by Dr. Bill Rawls
As many as 20% of Americans feel that their lives are ruled by their bowels. Whether they’re constantly wrestling with diarrhea or constipation (or both), abdominal pain, embarrassing gas, or a number of other bowel-related symptoms, they tend to have to plan each moment of every day with a mental map of the nearest restrooms in mind.
Business meetings, first dates, long airplane flights – they all take on a whole new level of stress when you’re wondering how many times you can go to the bathroom before someone gets irritated, suspicious, or angry.
If this sounds maddeningly familiar, you’re likely one of the 25 to 45 million Americans living with irritable bowel syndrome (IBS). The condition is miserable, inconvenient, and unpredictable; its causes aren’t well understood; and while there are some conventional treatments available, they only help alleviate some symptoms in some people, some of the time.
Sounds pretty bleak, but there is good news: You don’t have to remain at the mercy of your gut. There are some powerful, natural strategies you can implement to calm your bowel, improve your symptoms, and move on with your life.
If you’re hitting roadblock after roadblock with IBS treatment, it’s time to try something new. But first, it helps to understand what’s to blame for your misery in the first place.
Irritable Bowel Syndrome, Explained
IBS is a complex condition with no single identified cause, so it’s defined by its collection of symptoms. But even that’s not straightforward, because symptoms can fluctuate from day to day and wax and wane through a person’s lifetime.
It’s more common in women (2 in 3 sufferers are female) and in people under age 50, according to the National Institute for Diabetes, Digestive and Kidney Disease. Other risk factors include having a personal history of chronic stress, gut infection from a pathogen, or gut dysbiosis (an imbalance in the population of microbes that inhabit your digestive tract), or having a family member with IBS.
This seemingly odd mix of risk factors leads to confusion and discouragement for patients and doctors alike who are trying to pinpoint a specific trigger and targeted solution. Historically, IBS has even been classified by the medical establishment as a psychiatric disorder bordering on hysteria or hypochondria.
Symptoms of IBS can include:
- Abdominal pain
- Alternating diarrhea and constipation
- The feeling that a bowel movement may be incomplete
- Stools that contain mucus, which may be white in color
- Nausea after eating
- For women, symptoms tend to flare up during their menstrual period
Because symptoms are a moving target, at present the medical community recognizes three to four different types of IBS, which are defined by the changes that occur with bowel habits. It’s not uncommon for IBS patients to cycle through episodes of different types, followed by periods of regular bowel pattern. The four types of IBS are:
IBS with Diarrhea (IBS-D)
You may be diagnosed with IBS-D if, on the days your symptoms flare up, you experience watery or loose stools more than 25 percent of the time. In contrast, your stools are hard or lumpy less than 25 percent of the time.
IBS with Constipation (IBS-C)
If your IBS presents with constipation as the dominant issue, more than 25 percent of your bowel movements will be hard or lumpy, and less than 25 percent of them will be loose or watery.
IBS with Mixed Bowel Habits (IBS-M)
As you can probably guess, if you have this type of IBS, your stools may alternate between watery and hard on the days your IBS has been triggered. To meet the criteria for this diagnosis, you must experience watery, loose stools more than 25 percent of the time, and hard, lumpy stools 25 percent of the time.
Unsubtyped IBS (IBS-U)
If you have IBS symptoms but they don’t fit into one of the other categories, your IBS might be considered unsubtyped, where the consistency of your stool and bowel habits vary from the other types.
The incidence of the different types of IBS is equally divided between the first three types; IBUS-U is less common. About 75% of all sufferers alternate between the different types.
IBS Testing and Diagnosis
IBS is diagnosed by cataloging symptoms, performing a physical assessment, and taking a detailed medical and family history. Further testing may not be indicated unless you are over 50 or have certain symptoms including nocturnal symptoms that wake you up at night, weight loss, rectal bleeding, anemia, or evidence of infection. The tests that your physician may order to investigate your symptoms further might include:
On their own, blood tests won’t indicate whether you have IBS, but they may show whether your IBS might be associated with other problems such as anemia, inflammation, or infections.
If you have IBS with diarrhea, your doctor may ask you to collect a stool specimen to check for the presence of blood, bacterial infection, or inflammatory bowel disease (IBD), the two main types being ulcerative colitis or Crohn’s disease. (Absence of diarrhea effectively excludes infection or significant inflammation.) One such test is a Comprehensive Digestive Stool Analysis (CDSA) by Genova Diagnostics. This test is pricey, though it may provide some valuable information when symptoms don’t decrease with a restorative gut protocol.
Celiac Disease Testing
If your predominant IBS symptom is diarrhea or you have mixed bowel patterns, you may benefit from testing for celiac disease. This autoimmune disease is characterized by severe intolerance to gluten, a storage protein in wheat and related grains like barley and rye. Research suggests that people with IBS-D and IBS-M have higher incidences of celiac as compared to the general population.
