There is still a general belief with medical doctors and the public as well that Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are mostly stress-related psychological disorders. I have personally had many patients who were reluctant to discuss their bowel problems for fear of being labeled a “psych” case. Many practitioners still aren’t aware there can be legitimate causes of disease that come from both mind and body.
With IBS and IBD, as with most discussions, there is often an element of truth on both sides or there would be no controversy. First, let’s look at the validity of the stress factors. People with genetic short serotonin transporter systems react negatively to stress-related increases in cortisol (a stress hormone) than people with normal serotonin transport systems.1 Second, ALL people react to significant stress, which can produce damage to the gut epithelial lining. However, people with a history of IBD generally show more gut lining damage than those without IBD. The damage includes: increased levels of stress hormones, activation and degranulation of mast cells, mitochondrial damage in epithelial cells, and mucosal protein oxidation which can create multiple problems with permeability (leaky gut) and immunity.2 Again, this happens to everyone under stress, but is worse with IBS and IBD because stress can trigger a relapse of either condition.
On the other hand, there are many reports that suggest anywhere from 20 to 60 percent of IBS and IBD patients have had a serious gastrointestinal infection days or weeks before they began having symptoms of chronic bloating, abdominal pain, diarrhea or constipation (or both diarrhea and constipation) that may have lasted years. A study was done on 111 patients with IBS using the lactulose breath test (measures hydrogen and methane gas produced by too many of the wrong bacteria) and 84 percent of patients were positive, which indicates small intestinal bacterial overgrowth (SIBO). Those who were treated with a non-absorbable antibiotic, Neomycin, had a statistically significant improvement both in symptoms, and normalization of the breath test.3 A more recent study4 showed that patients with IBS, but without constipation, treated with rifaximin (a broad spectrum non-absorbable antibiotic) for two weeks provided significant relief of IBS symptoms including: bloating, abdominal pain, and loose or watery stools.
Both of these studies strongly suggest that bacterial overgrowth, which creates a low-grade infection, is a major part of IBS, and can be treated with antibiotics. In addition, I think the standard of care today strongly suggests using probiotics while on antibiotics. This has been shown to lower the incidence of antibiotic associated diarrhea (AAD), and especially Clostridium difficle diarrhea, which can lead to total removal of the colon or even death.
Probiotics alone have been shown to significantly help with IBS. More specifically, probiotics enhance gut barrier function, inhibit pathogen binding and modulate gut inflammatory response. They reduce visceral hypersensitivity associated with both inflammation and psychological stress. More importantly, probiotics can alter colonic fermentation and stabilize the colonic microbiota, show that dietary exposure to pathogens maybe less likely to create another relapse of symptoms.5
Once again we can see that the use of high fiber, essential oils (omegas), probiotics and digestive enzymes (Brenda Watson’s HOPE Formula) can be beneficial in preventing or treating intestinal inflammation—be it IBS or IBD.
1. Way BM. “The Serotonin Transporter Promoter Polymorphism Is Associated with Cortisol Response to Psychosocial Stress.” Biol Psychiat. 2010 Mar 1;67(5):487-92.
2. Farhadi A, et al. “Heightened Responses to Stressors in Patients with Inflammatory Bowel Disease.” Am J Gastro. 2005;100:1796–1804.
3. Pimentel M., et al. “Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study.” Am J Gastro. 2003;98:412-19.
4. Pimentel M., et al. “Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation.” N Engl J Med. 2011 Jan;364:22-32.
5. Spiller, R. “Review article: probiotics and prebiotics in irritable bowel syndrome.” Aliment Pharmacog Ther. 2008 Jun;28(4):385-96.