Cramping, bloating, stomach pain, flatulence, diarrhea and constipation … Do you have these symptoms regularly?
These are the typical symptoms of irritable bowel syndrome (IBS). It is estimated that about 10-25% percent of the population in western industrialized countries suffer from this syndrome.
If you are looking for a natural remedy that attacks the cause and not just the symptoms of IBS you should keep on reading.
But first let me explain briefly what IBS exactly is and how those who have it are affected.
What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome is a functional gastrointestinal disorder. It is not classified as a disease, because it has no organic cause. That's good news because it means there is no structural organic damage, but also bad news because the symptoms are very painful and sufferers often go on an odyssey of doctors until they are diagnosed correctly.
Because there is no organic damage and the symptoms are overlapping with other bowel diseases, IBS sufferers often are diagnosed incorrectly or, even worse, accused of being hypochondriacs. But unfortunately the symptoms are very real and painful.
A definite test for IBS does not exist, so the diagnosis of IBS is made by ruling out other bowel diseases with similar symptoms. There is also no definite treatment for IBS which makes dealing with this disorder subject to a lot of individual trial and error when it comes to helpful tips and tools.
IBS is a non-life threatening illness which does not progress into more severe bowel diseases. There is also no increased risk for developing illnesses like Crohn's disease, Inflammatory Bowel disease or Colon Cancer.
Diagnosis and symptoms of IBS
IBS is a chronic illness with symptoms coming and going depending on many factors such as stress level, diet, other illnesses or medication. According to the so called Rome 3 Criteria a diagnosis of Irritable Bowel Syndrome is probable when abdominal discomfort or pain, that matches at least 2 of the following 3 criteria, occur for more than 3 days per month (not consecutive) in the last 3 months:
Typical IBS Symptoms
- Abdominal pain / cramps
- Passage of mucus
- Bowel upset
- Abnormal stool frequency, form, passage
- Feeling of incomplete bowel movement
- Fewer than 3 bowel movements per week
- More than 3 bowel movements per day
If you`re having these red flag symptoms mentioned below, you might have another condition other than IBS. Please always see a doctor if you experience these symptoms.
Red flag symptoms
- Pain that awakens and interrupts sleep
- Diarrhea that awakens and interrupts sleep
- Blood in stool (visible or occult)
- Unintentional Weight loss
Which symptoms occur the most is highly individual, however sufferers of IBS are categorized into three types: Diarrhea predominant, constipation predominant and the mixed type with alternating diarrhea and constipation.
What causes IBS?
Irritable Bowel Syndrome is chronic functional disorder, which means no organic cause can be determined that triggers these painful symptoms. Today there is a lot of research in this field, but no definite cause has been found yet. The cause of IBS is simply unknown. However, the medical community has discovered several factors that play a major role in the formation of Irritable Bowel Syndrome.
- An increased nerve activity of the gut nervous system (enteric nervous system)
- Intestinal infections
- A disturbed gut flora
- Disturbance of gut motility (intestinal motility disorder)
- Unilateral or fat heavy diet that leads to a disturbance of gut flora
IBS patients have abnormally sensitive guts and often show signs of mild inflammation. Stress and inflammation add to the irritability of the gut and symptoms are usually triggered by certain foods or stressful life events (Food and mood).
Stress and anxiety as triggers for IBS
Irritable bowel syndrome has a strong psychological component. Symptoms are triggered or intensified by stress, anxiety and situations of psychological pressure.
Stress speeds up transit time through the bowel which leads to some of the described symptoms if your intestinal motility is already disturbed. Brain and gut are connected through the gut-brain-axis which could explain an intensification of symptoms due to stress or other psychological factors.
Stress also alters the gut brain interactions that can trigger intestinal inflammation which then cause IBS symptoms.
Food as trigger for IBS
Besides the psychological triggers for IBS symptoms the other big trigger is food or eating in general. Although this connection between food and symptoms is well know, identifying the components that cause the IBS flare-ups is very difficult, in many cases impossible. Because it is not just the food but also the context of the meal, i.e. if it is a stressful or relaxed environment or if you have to eat in a hurry, that plays a role in triggering IBS symptoms.
Because food components, context, environment and mood at the time of the meal all play a role in triggering Irritable Bowel Syndrome symptoms, sufferers often find it impossible to know with certainty which foods to avoid.
I will go into great detail about food and diet recommendations further down in the article, in the section about treatment.
