Welcome to the six-part blog series on “IBS Demystified.” In this series, we will explore Irritable Bowel Syndrome (IBS) from a functional medicine perspective, focusing on the various aspects of gut health and the functional medicine approach to managing IBS. Part 1 will delve into the key functional roles of the gastrointestinal (GI) tract and the 5 R’s of gut health treatment.
The conventional approach to IBS often centers on symptom management. This typically involves:
People with IBS can experience a variety of symptoms, including:
Many patients also report non-intestinal symptoms such as fatigue, nausea, backache, and urinary symptoms. These symptoms can vary widely in intensity and duration from person to person.
ROME IV Criteria for IBS:
The ROME criteria are a set of diagnostic criteria for functional gastrointestinal disorders, including IBS. The ROME IV criteria defines IBS as:
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The gastrointestinal (GI) tract, often referred to as the gut, is a complex and vital system responsible for the digestion, absorption, and assimilation of nutrients from the food we consume. However, its functions go beyond digestion, as the gut also plays a significant role in our immune system, neurological function, and overall health. In this section, we will explore the key functional roles of the gastrointestinal tract from a functional medicine perspective.
Digestion is a complex process that begins in the mouth with the breakdown of food by chewing and saliva. The food then travels through the esophagus and reaches the stomach, where gastric acid and digestive enzymes further break it down into smaller molecules. As the food moves into the small intestine, bile from the liver and pancreatic enzymes help digest fats, carbohydrates, and proteins, making nutrients available for absorption.
The lining of the small intestine contains specialized cells called villi and microvilli that increase the surface area for nutrient absorption. Essential nutrients, such as amino acids, fatty acids, vitamins, and minerals, are absorbed into the bloodstream and transported to various organs and tissues to support their functions.
The intestinal lining serves as a protective barrier between the gut and the rest of the body. It selectively allows the absorption of nutrients while preventing the entry of harmful substances, toxins, and pathogens. This barrier function is crucial for maintaining overall health.
Intestinal permeability, also known as “leaky gut,” occurs when the tight junctions between the intestinal cells become compromised, allowing larger particles to pass through the gut lining and trigger an immune response. Chronic inflammation, stress, infections, and certain dietary factors can contribute to increased intestinal permeability.
The gut is home to a vast and diverse community of microorganisms collectively known as the gut microbiota. This microbiota consists of bacteria, viruses, fungi, and other microbes, which play a crucial role in maintaining gut health and overall well-being.
The gut microbiota aids in the digestion of certain dietary components that human enzymes cannot break down. Additionally, it produces essential nutrients, such as short-chain fatty acids, vitamins, and neurotransmitters like serotonin, which influence mood and cognitive function.
A balanced gut microbiota is essential for supporting a healthy immune system, maintaining gut barrier integrity, and preventing the overgrowth of harmful microorganisms that could lead to gut dysbiosis.
The gut houses a significant portion of the body’s immune system, known as Gut-Associated Lymphoid Tissue (GALT). The GALT is a crucial component of the mucosal immune system, which plays a pivotal role in defending the body against harmful invaders while maintaining tolerance to beneficial substances.
In a healthy gut, the immune system maintains a balanced response, distinguishing between harmful pathogens and beneficial microbes or food particles. However, in cases of gut dysbiosis or increased intestinal permeability, the immune system can become overactive, leading to chronic inflammation and immune imbalances.
The gut and the brain are intimately connected through the gut-brain axis, a bidirectional communication system. The enteric nervous system, often referred to as the “second brain,” is a complex network of neurons that regulate gut functions independently. This system communicates with the central nervous system, influencing emotions, stress responses, and cognitive functions.
This gut-brain connection explains why certain emotions can manifest as gut symptoms (e.g., “butterflies in the stomach” during nervousness). Stress, anxiety, and other emotional factors can influence gut motility, sensitivity, and even the composition of the gut microbiota.
Functional medicine takes a comprehensive and personalized approach to address gut health issues, including Irritable Bowel Syndrome (IBS). The “5 Rs” is a fundamental framework that functional medicine practitioners use to support and heal the gastrointestinal tract. Each “R” represents a specific step aimed at addressing the root causes of gut dysfunction and promoting optimal digestive health.
The first step in the 5 Rs approach is to identify and remove potential triggers and irritants that may be contributing to gut issues. These triggers can include food sensitivities, allergens, infections, toxins, and medications. Common dietary triggers for gut problems include gluten, dairy, processed foods, and artificial additives.
Removing these triggers is crucial to reduce inflammation, repair the gut lining, and allow the gut to heal. An elimination diet or specific testing can help pinpoint the problematic foods and substances that need to be removed from the individual’s diet and lifestyle.
The “Replace” phase focuses on restoring digestive function by supplying the body with essential digestive enzymes, stomach acid (hydrochloric acid), and bile acids. Many people with gut issues, including IBS, may have insufficient production of these digestive components, leading to poor nutrient absorption and discomfort.
Supplementing with digestive enzymes can support the breakdown of proteins, fats, and carbohydrates, enhancing nutrient absorption. Additionally, hydrochloric acid supplements can help improve stomach acid levels, crucial for protein digestion and protection against harmful pathogens. Bile acid supplements can aid in fat digestion and absorption.
The gut microbiota plays a vital role in gut health, immune function, and overall well-being. In the “Reinoculate” phase, the focus is on restoring a balanced and diverse gut microbiome. Probiotics are beneficial live microorganisms that can be introduced to the gut to support the growth of beneficial bacteria and help maintain a healthy microbial balance.
Choosing the right probiotic strains is essential, as different strains have specific roles in supporting gut health. Lactobacillus and Bifidobacterium strains are commonly used for gut health, but the choice of strains should be individualized based on the person’s specific gut issues.
In the “Repair” phase, the goal is to heal and strengthen the intestinal lining. A healthy gut lining is essential for proper nutrient absorption and preventing the entry of harmful substances. Several nutrients and supplements can support gut repair, including:
The final step in the 5 Rs approach is to rebalance and support overall gut health through lifestyle modifications and dietary changes. This includes adopting a gut-friendly diet rich in whole foods, fiber, and fermented foods, while avoiding processed and inflammatory foods.
Managing stress and adopting relaxation techniques can positively impact gut health, as stress can exacerbate gut symptoms. Regular physical activity and adequate sleep also contribute to gut well-being.
Specialises in Surgical Gastroenterology, Functional Medicine and is apt at treating chronic gut issues.
Arka Anugraha Hospital, #2, 15th Cross Rd, 6th Phase, J. P. Nagar, Bengaluru, Karnataka 560078
