What Is IBS?
Irritable Bowel Syndrome (IBS) is a medical disorder characterised by a range of digestive symptoms including bloating, diarrhea, constipation, gas and general abdominal discomfort. It is estimated that around 15 – 20% of the western population suffer from IBS and related disorders at some point in their lives. IBS is twice as common in women as it is in men. It can occur at any age, but most often begins before the age of 40.
IBS has been classified into 3 sub-types
- IBS-D describes IBS which causes increased or frequent diarrhea
- IBS-C describes IBS which causes increased or frequent constipation
- IBS-M describes a mixed type of IBS which includes both symptoms
Causes Of IBS
IBS is classified as a “functional disorder,” meaning that the symptoms aren’t obviously caused by any physical or metabolic abnormality. There is no known exact cause of IBS and no single reliable test for it. As the symptoms are also common to other bowel conditions, it is mostly diagnosed by eliminating other digestive disorders when testing for those proves negative.
Even though it is challenging to find single cause for IBS, symptoms can be associated with and triggered by many confounding conditions including
Gut Dysbiosis: Studies have shown that up to 70% of IBS patients have gut dysbiosis - decreased levels of good bacteria and increased levels of bad bacteria. Prebiotics and probiotics are often prescribed to help alleviate IBS symptoms and their success in treating this is further evidence that this may be a cause.
Food intolerances and sensitivities: Sensitivities to foods such as gluten, dairy, legumes, eggs and yeast can cause the same symptoms as IBS.
Gut Permeability: Commonly referred to as “leaky gut”, this is a condition where cracks or holes develop in the lining of the intestine. This allows bacteria and toxins to enter the bloodstream, causing widespread inflammation and may trigger a reaction from the immune system.
SIBO: Small intestinal bacterial overgrowth is a condition where the small intestine has an abnormally high number of bacteria. SIBO is found in up to 80% of IBS patients. The treatment of SIBO with antibiotics can also be effective for treating IBS, however the use of antibiotics can kill off the helpful gut flora needed for normal bowel health.
Stress: There is a strong association between IBS and stress. Research shows that the nervous system controls the gut as well as responding to psychological stress. Feeling stressed can both worsen or even be the trigger for IBS symptoms, and the physical symptoms of IBS can cause psychological distress. Read on here for more on stress.
Medications: Some medications can contribute to IBS. Antibiotics can destroy your good gut bacteria and general intestinal health. Many over-the-counter painkillers such as NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) cause digestive issues in even those not experiencing any signs of IBS.
The first thing to identify is what is causing the IBS in the first place. The lack of one clear cause implies that IBS is caused, not by any one specific issue, but rather by a variety of interrelated diet and lifestyle factors that combine to damage the digestive system in multiple ways. While treating such a vague problem can be frustrating and time-consuming, understanding your symptoms and learning about potentially problematic food groups can help you handle IBS without making your gut the center of your life.
IBS And The Paleo Diet
Following a Paleo diet and eliminating foods such as grains, legumes, dairy and seed oils from your diet can go a long way in relieving symptoms and allowing your body to heal.
A Paleo diet can assist gut recovery by increasing consumption of vegetables, fruits, and lean protein. Eliminating processed foods filled with excessive sugar, unhealthy fats and refined grains is surely the way toward improved overall and digestive health.
Including foods such as bone broth, fermentable fibres (found in fruits, vegetables, starches, nuts and seeds) and fermented foods (such as sauerkraut, kimchi, pickles, kombucha) will nourish the gut.
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However, some foods that are otherwise regularly consumed on a Paleo diet can be harmful to people with chronic gut dysfunction. IBS can cause your digestive system to become hypersensitive, or intolerant to foods that otherwise cause little to no problems. You might want to consider eliminating nuts and seeds, nightshades, and eggs. Nuts are inflammatory due to their high levels of Omega-6 PUFAs, nightshades (like eggplant, bell peppers, and tomatoes) can exacerbate autoimmune problems, and eggs (especially egg whites) can be irritating because they contain antimicrobial compounds as part of their natural defenses. Fruits are not generally considered problematic, but if you have trouble with SIBO or other gut flora imbalances, the fructose they contain can provide a food source for the bacteria that have already imbalanced your gut flora, making the problem even worse. Remember, Paleo is always about listening to your body and adapting your diet accordingly.
There is research that shows that a group of carbohydrates known as FODMAPs, may significantly contribute to IBS symptoms.
FODMAPs are the chemical names of a collection of carbohydrates (sugars) that aren’t properly absorbed in the small intestine. FODMAPS are found in a variety of foods and include fructose, lactose, fructans, galactans, sorbitol, and mannitol. These sugars are not only found in non-Paleo foods including grains, dairy, and seed oils, but are also present in many Paleo-friendly foods like garlic, onions, asparagus, peaches, honey, and avocado.
FODMAP is an acronym for:
- Fermentable: The process through which undigested carbohydrate is fermented by gut bacteria to produce gases.
- Oligosaccharides: Fructans, which are found in foods such as wheat, rye, legumes, onions and garlic.
- Disaccharides: Lactose, which is found in dairy products such as milk, yoghurt and soft cheese.
- Monosaccharides: Fructose, which is found in honey, sugar, high fructose corn syrup and fruits such as apples and pears.
- Polyols: Sorbitol and Mannitol which are used in artificial sweeteners and found in some fruit and vegetables.
A low FODMAP diet reduces or removes certain foods which can relieve the symptoms of some IBS sufferers. The diet is not a diet for life, it is used as a diagnostic tool to monitor tolerance to foods which are high in FODMAPs. Generally, the diet starts with a period of high restriction for 2 to 6 weeks, then transitions to the next phase where certain foods are gradually re-introduced to assess tolerance levels. It is best followed under the supervision of a qualified healthcare practitioner who is experienced in the diet and management of IBS.
For more on FODMAPs, read on here
Eating to cure digestive problems can seem like a tiresome list of foods to eliminate, it is important to remember that the foods you do eat are as important as the foods you avoid. It is crucial to eat sufficient micronutrients while your body is healing itself, especially since malabsorptive digestive disorders like IBS often rob your body of nutrients. Following a personalized and customized version of a Paleo diet will supply all your micronutrient needs. Simply make sure to get enough of the vegetables you are able to tolerate, preferably very well cooked (this makes them easier to digest). This can be easily achieved using your slow-cooker along with your meat for a delicious and tender meal that takes almost no time to prepare. Bone broth and fermented foods will also support gut healing.
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Adding a probiotic can also help and both prebiotics and probiotics have been shown to be helpful, depending on the specific case. However, be cautious with your probiotic use if you have a problem related to overgrowth of gut flora, since this might feed the bacteria that are causing your issues. Some people find that taking digestive enzymes also helps relieve IBS symptoms.
It’s important to be very strict about your diet at first, to get the clearest possible picture of what you do and don’t react to, and to give your body the best possible change to recover. After your gut has healed, you can begin experimenting with previously eliminated foods.
Note: Any diet for IBS, including a personalized Paleo diet, will not be enough if you have undischarged trauma that is triggering symptoms. This is why some people search endlessly for the “right” IBS diet and never find it.
Until a definitive test and cure for IBS is found, the best general advice is to nurture your gut as much as possible by reducing inflammation and creating a healthy environment for gut flora. A Paleo diet is a good place to begin nourishing your body with nutrient-dense foods. By further identifying foods which trigger your IBS symptoms and eliminating these from your diet you can begin to heal and repair the gut, culminating in a lessening of symptoms and a higher quality of life.