Removing “Irritable” from your Bowel!

Gastro-intestinal symptoms can be an issue from the time you are born, typically called colic until the time you pass away. It is understanding what can be done in between this time that makes the difference and improves your quality of life.

A diagnosis of irritable bowel is given when a clinician cannot explain why you have the symptoms you experience. Gluten allergy and inflammatory bowel disorders have been ruled out but you still suffer from a range of irritating signs that all is not right.

Digestion starts in the mouth where enzymes start to break down sugars and you mechanically break down food fibres to make less work for the stomach. The stomach pH is meant to be very low and acidic to aggressively dissolve foods and once it is of a consistency to pass through into the small intestine, alkalizing chemicals are pumped in to help nutralise pH so that damage does not occur in the small bowel. Food and the neurotransmitters in the brain such as serotonin trigger pancreatic enzymes to help target specific sugar, fat and protein breakdown to single cell molecules for absorption through the intestinal lining.

Peristaltic waves help move foods along the system and these are usually an unsymmpathetic nerve response which means it is not influenced by your control.

The gut lining has a thick jelly mucus to help with further preparation of foods for digestion, the lining is a mass of hairlike protrusions but of a single cell and therefore very thin. Every cell is cemented together to make the wall impenetrable other than through the cell.

Inside the gastrointestinal tract along with food remnants and stools are bacteria, yeast and parasites that have entered your body. In good health, the immune system keeps the balance of power within range so that that organisms do not get out of control and dominate. When this happens, organisms can alter the pH, take up nutrients that are beneficial to health, give out toxic compounds as their own waste, take up water to cause constipation or cause diarrhea, vastly increase fermentation to give off gas and cause bloating, and disrupt the cells so that pancreatic enzymes are impaired.

In the absence of testing or knowing what to test for, understanding symptoms is a good start and then beginning a rebuilding plan to include treating organisms if present, re-inoculating the system with the appropriate anti-fungal or anti-biotic, taking out foods that can be causing extra burden, supporting pancreatic function, boosting the integrity of the intestinal lining and boosting the opportunity to heal.

This is a great place to jump in and identify by way of symptoms, just where the problem might lie.

Many people suffer from gastro-intestinal reflux or acidity. Specific foods can make this worse but identifying why your stomach is sending acid back up through the oesophagus, against gravity should be considered seriously. The stomach is meant to be very acidic but we combat this by taking alkalizing medications to alter the environment and make it more comfortable but digestion of foods is compromised.

Many women during pregnancy experience reflux because the baby starts to push on the stomach almost like a bloating action which tends to cause the lower esophageal sphincter at the connection between stomach and where your food enters. This then allows acid in the stomach to be pushed up. If this is happening to you in everyday life, it is not an acidity problem but a bloating issue from fermenting foods in the small intestine pushing on the stomach. A lazy pancreas, changed pH due to bacteria or yeast, a pH that is not promoting food breakdown, insufficient motility to move stool contents along to be eliminated. There are many causes to be considered.

We tend to focus on the bacteria in the lower gut by taking probiotics but small intestinal bacterial overgrowth (SIBO) also occurs. We have a lot of bacteria in our gut but the location of that bacteria is really important.  There are small amounts of bacteria all the way through the digestive tract, from the mouth to the anus, but the majority of the bacteria should be in the colon and very little in the small intestine, which is where we digest and absorb food.  Bacteria growing in the small intestine, can interfere with the assimilation of nutrients from food, which is one of the major adverse effects of SIBO.

Anything that causes food to be incompletely digested by the stomach and/or small intestine may cause flatulence when the food moves through the digestive tract due to fermentation by yeast, bacteria or prokaryotes normally or abnormally present in the gut. Prokaryotes are a completely different class of organism than bacteria. They are ancient, single-celled organisms with no cell nucleus and no membrane-bound organelles.  The ones you might have heard of in the news, halophiles and thermophiles are the ones that live in extreme environments like salt lakes or hot springs.  But we now know they are present in most living habitats including the human gut.

Prokaryotes tend to proliferate in the small intestine and feed off the hydrogen gas caused by an over growth of bacteria to then produce methane gas. Testing is done by measuring hydrogen and methane from your breath after being given a measure of lactose sugar. So typically, if you have a significant increase in hydrogen or methane after drinking the sugary solution, it means you have an overgrowth of bacteria in your gut.  To be more specific, when you have an increase in methane after drinking the solution, or if you just have high levels of methane at baseline, that indicates an overgrowth not of bacteria, but of these methane-producing prokaryote bacteria called archaea.  In otherwords the archaea feed off the hydrogen made from the bacteria fermenting the carbs or lactose sugar.  There is nothing very simple about irritable bowel and assessing a treatment plan, which is why a GP will often give you a broad spectrum probiotic, possibly digestive enzymes, an anti-spasmotic medication and anti-depressant.

Methane is not produced in the gut due to the bacterial colonies until a child is about 3 years old. It is often not detectable but identifying levels of methane when gut issues become an issue makes this identification important.