Celiac disease can be diagnosed using simple blood tests. But even if tests are negative, it’s important to note that you could still have a gluten intolerance. If you’re concerned that your symptoms could be related to a sensitivity to gluten, consider avoiding gluten-containing foods for several weeks, and take note of any changes in bowel habits or how you feel.
A colonoscopy if definitely indicated if you’re over 50, and it may be warranted if you have a family history of illnesses such as IBD or colon cancer. Additionally, if you’ve experienced a sudden loss of weight, bloody stools, increasing abdominal pain, or other serious symptoms, a colonoscopy may be performed to confirm a diagnosis.
What Causes IBS?
It’s a question that’s been difficult to answer due to limited technology. Years ago, bowel problems were predominantly diagnosed by X-ray — IBS was associated with normal X-rays, whereas other more serious inflammatory bowel conditions showed X-ray changes. With time, endoscopy replaced X-ray as a better diagnostic tool for evaluating bowel problems, but these technologies were limited to direct observation and tissue biopsies, which are also normal with IBS.
Today, newer technologies combined with older ones are starting to reveal specific abnormalities associated with IBS. This is leading to a better understanding of what IBS really is, and revealing some likely underlying causes.
1. Poor Diet + Bacterial Overgrowth
It has long been recognized that IBS is often triggered by ingestion of wheat and wheat products. In fact, there is a significant overlap in symptoms of IBS with celiac disease, indicating the need for everyone with IBS symptoms to be tested.
But wheat is far from being the only food associated with IBS. Certain dietary starches and sugars called short-chain carbohydrates have also been closely linked to IBS. Often referred to by the acronym FODMAP, which stands for Fermentable Oligo-, Di-, Monosaccharides And Polyols, these carbs are not well absorbed in the small bowel. As a result, they get fermented by bacteria in the colon, causing typical IBS symptoms.
Sources of FODMAPs include many grains and beans, certain fruits and vegetables, dairy, and certain meats and meat products. Indeed, the most common food triggers reported by IBS patients include dairy, wheat products, peas, beans, processed meats, fried food, and cabbage.
Research suggests that following a FODMAP-free diet to overcome IBS is hit or miss if it’s the only thing you’re doing to address the problem. Many sufferers find that they tolerate certain foods on the list just fine, but not others. This is likely because every person has a unique spectrum of microbes in their gut — different microbes ferment different carbohydrate sources.
Interestingly, all FODMAP foods are prevalent in the modern Western diet, and IBS is most common in developed Western countries. This diet is predominated by processed and packaged foods, most of which are loaded with carbohydrates in the form of starch and sugar — much more than the human body can use or absorb. This is great news for bacteria and yeast, as their favorite food is undigested carbs.
An overload of undigested carbs can also contribute to a condition called small intestinal bacterial overgrowth (SIBO), which is often present in people with IBS symptoms — just another suggestion that excess microbes in the small bowel may be guilty for at least some of the agony people with IBS endure. So, what causes SIBO to develop? Look no further than the standard American diet.
Excess sugar and starches allow bacteria and yeast to flourish in the small bowel, which can lead to the development of full-blown SIBO. These microbes proceed to irritate and compromise the protective mucous barrier of the intestine, which can lead to symptoms of IBS and – if the barrier is compromised – allow bacteria, toxins, and other irritants to cross the gut-blood barrier, known as leaky gut syndrome.
2. Chronic Stress + Disrupted Gut-Brain Communications
Unrelenting stress is another important factor that has been strongly linked to IBS. When the body’s perception of stress becomes chronic, the brain’s chemistry shifts toward a dominance of excitatory neurotransmitters over calming ones. This affects everything in the body, especially digestive functions.
The gut and brain have a two-way communication system called the brain-gut axis (BGA). The BGA consists of the central nervous system or CNS (the brain and spinal cord), and the enteric nervous system (ENS) — the 100 million nerve cells that line your GI tract and control digestion.
The brain and gut are in constant communication. The brain influences the gut and the gut influences the brain. Interestingly, many neurotransmitters are shared by both.
You’ve probably heard of serotonin, a well-known brain neurotransmitter. But in fact, about 90% of serotonin is produced in the digestive tract. It plays a key role in bowel movement and function by aiding in intestinal motility, sensation, and the secretion of waste products.
Once again, chronic stress comes into play here. Sustained stress is known to have a negative impact on serotonin production, which may perpetuate the vicious cycle of IBS symptoms.
When the production of serotonin is hampered, movement of food through the stomach and intestines slows down. Alternatively, excess serotonin speeds things up. So perhaps unsurprisingly, there’s evidence to suggest that regulation of serotonin levels is abnormal in those with IBS. Research has shown that blood levels of serotonin were lower in those with IBS with constipation, and higher in people with diarrhea-predominant IBS, according to findings in the journal Clinical Gastroenterology and Hepatology.
