Irritable Bowel Syndrome (IBS) is a commonly diagnosed functional gastrointestinal condition primarily characterized by symptoms of abdominal pain or discomfort and irregularities in bowel movements. IBS affects nearly 23% of the population globally. Despite this condition being so prevalent and frequently diagnosed, there is a lack of effective therapies for IBS in conventional medicine. There is a need for root cause analysis to understand the symptoms that manifest in IBS.
While many factors are involved in the etiology of IBS, such as nutrition and lifestyle, a hallmark of IBS is that it is psycho-somatic. Research shows comorbidities between IBS, stress, anxiety, and depression. This speaks to the role of the gut-brain axis in modulating and adapting to stress in the body. It also emphasizes how imperative the health of our microbiome is to both the body and mind.
What is Mind-Body Medicine?
Mind-Body Medicine recognizes the strong interconnectedness between the body and mind. Our body is always communicating with us, providing us with important information relative to its current state of physiological functioning. Through neural pathways governed by our nervous, immune, enteric, hormonal, and immune systems, our body and mind are in constant communication with each other. In fact, 80% of communication to the brain is from the body. This is termed afferent or bottom up-communication.
Lifestyle choices strongly affect our body's physiology and our overall health. For example, nourishing ourselves with nutrient-dense whole foods that are anti-inflammatory and support our microbiome, getting adequate sleep, and engaging in practices that help to calm our body and mind, are all ways to impact our health. This is due to the communication between the gut and brain via the vagus nerve.
The vagus nerve is considered a bi-directional highway between the gut and the brain. An example of this connection is how we may experience GI discomfort and sweat when we feel stressed. Bringing awareness to how stress affects our body and how we can support and promote balance among its systems is a way to support our health. Several mind-body therapies have been shown to be effective in reducing symptoms of IBS as they work on many mechanisms that can help support the physiological processes in the body and mind.
What is IBS?
Irritable Bowel Syndrome (IBS) is a complex and prevalent functional gastrointestinal condition that is frequently diagnosed. IBS is often a diagnosis of exclusion, and the causes remain uncertain as the symptoms of IBS are vast and often nonspecific. Moreover, functional GI disorders are challenging to diagnose as there are no observable changes in anatomy or lab values in conventional medicine.
Primarily, symptoms are related to irregular bowel movements, inconsistency in stool, abdominal pain, and discomfort often related to gas and bloating. The causes of IBS could be related to altered gastrointestinal motility, inflammation, increased gut permeability, food allergies or sensitivities, or an imbalance in gut bacteria. There is also often a lack of understanding or awareness in conventional medicine on how the origin of one's symptoms is related to IBS.
The symptoms of IBS are vast and often non-specific, including:
- Abdominal pain
- Inconsistencies in bowel movements
- Mucous in stool
- Irregularities in stool consistency
- Brain fog
- Feelings of urgency relative to bowel movements
- Feelings of an incomplete evacuation
IBS is commonly diagnosed based on these presenting symptoms in conventional medicine. Based on the symptoms, IBS is characterized into four subtypes, diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS- C), mixed IBS (IBS-M), or unclassified (IBS-U).
How Does Stress Affect IBS?
While many factors are involved in the etiology of IBS, stress is often a significant contributing factor. Stress can induce symptoms of (IBS) and may even be one of the more significant underlying factors. While stress can serve many adaptive functions, prolonged or chronic stress can impede our body and mind.
When we perceive a stressor, our body produces a cascade of hormones, causing our stress response to kick in, preparing us to fight or flight. This means that instead of focusing energy on digesting our food, our body instead reverts this energy to prepare us to deal with the perceived stressor or threat. Over time this can lead to compromised gut functioning, changes in motility, reduction in stomach acid and sufficient digestive enzymes for digestion and absorption, and a lack of diversity of beneficial bacteria in the gut. Insufficient sleep and exercise, coupled with inadequate nutrition, can further impede gut functioning and exacerbate nutritional deficiencies, all of which can further contribute to symptoms of IBS.
Top Functional Medicine Labs To Help Individualize Treatment for IBS Patients
Functional medicine recognizes that multiple underlying factors could contribute to the symptomatology of those with IBS. Functional lab testing is a hallmark of functional medicine as it gives us greater analysis and insight into what is happening in the body from a physiological lens. Furthermore, functional lab testing can help uncover why the symptoms manifested are present and how best to address those from a root cause perspective or analysis. Here are some common functional medicine labs to help individualize treatment for those with IBS:
Comprehensive Stool Analysis Testing
This test helps to assess key biomarkers of systemic inflammation, compromised digestion, and absorption. It also includes a comprehensive assessment of bacteria and yeast while identifying any imbalances in microbiota, including dysbiosis. Dysbiosis describes an imbalance in beneficial and pathogenic bacteria in the gut. All of these could be underlying factors contributing to symptoms present in IBS.
