Irritable Bowel Syndrome (IBS)

IBS says exactly what is going on, the bowel is irritated and letting you know that it is. Medically the cause is not precisely known, it is thought to be related to stress and to foods. Your bowel lets you know it is irritated by pain, abdominal distension, altered bowel patterns, which can vary from constipation to diarrhoea, or alternating between the two. Actually many people experience neither constipation nor diarrhoea but sticky stools that just don’t want to be passed. The lower bowel just never seems to empty properly and there are frequent small messy bowel movements.

From treating many people with IBS I have found that it is always associated with a food intolerance. Intolerance is different from allergy in that the effects are local, there is no overall bodily reaction, just the gut. There are a variety of foods that can contribute but the most frequent is lactose in milk. This is because there is a specific enzyme lactase that digests the milk sugar lactose. Babies are born with specialist cells in their gut that secrete lactase but once weaned many lose these cells and no longer secrete lactase and therefore cannot digest lactose. Cow’s milk is the biggest offender because it contains lots of lactose. Goat milk contains far less and is therefore much more readily digested. Wheat is also a fairly common offender, but it can be almost any food. Intolerance to wheat is not the same as coeliac disease which is caused by an intolerance to gluten a protein found in several grains.

A food intolerance would explain many of the symptoms because it results in the release of histamine within the gut, which causes contraction of the involuntary muscle in the gut. There are two sets of muscles, those that go around the gut and those that extend down the gut lengthways. These muscles work alternatively, so that the circular ones squeeze and the longitudinal ones shorten, this propels the food and the waste along the gut; this is known as peristalsis. When histamine is present the muscles of the gut contract and remain in a contracted state, so that the food and waste cannot move on. Any gas that is produced gets trapped above the contraction, causing the distension. When smooth muscle is stretched or constricted beyond its normal capacity it results in pain. Once the histamine reaction is over the muscles relax and the gas, food and waste can get on its way. All is resolved till the next time unless the offending foods are identified and avoided.

Research has found that treating with probiotics helps the symptoms of IBS suggesting that a cofactor is an imbalance between the helpful and harmful bacteria inside the bowel, called a dysbiosis. The helpful bacteria, probiotics, aid in the digestive process as well as manufacturing certain vitamins for us, but they are constantly under threat. We have all heard of how antibiotic treatment kills of many of the probiotic bacteria and how they will need replenishing after treatment, but actually there is a bigger threat than that. The pesticides used to treat our vegetables and animal feeds become contained in our food, these are anti-bacterial and kill the probiotics. Fluoride in toothpaste, chlorine in our water, in fact just being too clean and using antimicrobial sprays on work surfaces, all reduce the numbers of good bacteria. Antibiotics are commonly used in animal rearing because it increases growth, farmers are meant to stop the treatment long enough prior to slaughter for the antibiotics to have been gone from the flesh but many question whether this always happens.

Recent research has found that the claims for probiotic treatment are exaggerated. This is not my experience but the probiotic treatment needs to be specific. There are 15 different species of probiotics that inhabit our gut but we tend to only hear regularly about 3. Many of the combined probiotic capsules do not contain all. Now I rarely find that acidophilus is effective, that is because very few people seem to be deficient in acidophilus probably because it is widely available in our food. I also rarely find that a combination of the probiotics is helpful. What I do find is that different individuals require different species, and usually only one and they need that one in significant amounts. My feeling is that our bodies don’t all provide the right environment for all of these species, that for some reason one of the species just does not prosper. I find that many individuals with IBS who also have a lactose intolerance also respond well to treatment with infantalis. Infantalis is one of those 15 probiotics. Now, here’s an interesting fact. A new born baby’s gut is sterile, it contains no probiotic bacteria, after all it’s come from a sterile place. A new born baby cannot digest milk, because the gut is sterile and for about 48 hours the breast produces a clear liquid called colostrum. It is only after this 48 hours that milk is manufactured, during which time the baby’s gut has becomes invaded with probiotic bacteria. The first one to invade is called infantalis, hence its name. The baby is exposed to the infantalis as it passes down the birth canal and from the skin around the nipple. Mothers are no longer recommended to wash their breast prior to feeding for this very reason.

Interestingly many with a lactose intolerance find that they can tolerate small amounts of unpasteurised cow’s milk cheese; again this is because the milk having not been pasteurised contains bacteria, which help in the digestive process. Those who don’t have a lactose intolerance usually need other probiotics, but again it tends to be only one species.

The probiotic bacteria should literally line the bowel, squeezing out any pathogenic (harmful) organism from remaining in the bowel. When there are insufficient numbers of probiotic bacteria pathogenic organisms can invade and the invader is frequently fungal such as candida. This will increase the symptoms of IBS.

Incidence of IBS maybe increased if the protein in the food is not adequately digested prior to entry into the small or large bowel. All protein is made up of chains of amino acids which are broken up into pairs by the protein digestive enzyme in the stomach, these pairs of amino acids then enter the small intestine where they are broken up into single amino acids by the enzymes secreted from the pancreas and from the lining of the small intestine itself. If any of these enzymes are insufficient in amount or activity then protein digestion will be affected. When whole proteins enter the large bowel the bacteria ferment them, this produces gas which adds to the distension and the discomfort and to the changes in the consistency of the faeces. To make the protein digestive enzymes the body needs zinc, magnesium and activated vitamin B6. The stomach also makes a strong acid which is important for the enzymes to work, but this acid also protects us by zapping any harmful organisms that we ingest. Fungal spores are around us all the time and therefore constantly ingested. Zinc and activated B6 are required to make that acid so any deficiency will increase the risk of the presence of harmful organisms surviving to set up home in our gut.

IBS is therefore the result of a number of factors including nutritional deficiency, poor digestion, intolerance to specific foods and a dysbiosis of the organisms in our bowel. My assessment looks at all these factors: offending foods, nutritional status to make enough enzymes and stomach acid, presence of sufficient probiotic organisms, presence of harmful organisms. Treatment is about replacing any nutritional deficiency to aid digestion and to improve the immune response, specific probiotic treatment to balance the number and amount of species of helpful bacteria and help eradicate the harmful organisms.