual case.
Examples of these common diets include:
that would temporarily exclude certain foods that after a period of time, are re-introduced one at a time to assess for reactions.
For some people who suffer with IBS, the symptoms can be mild.
However, for many others, the symptoms can be severe, and the impact on day to day life can be significant to the degree that it can feel like it’s taking over life.
We don’t want that to happen.
With the right testing, it’s possible to pinpoint the trigger (or triggers) of IBS, to be specific in targeting treatment where it will achieve the greatest affect, and to say goodbye to IBS symptoms.
With this information, we can work as a team with our clients to design an individual plan that not only achieves results, but also educates and empowers you to take back control of your health, so that you stay healthy today, tomorrow, and for the long term.
Imagine how much better your life would be.
To your optimised, healthy future,
Dee & the Coho Health team
How can we help you? Send us a message below and we’ll come right back to you…