The role of gut flora in IBS
Our gut flora is the population of normal bacteria that live in our gut and in the lower parts of our intestine. We have a symbiotic relationship with these beneficial bacteria.
We host them and they take over important functions in our digestive process. They protect us against pathogenic or “bad” bacteria, they help regulate our immune system and assist in metabolizing certain food components to produce i.e. essential vitamins we need. Disturbance of this symbiotic relationship often leads to disease and illness.
Our gut also has its own autonomous nervous system, or enteric nervous system (ENS) which is linked to the brain via the gut-brain axis. Our gut also produces more than 30 neurotransmitters and contains more neurons than our spinal cord.
This high number of neurons are what enables us to feel with our gut. The complex nervous system of our gut is subject to a lot of clinical research today, which has lead to the gut being called our “second brain”. So that is what we mean when we say "Follow your gut!"
5 ways a disturbed gut flora can trigger IBS
Antibiotic use influences gut bacteria severely. Beneficial bacteria gets killed off along with the “bad” bacteria that causes an illness. A lot of patients report IBS symptoms after a period of antibiotic use.
Bacterial Infection (Gastroenteritis)
IBS patients often develops after a stomach or intestinal infection caused by bacterial infection (gastroenteritis). This is calles post-infetious IBS or PI-IBS. A weakened bowel is especially vulnarable to bacterial infection after an infection by a virus.
Inflammation in the bowel wall is commonly observed in IBS patients. This inflammation can be caused by an abnormal interaction of bacteria in the gut.
SIBO (Small Intestinal Bacterial Overgrowth)
IBS is associated with Small Intestine Bacterial Overgrowth (SIBO). This excessive overgrowth of bacteria in the small intestine causes inflammation along with other IBS typical symptoms.
Disturbed Intestinal Barrier
Your gut flora has a so called “intestinal barrier function”, which means it regulates the amount and type of bacteria that can enter your digestive system. If this defense mechanism is disturbed, overgrowth of pathogenic or “bad” bacteria can occur.
A study published in Digestive Diseases and Sciences in 2012 speaks of “clear evidence of the role bacteria play in the disease (IBS)” and concludes that “bacteria are key contributors to the cause of IBS”.
Read the full article here: Irritable bowel syndrome clearly linked to gut bacteria
IBS Treatment - So what can I do about it?
IBS is a somewhat mystical disorder with no definite cause, treatment or cure. Because there is no definite cure, treatment of IBS is all about relieving the symptoms and helping sufferers live a normal life.
In general, treatment revolves around the two big trigger points for IBS: Food and Mood.
Mood means treating the psychological component with measures that reduce stress and emotional tension.
Food means establishing a diet that takes stress off the digestive system, is low in foods that trigger symptoms and incorporates food that help cultivate a healthy gut flora. This is exactly where fermented foods that are rich in probiotics can help.
Besides managing your stress level and your diet, IBS patients are also using traditional healing methods like acupuncture and reflexology to relieve symptoms and to help calm down their bowels.
But what researchers are most excited about is the role probiotics can play in the treatment of Irritable Bowel Syndrome. Probiotics for IBS can be consumed as food or as dietary supplement. But before we dive deep into how fermented probiotic foods can help with not only the symptoms but potentially the cause of IBS, I'll give you a quick overview about all the treatments and healing approaches.
Mood - Psychological treatment
Because Irritable Bowel Syndrome has such strong psychosomatic component, treatments such as Psychotherapy, Cognitive Behavioural Therapy and Hypnotherapy have proven to be an effective. Reducing stress by developing coping mechanisms for situations of psychological pressures also protect the gut from reacting to stress with irritation.
Practicing stress relieving techniques such as meditation, yoga, qigong or tai chi are all effective means to prevent IBS symptoms from flaring up.
Even the use of low-dose antidepressants in patients with minor symptoms of depression and anxiety is not uncommon, especially when pain could not be relieved by antispasmodics.
Alternative healing methods
Two holistic healing methods that are both based on ancient science are acupuncture and reflexology. These two complementary therapies are also recommended for people affected by Irritable Bowel Syndrome.
Acupuncture is especially reported to be very effective at restoring normal bowel function and relieving symptoms.
Food - How adjusting your diet can help with IBS
For most IBS patients, food is the big topic. Irritable Bowel Syndrome is a disorder of the digestive system and everything we eat effects that system. Because IBS is so highly individual in the symptoms as well as in the triggers, sufferers have to do a lot of experimenting with their diet.
Since food is just one of many factors that can trigger IBS symptoms, it is often hard for patients to say with certainty whether a food group or component should be marked as a trigger food. It often revolves around other factors, like the context of a meal, that trigger symptoms.
Although symptoms and triggers are highly individual, there is a list of foods known to aggravate the digestive system and thereby triggering IBS symptoms. There is no official IBS diet, but patients can eliminate single food or food components from their diet and observe if they get better.
A simple change in your diet can already have a huge impact on your IBS symptoms. Try these tips and closely observe your symptoms to find out what works for you.
Avoid IBS trigger foods
Food can trigger symptoms and simply avoiding certain foods can bring fast relief and better your conditions. Here is a list of foods known to have an enhanced response in your bowel, also known as hyper visceral sensitivity....
IBS Trigger Foods
- Food with high fat content, especially fried food such as chips, fries or cookies
- Caffeine in coffee, tea or energy drinks
- Carbonated drinks
- High gas foods such as beans, cabbage, broccoli and cauliflower (in case gas and bloating are regular symptoms)
- Artificial sweeteners Sorbitol and Xylitol
- Carbohydrates known as FODMAPs (explanation further down)
The elimination of dairy seems to be advisable for many IBS patients. In an Italian study “Lactose malabsorption and irritable bowel syndrome: effect of a long-term lactose free diet” (Vernia et al) from 1995, over 43% percent of participants in the study had a complete remission of symptoms and another 40% had moderate improvements of their condition after eliminating dairy and other lactose containing foods from their diet.
Read the abstract of the study here:
Because it's so hard to identify single trigger foods, IBS patients often believe they have food allergies or food intolerances. While a food allergy is rather unlikely (less than 4% of IBS patients), food intolerances are much more common.
Food intolerances that are common in IBS patients are often to fructose, lactose and gluten. Also diets that are high in fibre or so called FODMAP foods are problematic. FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are sugars or sugar alcohols which cannot be absorbed fully by your digestive system.
Sugars that are not fully digested in the small intestine, travel all the way to the large intestine, where they act as food for the bacteria that live there. Sugar malabsorption is a known cause for bloating, diarrhea and abdominal cramps.
Guess which sugars cause the most trouble here? Answer: Lactose and fructose. So one more reason to be careful with dairy products, fruit and fructose sweetened sodas.
In the end, identifying your trigger foods is a highly individual process that involves a lot of trial and error. However eliminating dairy, gluten and fructose are good starting points. After a period of 3-4 weeks of eliminating a food group you should slowly reintroduce that food group back into your diet, to find out how much of it you can tolerate. Eliminating food groups permanently can lead to nutritional and microbial depletion, as well as to a diet you might not enjoy long term.
Apart from avoiding certain food groups, what else can I do?
It's not just what you eat but also how. Setting and context of a meal are just as important as the food itself. Here are some tips regarding the setting of meals that may help you:
IBS Eating tips
- Do not eat on the go. Take time, sit down.
- Don't eat alone. Eat with friends, co-workers or family.
- Eat at regular times. Don't skip meals.
- Turn of the TV or avoid your smartphone. Eat mindfully.
- Avoid large meals right before you go to sleep.
- Take time to prepare your meals. Stay away from ready meals or fast food.
Drink plenty of water
Hydration plays a key role in our digestion. Especially the constipation-dominant type must make sure to drink enough water, 6-8 glasses a day at minimum. Don't drink with meals!
Depending on what type of IBS patient you are, fibre can work for or against you. It can help reduce constipation but at the same time it can make bloating worse. It is recommended to slowly increase the amount of dietary fibre and closely observe symptoms. Fibre can be consumed through your diet or as a supplement.
Physical activity is the cheapest antidepressant available. Regular exercises not only relieves stress and depression, it also stimulates a normal bowel movements and aids digestion.
What about the cause of IBS?
Finally, this is where probiotics come into play. Until now, all the measures I talked about were about relieving symptoms or keeping symptoms from breaking out, now we will see how probiotics can aid.
Probiotics for IBS
'Probiotics' is just another word for beneficial bacteria. These “good” bacteria live in our digestive system by the billions. In recent years researchers have linked our microbiota, which is the community of microorganisms that live in our body, to a vast number of diseases, including mental illnesses.
Science today has no doubt that our microbiota directly influences our immune system, our mental health, our body weight and our mood. Manipulation of our gut flora in many experiments and studies has shown how beneficial microbes can be essential for our overall health.
By consuming probiotics we can now treat Irritable Bowel Syndrome at its root instead of just treating symptoms. Directly supporting your gut health by consuming beneficial bacteria can help your body heal itself without the use of medication.
Microbiota and health - Everything is connected ….
What was once a pretty exotic theory is common knowledge in the medical community today. Modern science has confirmed what ancient traditions have known for centuries. Intentionally altering your microbiota can directly influence our health, your mental state, your mood and your fatigue levels.
4 Ways Probiotics Heal your gut flora
Protection of your intestinal barrier
Good bacteria act as a gatekeeper to prevent bad bacteria from overgrowing. Your immune system constantly monitors this process. When this function is disturbed, i.e. because of increased permeability of the gut, inflammation and tissue damage can occur.
Another way the intestinal barrier is compromised is in depressive states.
Psychological stress has shown to increase permeability, which then can lead to food antigens and environmental toxins entering the body and cause inflammation or disturb glucose control.
Both inflammation and overgrowth of pathogenic bacteria are known triggers for IBS symptoms. Keeping your intestinal barrier intact through consumption of beneficial bacteria is great prevention strategy against key IBS triggers.
Prevention of stress-induced alterations to overall intestinal microbiota
Feelings like stress, psychological pressure and despair can directly influence the microbiota through the gut brain axis. Your gut health is influenced by your mood, and vice versa. A microbiota that is not intact get disturbed more easily by stress and mood, one of the main triggers of IBS symptoms.
But even if stress does not directly trigger IBS symptoms, it can lead to inflammation which in turn lead to symptoms like bloating, abdominal cramps or constipation. One way or another, a disturbance of our gut flora can cascade into a lot of problems.
Limitation of carbohydrate malabsorption
Most Bacteria love sugar. They eat sugar and metabolize it into CO2, carbon or lactic acid. When your gut bacteria is out of balance, some sugars are not metabolized in the small intestine and can reach the large intestine. In the large intestine the sugar gets eaten by bacteria and fermented which leads to gas production. This gas production often leads to typical IBS symptoms.
To avoid carbohydrate malabsorption IBS patients should eliminate certain sugars from their diet (start with lactose and fructose), and they can feed their gut flora with beneficial bacteria to aid digestion and nutrient absorption.
Limitation of SIBO (Small intestinal bacterial overgrowth)
Small intestine bacterial overgrowth occurs when bacteria that are usually found in the large intestine or colon proliferate in too large numbers in the small intestine. Fighting this overgrowth of bad bacteria with probiotics has shown promising results.
Although the exact mechanism is not completely clear yet, experiments have shown that probiotics can help with SIBO probably by acting on the intestinal immune function and by reducing inflammation.
I`ve worked my way through countless medical studies and reports, in case you want to read some of the original sources, check out this link.
Now we know that we influence our microbiota to help our gut regulate our mental and overall health, and we can prevent typical IBS triggers, like inflammation, SIBO or carbohydrate malabsorption from occurring.
So, how do I incorporate probiotics in my everyday life?
To get all the amazing health benefits, probiotics should be consumed regularly, if possible every day. There are two ways to get this done. You can either buy probiotic supplements or eat fermented foods, which are naturally rich in probiotics.
There certainly is a case for probiotic supplements. There are single strains of bacteria that have been found to be effective in IBS treatment, and these strains are available as dietary supplement.
But these strains are also available in naturally fermented foods and drinks. And with fermented food you not only get valuable probiotics but a ton of other health benefits as a “free bonus”.
Bifidobacteria and Lactobacilli for IBS treatment
Bifidobacteria and Lactobacilli are two lactic acid bacterial strains that are a safe and well-studied alternative to medication that solely focuses on the alleviation of symptoms. No negative side effects have been reported so far.
Bifidobacteria and Lactobacilli attack the problems of IBS where they originate, by regulating the gut flora and by aiding the barrier function of the gut. They also help fight overgrowth of bad bacteria.
Both Bifidobacteria and Lactobacilli both are available in a variety of supplements, but there also is natural way of getting those probiotics into your gut ...