A disruption in the brain-gut connection may account for why experiences with IBS vary from one person to another. The research is ongoing, but early studies using MRI and functional MRI suggest that people with IBS may have structural and functional abnormalities in their CNS. This could translate to dysfunctional communication and signals that send food too quickly through the digestive tract, leading to diarrhea, or too slowly (constipation).
3. Immune Dysfunction + Microbes
Because so much foreign matter and so many microbes pass through the digestive tract, 70% of the immune system resides in the gut. When something occurs to disrupt immune system communications, it allows potential pathogens in the gut to flourish that could result in disease, inflammation — and various symptoms of IBS.
Chronic stress and poor diet are often the underlying culprits. When immune system functions have been compromised and diet is overloaded with processed carbohydrates, overgrowth of potential harmful bacteria is inevitable.
Numerous studies demonstrate a prevalence of potentially harmful bacteria over favorable bacteria in IBS. For instance, the prevalence of clostridia species, a potentially harmful fermenting bacteria, over lactobacillus and bifidobacteria, which promote normal digestive function, has been well documented (El-Salhy 2012).
Beyond bacterial imbalance, about 10% of people with IBS say their symptoms began following the onset of an infectious episode in the gut, according to a review in the World Journal of Gastroenterology, which can lead to inflammation in the intestinal lining and low-grade systemic inflammation. The link depended somewhat on the type of infecting organism: bacteria, protozoa, and helminth (parasitic worm) were associated with prolonged IBS, whereas viruses showed only short-term effects.
In summary, because every person carries a different spectrum of the many thousands of species of microbes out there, and because multiple factors contribute to microbe imbalances, there is no set pattern of bacterial imbalance associated with IBS. This, in itself, would explain the high variability in symptoms experienced by IBS sufferers.
4. Genetics + Lifestyle
As I mentioned earlier, you’re more likely to develop IBS if one or more family members have it as well, which is leading many researchers to speculate that IBS has a hereditary component to it. Genetic research on IBS is lagging, but a study earlier this year out of the Karolinska Institutet in Sweden discovered DNA variants that are linked with increased risk of IBS in women.
Again, these findings are preliminary and more research is needed, but it’s important to remember that genes are not your fate. Factors such as exposure to environmental toxins, having excess stress in your life, and eating a poor, carbohydrate-laden diet can assist in switching “on” genes for IBS (and other illnesses). Which means making wise lifestyle decisions – including minimizing toxins and stress, and eating mostly natural, whole foods – can help keep those genes in “off” mode.
Inherited microbes may be as significant as genes. When we’re born, we adopt our mother’s microbiome, and then we quickly pick up more microbes from our immediate surroundings, which can include our father. If parents have poor health habits and therefore a disrupted gut microbiome, the microbes they share may potentially affect the future health of their offspring even more than the genes they pass down.
Natural Ways to Restore Gut Health
Currently, there is a range of over-the-counter and prescription medications for improving IBS symptoms. But therein lies the problem: They focus on alleviating symptoms, not resolving the underlying triggers for IBS, and so once you discontinue treatment, your misery will return.
Sometimes these approaches might be necessary to help manage symptoms while you also work on restoring a healthy foundation, and that’s okay. Fortunately, many people find that making the right diet and lifestyle changes and adding some additional, natural gut support are enough to ease IBS symptoms and restore gut health. Here’s what I recommend.
1. Embrace Herbal and Natural Digestive Support
Taking herbs and other natural supplements is possibly the simplest, most effective way to restore your gut health and overcome IBS. Herbs and plants contain natural antimicrobial, antioxidant, and detoxifying compounds that help counter the damage of what I call 21st century system disruptors: chronic stress, a poor diet loaded with processed foods, and environmental toxins like herbicides, pesticides, and plastics.
What’s most interesting to me is how well our bodies recognize and utilize these beneficial plant compounds. That’s because humans subsisted primarily on roots, herbs, leaves, stems, and barks for millennia, so we’ve honed a natural intelligence for assimilating their benefits after consumption.
- Herbs that contain mucilage, a demulcent that forms a protective film in the gut. Demulcents help soothe irritation in the mucosal lining that might be causing painful IBS symptoms, and also keep foreign substances out of the bloodstream if your mucosa has been compromised and you’re experiencing leaky gut. My go-to mucilage-containing herb is slippery elm bark.
- Digestive enzymes. When you’re experiencing digestive dysfunction, be it from IBS or another gut condition, natural processes like enzyme production can lag and further contribute to poor digestion. Supplementing with digestive enzymes can help fill in the gaps while you’re restoring your gut health — enzymes are especially important for breaking down the carbohydrates that feed bacteria and contribute to IBS and SIBO. Taking an assortment of enzymes (such as protease, amylase, alpha-galactosidase, lipase, and others) is ideal.
