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Diagnosing And Living With Irritable Bowel Syndrome

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By Celeste Cooper

Irritable bowel syndrome (IBS) affects over 10 percent of people worldwide, an estimate that includes people yet to be diagnosed. It predominately affects women (suggesting a possible hormonal influence), and most people are diagnosed before the age of 50. It tends to run in families, suggesting a genetic connection and one study (Beyder A, et al., 2014) suggests that two percent of us carry a loss-of-function gene mutation. Yet, the cause remains unknown.

Is IBS a disease?

While symptoms of IBS can mimic autoimmune and inflammatory bowel diseases or coincide with certain gastrointestinal disorders, it is not a disease of the bowel. It is a functional disorder characterized by “motility, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing.” (Drossman DA., 2016)

How is irritable bowel syndrome diagnosed?

The American College of Gastroenterology says the Rome IV Criteria are the gold standard for diagnosing IBS. Because our symptoms can change over time, the new criteria suggests a diagnosis of IBS with predominant diarrhea, IBS with predominant constipation, and IBS with mixed bowel habits should not be made. Instead, diagnosis should include:

  1. evaluation of frequent symptomatic episodes characterized by altered bowel habits, and
  2. lower abdominal pain that has continued for at least three months of the previous year.

They also recommend a careful medical history and the use of treatments that target our specific complaints.

Common symptoms

Symptoms are present at least three days a month, but they can occur independently of each other or in clusters.

Symptoms include:

  • changes in normal bowel movements
  • changes in stool appearance
  • changes in frequency of bowel movements
  • abdominal pain
  • bloating
  • cramping
  • constipation
  • diarrhea
  • gas and burping
  • nausea or heartburn

Experts worldwide suggest there are far more of us that live with IBS than what is reported. So, don’t keep your doctor in the dark. Report your symptoms and let your healthcare provider know how they affect your daily living.

Theories

We don’t know the cause of IBS, but according to The American College of Gastroenterology, several unproven theories exist. These include things like an intestinal infection, overgrowth of normal gut bacteria, and they say though it is highly unlikely, “food intolerance.” That said, they do admit that despite the lack of profound research on bacterial overgrowth, some of us do respond to treatment with antibiotics. And, they suggest that when patients with IBS-like symptoms don’t respond to reasonable treatment, they should be evaluated for celiac disease, a serious autoimmune disease that damages the small intestine when gluten is consumed.

Another possible cause of or contributor to IBS is Leaky Gut Syndrome (LGS). LGS characteristics include: chronic diarrhea, irritable bowels, fatigue, carbohydrate cravings, autoimmune conditions, headaches, a weak immune system, joint pain and arthritis.

Marcelo Campos, MD says in an article for Harvard Health Publications, increased intestinal permeability [LGS] plays a role in celiac disease, Crohn’s disease, AND irritable bowel syndrome.” He agrees more studies are needed, but he suggests chronic diseases, autoimmune diseases, chronic fatigue syndrome, fibromyalgia, arthritis, allergies, asthma, acne, obesity, and even mental illness may all be associated with a dysfunctional gastrointestinal system. One only needs to search the gut and chronic disease to know he is not alone in this thinking.

Minimizing symptoms

The amount and type of microflora in our gut is as important to our overall health as the flora and fauna of a watershed is to our environment. This is because our digestive system is responsible for extracting nutrients necessary for cellular metabolism and the well-being of our body. So, when our bowel isn’t functioning appropriately, we are affected negatively.

Things to consider:

  • diet, medication, and lifestyle changes.
  • traditional IBS diet or a diet low in FODMAPs.
  • immune system boosters:
  • prebiotics – nondigestible food ingredients that benefit gut-friendly bacteria.
  • supplements, such as:
    • composite probiotics containing B. infantis (probiotics are thought to promote gut-friendly bacteria).
    • soluble fibers, such as psyllium, guar gum, or calcium polycarbophil (fiber may increase symptoms for some and provide relief for others.)
    • peppermint oil (slows motility).
    • digestive enzymes, such as alpha-galactosidase (reduces symptoms caused by dietary FODMAPs (fermentable carbohydrates).
    • L-glutamine (minimizes intestinal permeability seen in IBS with diarrhea).
  • a new food” for Leaky Gut Syndrome, and more.
  • prescription or over-the-counter medications that target specific symptoms.
  • other measures, such as hydrating to treat the effects of water loss diarrhea.

Note: Some over-the-counter preparations can conflict with certain health problems or medications, so always check with your physician and/or pharmacist.

Those of us who live with IBS know stress can initiate an attack, in which case mind-body techniques are encouraged. I am a master of many techniques, and sometimes they work until my medications take effect. That said, once an assault is underway, no amount of creative visualization or meditation is going to stop the eventual explosion. Attacks don’t always occur during the day either. We can be jolted awake only to spend the rest of the night in the bathroom with severe abdominal flu-like symptoms. The sequel is random and repeats several times every month. So, is it any wonder we are psychologically vulnerable? But, there is hope. Exciting neurogastrointerology and motility research is underway, and I for one can’t wait to see what it brings.


Celeste Cooper, RN, is a frequent contributor to ProHealth. She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.


Resources:

Aragon, G., M.D. (2010).Probiotic Therapy for Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2010 Jan; 6(1): 39–44.

Bertrand J., et al. (2016). Glutamine Restores Tight Junction Protein Claudin-1 Expression in Colonic Mucosa of Patients With Diarrhea-Predominant Irritable Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2016 Nov;40(8):1170-1176.

Beyder A, et al. Loss-of-function of the voltage-gated sodium channel NaV1.5 (channelopathies) in patients with irritable bowel syndrome. Gastroenterology 2014 Jun;146(7):1659-1668

Böhn L., et al. (2015). Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial.

Gastroenterology. 2015 Nov;149(6):1399-1407.e2. doi: 10.1053/j.gastro.2015.07.054.

Canavan C., et al. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014 Feb 4;6:71-80. doi: 10.2147/CLEP.S40245.

Drossman DA. (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV.

Gastroenterology. 2016 Feb 19. pii: S0016-5085(16)00223-7. doi: 10.1053/j.gastro.2016.02.032.

El-Salhy, M., et al. (2017). Dietary fiber in irritable bowel syndrome (Review).

Int J Mol Med. 2017 Sep; 40(3): 607–613. Published online 2017 Jul 19. doi: 10.3892/ijmm.2017.3072

Lacy, B.E. and Patel, NK* H. Christian Weber, Academic Editor. (2017). Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Nov; 6(11): 99. Published online 2017 Oct 26. doi: 10.3390/jcm6110099

Staff, International Food Information Council Foundation. (Updated May 23, 2014). Functional Foods Fact Sheet: Probiotics and Prebiotics. Retrieved July, 2018).

Staff, ProHealth. (2018, June 28). New Medical Food For Leaky Gut. Retrieved July, 2018.

Tuck C.J., et al. (2018). Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by α-Galactosidase Treatment. Am J Gastroenterol. 2018 Jan;113(1):124-134. doi: 10.1038/ajg.2017.245.

Yuan, F. (2017). Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Current Medical Research and Opinion. Volume 33, 2017 – Issue 7.

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