Irritable bowel syndrome (IBS) is incredibly common – about 1 in 10 people are given the label. However, IBS is just that – not a diagnosis as such, but a mere label for a cluster of symptoms that might be caused by any one of a range of things.
So many patients are left feeling helpless when diagnosed with IBS, and fear that symptoms like cramping, diarrhoea or constipation, gas or bloating, and fatigue are lifelong. When in fact, there are numerous ways in which to help manage irritable bowel syndrome long-term.
The exact cause of IBS is unknown, but research shows that food intolerances, disordered balance of microbes in the gut, microbes tracking their way from the large gut to the small gut, or overactivity of the nerves of the gut can all cause the symptoms – and it’s a common misconception that nothing can be done simply because many patients are not being offered the tests that can make a difference.
Testing and diagnosis of IBS
1. SIBO Test: for small intestinal bacterial overgrowth
SIBO has been shown to be linked very closely with IBS. In fact, studies show 30%-85% of those who are diagnosed with IBS actually have SIBO (1). Small intestinal bacterial overgrowth (SIBO) can cause allergies, gas, bloating, bad breath, dental problems, foggy brain and more. People suffering from SIBO may find that things they think are good for them – such as fibre, probiotics, or fermented foods (which can be high in histamine) – actually worsen their symptoms. Often, nutritional trends such as Kombucha, packed with ‘good bacteria’, can be detrimental to a patient suffering from IBS when not guided by proper, individual treatment for their specific condition. Always consult your doctor when it comes to foods that can help your IBS condition.
SIBO occurs when bacteria expand from the colon back into the small intestine, and can occur as a result of low stomach acid, lack of digestive enzymes, immunodeficiency syndromes, anatomical or motility disorders. Bacteria or yeast existing in the upper gut means that foods are fermented there instead of being digested, and in turn produce products which have to be detoxified by the liver.
The test for SIBO involves fasting overnight, then drinking 10gm of lactulose syrup. Breath samples are collected for the next three hours. Prompt treatment of small intestinal bacterial overgrowth with antibiotics or antimicrobial herbs, change in diet (e.g. low FODMAP, which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet and alcohol avoidance) can help resolve the symptoms of gut fermentation. What’s more, patients who have undergone successful removal of SIBO had significant improvement in symptoms like abdominal pain and helped to relieve diarrhoea (2).
2. Leaky Gut Test: for increased intestinal permeability
Many patients with IBS also have abnormal intestinal permeability, or malabsorption, which is probably due to low-grade inflammation in the intestinal mucosa (3). 70% of the entire body’s immune system resides in the gut – proving how crucial it is to support its immune function. So increased intestinal permeability, or a ‘leaky gut’, usually manifests with things that negatively affect the immune system such as diarrhoea, food intolerances, increased allergies, fatigue, gas, bloating, skin disorders and more.,
Essentially, the gut lining should act like a sieve, letting smaller molecules pass through and keeping larger molecules out. Leaky gut means large food particles get absorbed into the bloodstream which triggers the immune system causing inflammation.
This test can be done at home and involves taking a 3g dose of polyethylene glycol and then collecting urine for 6 hours after. Intestinal permeability can be helped with supplements such as L-glutamine and slippery elm and should result in symptom improvement. Always consult your doctor before taking any new supplements.
3. Stool Test: for a comprehensive digestive analysis
It is extremely useful for patients with IBS to undergo a comprehensive digestive stool analysis. This looks at a number of faecal biomarkers – for example, pancreatic enzyme production which is needed to digest food, faecal calprotectin which can help distinguish irritable bowel syndrome from inflammatory bowel disease, levels of eosinophil protein X which are suggestive of food allergies, and more (4).
When dealing with the discomfort of IBS, it’s important to understand that there are ways you can improve your situation and manage your symptoms – every body is different and there are tests out there you can try, with the guidance of your doctor, to help you individually care for your condition long-term.
1. Small Intestinal Bacterial Overgrowth syndrome
2. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study
3. The Relationship between Small-Intestinal Bacterial Overgrowth and Intestinal Permeability in Patients with Irritable Bowel Syndrome
4. Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis
5. Novel Testing Enhances Irritable Bowel Syndrome Medical Management: The IMMINENT Study