Irritable Bowel Syndrome (IBS), Pt 3: Root Cause Management
Intro
IBS manifests as abdominal discomfort and changes to bowel habits, and is diagnosed via the Rome IV Criteria. IBS can happen in 10-15% of people in North America and 11% of people worldwide, and is a common gut health condition that people come to see me for in-office. Last week, I spoke about 6 root causes of IBS, and if you missed it, click here to read it. This week, I am going to speak about root cause management options from an integrative point of view.
Root cause options for IBS
Before we dive into possible treatment options for IBS, I want to clarify that this blog is educational only, and is not meant to diagnose or treat. So, if you do want to start IBS treatment, make sure you speak to your trusted doctor first before starting anything new.
Licensed Naturopathic Doctors (NDs) are trained to provide integrative medical care, and in naturopathic medical training, licensed NDs are trained in pharmacology and natural treatment options, such as nutrition, herbal medicine, and more. However, state licensure and scope of practice differs from state to state, and in some states, licensed NDs are able to prescribe pharmaceuticals and in some states licensed NDs are not yet able to. So, if you find yourself working with a licensed ND, you may see differences in how they approach IBS.
Below, you’ll find some of the root causes that I mentioned last week and what integrative treatments could be recommended by a doctor for each root cause.
Small intestinal bacterial overgrowth (SIBO)
SIBO can be treated integratively with conventional & natural options. Conventional options for SIBO include:
Pharmaceutical antimicrobials: In 2006, rifaximin for 10 days has been shown to improve symptoms in those with IBS. There is also literature that revealed that metronidazole was more effective than rifaximin at reducing hydrogen excretion from the lactulose breath test and that metronidazole was more effective than rifaximin at improving IBS symptoms. In addition to rifaximin and metronidazole, other pharmaceutical antimicrobials that could be prescribed are: Tetracycline, amoxicillin/clavulanate, ciprofloxacin, and doxycycline.
Pharmaceutical pro-kinetics: Pro-kinetics are a class of therapeutics that activate the intestinal migrating motor complex, which is necessary for moving things out of the intestines. Since intestinal dysmotility is a risk factor for SIBO, pro-kinetics could be prescribed by a doctor. Some pharmaceutical pro-kinetics are: Levosulpiride, low-dose naltrexone, low-dose erythromycin, and prucalopride.
Natural options for SIBO include:
Therapeutic diet: There are various diets that have the potential to treat SIBO, such as the low-FODMAP diet, Specific Carbohydrate Diet (SCD), Gut and Psychology Syndrome Diet (Gaps diet), and Cedar-Sinai Diet developed by Dr. Pimentel. The goal is therapeutic diet is to reduce food sources for bacteria to limit further growth of such bacteria.
Treat nutrient deficiencies: Supplementation and maintenance of vitamin B12, fat-soluble vitamins (vitamins A, D, E, and K), calcium, and magnesium may be necessary in those who are experiencing weight loss and/or vitamin and mineral deficients due to SIBO.
Natural antimicrobials: Certain herbal preparations have been shown to be as effective as rifaximin. These same herbal preparations have also been shown to be as effective as other antibiotic therapies for SIBO, especially for those who did not initially respond to rifaximin. Additionally, “the response rate for normalizing breath hydrogen testing in patients with SIBO was 46% for herbal therapies vs 34% for rifaximin.”
Natural pro-kinetics: There are no studies that have looked at natural pro-kinetics and SIBO. There are studies that do show that ginger and a specific herbal preparation, called Iberogast, have been effective pro-kinetics for optimal intestinal movement.
& more
Stress & Hypothalamic-pituitary-adrenal (HPA) axis dysfunction
Integrative options for stress relief & HPA axis dysfunction include:
Preventing hypoglycemia: Hypoglycemia is when someone experiences low blood sugar, leading to shaking, sweating, headache, burred vision, lightheadedness, weakness, and more. This episode of low blood sugar acts as a physical stressor to the body, and can activate the adrenal glands to send out catecholamines. A doctor may recommend dietary strategies to prevent episodes of hypoglycemia via strategic consumption of complex carbohydrates and protein.
Lifestyle medicine: Mindfulness-based stress reduction has been shown to improve HPA axis functioning and reduce symptoms of stress. And, exercise has been shown to support resilience to stress, but why this happens in the body is yet to be understood.
Herbal nervines: Nervines are a class of herbs that calm the nervous system. According to Mountain Rose Herbs, nervines have the ability to “help relieve normal muscle tension, circular thoughts, wakeful nights, and the occasional worry”.
Herbal adaptogens: Adaptogens are a class of herbs that help the body adapt to stressors. According to Mountain Rose Herbs, adaptogens “help restore overall balance and strengthen the functioning of the body as a whole without impacting the balance of any individual organ or bodily system.” And, they go on to say that adaptogens “help improve your mental functioning and allow your body to adapt more easily to stressful situations by curtailing an overactive adrenal response.”
Targeted mineral supplementation: Magnesium has been shown to reduce adrenal overactivity and enhances stress response by decreasing the release of adrenocorticotropic hormone (ACTH) from the pituitary gland and modulating adrenal sensitivity to ACTH.
Targeted amino acid supplementation: Phosphatidylserine has been shown to reduce the effects of excessive physical stress, specifically with exercise-induced stress, by reducing output of cortisol.
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Exocrine pancreatic insufficiency (EPI)
EPI can be caused by cystic fibrosis, chronic pancreatitis, and more. For those with cystic fibrosis, conventional treatment will be of benefit to manage symptoms. Some management options for EPI can be:
Diet: Limiting alcohol consumption and reducing consumption of fatty foods
Treat nutrient deficiencies: Those with EPI may have deficiencies in fat soluble vitamins since they do not have the enzymes to process fats, and it may be be recommended by a doctor to replete vitamins A, D, E, and K.
Pancreatic enzyme replacement therapy (PERT): Pancreatic enzymes supplements usually contain all 3 pancreatic enzymes - amylase, protease, and lipase. And, PERT may be recommended by a doctor for the treatment of malabsorption in those with EPI. Some conventional pancreatic enzyme products are: Creon, Zenpep, Pancreaze, Ultreasa, Viokase, and Pertzye.
Takeaways & Summary
There are way more root causes of IBS, and I strongly recommend that you speak to a doctor about root causes if you suspect that you have IBS. Remember, IBS is considered a diagnosis of exclusion and that conditions that look like IBS need to be ruled out first before IBS is diagnosed via the Rome IV Criteria. So, your doctor will order the pertinent testing needed first before diagnosing you with IBS, and then follow-up testing could be ordered to identify the root cause(s) of IBS for your specific case. And, the reason why it is important to identify to root cause is that it allows for better-targeted treatment.
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