Methane is a colorless, odorless, inert gas.  For a long time, it was thought that it didn’t really have any impact on human health, except for maybe causing a little bit of bloating and distention. This is very common and I see many adults and children with very bloated stomachs and unpleasant levels of gas.  Often they elect to do a Food Intolerance test but this is not always going to be helpful as it measures an antibody response to proteins. It can be a secondary place to start a diet but getting to the bottom of the bacteria and gas emissions is the primary issue as well as the type of carbohydrates involved in fermentation.

In the absence of testing, if you have abnormal bloating and gas, the next symptom of methane-producing archaea is constipation. It is not the only cause of constipation, and possibly constipation is causing higher methane production due to slow transit time, but research highlights that methanogenic bacteria are significantly associated with chronic constipation due to its correlation with colonic transit time.  So the more methane you have, the slower your transit time is.

If the result of a hydrogen and methane breath test is positive, the treatment is going to involve getting rid of both bacteria and methane producing issues which includes improving stool transit time with a stool softener such as glucomannan and using two different anti-biotics – 10 days of both rifaximin together with neomycin. Trialing them one after the other had some good results but taking them together has shown to be much more effective in knocking back gas production.

I would also not rule out botanical herbs and plant substances in a treatment program as they can have a really broad spectrum of activity and less likelihood of bacteria developing resistance due to their many protective active compounds.

Some people are opposed to taking anti-biotics and rightly so but rifaximin and neomycin are narrower in spectrum and less likely to knock out all bacterial colonies,

Antimicrobial botanicals such as cats claw, olive leaf extract, coptis etc and soil and sea based organisms such as chitosan, bentonite clay and diatomaceous earth secrete antimicrobial peptides. A broad spectrum probiotic is essential and are best taken in three week cycles by changing the brans. That way no one bacteria gets too well established to dominate in a somewhat compromised digestive environment. Another wonderful food or supplementary powder is Lauricidin, lauric acid, or good quality coconut fat which is antimicrobial. Starting the natural way is by far the best decision. After that you might need to bring in the army with the rifaximin and neomycin combo and then take a targeted probiotic such as Saccharomyces boulardii or in combination with others. Unfortunately the good prebiotic foods are often used by the bacteria to ferment and cause high levels of hydrogen so adding these in has to be done in small doses over time.

On the subject of fermentable carbohydrate foods, a specific carbohydrate diet identifies carbs as to their virulence for containing compounds that may burden digestion. FODMAPS is a method of reducing the volume of gas produced using dietary modification and reducing the amount of fermentable carbohydrates – fructans, oligosaccharide, dissacharide, monosaccharide and polyols.

Most starches, are broken down in the large intestine and gas from these foods is formed here unlike the gas from SIBO. Fermentative lactic acid bacteria such as Lactobacillus casei and Lactobacillus plantarum reduce flatulence in human intestinal tract and are often found in Probiotic formulas.

Probiotic foods such as kimchi, live yogurt, and kefir are known to reduce flatulence when used to restore balance to the normal intestinal flora. L. acidophilus may make the intestinal environment more acidic, supporting a natural balance of the fermentative processes. L. acidophilus is available in supplements. Non-digestible carbohydrates such as fructo-oligosaccharide, generally increase flatulence in a similar way as described for lactose intolerance. Other oligosaccharide foods that can cause problems are beans, lentils, dairy products, onions, garlic, leeks, turnips, radishes, sweet potatoes, cashews. Jerusalem artichokes, oats, wheat and yeast in breads. Cruciferous vegetables such as broccoli, cauliflower, cabbage and Brussel sprouts are common know causes of flatulence with increased pungency! The one common problem is usually bacteria in numbers feeding on the sugars from these foods.

Since problems involving intestinal gas presents as different complaints, the management is cause related.

Pain, bloating and abdominal distension is associated with gas. Pharmaceuticals can work to coalesce the volume of gas so it can pass as one action such as a burp. It doesn’t reduce the gas but makes it pass more readily.

Other drugs include rifaximin and neomycin as well as probiotics and digestive enzymes, especially with functional issues such as irritable bowel.  Digestive enzymes may significantly reduce the amount of flatulence by helping to improve the breakdown of food into single cells during digestion.

The 4 R’s shape the treatment plan.

Remove any foods that can be causing a known problems. This may also be bacteria, yeast or parasites and require medication or a trial of botanicals.

Replace what can be missing such as pancreatic enzymes, and acid raising foods such as lemon juice or betaine HCL.

Re-inoculate with good bacteria and live cultured foods.

Repair the digestive system good fats, anti-oxidants and clean protein. The diet should be low in sugar and instead focus on phytonutrient-rich vegetables, low glycemic fruit and healthy fat sources like avocados, extra virgin olive oil, coconut oil and sprouted nuts and seeds. Grass-fed beef, lamb, organic poultry and eggs and oil fish offer essential fatty acids and other compounds that enhance hormone function and reduce inflammation.

Other great anti-inflammatory foods include coconut products, berries, and non-denatured whey protein from grass-fed cows. This protein source is loaded with L-glutamine and enhances cellular glutathione stores which are both necessary for rebuilding the gut and de-inflaming the body. Add in anti-inflammatory herbs such as turmeric, ginger, garlic, cinnamon, rosemary, and oregano.

Share with us your experiences!