Testing for possible causes and treatment of IBS

IBS Clinical History

A detailed clinical history is taken to determine when symptom started, what triggers episodes, the progression of the disorder, the severity and frequency as well as any co-morbid symptoms of anxiety, depression, sleep, fatigue and cognitive deficits.

IBS Rome II criteria

The Rome II criteria is used as the basis for formal diagnosis of IBS

Red cell Essential Fatty acid profile

The red cell Essential Fatty Acid (EFA) Profile test is a specialised blood test that gives detailed composition of fatty acids in the red cells and is an excellent marker for identifying specific EFA deficiencies.

Every cell in the body has a lipid membrane protecting its boundaries. The brain consists of 70% lipids and 40% of the brain is made up of the long chain Omega 3 EFAs (EPA and DHA, which we get from fish). Studies have consistently found that deficiencies of Omega 3 EFAs (derived from fish) are associated with serious brain and systemic dysfunctions. Many of these studies prove that Omega 3 EFAs are essential for brain function. It is known that deficits are associated with all kinds of psychiatric disorders, cardiovascular disease, diabetes, cancer and Neurodevelopmental disorders.

Omega3 EFAs and Gut function

The gut cell wall, the epithelium, is constantly exposed to billions of organisms and toxins daily. The importance of the protective effect of the lipid membrane of each cell in the epithelium cannot be understated. If the lipid membrane is lacking in Omega 3 fatty acids, the protection may fail and unfriendly organisms and toxins can irritate the gut wall, possibly giving rise to Irritable Bowel Syndrome and Inflammatory Bowel Diseases. Of course EFA deficiencies are not the only possible causes of epithelial dysfunction, there are other nutrient co-factors and systems which also need to be considered

Red cell Essential Fatty Acid profile test is used to determine whether the percentage of fatty acids in the red cells are normal or not. The test results are used to help determine which type of fish oil (correct ratio of EPA and DHA) and which nutrient cofactors may be necessary.

Extended Faecal Microbiology Profile

This test done at Bioscreen Medical laboratory at Melbourne University is the only one used at the clinic for determining the profile of commensals (normal community of bacteria) in the gut. This innovative laboratory does the only commercially available test in the world that estimates the populations of commensal bacteria properly. The faecal sample is refrigerated and kept in an anaerobic pouch to ensure that no oxygen reaches the sample prior to analysis. Anaerobic bacteria would otherwise die on exposure to air, while aerobes would continue to reproduce during transportation if the sample was not refrigerated.

Immunoglobulin G (IgG) food sensitivities

Patients with IBS often feel they have some form of dietary intolerance and frequently try elimination diets. Tests attempting to predict food sensitivity in IBS have been disappointing. However, until recently no studies have examined the usefulness of IgG antibodies as a way of predicting food sensitivities and treatment response.

IgG antibodies are autoimmune antibodies to foods. Atkinson and colleagues in the Department of Medicine at the "University Hospital of South Manchester" assessed the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. Their findings were reported in the British Medical Journal, Gut, Oct 2004.

A total of 150 outpatients with IBS were randomly assigned to receive, for three months, either a diet excluding all foods to which they had elevated IgG antibodies (by ELIZA assay) or a sham (placebo) diet excluding the same number of foods but not those to which they had antibodies. The primary outcome measures were

Changes in IBS symptom severity and global rating scores.
Symptoms not related to colonic function
Secondary outcome measures were quality of life, anxiety and depression

After 12 weeks, the true diet group reported a 10% greater reduction in symptom score than the sham diet. However, those patients who were fully compliant to their diet experienced a 26% greater reduction in symptoms. All other outcomes showed trends favouring the true diet. The conclusion was that food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.

We have been using IgG Testing as a basis for food elimination for the last five years with considerable success, as part of the treatment for IBS and IBD and to normalise the gut function of children with Autism Spectrum Disorders.

Intestinal Permeability Test

Leaky gut is an expression which means that the gut lining has become impaired or “leaky, ”allowing molecules of partially digested food or bacterial toxins to cross the gut barrier and irritate the gut wall or cross into the blood stream. A measured amount of two sugars, Lactulose and Mannitol, is given and all urine passed for the next six hours is collected. The recovery of the sugars in the urine is used as a marker to estimate intestinal permeability, with higher than normal recovery suggesting a “leaky gut”.

I am often told by patients that their medical practitioner has told them that the terms: Leaky gut, intestinal permeability and Intestinal dysbiosis are nonsense and do not exist in medicine. This is probably because the doctor is not in touch with recent medical terms. A search on Medline, the US. National Library of Medicine found 31 peer reviewed papers on leaky Gut; 6580 on Intestinal permeability and 63 on intestinal dysbiosis.

Dietary habits and nutritional uptake

Many patients with IBS have a relatively poor diet, although many others have excellent diet. Hence for some, their nutrient uptake may be inadequate for good health due to malabsorption. Dietary assessment, remediation and nutritional supplementation are also essential components of treatment.

If Depression and/or Anxiety is present, QEEG Functional Neuroimaging may be necessary.

QEEG Neuroimaging is used to determine whether the anxiety and depression are secondary to cellular malnutrition, or are primarily due to other brain based factors, such as abnormal brain asymmetry or abnormal brain power levels, or other brain patterns that are known to predispose to anxiety and/or depression.

Treatment for IBS at The clinic

ONLY AFTER ASSESSMENTS TO SUPPORT CLINICAL HYPOTHESES,
treatment involves the following components:

IgG sensitive foods are eliminated.
Other foods that trigger bloating, discomfort and loose stools are also eliminated. There may be a lack the enzymes to breakdown these foods. For example: Lactose intolerance due to deficits in lactase enzyme. This is not to be confused with IgG sensitivities to cow's milk.
A healthy diet based on the Harvard Medical school Food Pyramid is recommended.
In severe cases our own Gut Recovery Diet is used to starve specific overgrown bacteria.
Promote fish consumption.
Enteric pathogens, parasites, protozoas and flagellates are treated.
Specific antibiotics may be used to promote optimum Gut microbiology profile.
Specific nutrient Supplements are used to promote optimum cellular nutrition, gut, immune and brain cell repair.
Specific prebiotics and probiotics are supplemented, based on the Extended Faecal Microbiology analysis.

:: Treatment of IBS

IBS is a metabolic dysfunction. It therefore makes sense to evaluate the possible metabolic root causes and triggers and treat these with biomedical means.

We consistently have success treating IBS using the tests and protocols outlined here.

The nutrients used are specific to each individual

Eradication of intestinal Dysbiosis improves IBS

"Small intestinal bacterial overgrowth is associated with IBS. Eradication of this overgrowth eliminates IBS in 48% of subjects"

Pimentel, M., E.J. Chow, and H.C. Lin, Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol, 2000. 95(12): p. 3503-6

Psychiatric disorders in patients with IBS

Several studies have shown that up to 70% to 90% of patients with IBS who seek treatment have psychiatric comorbidity, most notably mood and anxiety disorders. Recent studies have shown a high prevalence of IBS in psychiatric patients who seek treatment, with a prevalence of 19% in schizophrenia, 29% in major depression, and 46% in panic disorder among other disorders

Garakani, A., et al., Comorbidity of irritable bowel syndrome in psychiatric patients: a review. Am J Ther, 2003. 10(1): p. 61-7.