IBS, or irritable bowel syndrome, can be debilitating for many.
As someone who’s well accustomed to gut issues, I could label myself as a master in the arts.
The daily struggle of sucking in your bloat to hide the sudden look of third-trimester pregnancy.
When you pray to dear god that the accommodation’s toilet is far away from bae, with sound-proof walls and silicon-sealed edges around that door.
Being down right jealous of the friend who can eat beans followed by a skip to the beach with an effortless six pack.
And hoping to dear Christ that this tram isn’t delayed one more second so I can run out of those doors like a gazelle across the African savanna.
So what exactly is IBS?
There are two key types
- IBS – C
- IBS – D
Constipation, or diarrhoea.
Some face a combination of both.
Up until recent years, there haven’t been a lot of sustainable treatments or decent explanations. You usually ended up leaving your GP with another prescription for pain relief.
We have known for sure that triggers like anxiety or certain foods may make matters worse. You know, that feeling you get when you’re about to do your presentation and you have to race to the toilet. (I think I just figured out why it’s really called the “runs” ).
But as with many conditions that go into the “too hard” basket, it was deemed another “we don’t really know why it happens” type of condition.
The first major advancement to gaining some control (and dignity on your first holiday away with the new squeeze), was the discovery of FODMAPs.
“Fermentable oligosaccharides, disaccharides, monosaccharides and polyols”
Say what now?
I’ll break it down.
Saccharides = sugars.
Imagine each sugar molecule alone is 1 bead on a necklace.
The prefixes stand for how many chains. E.g ‘di’ means two – so two sugars; your beaded necklace has two beads.
These different chains of sugars are found in nature amongst fruits, vegetables, grains, dairy, honey and the works.
Now what makes them ‘fermentable’?
The way our beneficial gut bugs access their fuel, is by ‘fermenting’ – or breaking down, these sugars – (or chewing up your beaded necklaces).
But, when these guys get out of hand, too much fermentation goes on, thus causing a lot of discomfort, bloating, and ultimately and irritable bowel.
For some, this can cause debilitating pain, doubling over with toes turned in whilst strongly considering writing your will whilst on the throne.
In IBS-D, this can see people having fast evacuations after every meal. Whist in IBS-C, some are left clogged for more than a week, and sorely disappointed even when the day comes to clear.
As mentioned, the introduction of FODMAPs thanks to Dr Sue Shepherd’s PhD research with Monash University has helped many regain control over their lives. The elimination diet reduces symptoms when removing these trigger foods such as onions, garlic, beans, dairy and/or wheat.
But today I’m here to tell you there’s one more step to this that many are missing, thus never getting a true handle on their debilitating condition.
The real reason why you likely have IBS that no-one’s telling you
So you now know a bit about FODMAPs right?
But do you know WHY all of a sudden YOUR gut bugs have gone rogue on a feasting frenzy, but your mate eating Mexican at Bondi beach hasn’t?
Cue a condition called SIBO.
(FFS another acronym.)
Small-intestinal bacterial overgrowth.
This condition is now being recognised as being responsible for up to 90% of IBS cases.
Furthermore, there’s also a special reason why some experience C, whilst others get the D (soon to come).
So what is SIBO?
You’ve got your small intestines (what look like coiled snakes in the middle of your abdomen), which then flows on to the large instestine/colon (which runs up, across and down around the outside of the SI).
Connecting these two tracts is the ileocecal valve
The large colon is predominantly where your gut bugs should reside.
When all is happy days, the ileocecal valve should not allow the gut bugs to pass back up into the small intestine.
However, we now understand that this doesn’t always happen. Much in a similar way as a weak oesophageal sphincter allows some people to get reflux.
So now, your gut bugs have been let free to roam the SI, where they don’t belong.
As I went through my 4 year health science degree, learning about this condition, the symptoms all started sounding very familiar:
- IBS (more IBS-D when younger, but lead into IBS-C throughout my adult years)
- Bloating with just about every meal
- Random gut pains
- Food intolerances
- A niggling pain in the lower right abdominal quadrant.
- And other weird, seemingly un-associated symptoms such as skin flare-ups, poor immune system, hormonal disruptions and joint pain (not to mention period pain, which we also know can be highly linked with a leaky gut).
So last year, I finally took the test through Gastro-lab, and confirmed my strong suspicion. Funnily enough, it was only because the Gastro-lab rep had come to my clinic to talk about their testing services, that I decided to experience the test myself so I knew how to instruct my patients better.
And low and behold.
It was confirmed.
I had SIBO.
