Irritable Bowel Syndrome (IBS) affects an estimated 5-10% of the global population, with 25-45 million people in the U.S. alone grappling with its challenges. Despite its prevalence, the exact cause of IBS remains a mystery, making it a difficult condition to manage.

Many IBS sufferers undergo rigorous testing only to be left with more questions than answers. As gut health continues to be a major focus in contemporary research, hopefully, new insights will emerge.

In this post, we'll explore what we currently know about IBS and offer a unique perspective from the lens of Chinese Medicine, which has long-recognized patterns similar to what we now call IBS.

IBS is intricately linked to the “gut-brain axis,” a concept that underscores the connection between our digestive system and mental health. Let's dive into these topics to better understand and navigate IBS!

What Is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a group of symptoms that impact the digestive system, ranging from mild and manageable to severe and disruptive. It often includes symptoms like pain, bloating, and changes in bowel habits.

In the past, IBS used to be known as a "diagnosis of exclusion." Before 2006, there were no specific diagnostic criteria for IBS. Instead, it was diagnosed based on symptoms like abdominal pain, bloating, and changes in bowel habits, only after ruling out other illnesses.

This early approach led to a history of excessive testing and confusion in managing IBS that continues today. However, in 2006, the Rome III criteria were introduced, providing a validated set of symptoms for diagnosing IBS! The Rome IV criteria, released in 2016, further expanded our understanding! The Rome Foundation is a non-profit organization that guides the diagnosis and treatment of Disorders of Gut-Brain Interaction, DGBIs, previously known as Functional GI Disorders, FGIDs).

Symptoms of IBS

IBS shares symptoms that overlap with many other digestive conditions, including some outside the gastrointestinal (GI) tract. Each person’s symptoms are unique and can vary widely, occurring consistently or unpredictably! Flare-ups may be followed by periods of normal function or remission.

The most common symptoms associated with irritable bowel syndrome are:

• Constipation
• Diarrhea
• Abdominal pain and cramping
• Bloating and gas
• Feeling of incomplete evacuation of stool (tenesmus)
• Nausea
• Upset stomach
• Anxiety and Depression

The Diagnosis of IBS

To be diagnosed with IBS, a person must experience symptoms at least one day per week for at least three months. These symptoms generally include abdominal pain and/or changes in either the form or frequency of bowel movements.

Subtypes of IBS

Based on the latest Rome IV criteria, there are four subtypes of IBS that help classify individual experiences. These subtypes are determined by the patient's most predominant or disruptive symptom:

• IBS-C (Constipation predominant)
• IBS-D (Diarrhea predominant)
• IBS-M (Mixed type)
• IBS-U (Unclassified)
• PI-IBS (Postinfection): A subclassification of IBS triggered after infection

The subtypes are fairly straightforward, but if you want more detailed information, you can refer to the Rome criteria.

Potential Causes, Triggers, and Risk Factors for IBS

As we learn more about gut health, we discover that disorders like IBS may share similar causes and exist on a continuum rather than being completely separate "disease entities." This is particularly true for diseases classified as "disorders of gut-brain interactions" (DGBIs).

Given this spectrum, I'll explain the "why" of IBS by exploring potential causes, common triggers, risk factors, and related or overlapping conditions. Keep in mind that any combination of these factors may contribute to an individual's experience of IBS. My goal is to provide an overview, though it may not be exhaustive.

Potential Causes of IBS

The underlying causes of IBS are likely multifactorial. Here are some of the most common contributing factors:

• Disruption of the Gut-Brain Axis - We know that there is a two-way relationship between the nervous system and the gut. Think of this pathway as a dimmer switch - people with IBS often have less intense and less free-flowing communication between the brain and the gut.
• Post-infectious - The research shows that there is a potential connection between GI infections and the development of IBS.
• Dysbiosis - An imbalanced microbiome is also associated with IBS. Remember, the balance within the microbiome is connected to immune system, inflammatory balance, and nervous system activation.
• Diverticulitis - There is also an association between flare-ups in patients with diverticulitis and the development of IBS.

Common Triggers for IBS Flare-Ups

Triggers differ from causes in that a trigger is an event that leads to flare-ups of the underlying condition. Some of the most common triggers include:

• Stress - Emotional stress, whether acute or chronic, has been demonstrated to cause shifts in the microbiome and is also associated with IBS flares.
• Hormonal changes - Fluctuating hormones, such as with a menstrual cycle, are linked with increased severity of IBS symptoms.
• Diet and food sensitivities - Many people have specific food triggers for IBS flare-ups, including gluten, dairy, soy, and peanuts.

