IBS or IBD?
How often have you seen someone dismissively refer to their IBS symptoms with body language that says ‘don’t go there’ , ‘can we change the subject’. Many people with ‘tricky’ digestive systems simply put up and shut up. That is, they don’t like talking about it, they put up with niggly – even distressing – symptoms, and because their suffering comes and goes, they’re perpetually in a state of hope that ‘perhaps it’s gone away now . . .’, or ‘perhaps it was just something I ate . . .’
In fact, knowing whether you have IBS (Irritable Bowel Syndrome), or IBD (Inflammatory Bowel Disease), is actually very important.
IBS is a functional disorder of the gut, an umbrella term covering gut symptoms like bloating, constipation, cramps and diarrhoea, from various causes, that require investigation to enable a targeted, tailored solution. IBD on the other hand is a structural, inflammatory disorder where a person’s own immune system attacks their gut wall, leading to sores, ulcers, scarring and sometimes narrowing of the intestines. They may also suffer cramps and diarrhoea but actual physical changes to the intestinal tissue can be viewed using CT or MRI scans, or endoscopy with a biopsy to confirm the immune system’s involvement.
Symptoms of IBD can also include bloody or black stools, weight loss, loss of appetite, fever, fatigue and inflammation of the joints, skin or eyes. Pain is generally felt down the right hand side of the abdomen with IBD Crohn’s disease, and down the left hand side with IBD Ulcerative Colitis.
Treatment involves the use of corticosteroids to dampen down the immune reactivity, Aminosalicylates to support the intestinal lining, antibiotics if the disease causes infection, and inflammation blockers. None of these get to the route cause of the disease, they cycle patients in and out of remission.
See a doctor –
It is important to differentiate between the two, because whilst IBS can be inconvenient, even distressing with its symptoms of nausea, constipation, bloating or diarrhoea, IBD on the other hand produces visible structural damage to the gut, causing digestive dysfunction, nutrient deficiencies, and long-term consequences if left untreated. So seek the opinion of a doctor, if you’ve been ignoring symptoms of IBS, how else will you know which you have?
Functional bowel issues like IBS are widespread and many people are tempted to self-diagnose and self-medicate with over the counter remedies like probiotics. They might also experiment with excluding certain foods or minimising the ones that seem to trigger symptoms. None of this will work if it’s IBD that you have. I hope that reading the above will encourage people to understand the utility of seeing a doctor to differentiate between IBS and IBD and get a proper diagnosis. A case in point was the patient who decided to experiment with a course of strong probiotics to treat what they assumed was IBS, only to end up in hospital with a case of sepsis. Their damaged bleeding gut from undiagnosed IBD allowed the probiotic bacteria to stream through the damaged intestinal wall, producing a massive systemic immune reaction. Probiotics do have their use, but you need a healthy, functioning, gut mucosal barrier to keep them where they belong – in the gut.
Whilst mainstream medicine currently offers symptom management with drugs for IBD, the evidence base does confirm that the pathogenesis – the development of the pathology of IBD – occurs from having a three-fold combination of:
- genetic susceptibility,
- certain lifestyle factors,
- and/or a past infection, probably in the gut.
Simply having the genetic predisposition is no guarantee of developing IBD, (the genes involved are numerous and weak), you need the triggering lifestyle factors too – some of which are modifiable choices, i.e. within our control.
This is where nutritional therapy comes in.
A registered Nutritional Therapist will seek to identify the patient’s own particular disease antecedents, triggers and mediators, the factors that preceded and increased their risk or actually triggered the development of their disease, and even the factors that may be perpetuating the disease, preventing it from resolving.
‘Dysbiosis’, the term we use to describe gut microflora that’s out of balance, or lacking healthy diversity, can be a driving factor. Another can be food intolerances and reactivity setting up chronic inflammation in the gut. Dysbiosis has many causes, it can result from antibiotic use or parasitic infections, it can result from functional issues like low stomach acid, poor bile acid production, slow gut transit, or poor food choices – particularly insufficient fruit and vegetables. All of which – if identified – can be modified to reduce their capacity as risk factors for IBD. The ‘functional medicine’ approach allows for the individual’s multiple antecedents, triggers and mediators (of their IBD) to be identified and modified, to move away from a disease centred approach, towards a patient centred approach.
There are multiple, evidence based interventions that can aid the nutritional therapist in coaxing the IBD sufferer towards a reduced disease risk state. We may not be able to change an individual’s genes, but it is their lifestyle choices that influence the expression of those genes. Book in to work with me if you have had a diagnosis of either Crohn’s or Ulcerative Colitis, or indeed just have stubborn symptoms of IBS that with a little help, might be better supported. Read the article on the Cyrex saliva test (Array 14), that can help to identify IBD and it’s triggers and mediators.