Along with severe fructose malabsorption (fructose being found high in most fruits, honey, asparagus, wine and many other things).
But not only that, I had the worse of two kinds – the son-of-a-bitch ‘methane-dominant’ SIBO.
So you know how IBS can be C or D dominant?
Well that’s strongly associated with these two SIBO types.
IBS-D is more commonly linked with hydrogen-producing bacteria/bugs, whilst IBS-C is often linked with methane bugs. And any health practitioner who treats SIBO knows that the methane dominant kind is a stubborn prick.
So given what you’ve learnt here, you can understand why the FODMAP diet helps IBS/SIBO sufferers – because it starves those rampant bugs of the foods they love so much.
BUT, one big fat but.
It doesn’t always get rid of it – it just keeps it controlled.
This means that it can flare up after one burrito. Additionally, it’s not healthy to cut out FODMAPs permanently due to your large intestine needing those important prebiotic fibres and help us absorb nutrients.
So how do you get rid of SIBO?
Well I’m glad you asked.
Just like any pathogen or infection, you have to eradicate the overgrowth, otherwise they’ll set up shop for good, pitching tents, towns and all sorts of fiascos. They even get so territorial, that they literally build protective domes over themselves to protect from standard anti-microbials or antibiotics (called bio-films).
These bio-films serve as another road block to many standard “weed, seed and feed” protocols, and even anti-biotics.
It’s sounding complex right? Well at first, it sure is.
But once you get a full handle on what’s going on, and assess the person holistically, you can tailor the protocol to you.
So last year, after receiving my ‘diagnosis’, I used the protocol I used on other clients, on my very own self.
It was strict. It was expensive. And took some self-discipline.
But it was the best my gut had felt in a very long time.
In a nut shell, the protocol entails specific dietary measures, potent herbal anti-microbials that are shown to be specific to methanogenic bacteria, bio-film disrupters, specific probiotic strains and gut healing nutrients.
Regular bowel movements, and no morning gut pains (which had became the norm for me for years).
I was so bloody pleased with myself that I could finally stick to something (regardless of helping others commit to their plans, I wasn’t always the best myself (it’s true what they say, every practitioner needs their own)).
All was going pretty smoothly.
I’d knock back every lolly and chocolate passed under my nose.
I wasn’t drinking alcohol.
I started a new job.
I moved house.
And then it was Christmas.
Staying on top of this protocol, and sealing the deal properly, was like treading deep-end water with a strong rip tide.
The waves pulled me under.
I caved in.
The stress got on top.
We had to eat take out more than I’d like to admit, and sure enough the SIBO all came flooding back.
So bloody frustrating. And all that money spent on the treatment.
In retrospect, all was not lost. As I do feel it wasn’t as bad as before, I have regular bowel movements and I’m permanently more mindful of my triggers.
But In the hours and hours of research, reading, podcasts and support pages revolving around SIBO, one thing for sure I learnt, was that SIBO can be notorious for returning several times over, methane-dominant being the worst.
So why is this?
Cue the final missing piece of the puzzle, that you definitely need to know when treating SIBO.
You thought we’d got to the underlying cause of IBS – that being SIBO.
But going one step further, you need to ask yourself – why did I get SIBO in the first place?
There are a few key suspects
- A low migrating motor complex (that wave of contractions that keep your bowels from moving stools along)
- Adhesions around the ileocecal valve – which can potentially be caused by an appendectomy, or endometriosis
- Inflammatory or autoimmune diseases such as Chron’s, UC, or coeliac disease
- Frequent antibiotic use
- Other GIT infections
One thing I’d suspected for sure, was the fact that I had my appendix removed. In more recent years I’ve constantly noticed that sharp or pulling pain around the ileocecal valve (which is next to your appendix – or lack thereof). My osteopath had also mentioned something going on around that area when palpating that area.
So given this information, it will take some holistic investigating to figure out where the SIBO is stemming from for you. But it is this part of the treatment plan that will be at the cornerstone of keeping it away for good.
Going back to my own journey, I am going to make it my next mission to combine manual therapies with my next treatment plan in the hope to see if we can free up any possible adhesions around the valve.
Thankfully, I’m also not about to start a new job or move house for a very long time.
So has this piece helped the penny drop for you and your IBS?
This condition doesn’t have to be a life sentence, and there are real solutions.
Granted, it takes a holistic approach, some determination and a bit of money (around $500-$800 in prescriptions and appointments). But really, it’s an investment to finally take back control and feel better than ever.
If you’re looking for further guidance on where to go next, feel free to send me a message or email any time.