What is it and how do you actually deal with it?

“We can’t find anything wrong with you in the tests. Your stool sample and blood tests came back normal. Everyone gets a little diarrhoea/constipation, at least we know it’s not going to kill you.  It seems you have IBS; try stress relief and perhaps some probiotics”.

If you’re reading this, you may have heard this line before. And you probably still suffer digestive problems after many years.

So let’s have a look at ‘IBS’. IBS really is a wastebasket label. Why? Because it tells you nothing, it diagnoses nothing and there is no mainstream or standardized treatment for it. It is a diagnosis of exclusion. That means whoever gave you the diagnosis, whether yourself, the internet or your doctor, it means all the nasty stuff has been ruled out (which is a very good thing in a way) and no-one’s really sure what is going on, but your bowel movements aren’t normal. So IBS is not really a condition but a number of symptoms (gas, bloating, diarrhoea, constipation, pain).

So what is going on?

Well, I’d like to explain what current research shows us about the digestive tract, psychology and measurable markers in sufferers of IBS compared to those with normal bowel transit and no digestive complaints.

What’s causing all this?

  1.     Dysbiosis – the microbes in your gut are out of balance

Dysbiosis refers to the microbial  imbalance in or on the body, however the term often refers to the ecology inside the digestive tract.  Inside your digestive tract from mouth to anus are trillions of bacteria, eukaryotes and archaea (prokaryotes-ancient single celled organisms). This micro-climate, like any in nature, exists in a particular balance. And like a weed introduced to a forrest or garden, it can take over and distrupt balance, suffocating the natural habitat.  Eating food that your body has not been used to or food that is over processed or taking anti-biotics which wipe out the whole gut ecology can cause this imbalance in your gut as the “weeds” or bad bacteria take over and populate your intestine.

  2.   SIBO- Small Intestine Bacterial Overgrowth

SIBO stands for small intestine bacterial overgrowth. It’s when bacteria begin to take over in your small intestine where there shouldn’t really be much bacteria there at all.

So, when you have SIBO, you have an imbalance of healthy bacteria and an overgrowth of fermenting and gas producing organisms. What happens here is that when you ingest certain sugars such as fructose and lactose and fibers, they are broken down into hydrogen by bacteria. This excess hydrogen is then broken down by the bacteria into sulphites and the archaea break it down into methane as a by product.

SIBO has been detected in a majority of people with digestive complaints labeled with IBS.

  3.   Gas

99% of the volume of flatus is non-smelly gases such as oxygen, nitrogen, carbon dioxide, hydrogen and methane. The 1% gas in flatus that causes the smell comes from a combination of volatile sulphur compounds (VSC), especially hydrogen sulphide (H2S- rotten eggs), Methyl Mercaptan (MM- decomposing vegetable smell) and Dimethyl Sulphide (DMS- wild radish smell).

The significance of methane is that it is a colorless, odourless inert gas that is present in around 50% in SIBO sufferers and 100% in sufferers of constipation. Also, the amount of methane produced in people with SIBO, is considerably higher than people with fructose malabsorption or lactose intollerance which are sepperate issues.

Overly ‘smelly’ flatulence usually indicates that incompletely digested food arrives to the large intestine, from the stomach and small intestine, and starts to ferment with the large intestines bacteria.

Undigested food entering the large intestine may indicate quite afew things. Firstly, the stomach HCL pH should be acidic, around pH1. Stress can alter the pH making it more basic and unable to digest proteins properly. Chewing food can be insufficient to make the size of the chunks in the stomach small enough and covered in enough amylase enzyme from the mouth saliva. Pancratic enzymes may be deficient or bacteria may have invaded the small intestine.

Some people are unable to digest certain sugars in food such as fructose, lactose and oligosaccarides. This may require lessening the load of these foods by following a FODMAP diet.

Hydrogen sulphide is produced from foods high in sulphur such as cauliflower, eggs, allium family such as garlic and onions and proteins such as meat and nuts. Sulphur is a very important part of your diet, it helps the methylation detoxification process in our body which prevents allergies, food sensitivities and detoxes excess hormones and toxins. However some people just don’t digest sulphur very well and this may be due to a genetic mutation such as CBS, but research is still catching up with this one.

  4.  Parasites

Parasites; an organism than lives in or on another organism of another species known as the host, from the body of which it gains nutrients.

The common parasites in subcategories that affect humans are:

Protozoa (single celled organism >1mm): Malaria, Giardia, Toxoplasmosis, etc. Standard stool test from your doctor will pick up these infections.

Protozoa common to cause digestive discomfort not picked up on standard testing is Blastocystis hominis (2-20% of the opulation) and Dientomeba fragilis (<10% of the industrialized population).

Parasitic Worms/Helminths  () Flat worms such as tape, Fulkes such as blood flukes, Round worms such as thread, hook or pin worms.

