IBS Treatment Options

Is there one pill that can cure IBS?*

Unfortunately, no. A more realistic expectation is that there will be several factors that will help cure IBS.  The key to getting better is to identify the factors that may be causing IBS.

Things to consider include:

• Is there a food allergy that that may be causing symptoms? Many patients come in with a hunch that wheat, or dairy, or soy, or some other food may be making their symptoms worse. This is because the foods may trigger an allergy response from the body causing symptoms. This may or may not be the case. I work with patients to either do an Elimination-Challenge Diet (the gold standard) or a food allergy test (second choice) or both, to identify if there are food triggers.

• Is there a lot of inflammation going on in the digestive tract? It is very, very common for me to hear, "I got a GI infection while on vacation in Mexico and I've been having symptoms since then."  If this is the case, I would usually order a stool test to see if there are there are parasites or bacteria or yeast; if yes, we treat with the appropriate medication or herb. If not, then we focus on rebuilding the health of the lining of the gut to decrease inflammation.

• Is there an overgrowth of bacteria? Some studies estimate that up to 10% of IBS is caused by SIBO or Small Intestinal Bowel Overgrowth. We can determine this through lab testing. If this is the case, I can prescribe an antibiotic to get rid of the bacteria, while at the same time introducing "good bacteria" into the gut with probiotics.  I also have a conversation with the patient about why they have have bacterial overgrowth in the first place. Possible reasons could be: they took a lot of antibiotics in the past for acne/UTI or others; or they eat a lot of foods with sugar, etc.

• Is this person producing enough digestive enzymes to properly digest food leading to malabsorption or diarrhea? I have seen many cases of these where some people, for whatever reason, do not produce enough enzymes to digest food properly. For example, I've run test which show that a person's stool has a very high level of fat; usually, the symptoms are loose stools and lots of gas; when we tried to give an enzyme called lipase (which digests fat), the symptoms went away.  Other people have difficulty digesting certain types of carbohydrates or some types of protein.

• Is stress a factor? For some people yes; but my experience is that most people who have IBS usually have some type of symptom whether they are stressed or not, high stress just makes things worse. In any case, all of us benefit from trying to reduce stress in our lives and I discuss stress reducing options with patients as well.

*Historical note: There used to be a medication approved for IBS called Zelnorm; but this has been taken off the market because of side effects which affected the cardiovascular system.

Can you give examples of things you use to treat IBS?

Integrating western and complementary therapies seem to produce the best outcomes in my experience.

Here are a few examples:

• Antibiotics. These are prescribed for patients with confirmed Small Intestinal Bowel Overgrowth. One antibiotic that is frequently used is Rifaximin or Xifaxan. This antibiotic is not easily absorbed into the body and it only stays in the intestine where it is supposed to be getting rid of the bacteria. As a naturopathic doctor, this sounds like a good idea to me because you are able to achieve the therapeutic goal (getting rid of bacteria in the gut) but at the same time, you reduce the risk of exposing the patient to more antibiotics than necessary. 

• Probiotics. Probiotics are "good bacteria." They are found in yogurt and other cultured foods like kimchi, miso soup or sauerkraut. These foods may be sufficient for health maintenance, but when I am treating somebody, we may have to use higher doses in pill form. Probiotics do the following:
  • Fight off bad bacteria
  • Help soothe the gut and decrease inflammation
  • Help the body digest foods
  • Improve the immune system
  • Promote healthy, well-formed bowel movements
  • Decrease gas
• Herbs. There are several herbs that are typically used to improve digestion.
  
  • For some patients who prefer to not use antibiotics, there are some herbs that have antimicrobial properties, and these may be used if indicated. Examples include oregon grape root, uva ursi, tannin-rich herbs.
  • Althea (marshmallow) and Ulmus are two herbs that are frequently used to help soothe the mucosal lining of the gut, and to decrease inflammation; this is because these two herbs have mucilagenous properties.
  • There are many other herbs that can be used to promote the rebuilding of the lining of the gut.
• Supplements.
  
  • Digestive Enzymes.
    
    • Available in prescription form (such as Creon 6000) and over-the-counter form.
  • L-glutamine
    • This is an amino acid that is the preferred fuel of the cells that line the intestines. We give these to some patients to help promote the rebuilding of the lining of the gut. Getting the right dose is important to get the right results.  L-glutamine is typically found in food, but for people who have digestive issues, they may need more.