I see that a study has been published today in the New England Journal of Medicine  that concerns the condition irritable bowel syndrome (IBS). You can read a summary of the study here. This study tested the effect of an antibiotic (rifaximin) on individuals with IBS. Compared to placebo, two weeks of this antibiotic helped to reduce IBS symptoms, and this benefit was sustained for some weeks after the antibiotic was taken.
How might this work? Well, the antibiotic’s benefits here almost certainly had something to do with the fact that imbalance in the organisms within the gut is a potential underlying factor in IBS. I have seen in my time in practice many individuals with IBS symptoms and normal stool test results (from conventional testing) who turn out to have significant imbalance in the gut when more sophisticated stool analysis is performed. Not uncommonly we find one or more of the following:
1. a lack of healthy bacteria
2. the presence of potentially pathogenic (disease-causing) bacteria
3. the presence of potentially pathogenic (disease-causing) yeast organisms
4. the presence of potentially pathogenic (disease-causing) parasitic organisms
On occasion, I have used conventional drugs in an effort to kill off one or more offending organisms, and believe such an approach has at least some merit. However, I don’t believe that this approach should be the mainstay of treatment.
To begin with, such treatment may further erode the population of healthy gut bacteria. This, as I pointed out above, can already be quite depleted.
So, I think it makes sense to use probiotics (healthy gut bacteria supplements) in cases of IBS. And my experience with them has been generally very positive. And I would certainly advise using them after a course of antibiotics, even if the antibiotics have been taken to treat a condition that is outside the gut.
Another major, but often-overlooked, factor in IBS is food sensitivity. Here, foods have the seeming capacity to irritate the lining of the gut and provoke digestive symptoms. In theory, any food can do this, however I have to say that my experience in practice tells me the number one offender here is wheat. Other gluten containing foods including rye and barley should be viewed with some suspicion here too.
Not everyone has a problem with such foods. Even not everyone with IBS has a problem with such foods. However, I can say, hand on heart, that I have found the removal of these foods from the diet (and perhaps other grains too) is a generally hugely beneficial strategy in individuals with IBS.
Some find it hard to accept that supposedly healthy and wholesome foods such as wheat and other grains can be problematic to gut health. However, let us not forget that grains are a relatively recent addition to the diet and, from a theoretical standpoint at least, are foods we’re not likely to be best adapted to. Specifically, grains are rich in certain proteins (rich in the amino acid proline) that are thought to be hard to digest, and this can lead to gut irritation. Grains are also quite rich in substances called lectins which may not be digested in the gut, and end up triggering inflammation in and beyond the digestive tract.
Those of you with IBS may be interested in listening to an audio-book I recorded on this subject last year. You can learn more about its contents and how to purchase it here.
1. Pimentel M, et al. Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation. N Engl J Med 2011; 364:22-32