Can IBS be Reversed?

Celiac.com 02/23/2017 - IBS, also known as Irritable Bowel Syndrome, is a miserable condition. If you've ever had food poisoning or experienced Montezuma's revenge from travel, you have a good idea of how someone who suffers from IBS may feel. But while your food poisoning passed in a couple of days, imagine what it would be like to live like that each and every day.

You have loose bowel movements anywhere from 4 to 20 times per day. And often they are so urgent that making it to the bathroom is not always possible. You don't need to think about that scenario for long to realize why patients with IBS often choose not to venture far from home. They can literally become ‘house bound' by this condition.

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The chronic diarrhea often switches to constipation for several days before the diarrhea resumes, but they rarely have ‘normal bowel function'. Imagine if you were diagnosed with this condition. You would want to know the treatment and, hopefully, the cure. Most doctors will tell you that there is no cure. They'll also start talking to you about your stress levels. Do you think it's more common for the stress to precede IBS or to be a result of it? Do you think it's at all stressful to never know when you'll next need to ‘dash' to the restroom? Do you think it's at all stressful to constantly have to contemplate what it would be like if you DIDN'T successfully make it to the restroom?

Yes, in my experience I do find that in the vast majority of cases the stress is secondary to the condition, not primary. That's my experience, but I also haven't met a case of IBS that I haven't cured – providing the patients were compliant, of course.

If you look online, this is what ‘WebMD' has to say about the condition:
"Although there currently is no cure for IBS, careful attention to diet and stress management should help keep your symptoms under control and perhaps even prevent them from coming back."

"In many people who have IBS, eating may trigger symptoms. But for most people, there is not a particular type of food that triggers symptoms."
"Increasing the amount of fiber in your diet can help control constipation. High-fiber foods include fresh fruits (raspberries, pears, apples), fresh vegetables (peas, brussels sprouts), wheat bran, and whole-grain breads and cereals. Beans such as kidney, pinto, and garbanzo are also high-fiber foods, but they should probably be avoided if gas is one of your symptoms."

"You can take steps to reduce the possibility that certain foods will cause symptoms, such as avoiding or limiting gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol."

Okay. So according to them you should eat wheat bran, but you should avoid beans and cabbage. To say I disagree would be an understatement. I personally have not met a single person with IBS who wasn't gluten intolerant and I have never found anyone with this ailment who couldn't eat some beans and cabbage. Gas is a result of poorly digested food. The cause isn't typically the ‘gassy' food, but rather a food intolerance that is creating stress on the small intestine, resulting in a compromised ability to produce enzymes and properly digest food. Gassiness is an easy symptom to cure, but avoiding beans and cabbage is not typically the answer.

Let's look at some recent research that shines some light on this topic: Just last month Gastroenterology published an article entitled ‘A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function'. This study was performed by a team of doctors at the Mayo Clinic.

Their goal was to discover whether IBS patients with diarrhea as their predominant symptom could benefit from a gluten-free diet. They performed genetic testing for celiac genes on 45 IBS patients who fit their criteria. Twenty-two patients were put in the gluten containing diet group, while twenty-three were put into the gluten-free group. In each group, 50% had the celiac genes and 50% of the group did not.

Bowel function (number of bowel movements) and permeability, as well as the production of inflammatory chemicals were measured. Those on the gluten containing diet had more bowel movements per day, with the greater number seen in those positive for the celiac gene. So too was intestinal permeability (leaky gut) more prevalent in those consuming gluten and positive for the celiac gene.

While effects of gluten were certainly stronger in those with the celiac gene, even those without the gene were affected when compared to the gluten-free group.

The authors' conclusion was that gluten alters bowel barrier function in IBS patients with predominant diarrhea, particularly among those who carry the celiac gene. They concluded with this statement: "These findings reveal a reversible mechanism for the disorder."

Did those who reacted to gluten suffer from gluten sensitivity? Is that why they still reacted negatively to gluten despite not carrying the gene for celiac? It would be interesting to find out.

In my clinical experience, it is often the case that a patient suffers from IBS but does not have celiac disease. We find them to be gluten sensitive. The treatment of avoiding gluten is still the same, but these patients do not carry the celiac gene.

It seems that while a gluten-free diet isn't the answer for 100% of IBS patients, it is definitely a component in enough people suffering from IBS that it would be a shame to not test for it. Do you agree?

It seems to be a better course than recommending eating gluten and avoiding beans, while stating there is no cure. I'm sorry if my comments seem caustic, but it is upsetting to see such advice given that, in my opinion, does next to nothing to improve the lives of those who are suffering.

If you have IBS or know of someone who does, do consider getting testing for celiac disease and gluten sensitivity. Remember that these tests aren't perfect. Even if you test negative, it would do no harm to try a 30 day gluten elimination diet.

Let me know how it goes and please contact me should you have any questions. Our destination clinic treats patients from across the country and internationally, so you don't need to live locally to receive help. You can call us for a free health analysis at 408-733-0400.

Reference:

• Gastroenterology. 2013 Jan 25. pii: S0016-5085(13)00135-2. doi: 10.1053/j.gastro.2013.01.049. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O'Neill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR.