IBS and the Gut Microbiome
A potential cause of IBS is SIBO (small intestinal bacterial overgrowth) or IMO (intestinal methanogenic overgrowth). According to a 2022 study, nearly half (49%) of SIBO/ IMO cases are initially diagnosed as IBS without proper SIBO/IMO diagnosis given.
SIBO/IMO occurs when the bacteria or archea that live normally and peacefully in the large intestine move up into our small intestine, causing unwanted bloating and gas production, constipation, diarrhea, or both. As the research into the gut microbiome continues to grow, more and more studies are finding that IBS is very much correlated to our gut microbes and how we balance and feed our gut microbes through our dietary choices, medication, stress, as well as the proper flow and migration of these microbes.
Our gut microbiome plays a huge part in the gut-brain axis, in other words, the connection between our gut and brain. This connection seems to be responsible for the majority of symptoms that are present with this disease. The gut-brain axis is made up of both the human nervous system and our gut microbes that is housed primarily in the large intestine. Rather than the brain sending the signals and the gut listening, the gut also appears to have its own “voice” mainly through the microbes that live in our colon.
Essentially, when these microbes are unhappy because of poor dietary choices, medication use, stress, genetic influences, dysmotility or impaired movement, or even environmental factors, the gut becomes irritated or inflamed. This then causes the symptoms that are largely associated with IBS. This is one major theory of how IBS symptoms have come to be. However, there is still new research literature appearing every day about the relationship between the gut microbiome and the brain.
Are restrictive diets good for IBS?
Ok, so if my dietary choices affect my microbiome, what types of diets should I be on? Depending on who is on your care team, an elimination diet might be on the table for you. Currently, however, restrictive diets are controversial in the treatment of IBS. It’s important to note that temporarily removing common trigger foods, like gluten, may be a good place to start if you want to reduce symptoms. Though only a small portion of the population have Celiac disease, gluten is associated with inflammatory gut symptoms. Egg whites, lactose or dairy products can also be triggers for many people. Eliminating these common trigger foods can help in alleviating symptoms and finding remission. In some cases, restricting major inflammatory nutrients and foods can be beneficial, though extremely restrictive diets that remove a significant category of food are also controversial and have a higher likelihood of causing longer term issues.
In current literature, one of the most common treatments for IBS specifically are systematic restrictive diets-- the most common is the low FODMAP diet. This diet has become more and more popular (similar to the gluten-free and dairy-free diets), however it is controversial and may not be a life-long diet. Working with a dietitian who is trained in this diet can be helpful for immediate remission. However, the foods that have “high FODMAPs”-- which are the ones that would be temporarily eliminated from the diet-- are often good prebiotics, and important in facilitating a #GoodGut microbiome. Unfortunately, experienced dietitians know that when individuals remain on the low FODMAP or other restrictive diets for too long, they find that they are only able to tolerate 10 different foods while still having some symptoms of IBS. On top of that, these individuals are most likely to be nutrient deficient due to the lack of diversity in their diet. The approach that should be taken on an IBS health-focused journey is not to limit foods indefinitely, but recognize root causes and how to reintroduce fiber, and eventually tolerate problematic foods. If you start your IBS journey with a dietary restriction protocol, make sure to work with a dietitian that is experienced in gut issues, and can assure that you get all the nutrients that you need through your diet and avoid disordered or overly-restrictive eating habits.
What are FODMAPS?
So what are FODMAPS? FODMAPs stand for the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. They are highly fermentable sugars or carbohydrates that will ferment and cause potential gas and bloating in the large intestine. When dealing with gut health, FODMAPS are important to understand since they can either make IBS symptoms better or worse. These compounds found in food tend to cause more gas and bloating within an individual who is dealing with IBS since they are fermentable. If an individual is dealing with symptoms such as gas, bloating, intestinal/abdominal pain, changes in bowel movements, or constipation, they may be prescribed a low FODMAP diet.
PLEASE NOTE: This diet is NOT a fix to a problem, it is a temporary symptom relief tool while looking for the root cause of the gut dysfunction and dysbiosis. Even if an individual is prescribed this diet,it is not the full answer to the root cause of their problem.
Want to learn more? Make sure to stay tuned for the next blog in this series on solutions for your #goodgut!