- Bitter herbs. We have bitter receptors throughout our gastrointestinal tract, and when they’re activated by bitter herbs and foods, it releases the saliva, enzymes and bile we need to break down food. This process is part of that natural, built-in intelligence that began forming in humans thousands of years ago when we survived on foraged plants – the bulk of which were bitter.
We’ve basically eliminated bitter herbs and foods from our modern diet because they don’t taste good. To get them back in your life, reach for aromatic bitters, bitter herb extracts in an alcohol base. Look for one that contains herbs known for helping digestion, including burdock, dandelion, and gentian root, as well as fennel seed and ginger, and simply squeeze a dropperful or two on the back of your tongue before every meal.
- Probiotics. Evidence of probiotics’ benefits for various health concerns is marginal at best, but they have been shown to help folks with IBS. It’s really trial and error, however: Because every person’s gut microbiome is different, some people gain benefit from a probiotic and others do not.
The best probiotic to consider for IBS is one that contains both lactobacillus and bifidobacteria species. Just be aware that using probiotics can make SIBO symptoms worse. If you experience symptoms such as trapped gas and bloating, discontinue use of the probiotic.
2. Adopt a Clean Diet to Nourish Your Body
By now, you probably know the first thing I’m going to say: It’s time to stop feeding bad bacteria and cut back on processed foods and carbohydrates. Wheat and products containing significant amounts of gluten are best avoided. (Trace amounts of gluten are okay unless you’re certain you have celiac disease.) Grains in general are best minimized or avoided, with the exception of white rice and quinoa, which are tolerated well by most people.
But remember, different foods bother different people. So I’d recommend eliminating all of the top IBS trigger foods from your diet to see which are a culprit for you. That list again is dairy, wheat products, peas, beans, processed meats, fried food, and cabbage, as well as alcohol and caffeine. If symptoms improve, you can try slowly adding one food at a time back to your diet, leaving several days between to watch for a reaction.
Here are some additional, basic guidelines on what to eat to restore gut and immune system health – and alleviate IBS symptoms along the way:
- Fill your plate with mostly vegetables. The soluble fiber in vegetables has been associated with improved bowel function and a decrease in severity of IBS-related diarrhea and constipation. Vegetables also provide ample vitamins, minerals, other essential nutrients for balancing the microbiome and promoting optimal intestinal motility.
- Avoid food with labels. By this I mean opt for fresh, whole foods as opposed to packaged stuff that’s likely full of processed carbohydrates and artificial colors and flavors. I aim to make 90% of the groceries I buy label-free – it’s not always possible, but it’s a great goal.
- Up your prebiotic intake. Prebiotics are non-digestible carbohydrates in food that support the growth of beneficial bacteria in your gut. Inulin and fructo-oligosaccharides, found in onions, garlic, chicory, and Jerusalem artichoke, provide nourishment for favorable bacteria.
- Eat fermented foods. Regular consumption of fermented foods such as kimchi, yogurt, sauerkraut, and kefir is important for seeding the intestinal tract with favorable bacteria. Probiotic foods sometimes prove to be more beneficial than probiotics.
- Stay hydrated. It helps to nourish your cells, detox the body, aid in digestion, control inflammation, and so much more. Filtered water is your best source of hydration. Another great beverage is ginger tea: ginger has excellent anti-inflammatory properties, plus, it offers antiviral and other antimicrobial properties. Avoid carbonated beverages, alcohol, coffee, and drinks with sugar alcohols (like sorbitol), which are common diarrhea and constipation triggers for those with IBS. Finally, don’t forget hydrating foods. Fluid-rich options include apples, berries, cucumbers, watermelon, and romaine lettuce.
Stress is so normalized in our modern society that you might get a look of disbelief (mixed with a hint of envy) if you tell someone you’re not feeling the pressure of some deadline or other life demand. But if you want to overcome IBS, it’s vital that you get stress under control.
What relieves stress is different for everyone – if there were a one-size-fits-all solution, we’d all have happier guts and a flourishing immune system. So, take the time to find an activity that dependably takes the edge off for you.
I know practicing qigong, meditation, and yoga work for me. Regular walking is probably the best activity you can do: it’s a great stress-reducer and mood lifter, and several clinical studies have shown it has positive benefits for IBS. For all you type As out there, consider at least 10 minutes of de-stressing a daily deadline you have to meet.
IBS can feel like a constant thorn in your side – both literal and actual. But you don’t have to let your life be ruled by your symptoms. By pairing the right herbs and natural remedies with healthy diet and lifestyle changes, you can take back control of your digestive health and finally find significant relief from your symptoms.
Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ best-selling book, .
You can also read about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Always consult your qualified healthcare provider before beginning any diet or program.
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