The Truth about IBS and IBD
Picture this: Allison had been gassy, bloated and had what she casually referred to as “completely unpredictable, irrational and rude bowels” since middle school. After being constipated for days, Allison experience 3-4 days of diarrhea, sometimes with cramping or pain throughout her belly.
An adult now, Allison had quit ballet and karate in high school because she was so embarrassed by the gas she would pass in class and rehearsal. Just a few years out of college, Allison found it hard to go on dates, for fear of what her digestive system might have in store for her.
Enter IBS and IBD
Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are conditions I see commonly in my practice. 11% of the American population suffers from IBS, while another 1-1.3 million suffer from IBD. The number of undiagnosed and uninformed sufferers is in the millions.
The pain and discomfort accompanying both IBS and IBD (not to mention the unflattering nametag) are less than glamorous additions to anyone’s life. Folks with either condition often go looking for the quickest possible fix, and most health practitioners are ready to offer it up.
The problem is, conventional medicine has it wrong when it comes to treating IBS and IBD.
The most common treatment protocol emphasizes prescription medication targeted at suppressing symptoms while leaving the actual root cause untouched. The problem with this method of treatment is that the thing that’s hurting your gastrointestinal (GI) system and causing your symptoms is still eating away at you, regardless of whether you feel it or not, and inflammation within the gut continues to increase, potentially leading to further long-term damage.
IBS and IBD Basics
The Difference Between IBS and IBD
Both IBS and IBD are the source of pain and discomfort ranging from cramping, bloating, irregular bowel function (such as Allison’s “rude bowels,”) gas, bloody stool, fatigue, and loss of appetite.
IBD describes a more severe and chronic condition, classified as either Crohn’s disease or Ulcerative Colitis. The marker for Crohn’s disease is inflammation in any part of the gastrointestinal tract (that means from mouth to anus,) and Ulcerative Colitis specifically relates to inflammation in the large intestine, commonly referred to as the guts or bowel.
On the other hand, a patient diagnosed with IBS experiences pain, bathroom troubles and discomfort, but lacks the chronic inflammation in the GI tract as seen in IBD. IBS could turn into an IBD if it is not properly diagnosed and treated.
In the average medical practice, patients with these symptoms often have an endoscopy or colonoscopy. If you have IBS, you’re told “everything is normal, you’re fine” and to take a drug to regulate your stool without healing the root cause. If you have IBD, a colonoscopy is important for diagnosing your condition and differentiating it from IBS. It’s often that folks diagnosed with IBD receive immune system suppressing drugs for life, which certainly helps with symptoms, but also has potential long term health consequences.
The Functional Medicine Route
When it comes to an integrative or functional medical assessment, consider the following if you suspect IBS or IBD:
- a comprehensive and evidence-based stool analysis
- testing for Small Intestine Bacterial Overgrowth (SIBO)
- micronutrient blood testing
- signs of infections/viruses/parasites
- signs of vitamin, mineral and other nutrient malabsorption
- evaluation of generic factors
- lifestyle, stress, sleep
- a comprehensive discussion around nutrition and the emotions behind food choices.
What Causes IBS and IBD?
The bowel may become irritated as a result of improper digestion and pathogenic microbiota attacking the inner and outer lining of the intestinal tract. In severe cases, this can lead to further imbalance correlated to autoimmunity and even cancer. You can avoid excessive pathogenic material within the GI tract with the right food and nutrients to promote healthy digestion and absorption. We have to consider a multitude of factors in order to facilitate healthy digestion.
The Digestive Journey
Food begins its digestive journey in the mouth via salivary enzymes. When it travels into the stomach, it is further broken down by way of hydrochloric acid, gastric lipase, pepsinogen, intrinsic factor, and other enzymatic and catalytic biomarkers to prepare for continued breakdown and absorption.
Prescription and over-the-counter medication, smoking, alcohol, and a diet consisting of low-nutrient/highly processed foods easily disrupts this delicate stomach ecology.
A common response to these unhealthy lifestyle factors is a depletion of stomach acid. In fact, the familiar throat burning sensation characteristic of heartburn is often not due to too much stomach acid in folks with IBS and IBD.
Rather, excessive intra-abdominal pressure, caused by gas, the byproduct of improperly digested food, forces the lower esophageal sphincter to open in the reverse direction causing acid to leak upwards. Therefore, ant-acid medication actually makes this problem worse while disguising the symptom.
Into the Intestines
Once the food progresses from the stomach into the small intestine, millions of tiny brushes called “villi” contain bundles of enzymes to further break down food for nutrients to be absorbed into the blood.
In the case of carbohydrates and proteins, these finger-like villi are tasked with converting the food to their simplest sugar or amino acid forms.
IBS and IBD patients typically lack an abundance of these enzymes, which causes the food to remain unchanged and become a major food sources for pathogenic bacteria and fungi in the GI tract.
A Lack of Healthy Villi
You may be wondering: why do IBS and IBD patients lack healthy villi?
An imbalanced microbiota can be caused by:
- too much sugar
- not enough nutrients
- prescription drugs
- overexposure to antibiotics
- genetic factors
All of this improper digestive activity causes the small intestine to become inflamed, which yields an excess of mucus inside the gut, further slowing motility. Not only that, but a highly inflamed mucous-ridden intestine often leads to malabsorption of fats, which can be observed via pale-colored fatty stool after eating (even healthy) fatty foods.
This chain reaction of improper digestion, due to an imbalanced stomach and gut ecology, continues into the bowel. This homeostatic disruption wreaks havoc on the body – not to mention the mind and soul.
The Problem With Prescription Drugs to Treat IBS and IBD
Prescription drugs do not attempt to restore the microbiota ecology in the gut so that the villi can do their job effectively. Prescription drugs work by way of targeting the noisiest symptom, leaving the underlying problem untouched. Some examples include:
- Antidiarrheal agents, which include the chemicals diphenoxylate and atropine that interfere with the body’s natural immunity driven mucus response
- Bile acid altering agents such as cholestyramine, which interfere with neurotransmitter activity
- Osmotic laxatives, which force motility by creating unnatural convulsions in the intestine, forcing stool out of the body which can be extremely painful
When the inflammation becomes so bad, certain individuals even undergo surgery to remove part of their intestine.
IBS and some forms of IBD are largely preventable and treatable with the right natural approach. Seek advice from a functional medicine practitioner if bloating, diarrhea, pain and discomfort are familiar to you.
At the core of functional medicine is an emphasis on the individual and figuring out what triggers your symptoms so we can stop the cycle of feeling exhausted and unwell. Through targeted labs and evaluation, there is a better alternative than drugs for treating IBS and IBD.
Victoria Albina, NP, MPH is a licensed and board certified Family Nurse Practitioner, herbalist and life coach, with 20 years experience in health and wellness. She trained at the University of California, San Francisco, and holds a Masters in Public Health from Boston University and a bachelors from Oberlin College. She comes to this work having been a patient herself, and having healed from a lifetime of IBS, GERD, SIBO, fatigue, depression and anxiety.
She is passionate about her work, and loves supporting patients in a truly holistic way - body, mind, heart and spirit. A native of Mar del Plata, Argentina, she grew up in the great state of Rhode Island, and lives in NYC with her partner. A brown dog named Frankie Bacon has her heart, and she lives for steak and a good dark chocolate.