Season 4, Episode 7: Will IBS Ever Go Away?
Will my IBS ever go away? The short answer is not really, but naturally, there is a longer, more complex answer. We all know that IBS is a very complex disorder, and its pathological cause is not known which makes it harder to treat. However, despite there not being one clear path of treatment, there are different ways to help patients facing this chronic gut issue. During this episode, I explain why IBS is hard to treat, the importance of creating a diverse gut microbiome, and encouraging healthy motility of your gut.
In this episode, we cover:
IBS is very complex and hard to treat
Are there potential treatments?
The gut-brain connection as a way to treat IBS
How to improve your dysbiosis
What role does your immune system play?
Encouraging healthy motility
The real answer for IBS management
Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.
Today’s episode is sponsored by Sunfiber. Sunfiber is a prebiotic fiber supplement that is gut-friendly as a soluble, low FODMAP fiber. Sunfiber-containing products typically contain between 5-7 grams of fiber, and it mixes into water or food without adding color, texture, or flavor. That means you can easily add this to your routine to increase your intake and benefit the balance of your gut without the symptoms. Sunfiber can be found in hundreds of different products. Find your favorites at Sunfiber.com
Will IBS ever go away? The short answer is not really but also, maybe.
The reason why that seems like it kind of contradicts itself is that IBS is very complex. It is a disorder, and that means that there's really not a known pathological cause, so there's not a really pathological cause to treat. There's not this clear treatment and even measurement of whether you are in an active disorder or disease state versus an inactive state, or whether a disease is present or it's not present at all, which we see with other conditions and other diseases. IBS is not considered a disease for that reason.
Now, there's a huge YET around this, because we've learned so much more about IBS in the recent years, and one big thing that we've learned is the link between post infectious IBS and SIBO. They might kind of coexist or be the same thing or lead to one another, there's a lot of debate around that because of the new findings that we have with SIBO.
When we think about this connection between post infectious IBS and SIBO, where we see that there are specific overgrowth of pathogenic bacteria, when you have a foodborne illness. So when you have an illness, your body produces toxins to kind of fight the proteins in that pathogen that comes in those are called anti CDTV, and anti vinculin antibodies. And what these things are going to do is fight that, the toxins found through those proteins, but it's also going to create kind of this autoimmune effect in the body. This can lead to visceral hypersensitivity, increased permeability, which is that leakiness effect and an overgrowth of these bacteria that then contribute to symptoms. Since we've been able to learn about this, this could lead to IBS being considered a slightly autoimmune condition, or have more of a pathogenic cause and treatment.
Whenever we develop better treatments around this, and the better we understand how this works, and what measurements we can look at to see if it's gone, we may have what's called a remission of IBS versus maybe a cure. We may also have a cure, it's hard to know, because the medical community has to first identify what this pathogenic thing is, how to actually define it, how to measure it and how to measure it well, and then how to treat it and treat it well. There's a lot that we still have to learn. But this may be one thing that's talked about when we say, you know, IBS might be able to be treated or cured, or go away, or whatever it may be, that's really linked there.
Now, when it comes to the other drivers of IBS, there could be potential treatments, and even fixes of these different drivers. What we have to know with this is that we don't always know exactly what driver is present for each person when you get a diagnosis of IBS. IBS is diagnosed based on symptoms meeting the Rome IV criteria, so symptoms over time. Now this is a good diagnostic criteria and it's been developed alongside research and what we're seeing in research, but the problem is that we don't have this a test or even a method of kind of picking out what area you fit into, whether it's post infectious IBS, or your main gut brain driver or a motility driver, whatever it may be.
The problem with that is that there could be overlapping conditions and there could be clear causes of these drivers that can be fixed, which would lead to what seems like a cure, or it seems like IBS is gone and goes away. That is what a lot of people experience and they may talk about. So you may hear people talk about how their IBS went away after they discovered X, Y and Z. That may be because they fixed one of the drivers of the symptoms.
Again, over time, and in time, we may be able to have a better explanation for this and we may be able to, you know have more testing and even a breakdown of criteria based on these different things, but when we do think about these drivers, we can think about how to address IBS, so even if it's not considered cured or completely gone, we can manage it. And that's what I always like to tell those who are living with IBS and ask me this question of will it ever go away? It might, because it can happen and I'm not going to be the one they say that it absolutely cannot, but from what we know, currently, it's not that it just goes away, but it is that we manage it if you're able to get full control over it.
So let's jump into those different drivers and what that looks like!
First is the gut brain connection. We know that with IBS, the gut brain communication pathway is altered, so there's a bit of a disruption in this communication, like the both ends are yelling at one another. They're missing each other in communication, and they're just not really working well together. We know that we can improve this, but we don't fully know why it's altered. There's a lot of new development and new understanding of this, like how different pathways in the brain function differently for those with IBS versus healthy controls, which leads to this pain and visceral hypersensitivity piece. We also know that there's a lot of connection between anxiety, depression, and IBS kind of working in both directions. So there's a lot that's probably going on here but we haven't been able to fully identify exactly what it is. Likely, it's very complex, and it looks different for each person.
When it comes to improving this connection, we can use mindfulness techniques, visualization techniques, we can use stress management as a piece of this, routines. And then there are also some treatments like that directed hypnotherapy and Cognitive Behavioral Therapy, or CBT, specifically for IBS. Now, this can be done through a trained psychologist, like a GI psychologist, or there are some apps as well like Nerva for hypnotherapy, and Mahana IBS for CBT, those are things that you could explore to see if that improves your gut brain communication, especially if you have identified that this could be a main driver for you.