Potential Risk Factors for IBS

• Trauma and Adverse Childhood Events (ACEs) - Emotionally traumatic life events, including ACEs, are associated with an increased risk and severity of IBS.
• Exocrine Pancreatic Insufficiency - Not properly digesting food because of poor digestive enzyme production is associated with an increased risk of IBS.
• Diet and food sensitivities - Eating an inflammatory diet such as the Standard American Diet (SAD) and having multiple food sensitivities increases the risk of IBS.
• Endometriosis - There is an association between endometriosis and the incidence of IBS.

Conditions That Overlap With IBS

• It’s important to consider conditions that are related to IBS as they may share underlying causes. This is not a complete list, but it highlights some of the most common overlapping conditions.
• Acid reflux, leaky gut, functional dyspepsia - these are other conditions on the DGBI spectrum that are related to IBS.
• Mental Health Disorders - anxiety, depression, and PTSD are related to increased incidence of IBS.
• Inflammatory Bowel Disease (IBD) - These include Crohn’s disease and ulcerative colitis, and research has started to draw a causal relationship between IBD and IBS.
• SIBO (Small Intestinal Bacterial Overgrowth) - Overgrowth and invasion of bacteria into the small intestine are related to IBS.

A Traditional Chinese Medicine Take on IBS

This is easily one of my favorite patterns to talk about through the lens of Traditional Chinese Medicine (TCM). My own lightbulb came on when I realized that both TCM and conventional medicine are describing the same experience of IBS - just with a different framework and medical language.

In TCM, gut health is a central pillar. This ancient system views our digestive capability as a direct reflection of our ability to create energy or life force (Qi, pronounced “chee”). Our digestive power is part of our Earth element in Five Element Theory - a core concept in TCM.

Balanced digestive energy is akin to having a balanced Earth element. But here’s the catch: in TCM, everything is about balance! There are four other elements - fire, water, metal, and wood - that interact with and affect the Earth's elements.

In IBS, the main culprit is the Wood element. The Wood element oversees the “free flow” of energy, including our emotions. When this flow is disrupted by frustration, stress, and pent-up emotions like anger, our digestion (the Earth element) suffers.

Think about how stress can affect your digestion - stomach noise, loose bowel movements, constipation, and gas. I often half-jokingly tell my patients that “emotional constipation” can cause actual constipation.

And that’s IBS and TCM in a nutshell! There are many more considerations and dynamic relationships in the Five Element Theory, but I hope this brief exploration piques your interest.

How to Treat IBS Naturally

As you can see, there is no one-size-fits-all treatment for IBS due to various causes, triggers, and related conditions. However, we can summarize the most common interventions into the following categories. For many, it’s about finding the right combination of interventions that works best for you!

Nutrition

• Avoid triggering foods and beverages, keep a food diary to help identify triggers
• Slowly increase plant-based fiber intake
• Limit conventional dairy products
• Avoid gluten, even for those without Celiac disease
• Consider the low-FODMAP diet to decrease hard-to-digest carbohydrates for a certain period of time
• Consider an elimination diet for 6-12 weeks to identify dietary triggers

Lifestyle

• Regular, moderate exercise can help build aerobic resilience
• Twisting poses in yoga are shown to benefit digestion
• Breathwork, meditation, and other therapies that work on the vagus nerve can help support the brain-gut connection

Supplements

• Digestive enzymes can support adequate breakdown and absorption of proteins, fats, and carbohydrates.
• Probiotics can help temporarily support the microbiome.
• Prebiotics can help to signal the growth of beneficial bacteria in the gut and decrease inflammation.
• Soothing herbs such as aloe vera, slippery elm, and marshmallow root can be supportive for some.

For a comprehensive supplement solution, consider trying Horizon, our high-quality formula packed with probiotics, prebiotics, and digestive enzymes. Horizon also supports digestive health, reduces bloating, and promotes nutrient absorption!

Mind-Body Therapies

• Cognitive Behavioral Therapy (CBT) and counseling
• Biofeedback
• Traditional Chinese Medicine
• Ayurvedic medicine
• Hypnotherapy

Conclusion

Managing IBS requires a multifaceted approach that addresses the personal symptoms and unique potential causes. An integrative approach can offer benefits to those suffering from IBS by emphasizing the complex balance of the body and the gut-brain connection.

Nutrition, lifestyle changes, and targeted supplements can significantly improve gut health and overall well-being. Viewing IBS through a holistic lens provides comprehensive care and increases the chances of long-term relief.

Stay connected with us for more insights and tips on gut health and beyond! Follow Cielo and Dr. Kenny on Instagram.