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References
Sood, R., Law, G. & Ford, A. Diagnosis of IBS: symptoms, symptom-based criteria, biomarkers or 'psychomarkers'?. Nat Rev Gastroenterol Hepatol 11, 683–691 (2014). https://doi.org/10.1038/nrgastro.2014.127
National Institute of Diabetes and Kidney Disease. (November 2017). Definition & facts for irritable bowel syndrome. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
Ireton-Jones, C., Weisberg, M. (12 August 2020). Management of irritable bowel syndrome: Physician-Dietitian collaboration. Nutrition in Clinical Practice, volume 35 (issue 5), pp 826-834. https://doi.org/10.1002/ncp.10567
Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014). Irritable bowel syndrome: a microbiome-gut-brain axis disorder?. World journal of gastroenterology, 20(39), 14105–14125. https://doi.org/10.3748/wjg.v20.i39.14105
Martin, C. R., Osadchiy, V., Kalani, A., & Mayer, E. A. (2018). The Brain-Gut-Microbiome Axis. Cellular and molecular gastroenterology and hepatology, 6(2), 133–148. https://doi.org/10.1016/j.jcmgh.2018.04.003
Bennet SMP, Böhn L, Störsrud S, et al. (2018). Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. BMJ Journals: Gut Microbiota, volume 67, (issue 5). https://gut.bmj.com/content/gutjnl/67/5/872.full.pdf
National Institute of Diabetes and Kidney Disease. (November 2017). Definition & facts for irritable bowel syndrome. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
Sood, R., Law, G. & Ford, A. Diagnosis of IBS: symptoms, symptom-based criteria, biomarkers or 'psychomarkers'?. Nat Rev Gastroenterol Hepatol 11, 683–691 (2014). https://doi.org/10.1038/nrgastro.2014.127
Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014). Irritable bowel syndrome: a microbiome-gut-brain axis disorder?. World journal of gastroenterology, 20(39), 14105–14125. https://doi.org/10.3748/wjg.v20.i39.14105
Martin, C. R., Osadchiy, V., Kalani, A., & Mayer, E. A. (2018). The Brain-Gut-Microbiome Axis. Cellular and molecular gastroenterology and hepatology, 6(2), 133–148. https://doi.org/10.1016/j.jcmgh.2018.04.003
El-Salhy, M., Hatlebakk, J. G., and Hausken, T). (7 August 2019). Diet in irritable bowel syndrome (IBS): Interaction with gut microbiota and gut hormones. Nutritional Management of Gastrointestinal Diseases and Disorders, volume 11 (Issue 8), https://www.mdpi.com/2072-6643/11/8/1824/htm
Rej, A., & Sanders, D. S. (2018). Gluten-Free Diet and Its 'Cousins' in Irritable Bowel Syndrome. Nutrients, 10(11), 1727. https://doi.org/10.3390/nu10111727
Gibson, P. & Halmos, E. (8 March 2019). Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome. Journal of Gastroenterology and Hepatology, volume 34 (issue 7), pp. 1134-1142. https://onlinelibrary.wiley.com/doi/full/10.1111/jgh.14650
Bennet SMP, Böhn L, Störsrud S, et al. (2018). Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. BMJ Journals: Gut Microbiota, volume 67, (issue 5). https://gut.bmj.com/content/gutjnl/67/5/872.full.pdf
Knoff, L. (2010). WHole-food guide to overcoming irritable bowel syndrome. New Harbinger Publications, https://books.google.com/books?hl=en&lr=&id=JPM9cZfVigoC&oi=fnd&pg=PR3&dq=veggies+to+heal+IBS&ots=jgE83spHAc&sig=hCCO6lqpJocKSOLwfnAqS9-_WnE#v=onepage&q&f=false
Fukudo, S. and Kanazawa, M. (2006). Effects of fasting therapy on irritable bowel syndrome. International Journal of Behavioral Medicine, Volume 13, (Issue 3), pp 214-220. https://link.springer.com/content/pdf/10.1207/s15327558ijbm1303_4.pdf
Anton, S. et al (31 October 2017). Flipping the metabolic switch: Understanding and applying the health benefits of fasting. Wiley Online Library, volume 26, (issue 2), pp 254-268. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22065?casa_token=a6N0GsS09UcAAAAA%3AV45eq6CoL1IxwtWZpVUA-Uy87OYfIq2aoG3j0QSMHze4tuPrB-XzJK9Cgo6TGe-pI_XwSCKXZLbrTA
Qin, H. Y., Cheng, C. W., Tang, X. D., & Bian, Z. X. (2014). Impact of psychological stress on irritable bowel syndrome. World journal of gastroenterology, 20(39), 14126–14131. https://doi.org/10.3748/wjg.v20.i39.14126
Garland, E.L., Gaylord, S.A., Palsson, O. et al. (2012). Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med volume 35, 591–602. https://link.springer.com/article/10.1007/s10865-011-9391-z
Afzal, A., Gonsalkorale, W. M., Miller, V., Whorwell, P. J. (23 July 2003). Long term benefits of hypnotherapy for irritable bowel syndrome. BMJ Journals, volume 52 (issue 11), pp. 1623-1629. https://gut.bmj.com/content/52/11/1623.short
Ireton-Jones, C., Weisberg, M. (12 August 2020). Management of irritable bowel syndrome: Physician-Dietitian collaboration. Nutrition in Clinical Practice, volume 35 (issue 5), pp 826-834. https://doi.org/10.1002/ncp.10567