And like I said, mindfulness is a big piece as well as nervous system regulation, and that's something you may learn through CBT, you may learn through therapy, or working with a professional one to one or something we can also learn with understanding how the nervous system works, and when to switch from that stress state to the the rest and digest state.
Now the second main driver is dysbiosis. We know that we can improve dysbiosis, which is an ideal makeup of microbes in the gut by eating a diet rich and diverse fiber sources. This is going to help create more diversity in the gut, which is the opposite of dysbiosis. We also know we can improve this by stress management, because increased stress is going to actually contribute to more dysbiosis and the overall support of our microbiome community, which may look like you know, avoiding unnecessary antibiotics if that's possible, and helping support the growth with maybe fermented foods, if that makes sense. For some people probiotics may fit into there or specific prebiotic foods and resistant starches, all of that can contribute to a healthier, more diverse microbiome.
In the future, there may also be more clear treatments in this area and things that we could consider, like maybe that'll be a fecal transplant of some sort, or something that can directly treat this poor makeup. But first, we have to know how to truly test this because we know just stool testing doesn't work. It's not truly indicative of what's happening in the small bowel and the large bowel, and so we have to be able to test this to better understand it and then be able to potentially treat it. But for now, we can use these strategies to see a positive shift in the right direction and that can be a major form of symptom control and management.
The third driver is the immune reactions. Now this is linked to that post infectious IBS piece that I mentioned earlier. This all has to do with these antibodies that the body is producing. And so there's going to be some treatment involved in that, which again, is likely right around the corner, but there also may be a mast cell activation issue with IBS. Mast cells are immune cells that are found in the gut. And we have certain disorders out there like they're called mast cell activation syndromes, and these are where the mast cells are not acting appropriately, So they're meant to to break down in terms of times of inflammation and a big immune reaction and they produce histamine which is part of that inflammation and immune response.
Now with IBS, we can see that some with IBS do have more mast cell breakdown. And it may not be that it's a mast cell activation syndrome, but it could be that there's something going on with the communication or with how the body's responding. And again, that might be linked to that potentially auto immune like state.
There are treatments out there for mast cell activation issues like mast cell stabilizers and so this could be something that is used in the future and this is something that we need to learn more about. For now, what we can do is support the immune system overall, which may look like increasing mineral intake, optimizing nutrition, working on stress management routines, adequate sleep, healthy movement, all of those different things can help support the immune system in the body to then help support these reactions.
More tailored interventions might look like looking at allergens, or specifically looking at histamine loads for certain people. So that's something that we might tailor and again, that would be done more one to one with a well trained dietician like myself or the dietitians on my team.
The fourth main driver is the motility piece. And this is pretty much present in everyone with IBS. The goal here with altered motility is to address it, improve it and move towards healthy motility. So for diarrhea, this may look like more holistic strategies and diet interventions like the low FODMAP diet. This may also look like other contributing factors like the immune reactions, SIBO, dysbiosis, pancreatic function and intestinal permeability, we might kind of fine tune what's going on based on the full picture.
For constipation, we can typically improve this with diet, movement, bowel retraining, toileting habits, routines and stress management. We may also address other causes and contributors, which we may see in those with diarrhea as well. But that can include thyroid issues, pelvic floor dysfunction, scar tissue, or adhesion issues, or even a hormonal component. So we're going to look at this again, holistically, think about what are all the contributing factors, and we're going to address and kind of treat the constipation or the diarrhea, and then we're gonna move towards what we call healthy motility. And that's where stress management, healthy diet, routine, sleep, all of that starts to come together and help support the body in the body's function.
So kind of wrapping this up, where we stand with IBS and the current research, there is a belief that it is something that is considered chronic, and it will not just go away. We don't believe you grow out of it necessarily, or that there's actually a cure out there. But on the bright side IBS can be managed, you can get to a place where you don't even meet the criteria of IBS anymore, I technically don't meet the criteria for an IBS diagnosis anymore, because the symptoms have been improved.
Sometimes this means that you will have support in place that's helping you control your symptoms and sometimes control happens more easily and simply with the habits that you're able to incorporate and build into your life. Sometimes this looks like you know, having some discipline and having a bit of control over some of the things going on. Sometimes it doesn't, sometimes it can look like a bit more freedom and it really does depend on each single person and can be very unique based on what else is going on.
But the way that you're going to get there is by working with someone who understands how to actually manage it, who understands how these drivers work, and how to address these drivers so that we can move to a place of control. How to understand what other contributors aside from just IBS might be impacting the body and how the body's responding, and then know how to address those. And that is something that I do, that's what my team does, it was in our scope of dietetics. So if that's something that you're interested in, schedule a consult call because we would love to help you.
I hope that this conversation was at least a helpful place to start and better understand what's going on. We also have a free course called the IBS Fundamentals Course and this is something that will help you kind of better understand what these drivers mean, what IBS means, the diagnosis and all of that. If you are interested in going deeper on this topic specifically that would be helpful. It's completely free, so check that out!
But if you do have any initial questions or thoughts or something that you want to share, please come over to Instagram at @erinjudge.rd and let me know! Share it on your stories, message me, whatever you want. You can also join us at The Gut Community on Facebook to have a conversation there if that is your preferred method of communicating. Thank you so much for tuning in and I will see you on the next episode!