IBS: 4 ways to find relief

The variation of bacteria strains in your intestinal tract is collectively called “bacterial gut flora” or “bacterial milieu.” Gas is a by-product of naturally occurring bacteria that digest certain foods in your intestinal tract — mainly in your large intestine. The healthier your gut bacteria strains are, the less gas you’ll have and the less smelly will be your gas.

Certain gases are directly linked and highly correlative of pains of irritable bowel syndrome (IBS). In some studies up to 80% of patients with IBS also had a positive hydrogen breath test, and in other studies methane was determined to be the causative gas highly correlative with IBS symptoms, both of which are treatable with antibiotics. ^{[1] [2] [3]} For example, the antibiotic Rifaximin (discussed further below) improved IBS symptoms in 33 to 92% of patients and killed intestinal bacteria in up to 84% of patients with IBS. Results were sustained for up to 10 weeks after the treatment ^[4] (with no other treatment added).

In a current phase 2 clinical trial, ^[5] the drug Lovastatin is being studied too because of its effect on methane-producing bacteria, which is perceived as the underlying cause of pain, bloating and even constipation of IBS.

The worst foods

What foods cause these bacteria to produce gas? Most predominately it is the complex carbohydrates. When unhealthy bacteria feed on starches they produce the gases hydrogen, carbon dioxide, methane, and the more smelly one — hydrogen sulfide. These complex or starchy carbohydrate foods include potatoes, corn, and gluten-containing wheat products (breads, cereals, and pastas).

I believe the other gluten containing grains contribute to IBS and belly gas just as much. These are barley, rye, spelt, kamut, and triticale. Be aware that almost half of American adults are gluten intolerant more or less, but most haven’t even made this connection to their illnesses yet. But the non-gluten grains are thought to cause much less gas. They are:

• Rice
• Quinoa
• Buckwheat
• Millet
• Amaranth
• Arrowroot
• Cassava

Simple sugars also contribute to the bacterial gas factory in your gut. So, if you are a “farter,” then think back on all the carbohydrates you recently ate. Contrast this with fats and proteins which cause bacteria to produce very little gas.

Fiber is another one to learn about. Dietary fiber is a complex carbohydrate that does not get digested or absorbed into your bloodstream from your small intestine, so it reaches your large intestine relatively intact. There your bacteria digest fiber (a.k.a. fermentation), which produces gas. Fiber is a double-edged sword; adding fiber to your diet may alleviate constipation but it can also increase gas production — especially if you have a bad bacterial flora.

Soluble fiber foods are barley, beans, nuts, oat bran, seeds, lentils and many fruits; insoluble fiber foods (do not dissolve/gel in water, but rather adds bulk to stool) are cellulose component of cabbage, corn bran, legumes, root vegetables, seeds, and wheat bran.

My guideline for any high fiber food if you have IBS is to start low, and go slow. You will need to be careful to soak your beans and grains, and steam or cook your veggies.

Other foods that worsen abdominal cramps and diarrhea of IBS are highly fried food, coffee/caffeine, or alcoholic beverages. Also, eating a huge meal can be a trigger.

Ways to clean up intestinal organisms that contribute to IBS

There are a few different ways to clean up intestinal organisms. Let me outline some options here. All of these would be useful together, not just one alone.

1. Change your diet: The best way to clean out gas-producing gut bacteria is to change the food you offer them (food you eat) so only the healthy ones want to live there. If you can first do a bowel cleanse with the over the counter Miralax (polyethylene glycol) at high dose, until you are passing liquid. This medicine increases the water content of your stool to cause diarrhea. Alternatively, start with colon hydrotherapy (search online for this service near you) to clean out your colon. Immediately after bowel cleansing, begin a whole foods diet and eliminate junk foods, highly refined sugar, and other simple carbohydrate-generating foods (i.e. breads, pastas, desserts, etc.). Cook most of your veggies if needed at first, but your body will love all that comes from nature more than what comes from packaged refined/processed food.
2. Use prebiotics and probiotics: prebiotics are foods that aid in healthy bacteria colonization. These include asparagus, bananas, Jerusalem artichokes, oatmeal, and legumes. Probiotics are the actual healthy bacteria themselves, and come in blends containing lactobacillus acidophilus and bifidus species. You can also buy prebiotics and probiotics online.
3. Prescription antibiotics: Metronidazole (Flagyl^®) is a low cost ($20), narrow-spectrum antibiotic that has been shown to kill off gut bacteria, reduce fermentation (gas production) and improve symptoms of IBS. ^[6] I typically start a patient on this along with instructions to begin probiotics at the tail end of this treatment, along with dietary instructions as described. Rifaximin (Xifaxan^®) is a new semisynthetic antibiotic that is poorly absorbed into your bloodstream, which is ideal for killing bacteria that hang out in your gut. It received FDA approval for IBS in May 2015, but is expensive ($200).
4. Relieve stress that worsens IBS. We can talk about relieving IBS without addressing the connection to stress. Lack of exercise and irregular eating habits are known to worsen IBS. Also, lack of sleep plays havoc with your stress hormone cortisol. That’s because lack of sleep and prolonged stress weaken your ability to feel well, taxing your feel good hormones serotonin and dopamine. So, if counseling and other stress reduction technique do not make a difference, consider natural or even prescription serotonin enhancers. Tricyclics or selective serotonin reuptake inhibitors, and even serotonin-norepinephrine reuptake inhibitors are proven to provide symptom relief for IBS.

In my next article I’ll tell you about small bowel intestinal overgrowth (SIBO) and how treating this will also treat IBS, rosacea, fibromyalgia, and more.

To feeling good for optimal health,

Michael Cutler, M.D.
Easy Health Options

[1] Lin, HC (Aug 18, 2004). Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA: 292 (7): 852–8
[2] Pimentel, Mark (2006). A new IBS solution : bacteria, the missing link in treating irritable bowel syndrome. Sherman Oaks, CA: Health Point Press. ISBN 0977435601.
[3] Reddymasu, SC; Sostarich, S; McCallum, RW (Feb 22, 2010). Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC gastroenterology10: 23. PMID 20175924.
[4] Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009 Mar;18(3):349-58.
[5] http://www.prnewswire.com/news-releases/synthetic-biologics-initiates-second-syn-010-phase-2-clinical-trial-intended-to-treat-irritable-bowel-syndrome-with-constipation-ibs-c-300156246.html
[6] Dear KL, Elia M, Hunter JO. Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome? Dig Dis Sci. 2005 Apr;50(4):758-66.