Irritable Bowel Syndrome (IBS)

By Dr. linell king

Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal (GI) disorders encountered in clinical practice. In fact, in the United States, it is estimated that 8-15 percent of the adult population suffers from IBS symptoms, with women affected nearly twice as often than men.

IBS is a group of symptoms that occur together, including recurrent pain in the abdomen and changes in bowel movement, which may include diarrhea, constipation, or both. People with IBS suffer uncomfortable stomach cramping, bloating, and excessive gas. It’s no surprise, then, that IBS reduces health-related quality of life to a greater degree than even diabetes or end-stage renal disease.

Until recently, the cause of IBS wasn’t well understood. Patients with IBS do not have visible signs of damage or disease in their digestive tract. In fact, doctors generally diagnosed IBS merely by symptoms. Emerging science on the microbiome has led to advances in knowledge of not just IBS, but its relationship to mental health.

Microbiome: The microbiome refers to the trillions of bacteria, fungi, and viruses (together known as microbes) that live primarily in the gut. These microbes can help us in many ways – but some, in smaller numbers, can be potentially harmful. Recent research has shown that gut microbes help us digest certain foods, break down toxins that stick to the gut lining, manufacture vitamins and other nutrients, and maintain a healthy immune system. Microbes in your GI tract are critical to a well-functioning gut.

IBS and the brain: Patients suffering from IBS are significantly more likely to develop mental health conditions. But how might your belly be related to your brain? The connections are multi-fold:

IBS can have significant negative impact on your personal and professional life, causing stress, anxiety, depressed mood, and disrupted sleep. We know that excessive anxiety and stress paradoxically lead to additional GI problems, like diarrhea. The relationship is cyclical.

Importantly, evidence has also linked microbes in your belly to mental health. Microbes in the gut send hormonal signals or neurotransmitters, like Serotonin, GABA, and cortisol to name a few – to the brain. Microbes in your gut are critical to a well-functioning brain.

Dysbiosis: A healthy gut leads to good body and brain health. But what happens when the microbes in your GI tract become unbalanced? It’s called ‘dysbiosis’ and can be caused by the following:
• A dietary change that increases your intake of bad fats or food additives or insufficient vegetables
• Medications that affect gut bacteria, such as anti-biotics, acid-reducing medications, over-the-counter pain relievers, steroids, or oral contraceptive pills
• High levels of stress or anxiety that can weaken your immune system
• Excessive alcohol consumption causing bacterial overgrowth
• Poor dental hygiene, which allows bacteria to grow out of balance in your mouth

IBS treatment: Fortunately, there are dietary, behavioral, and pharmacologic approaches that can help treat IBS.

Probiotics: A probiotic supplement contains natural bacteria that are similar to microorganisms you naturally have in your digestive tract. Ample research has shown that probiotics help restore an unbalanced microbiome by helping your GI tract crop out the bad bacteria, strengthen the intestinal barrier, and reduce inflammation. Probiotics can be a vital option for some IBS sufferers; however, some types of probiotics may worsen some conditions or symptoms, so it’s important to talk to your healthcare provider before starting a regime.

Diet: Some IBS symptoms respond to dietary modification. According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms may be eased by simple diet modifications, including eating more soluable fiber, found in beans, some fruits, and oats; limiting caffeinated beverages and fatty foods; reducing intake of carbohydrate-rich foods, like lactose, fructose and sorbitol; and avoiding gluten.

For more severe and persistent IBS, your doctor may recommend a trial of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet to reduce or avoid certain foods that contain carbohydrates that are hard to digest. A FODMAP diet typically lasts for a limited time, followed by slowing reintroducing foods as tolerated.

Counseling: General therapy is most often recommended to help sufferers manage the uncontrollable and unpredictable symptoms of IBS. Patients learn relaxation and stress management tools and meditation and mindfulness for pain. Research in GI Psychology, a newer and specialized field, has shown promising results for cognitive-behavioral and exposure therapies. These therapies address specific IBS symptoms and behaviors, for example isolation due to humiliation.

Medications: Your healthcare provider may prescribe further supplements or medications based on your specific IBS symptoms. Over-the-counter laxatives and antidiarrheals are first-line treatments.

Antidepressants or anti anxiety medications, for example, are suggested if you have abdominal pain and constipation and have depressive, anxiety, or disrupted sleep symptoms.

For more severe IBS, FDA-approved IBS medications include Alosetron and Eluxadoline – both antidiarrheals, and laxative agents like Lubiprostone and Linaclotide. Rifaximin is an antibiotic that can decrease bacterial overgrowth and diarrhea.

Irritable bowel syndrome can present as mild to severe in symptoms. A thorough understanding of IBS is unravelling and there is yet no cure. Research is busy understanding the exact causes and best treatment options for suffers. As science and technology evolves, so too with be the understanding and treatment of IBS.

Linell King MD, renowned internist and author of “Mastering Vitality” received his medical degree from the University Of Wisconsin School Of Medicine, and completed his residency at The Johns Hopkins University Sinai Hospital Program of Internal Medicine.  He has been practicing for twenty years; currently at his “Naples Vitality” office in Naples, FL.

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