The numbers of people developing IBS, SIBO or IBD is rapidly increasing within North America, India and other parts of the world. Our food supplies are incredibly polluted with pesticides, herbicides, etc. Our food is laced with genetically modified ingredients, sugars, hydrogenated oils, etc. Our lifestyles are too fast paced without any rest, our sleep cycles are all over the place with most people staying up past 2 A.M…. you can begin to see why we, as a race, are having so many difficulties with our health. This article is intended to give you some new information you may not have heard before in regards to IBS, SIBO and leaky gut!
How can you develop IBS?
You can develop intestinal imbalance from many ways. A few of the common ways are dysbiosis from infection, brain inflammation from a head injury, chronic stress, ingestion of toxic substances (medications, drugs, GMO foods, pesticides, etc.
If you took many rounds of antibiotics and have no beneficial flora left, the opportunistic pathogens within the intestinal system (candida) will overgrow and infect the colon. This triggers chronic inflammation in the intestines which leads to IBS. If you had a head injury and now have brain inflammation, the vagus nerve which connect the gut and the brain does not fire effectively and you end up with poor vagal motor nerve outflow. this means that every-time you eat a meal, you wont have signals from the brain to the digestive organs to secrete enzymes. Overtime, this leads to loss of oral tolerance of food and you end up developing food sensitives which trigger inflammation and IBS flares. If you are chronically stressed, your immune system Th1 cells get suppressed and your Th2 immune cells rapidly produce. these Th2 immune cells lead to chronic inflammation and tissue destruction. When you have tissue destruction within the intestinal system, your body literally attacks your gut lining causing IBS and eventually, IBD. There are many other ways in which you can develop IBS but these are just a few common ones.
Systemic inflammation leads to brain inflammation which makes you lose vagal motor tone and you then lose down-going peristalsis in the intestine. This downward motion (motility) of the intestines is what keeps your bowel movements regular and the probiotics in the Large intestine where you want them. When you lose this motility, bacteria from the large intestine creeps up to the small intestine which triggers epithelial inflammation and NFkB (inflamamtory cytokine) production in the epithelial lining of the intestine. This then drives systemic inflammation. One can also get systemic inflammation from pollen or a high ozone day (hot sunny day) and that can set off this whole inflammatory mechanism as well. Brain inflammation inhibits vagal motor nerve outflow which yields you a loss of acetylcholine-mediated inhibition of TNFalpha in the intestines and spleen which essentially makes you lose your anti-inflammatory effects which then again reinforces systemic inflammation.
Connection to SIBO
In a person who has lost their downward motility, they will get the development of SIBO (Small Intestinal Bacterial Overgrowth). If inflammation is the primary cause, then in susceptible individuals, they will develop IBD (Chrons, Ulcerative colitis, etc).
Ohman L. et al. 2010. states that Individuals with IBS usually have disturbed neural function (anxiety, depression, irritability, etc) along the gut-brain axis. They also have chronic low-grade inflammation and immunological alterations in the development of symptoms compatible with IBS (Ohman L. 2010). They usually have infection in the gut too from candida, parasites, viruses, etc.
Types of IBS
There are 2 types of IBS – IBS-D (diarrhea) and IBS-C (constipation). Depending on the type of bacteria you have in your intestines can determine the type of stool/IBS you will have. If you have flora in your intestines that produces methane, you will lean towards IBS-constipation but if you have hydrogen producing flora, you will have more IBS-diarrhea. If you have both bacteria, you will tend to alternate between diarrhea and constipation.
Dietary Evidence
There is evidence that being gluten free and following a low FODMAP diet can be useful for IBS (Chey W. et al 2015). The most important thing to do when you develop IBS is cut out ALL inflammatory foods including gluten, dairy, cane sugar, yeast, etc. Once you’ve successfully calmed down inflammation in the digestive tract AND cleared it out of most the pathogens, you can then begin working on re-sealing the gut lining. It is important to note that if you go gluten free, you need to consider avoiding gluten cross reactors such as yeast, millet, rice, etc. YOu can get a full ELISA IgG, IgA test to determine your sensitivities and what gluten cross reactors are a trigger for you. If you continue to eat those foods, it will trigger IBS symptoms and prevent you from resealing up your gut lining (Chey W et al 2015). Chey W. et al (2015) found that individuals avoiding gluten had a higher rate of improvement in their IBS than those that didn’t. The most common marker for IBS is going to be either overgrowth of bad bacteria or inadequate growth of favourable flora.
Are Breath tests Accurate for SIBO/IBS?
A breath test is where you consume lactulose and then capture air samples to see if there is a production of hydrogen or methane. The sugar solution is used to promote the proliferation of the flora that produced the gas which then gets absorbed into the blood stream and gets off-gassed by the lungs to create detection opportunity in the test. Most the time the test comes back normal when you in fact do have IBS, SIBO, etc. These tests can be somewhat expensive and the common clinical experience is that when a person has a lot of gas and bloating the breath tests will come out abnormal (which means you have SIBO). So essentially, you spend a lot of money to determine if you have gas and bloating which you could tell yourself without spending money. Sometimes a person will go for a breath test and it will come back normal despite the fact that they have obvious symptoms of bloating. What often happens in this case is that the sugar solution that the person drank simply is not the solution that the predominant flora are going to consume to drive their proliferation. If this is the case, they will get a negative breath test. Overall, these tests are expensive and quite inaccurate.
BAD reactions against GOOD bacteria
Just as it is inappropriate to have a negative reaction against food, it is also inappropriate to have a bad reaction against FAVOURABLE bacteria, however it can happen especially with leaky gut. Our bodies are not supposed to be reacting negatively to food or Flora but often times it does which is often times why a person might feel worse when supplementing with probiotics.
Microbiota instability and significant differences in bacterial composition (mainly reduced Lactobacilli and bifidobacteria and elevated aerobe to anaerobe ratios) makes the IBS gets worse and flare up. Large amounts of bacterial concentrations that adhere to the mucosal surface (biofilms) of the gut triggers a lot of inflammation. These bacterial colonies form a structure in which the bacteria are embedded into the lining of the gut which makes them highly resistant to antifungals and other supplements making them difficult to eradicate. In IBS, more bacteria adhere to the mucosal wall which makes the IBS very persistent and chronic.
Conclusion
I hope this article gave you a bit more information as to why you have IBS, how it works and how it affects your body. Everyone tells you that IBS is due to leaky gut but that is not necessarily the case and it is much more intricate than that. I hope you are able to take this information and see where you can apply it to improve your own intestinal health.
Resources:
Chey W., Kurlander J., Eswaran S.: Irritable Bowel Syndrome: A Clinical Review. JAMA: 2015 Mar 3;313(9):949-58.
Ohman L. and Simren M.: Pathogensis of IBS: role of inflammation, immunity, and neuroimmune interactions. Nature Reviews Gastroenterology Hepatol. 2010 Mar;7(3):163-73.