Fermented Food - A natural probiotic IBS Remedy
Today the connection between the consumption of fermented foods and the growth of beneficial microbes in our guts is well established. Fermented foods have a positive effect on our microbiota which is directly responsible for regulating our immune system, our digestion and our mental health and mood.
"The processes required for fermented foods were present on earth when man appeared on the scene… When we study these foods, we are in fact studying the most intimate relationships between man, microbe and foods."
Making fermented foods part of your daily diet will strengthen the colonies of good bacteria inside your gut. All done with delicious food - what could be better?!
So the question is...
Which fermented foods contain Lactobacilli and Bifidobacteria?
Answer: Almost all of them! But you have to make them yourself!
Lacto-Fermentation or Wild Fermentation for vast amounts of Lactobacilli
The easiest and most popular fermentation method is lacto-fermentation. Lacto-fermentation is the process when the bacteria Lactobacillus is converting sugars into lactic acid. Numerous strains of Lactobacillus naturally occur in all plants.
So when you are fermenting your own fruit and vegetables, there is no need for any added bacterial cultures. You simply use the natural yeast and bacteria on your fruit or veggies to start the fermentation process.
Because you're only using bacteria and yeast that are naturally present in plants, this method is called “wild fermentation” as opposed to "cultured fermentation" which introduces specific bacterial cultures (the two can also be combined in particular methods).
The lactic acid that forms during the fermentation process also preserves the food by inhibiting growth of pathogenic or “bad” bacteria. The Lactobacilli create an acidic and anaerobic environment where harmful bacteria cannot thrive.
Acidic means that pH-levels are so low that harmful bacteria cannot survive. Also creating an anaerobic environment, i.e. no air, keeps ferments from oxidizing and harvesting potential bad bacterias. So, keep those veggies under their brine!
The creation of an environment where harmful bacteria cannot live makes fermentation the safest food preservation technique there is. Some ferments like sauerkraut or kimchi can be kept for months, even years without going bad.
Pasteurisation - Kill the good with the bad
Fermented foods that are rich in probiotics are always unpasteurized. With pasteurization, food is heated to high temperatures to kill off bad bacteria. In this process the good bacteria also get killed off and you're left with dead biomass.
Unfortunately most foods you can buy in the supermarkets today are pasteurized. That's why fermenting your own fruit and vegetables at home will give you the best probiotic content with all the health benefits you're looking for.
Cultured Dairy Products for Lactobacilli and Bifidobacteria
Yogurt and kefir have long been known as sources for probiotics. The Lactobacillus strains were actually first observed in milk products. Both yogurt and kefir can be bought in stores or made at home using kefir grains or yogurt starter cultures.
When using a store bought yogurt or kefir you simply have to check the food label to see if Lactobacilli and Bifidobacteria are present in the product. Not all commercial yogurt have enough live cultures in them, so you have to check each manufacturer individually. If you want to be certain that your dairy ferment has enough living probiotics in it, you will have to ferment it yourself.
When you're fermenting your own cultured dairy products at home the number of yeasts and bacterial strains will vary depending on your locations and the conditions under which the culture is kept. Studies have found about 16 different strains of Lactobacilli that are commonly present in fermented milk products.
Find both studies here:
Probiotic Supplements for Bifidobacteria
To get a large amount of Bifidobacteria into your system, probiotics supplements are a legitimate choice. Although I'm always advocating for natural remedies, in this case supplementation can make sense. Taking a supplement for a limited amount of time with the goal of intestinal colonization has shown great results in many IBS patients. However, please always consult with your doctor before taking any probiotic supplements.
To sum it all up
I know that was a lot of information …but to sum it all up, here is the reason why fermented foods are great for treating Irritable Bowel Syndrome.
Fermented foods are rich in probiotics, beneficial bacteria that already live in our guts. A healthy community of good bacteria, or gut flora, or intestinal microbiota regulates our digestion, our immune system and even our mental health and mood. Disturbance of this flora is the root cause for many different health issues including Irritable Bowel Syndrome. By consuming probiotics through fermented foods you strengthen your gut flora by directly colonising it with good bacteria.
Fermentation is an ancient art and science. Our ancestors have used this food preservation and nutrient alteration technique for thousands of years, and modern science is just getting started with putting sound medical research behind a lot of old wisdom.
Using the natural healing power of fermented foods in your everyday life is easy, safe, cheap and effective and will introduce you to a whole world of new flavours and ingredients … and heal you along the way.