Parasitic Flukes () Shistosoma, fasciola hepatica, etc

Ectoparasites () Scabies, headlice, ticks, etc

The most common, tricky and undetected parasites I have come across in the clinic would be Dientameba Fragillis and Blastocytis Hominis. Reasons being that they are not that uncommon and not tested for. Not only are they not part of a standard parasite stool test, they require 3 fixative samples to be properly detected. We have Chinese medical herbal protocols to follow, however the common wetsern medications used are Metronidazole (flagyl), Furazolidone (Furoxone) and Ciprofloxacin (Ciproxin) orally, however side-effects can be significant and so is resistance. If the parasite is resistant to this first line treatment, colonoscopy infusions are offered of Nitazoxanide, Secnidazole and Furazolidone which is a triple therapy developed in Sydney By Dr Thomas Borody at CDD and has a much higher success rate and low incidence of severe side-effects.

I find gentle herbal preparations work very wel over time. If they don’t, we can call in the big guns as above. However, side-effects should be expected.

  5.   Mast Cell Disorder

Mast cells are better known for their harmful effects during inflammatory conditions such as asthma and allergy.However, the role of mast cells in GI infections has largely been ignored which is interesting because this reaction seems to have evolved as a defence system against intestinal worm infestations(Mixed Organic Brain Syndrome as a Manifestation of Systemic Mastocytosis. Psychosomatic Medicine Vol. 48, No. 6 (July/August 1986).

Parasitic infections can also lead to something called Systemic Mastocytosis (SM).

Mast cells are a type of white blood cell which contain pharmacologically active granules which are released to kill harmful bacteria or parasites on contact. Mast cells are found in various places in the body, abundantly in the digestive tract.

Rather than the traditional thought that feeling unwell is due to a fight between good and evil between parasite and host, modern research points to the mast cell response and degranulation is a more likely cause of these un-well symptoms.

Tricyclic antidepressants are a mainstay treatment for IBS and panic disorder. Coincidentally these drugs inhibit the release of pro-inflammatory mediators from human mast cells. (Clemons et al. Journal of Clinical Psychopharmacology: June 2011 – Volume 31 – Issue 3 – pp 385-387.)

Ranitidine (Zantac) a histamine H2-receptor antagonist and cetirizine (Zyrtec) an H1-receptor antagonist have been used for this condition with surprisingly positive results, however, they seem to wear off after 2-3 months.

Sodium cromogylcate, another mast cell mediating drug has been used to treat food allergies (Byars & Ferrares 1976), however tolerance levels are commonly reached after 3 months also.

Chinese medicine offers a herbal formula that is currently undergoing phase 2 drug trials to treat peanut allergies in children. In studies, the FAHF 2 formula significantly reduced TNF-alfa, Mast and Basophil Cell proliferation, significantly calming the body’s immune response.

So which bacteria should be where in my gut?

There are bacteria all along your digestive tract from mouth to anus; in fact 60-80% of the dry weight of your stool is actually bacteria. Most of the bacteria should reside in your large intestine. Sometimes the bacteria overgrow in your small intestine (where there should be hardly any at all) and cause SIBO. Your small intestine is the main part of your digestive tract, between your stomach and large intestine, where most of the digestion and absorption of nutrients take place. Digestion in the small intestine is facilitated by bile juice from the gallbladder and pancreatic enzymes from the pancreas and bicarbonate is released to alter the pH after it comes from the highly acidic environment of the stomach.

The large intestine contains over 700 species of bacteria that all perform their own functions from producing vitamins, digestion and immune regulation.

In the clinic we use different types of bacteria for each patient. Lactobacillus Plantarum 299v is a very useful probiotic to reduce inflammation and help re-introduce a healthy level of gut bacteria. Some patients find a decrease in Nissle strain EColi which is also beneficial. The best way to ascertain which probiotic you need is through adequate testing or with a qualified and experienced practitioner.

The difference between diarrhoea & constipation SIBO

This is difficult to say, however it appears that different types of bacteria and gasses have different effects on gut motility. For example, people with constipation have a higher methane breath reading and diarrhoea patients show higher levels of hydrogen.

Some research suggests that the primary cause of constipation is an overgrowth of anaerobic bacteria (99% of the bacteria in the gut which don’t need oxygen). These bacteria secrete neurotoxins which damage neurons which paralyse the muscles surrounding the intestine causing constipation.

What do I do now?

There are so many ways to treat IBS, and there are so many considerations.

After hundreds of patients and suffering myself for many years before getting proper treatment my answer is, it isn’t easy and it isn’t simple.

Having said that, there are some commonalities and clues as to where your gut problems started. I find a lot of patients problems started either after a trip overseas, a period of prolonged illness that included a lot of medication, usually antibiotics, a period of intense stress, or sometimes just working with soil.

From there we may seek a Comprehensive Digestive Stool Analysis (CDSA) or just got straight into treatment.

Treatment usually combines acupuncture to relax the mind, reduce stress and balance the dysfunctional systems of the body (including stomach acid and digestive enzymes), herbal anti-biotic/anti-parasitic, probiotic, prebiotic and then rebuilding the gut lining.

If you would like to call us for a consultation to discuss your digestion and how to provide a sustainable approach to digestive health, please call/email the contact below.