A new IBS test developed by Scientists in Canada may correctly identify IBS-Diarrhea, -Mixed, and -Undefined. This is a pilot study and requires confirmation in follow-up studies. But their findings highlight some potential drivers of these forms of Irritable bowels syndrome.

Several metabolites were elevated in the urine of those with IBS-D, -M, and -U in comparison to healthy controls.  Of particular note were several metabolites indicative of breakdown of the intestinal wall including:

• Collagen breakdown
• Protein breakdown
• High cell turnover
• Low grade inflammation

Ironically, Irritable bowel syndrome is separate from inflammatory bowel disease(IBD) by the absence of inflammation. But people with IBS are 10x more likely to progress to IBD within 3 years than healthy controls.

Thus, IBS may be an inflammatory gateway to IBD. With inflammation found in IBS at an almost unmeasurable level outside of increased urinary metabolites.

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What does this tell us about IBS?

I think the findings of this study imply that people with IBS have low grade inflammation and leaky gut. Many with the condition have assumed this for quite some time.  A lot of attention was paid to the microbiome in past research. In this study, urinary metabolites from the microbiome weren’t different between IBS patients and controls except those from inflammation.

The problem with focusing on the microbiome is that people assume the microbiome is driving the problem.  But it’s becoming clearer that a healthy microbiome flourishes in a healthy gut. While the relationship is mostly in that direction, it’s definitely a 2-way relationship.  Addressing inflammation, collagen breakdown, and cell turnover is how you address this problem. Dropping probiotics and prebiotics in to an inflamed and damaged gut will never yield good results.

So what does this study tell us about addressing IBS?

• Optimize circadian rhythms- Circadian rhythms regulate cell turnover, inflammation/immune activation. They also regulate most aspects of digestion including motility, enzyme secretion, and mucosal defense.  You can’t skip this step, particularly if you have insulin resistance, no matter how much you want to.  You have to do this step first, particularly if you react to any of the below.
• Increase collagen intake to provide the basic building blocks to repair the gut.
• Utilize supplements that can help quash intestinal inflammation including sulforaphane and falcarinol.
• Increase intake of building blocks that support cellular health such as nucleotides*, polyamines, and omega-3 fatty acids.

Conclusion

Following this plan generally yields excellent results, particularly in people with diarrhea pre-dominant IBS.  This small study provides evidence that the focus on addressing IBS-D, IBS-M, and IBS-U should be on:

• Building a healthy gut
• Building resilience
• Restricting inflammatory triggers until you accomplish the top 2

*As far as I know, the only product currently marketed with nucleotides is from Nordic Health Laboratories.  I’ve found it to be useful to expedite repair when I’m doing things that breakdown the gut, specifically alcohol consumption.  That product can be found here.  You may need to search “Nucleotides” to find it.