Over 50 million Americans have been diagnosed with irritate bowel syndrome (IBS), and it’s quite likely that at least that many of us are walking around with IBS but haven’t been diagnosed yet.
Gas, bloating, distension, spasm, queasiness, stomach pain, intestinal pain, constipation, diarrhea – or a combination of the two – are common features of IBS.
IBS used to be thought of as a “wastebasket” diagnosis. You went to your doctors, they ran a bunch of tests, maybe some blood work, maybe some imaging, maybe an endoscopy/colonoscopy…everything came back “fine”, there was no indication of anything wrong in your tests. No lumps or bumps. No ulcers. No inflammatory bowel disease, no Celiac disease, nothing in the blood tests, nothing at all to see. So, when everything else gets ruled out, you get the diagnosis of IBS.
IBS is also commonly referred to as a functional gastrointestinal disorder. This means that it impacts the function of your digestion (as anyone with IBS will readily tell you, or you have experienced yourself!) without there being a physical cause to point to that explains the change in function.
The New Model of IBS
With the explosion of research into the microbiome – the colony of at least a trillion beneficial bacteria that reside in your large intestine and provide innumerable functions for your body – and the heavy prevalence of IBS, some smart researchers have a fresh perspective on IBS.
They have found two common themes that underpin those with IBS. IBS is interesting because it is a highly individual disorder – ten different people with IBS will experience it ten different ways – but these cornerstones remain for all:
1. Dysbiosis is present. Dysbiosis is simply a catch-all term for an unhealthy imbalance in your microbiome. An imbalance that will create symptoms. Your microbiome is responsible for many functions in your body, including digestion, immune health and function, hormonal creation, activation, recycling and detoxification. Your microbiome makes nutrients for you, helps you extract nutrients from your food, protects you against pathogens and disease and allergies and even has a say in your blood pressure, cholesterol, and how fat you are.
Dysbiosis, then, is this healthy, beneficial landscape thrown off its game. It could be that..
- There are too few good, beneficial guys
- That there are two many “frenemies” (bacteria that could be beneficial or harmful depending on the circumstances)
- That there is frank infection with bad bacteria, yeasts, or parasites
- That the bacteria have located themselves somewhere in the body that they don’t belong (classic example here is SIBO/small intestine bacterial overgrowth, and SIBO & IBS are commonly found together)
Some form of dysbiosis is present in those with IBS.
2. Second Brain imbalance is present. Your Second Brain is a super highway of nerves that is present in your entire GI tract, top to bottom. There are SO many nerves that the only structure in your body that has more is your brain, and that’s why your Second Brain is named as such 😉 The technical name for your Second Brain is the Enteric Nervous System (ENS) and it monitors all aspects of digestion on a second-to-second basis and manages digestive function, motility and regularity. It is responsible for perceiving pain in the digestive tract and relaying that message to your brain.
In fact, your brain and Second Brain are in a two-way relationship. Your Second Brain doesn’t need your brain to digest, but it does take input from your brain. When you are stressed, you may notice you feel it in your gut. This is an example of the two-way feedback present.
Folks with IBS have a disrupted Second Brain. They struggle with motility and regularity (diarrhea, constipation or both are key features of IBS) and their Second Brains perceive pain in the gut faster than folks without IBS. This means their guts are more painful and tender.
IBS symptoms are always worsened under times of higher stress. Those with a history of abuse, trauma and chronic stress are at higher risk of developing IBS (and virtually all chronic conditions).
A New Approach to IBS
With this knowledge comes a great opportunity to approach IBS in a way that supports the very cause of the issue, instead of taking medications to cover up the symptoms, or offering antidepressants or other some such inadequate clinical approach.
The new approach to IBS will encompass techniques that help correct dysbiosis and calm and balance the Second Brain. Utilizing a low-FODMAP diet (clinically shown and proven over and over to reduce symptoms and help the microbiome), gut restoration practices targeted to balance the microbiome, and interventions aimed at de-stressing the Second Brain via supplementation, daily exercises, mindfulness practices and other research-based lifestyle therapies strategically used to soothe the Second Brain, re-wire the brain and nervous system for greater peace and less pain and reactivity are central approaches to the new model.
This is an approach I have been honing and re-honing in my clinical practice with my own clients for the last couple of years, to fill the enormous gaps I have seen in conventional management of IBS.
Testing for IBS
Anti-cdtb and anti-vinculin: these are blood tests that measure the antibodies your body is making against two proteins that are made in high amounts by the “bad” bacteria present in those with IBS. These tests can be ordered by your doctor and are considered diagnostic for IBS and confirm the dysbiotic component of IBS. You can read more about this test/share information about it with your doctor here.
CDSA (comprehensive digestive stool analysis): this is a stool test that can be used to confirm/deny dysbiosis and give you a snapshot of the function of your gut in real time. A CDSA will qualify and quantify the healthy bacteria present in your gut, and it will also identify bad/pathogenic bacteria, yeasts and parasites, if present. If the bad guys are present, it will tell you what conventional and integrative/natural antimicrobial agents they are sensitive to. This is a major perk of the test!
A CDSA will also measure spilled fats, proteins and fibers in the stool and measure pancreatic enzyme output, giving you good insight into your digestive ability, if you are breaking foods down (lots of folks with IBS don’t) and your ability to absorb them. The CDSA checks for markers of inflammation, quantifies your short chain fatty acid production (SCFAs), looks for blood in the stool, and basically gives you an enormous amount of data that will help guide your treatment approach and gut restoration. My favorite lab is Genova Diagnostics, and I also like Doctor’s Data.
The big picture here is that with a greater understanding of what is going on in folks with IBS, we can be extremely decisive and laser-focused with our interventions.