Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder and represents thirty to fifty percent of all referrals to gastroenterologists. IBS has been attributed to physiological, psychological and dietary factors. In general, the diagnosis of IBS is often made by exclusion, as a result of ruling out other conditions that have a similar symptom picture to IBS (e.g. diabetes, lactose intolerance, ulcerative colitis, Crohn’s disease, diverticular disease, etc). These symptoms include but are not limited to abdominal distention, constipation, abdominal pain that improves with bowel movements and loose or frequent stools.

What causes IBS? The short answer is that we still don’t know. IBS is likely a multi-factorial condition. Some of the contributing factors include:

(1) Food sensitivities: Many who suffer with IBS symptoms report being sensitive to certain foods, especially grains (50%) and dairy (42%).

(2) Changes in gastrointestinal muscle activity: Many with IBS experience either constipation due to increased GI muscle contraction and/or diarrhea due to changes in release patterns of hormones and enzymes.

(3) Digestive hypersensitivity: Those with IBS often report bloating, flatulence and abdominal pain after eating.

(4) Inflammation: Though not classically recognized as an inflammatory disease, individuals with IBS do tend to have more inflammation. This inflammatory state contributes both to intestinal pain and poor absorption of nutrients. It also leads to “leaky gut”, the phenomenon of poorly digested food particles passing from the GI tract directly into the bloodstream, where their undigested state causes immune reactivity.

(5) Altered gut flora: Individuals with improper balance of GI bacteria are more prone to IBS symptoms.

(6) Mental and emotional stress: Those who are more prone to anxiety, depression, and other forms of psychological distress are more likely to experience IBS type symptoms, as are those who have difficulty sleeping.

In order to effectively treat IBS, all of the above issues must be addressed. While this article is too brief to review all of the pertinent tests or therapies available to a naturopathic physician, there are a few highly effective treatments I will review here.

First, I recommend getting tested for food sensitivities. In most cases the reactivity to these foods appears to be related to prostaglandin synthesis or to IgG reactions. Prostaglandins are inflammatory mediators that are often best managed with botanical treatments and an IgG reaction is a very specific immune reaction.

This specificity is significant because IgE skin tests—the most common allergy panel offered by mainstream physicians—will not detect IgG sensitivities, thereby possibly missing relevant food reactions. For many patients, an Eliza IgG test may be a better indicator of the role that food plays in IBS. Further, many patients have noted marked benefit when using elimination diets such as FODMAPs or the Whole-30. While these programs may require a lengthy period of a restricted menu, the initial improvements can be seen in as few as two weeks.

Second, I recommend avoiding refined carbohydrates. Meals high in refined sugar contribute to IBS symptoms and lead to inappropriate growth of yeast and bacteria in the gastrointestinal tract that impact proper GI motility. Also, inclusion of fiber in the diet is an important part of the treatment plan. It is important to consider the best type of fiber to use. Wheat bran, for instance, should not be used as grains such as wheat are among the most commonly implicated foods in IBS. In general, fiber from fruit and vegetable sources should be increased. Acacia fiber also tends to be well tolerated.

Third, IBS is often associated with cramping, pain and intestinal spasm. These symptoms are frequently improved by taking enteric coated peppermint oil between meals as menthol is highly effective at relaxing smooth muscle contraction. It is important to use enteric coated oil as otherwise menthol will result in relaxation of the esophageal sphincter, causing heartburn. An additional benefit of such volatile oils is their efficacy against Candida albicans, one of the underlining factors that contribute to IBS. For a similar reason, a potent probiotic that contains Lactobacillus acidophilus, Bifidobacterium and Saccharomyces is important to include.

Finally, because emotional stress (anxiety, depression, sleep disturbances, feelings of hostility) are triggers for IBS, relaxation therapies such as yoga, meditation, biofeedback and even a slow 30 minute daily walk offer significant benefits.

Dr. Daniel Smith practices at Bear Creek Naturopathic Clinic. His office is on 2612 Barnett Ave.  He specializes in naturopathic oncology, but still maintains a strong family practice, treating all manner of conditions. He can be reached at 541-770-5563 or at drdanielnd@gmail.com. If you would like to schedule an appointment, please ask specifically for Dr. Dan.