Small intestinal overgrowth (SIBO) describes a pathogenic overgrowth of bacteria in the small intestine and could lead to some of the underlying symptoms of IBS. This non-invasive breath test measures the digestion of a lactulose solution by measuring the amount of hydrogen and methane (gases produced by the bacteria) exhaled.
Organic Acids Testing
The Organic Acids Test assesses for metabolic markers that are excreted in the urine. Alterations and imbalances in gut microbiota and organic acid levels have been found to be evident in those with IBS and could be strongly contributing to symptoms.
Food Sensitivities Testing: IgG Food MAP with Candida + Yeast
Food Sensitivities can cause symptoms congruent with IBS, such as gas, bloating, and diarrhea. Therefore, testing for individual food sensitivities and intolerances and then reducing them in the diet is recommended.
Neurotransmitters & Micronutrients Testing
As many with IBS also have comorbidities with stress and anxiety, assessing neurotransmitter balance can help shed light on any imbalances that could further contribute to presenting symptoms. Evaluating for sufficient micronutrient levels is also strongly encouraged since IBS affects the gut and may reduce digestion, absorption, or assimilation of nutrients. The Neurotransmitters + Micronutrients panel will evaluate all of those.
Cortisol: Adrenocortex Stress Profile Testing
This test measures cortisol and DHEA through timed saliva samples. The Adrenocortex Stress Profile provides a comprehensive understanding of any imbalances of the stress response (HPA axis) that could be contributing to IBS symptoms.
The DUTCH Complete Testing
This test is another option that combines markers from some of the other tests. This test can measure sex, stress, and adrenal hormones, including their metabolites, providing a more thorough picture of the body's stress response. This test also includes organic acids, which measure bacteria that may contribute to symptoms of IBS.
Other Labs to Check
To rule out conditions that may present similarly to IBS:
Comprehensive Metabolic Panel Testing
This comprehensive test measures biomarkers for metabolism, kidney, and liver health, as well as blood glucose and electrolytes, all of which could be underlying factors contributing to IBS symptoms.
Comprehensive Thyroid Panel Testing
The comprehensive thyroid panel assesses thyroid function, which is significantly related to metabolic and gut health. When our thyroid isn't functioning as it should, this can lead to symptoms that mirror IBS.
Mind-Body Techniques To Help with IBS
Because stress is often an underlying factor in IBS, implementing practices that help to regulate or counteract stress can be incredibly beneficial. Mind-body practices or techniques are effective in reducing symptoms of IBS. The reason for this is multifaceted. However, it appears to relate to how these practices promote parasympathetic nervous system dominance, or our body's rest, digest, restore, and renew phase. Mind-body techniques also help improve blood flow and vagal tone and reduce inflammation, all of which can support stress and IBS.
Let's take a look at some of the mind-body practices supported by the literature:
Biofeedback for IBS
Biofeedback is training using a tool to gain information about your nervous system. Heart Rate Variability (HRV) is a form of biofeedback that measures stress in the body. The heart is one of the most apparent signs of stress in the body. When the body is in a relaxed state, the heart naturally has a smooth rhythmic pattern called coherence. High levels of coherence correlate with increased vagal tone, all of which positively affect our health. Research found that HRV biofeedback can improve symptoms of IBS by relaxing the body.
Mindfulness Meditation for IBS
Mindfulness and Meditation can exert a number of favorable effects on the body and mind. A systematic review of randomized controlled trials in adult participants with IBS was conducted with mindfulness meditation. The results showed that those who participated in the mindfulness meditation reported a higher quality of life and significantly lower pain.
Acupuncture for IBS
Acupuncture involves using thin needles at strategic points of the body to elicit favorable physiological effects, such as reduced anxiety or pain. A systematic review of 24 randomized controlled trials comprising 1,885 participants with IBS-D found that acupuncture and related therapies improved symptoms of stress, anxiety, and depression.
Deep Breathing for IBS
Deep, vagal breathing from our diaphragm (sometimes called "belly breathing") can support the body's stress response and have calming effects on our nervous system. This type of breathing helps our body to get into Parasympathetic Nervous System dominance, improves vagal tone, and oxygenates our system, providing more nutrients to our cells. This study's 6-week Slow Deep Breathing intervention improved symptoms in IBS-C patients.
Yoga for IBS
Among many factors, yoga helps increase vagal tone, Parasympathetic (PNS) dominance and relieve tension and stress. The findings of this systematic review, including six randomized controlled trials of 273 participants, showed a reduction in bowel symptoms associated with IBS and other symptom severity, including anxiety. Also, there were significant improvements in quality of life and physical functioning.
Massage for IBS
In addition to improving blood flow, decreasing stress, and reducing inflammation, abdominal massage may also help to support the muscles needed for effective and healthy bowel movements. Research suggests that therapeutic massage is beneficial for those with IBS.
While the etiology of IBS is multifaceted, stress is a strong underlying and contributing factor. Mind-body techniques can help reduce and regulate stress, improve blood flow and vagal tone, and ultimately support other aspects of our health, such as digestion, gut functioning, and microbiota diversity. It is also important to take care of ourselves the best we can on a daily basis with sufficient sleep, nutrition, and hydration. Sleep is imperative to the functioning of our microbiome and a way to combat stress, as is nutrition, breathwork, and moving our bodies in intentional ways.
A functional medicine approach to IBS recognizes the many factors that influence its etiology and how addressing these underlying factors can help promote balance and renewal of the body's systems. Functional lab testing is encouraged to assess the underlying root causes for many of the symptoms of IBS. Implementing mind-body techniques to address stress can benefit those suffering from IBS.
Lab Tests in This Article
- Adriani A, et al (2018). Irritable bowel syndrome: the clinical approach. Panminerva, 60(4):213-222.
- Anconca A. (2021). The gut–brain axis in irritable bowel syndrome and inflammatory bowel disease. Digestive and Liver Disease, 53, 3, 298-305.
- Baboș C-I, Leucuța D-C, Dumitrașcu DL. (2022). Meditation and Irritable Bowel Syndrome, a Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 11(21):6516. 6
- Bonaz B., Sinniger V. & Pellisser S. (2017). The Vagus Nerve in the Neuro-Immune Axis: Implications in the Pathology of the Gastrointestinal Tract. Front Immunol, 8, 1452.
- Bassotti G. (2022). Irritable Bowel Syndrome: A Multifaceted World Still to Discover. Journal of Clinical Medicine. 11(14):4103.
- Bellini, M. et al.(2014). Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy. World journal of gastroenterology, 20(27), 8807–8820.
- Breit S, Kupferberg A, Rogler G. & Hasler G. (2018). Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry, 4, 44.
- Chey WD, Kurlander J & Eswaran S. (2015). Irritable bowel syndrome: a clinical review. JAMA, 313(9):949-58
- Christian W. H (2022). Irritable bowel syndrome and diet. Current Opinion in Endocrinology & Diabetes and Obesity, 29, 2, 200-206.
- Cloyd, J. (2022, December 15). IBS-C: Diagnosis and Natural Treatment Options. Rupa Health. Retrieved March 11 2023
- Dinan T. G & Cryan J. F. (2012). Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology. Psychoneuroendocrinology, 37, 1369-1378
- Drossman DA & Hasler WL.(2016). Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology, 150:1257–1261
- Guo Y. (2014). Irritable Bowel Syndrome Is Positively Related to Metabolic Syndrome: A Population-Based Cross-Sectional Study. Plos One,
- Henry, K. ( 2022, October 31st ). IBS vs IBD: Know The Symptoms. Rupa Health. Retrieved March 13 2023.
- Labanski, A et al. (2020). Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: A transdisciplinary challenge. Psychoneuroendocrinology, 111
- Liu J, et al. (2022). Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome. Front Neurosci.
- Mishima Y & Ishihara S. (2022). Molecular Mechanisms of Microbiota-Mediated Pathology in Irritable Bowel Syndrome. International Journal of Molecular Sciences, 21
- Mróz M, Czub M, Brytek-Matera A. (2022). Heart Rate Variability-An Index of the Efficacy of Complementary Therapies in Irritable Bowel Syndrome: A Systematic Review. Nutrients.
- Ruscio M, Guard G., Piedrahita G., & D’Adamo. (2022). The Relationship between Gastrointestinal Health, Micronutrient Concentrations, and Autoimmunity: A Focus on the Thyroid. Nutrients, 14
- Saha L. (2014). Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World J. Gastroenterol, 20, (22), 6759-6773.
- Schumann, D. et al. (2016). Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review. Clinical Gastroenterology and Hepatology, 14, 12, 1720-1731.
- Shrestha B, Patel D, Shah H, et al. ( 2022) The Role of Gut-Microbiota in the Pathophysiology and Therapy of Irritable Bowel Syndrome: A Systematic Review, 14
- Tana C. et al. (2010). Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome. Neurogastroenterol Motil, 5
- Tarar, Z.I., Farooq, U., Zafar, Y. et al. (2023) Burden of anxiety and depression among hospitalized patients with irritable bowel syndrome: a nationwide analysis. Ir J Med Sci
- Xuesong Wang, et al. (2022). Acupuncture and related therapies for the anxiety and depression in irritable bowel syndrome with diarrhea (IBS-D): A network meta-analysis of randomized controlled trials. Frontiers in Psychiatry,