Irritable bowel syndrome (IBS) – what is it exactly?
1 in 5 people in the UK have IBS which is very common; there is no need to feel alone if it affects you. It may be reassuring to know that IBS can be helped with a little time and dedication to restoring health fundamentals, herbal medicine and understanding the likely causes and triggers.
The gut is the epicentre of health; it is the gateway to nourish all fabrics of the body. It delivers the raw materials for vital bodily functions from making neurotransmitters to remodelling bone which is a living tissue. The gut lining also separates the internal body from the outside (our environment). It has the important job of deciding what is helpful to the body and what the immune system should get rid of – in this way, the gut really is the heart and brain of the immune system. In a nutshell; a healthy gut equals a well-functioning immune system. This is relevant because by improving IBS symptoms, your overall health could improve.
One of the key things I focus on with IBS is managing emotions and stress relief – there is interestingly and undoubtedly an emotional link to IBS in many cases.
It can impact quality of life with people planning schedules around loos, or simply feeling too uncomfortable to do the things they want.
IBS affects people in different ways. The symptoms are varied but include bloating and distention, flatulence, reflux, heartburn, fatigue, low concentration, mood changes, diarrhoea or constipation - or both. These are some possible symptoms of IBS that occur alongside abdominal pain or discomfort.
IBS is categorised as a “syndrome” which means the direct cause is unknown and the illness is defined simply as a cluster of certain symptoms. As with most chronic issues, there isn’t one cause – it is usually a combination of one or more factors that align at a point where symptoms become noticeable. Time and dedication are needed to unravel the potential factors that led to your symptoms. Working backwards – to move forwards!
IBS and EMOTIONS
There is a clear link between emotions and IBS symptoms which seems to work both ways - as a contributing cause, and worsening already-existing symptoms.
Christopher Hedley, an inspirational herbalist and teacher once said “We brush our emotions under the diaphragm”. I always remember his very relevant words, particularly with IBS patients. Trapped emotions usually manifest in symptoms involving the skin, gut or the heart.
IBS - What happens in the digestive system?
Changes in the gut lining and “good” bacteria community
Helpful bacteria (gut microbiome) live inside your gut lumen, alongside the mucus layer and cells which thinly line your gut. Ever-growing research shows the microbiome’s function is so wide and pivotal to health, it might as well be considered another organ. Very importantly…it teaches your immune system how to behave appropriately, affects your metabolism, makes vitamins, modulates gut-brain axis communication and influences sensations and gut motility (how quickly or slowly food moves through your digestive tract).
In IBS some or all of the above functions are disrupted and a low-grade, unresolving inflammation persists, which can also affect the rest of the body. If the immune system is acting inappropriately, you may be reacting to foods that would usually be recognised as “normal” by the immune system which lines the gut (60 – 70% of your immune system resides in the gut). CRP, a general inflammatory marker, may be raised in IBS.
Neuroendocrine changes
Nerves carry communication messages which determines the release enzymes and hormones. In IBS, this communication is disrupted and changes in the way nerves and hormone-secreting glands communicate occur. This means that hormones which orchestrate digestive function can be negatively impacted. For example, neuroendocrine changes in the gut may affect:
How fast food moves through your digestive tract (involving serotonin) causing diarrhoea or constipation
If enough pancreatic enzymes and stomach acid are released to properly digest and absorb nutrients from food
If enough bile is released to emulsify fat in foods, and reabsorb bile acids once used. If bile acids aren’t reabsorbed properly, diarrhoea can occur.
Nervous system changes
In many IBS patients, the signals between the enteric nervous system (the nervous system governing gut function) and the brain are negatively affected. For this reason, IBS sufferers are hypersensitive to movement in their gut wall (heightened sensation) – and pain is felt even when the response is disproportionate to the level of “stretching” occurring in the gut wall.
What are risk factors for IBS?
As with most chronic illness, symptoms arise when a few factors align causing imbalance in the body noticed by people as symptoms:
Prolonged stress (emotional stress)
An infective trigger such as parasites or gastroenteritis
Adverse childhood experiences (stressful events affecting the way your nervous system responds to the world)
Diet
Antibiotic usage
Genetics (which can set up susceptibility, but not a determinant)
The herbal approach
Ease symptoms for the patient as a start
Herbs make people comfortable while the longer-term work can be done.
Temporarily removing foods that the patient is reacting to create space for gut healing to occur. The common problematic foods include gluten, dairy, sorbitol (or sugar alcohol) in “sugar-free” foods and high FODMAP or fructose foods.
Carminative herbs reduce bloating and pain (cardamom and fennel are examples)
Antispasmodic herbs relax the smooth muscle in the gut reducing pain
Anti-inflammatory herbs help with pain by calming inflammation (in the brain and gut) but also reduce damage on the gut lining
Nervine and adaptogen herbs to calm anxiety and build resilience to stress
Astringent herbs for diarrhoea
Laxative herbs for constipation
Heal the gut lining and rebalance the gut microbiome
Working together to create new habits – all done gradually, without causing additional overwhelm. Incorporating healing foods, herbal medicine, and supplements to allow the gut microbiome to flourish.
Consider eating habits to help healing:
Enough fasting time between meals to allow the gut’s “self-cleaning system” to kick in (known as the migratory motor complex).
Chewing food well to help a strained digestive system
Avoid drinking liquids close to meals (dilutes stomach acid needed for digestion)
Avoid eating on-the-go or if stressed - this disengages the “rest and digest” nervous system mode improving digestion. When stressed, digestive function is deprioritised as a function
Attend to the nervous system
Finding the best ways for the patient to manage stress. This might be learning to schedule in downtime, yoga, meditation, setting boundaries, adjusting sleep habits, or working on trapped emotions and underlying issues.
Recognising nutrient deficiencies
Malabsorption of nutrients is possible if the gut lining is not functioning optimally. If you suspect you may be deficient in a nutrient, read more about signs and symptoms here.
Next steps…
If you’ve been enduring IBS for some time, it may be reassuring to know that it doesn’t have to be this way. Partner a medical herbalist who can guide you through the likely dietary triggers, and help unravel your experience to plan a positive way forward.
REFERENCES
IBS - General Practice notebook. Available at: https://gpnotebook.com/simplepage.cfm?ID=1369047061 (Accessed: December 12, 2022).
Knott, D.L. (2021) Irritable bowel syndrome (IBS): Symptoms, causes and treatment, Patient.info. Available at: https://patient.info/digestive-health/irritable-bowel-syndrome-leaflet#nav-0 (Accessed: December 12, 2022).
Nicolle, L. and Beirne, A.W. (2010) A practitioner's handbook: Biochemical Imbalances in disease. London: Jessica Kingsley.
Bone, K. (2021) Functional herbal therapy: A modern paradigm for clinicians. London: Aeon Books.
Hechtman, L. (2019) Clinical naturopathic medicine. Chatswood, NSW: Elsevier.
