Even if you don’t suffer from Irritable Bowel Syndrome (IBS), there’s a good chance you know someone who does. In fact, up to 15 percent of Americans have Irritable Bowel Syndrome—affecting some 45 million people. And as a syndrome, the precise cause of the condition is not known—and often manifesting with varying features in different people. Notably, this has made both the diagnosis and management of irritable bowel symptoms challenging for some time. There is growing scientific data showing a direct correlation to gut health, mental health, and IBS.
Fortunately, new insights regarding Irritable Bowel Syndrome are slowly being revealed. Information about the gut-brain connection is starting to highlight some important clues about what causes irritable bowel symptoms. And the immunologic system appears to play an important role in addition to this gut-brain connection. From new tests to treatments, patients with irritable bowel symptoms are enjoying increased hope that better solutions may be just around the corner.
Irritable Bowel Syndrome —Subtypes and Symptoms
While many individuals share many complaints when it comes to irritable bowel symptoms, significant variability also exists. In general, individuals with irritable bowel symptoms tend to have constipation, diarrhea or both.
Also, abdominal pain, abdominal bloating and flatulence are also routinely present. But the pattern of these symptoms distinguishes different types of Irritable Bowel Syndrome. And this fact often affects management.
Overall, there are four subtypes of irritable bowel symptoms. These include the subtypes of C, D, M and U. Irritable Bowel Syndrome patients with C-subtype primarily suffer from constipation, while patients with D-subtype have greater difficulty with diarrhea. M-subtype patients experience a mix of diarrhea and constipation, often alternating in occurrence. And finally, U-subtype patients fail to fall into any of the other categories leaving them “un-subtyped”. Interestingly, each subtype may be caused by different etiologies.
Suspected Causes of IBS — The Gut-Brain Connection and the Immune System
While a definitive cause of irritable bowel symptoms is not known, theories do exist based on recent research. Current evidence shows that a gut-brain connection exists and which plays a role in irritable bowel symptoms. Part of the problem is that the nerves that regulate bowel motility do not function properly. This case can result in poorly coordinated intestinal flow causing diarrhea, constipation or both. It can also trigger pain, which plays a part in the gut-brain connection. The pain, perceived by the brain, causes a release of hormones and triggers digestive enzyme release, causing more irritable bowel symptoms.
What causes this abnormal nerve dysfunction in the first place? Many patients with irritable bowel symptoms appear to have an infection of the intestinal tract prior to the IBS onset. Research now shows that the immune system generates specific antibodies that cause damage to the intestinal lining and, potentially, even nerves. Also, an infection may cause changes in the microbiome, the normal “good” bacteria lining our digestive tracts. These immunologic effects may affect the gut-brain connection and initiate irritable bowel symptoms.
Diagnosing Irritable Bowel Symptoms — Linking Gut Health and Mental Health
For the most part, Irritable Bowel Syndrome is diagnosed clinically based on symptoms. This fact and the ruling out of other possible causes of complaints have been the mainstay of diagnosis—which has been rather inefficient, to say the least.
On average, it takes a person going through six years with symptoms before they are actually diagnosed with irritable bowel symptoms. But with gut-brain connection and immunology research, new diagnostics are becoming available.
With suspected microbiome changes and bacterial overgrowth being considered as causes, some tests evaluate this aspect of IBS. For example, intestinal cultures and various breath tests assess potential microbiome changes that might be triggering disturbances in the gut-brain connection. Also, companies like Gemelli Biotech Inc. have developed new antibody tests that are linked to Irritable Bowel Syndrome. Specifically, Gemelli Biotech’s ibs-smart™ evaluates the presence of two antibodies linked to post-infectious IBS of the D or M subtypes. These antibody tests are highly specific and offer results in just a few days.
Diet and Lifestyle Gut Health Factors with Irritable Bowel Syndrome
Regardless of the gut-brain connection and immunology effects, diet and overall gut health play a vital role in improving or worsening irritable bowel symptoms. While the foods that might trigger Irritable Bowel Syndrome symptoms vary among persons, some common food triggers are appreciated. For example, wheat, gluten, dairy, lactose and caffeine often pose problems. And cruciferous vegetables, beans, legumes and higher fiber diets may trigger complaints.
While these types of foods may worsen irritable bowel symptoms, other foods can help individuals with the condition. For example, a common diet approach called FODMAP—an acronym for Fermentable, Oligo-, Di- and Mono-saccharides and Polyols—encourages specific types of saccharides and polyols in the diet.
Lactose-free dairy, feta, and brie cheeses, and various meat and soy proteins tend to be safe. Likewise, some fruits and vegetables are better tolerated including kiwi, melons, strawberries, lettuce and carrots. Depending on which foods trigger one’s irritable bowel symptoms, diet strategies remain important management considerations.
Irritable Bowel Syndrome Treatments Targeting the Gut-Brain Connection
One of the important management strategies for Irritable Bowel Syndrome involves stress management. Higher levels of stress have been linked to worsening frequency and severity of irritable bowel symptoms.
In fact, stress and gut-brain connection are interlinked. For example, stress can negatively affect gut motility, digestive enzyme sensitivity, and a person’s microbiome. For this reason, stress management techniques like relaxation therapy can be very helpful in managing symptoms.
Other treatment options today for Irritable Bowel Syndrome also target the “gut” part of the gut-brain connection. For example, in the presence of bacterial overgrowth or with changes in the microbiome, antibiotics may be used. In some instances, serum-derived bovine immunoglobulin/protein isolate (SBI) is administered to improve intestinal function. Specifically, immunoglobulin therapies “tie-up” some bacteria in the microbiome preventing intestinal wall injury or damage. In some cases, this therapy is combined with probiotics to promote a healthier microbiome and gut-brain connection.
Looking Ahead for Irritable Bowel Syndrome Patients
The new insights regarding the gut-brain connection, the microbiome and the immune system related to IBS are exciting. Companies like Gemelli Biotech are improving both the efficiency and the accuracy of IBS diagnosis. And immune and microbiome therapies have the potential to make tremendous progress in managing IBS in the near future. For a condition that affects millions, that would be very encouraging news.