Scientists in Canada have developed a non-invasive urinary test for irritable bowel syndrome(IBS) that may be able to identify IBS-Diarrhea, IBS-Mixed, and IBS-Undefined. While this is a pilot study and needs to be confirmed in follow-up studies, their findings highlight some potential drivers of these forms of IBS.
Several metabolites were found to be elevated in the urine of those with IBS-D, IBS-M, and IBS-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, and low grade inflammation. Ironically, IBS is differentiated 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 the inflammation found in IBS being at an almost unmeasurable level outside of increased urinary metabolites.
What does this tell us?
I think the findings of this study imply that people with IBS have low grade inflammation and leaky gut, which many with the condition have assumed for quite some time. A lot of attention has been paid to the microbiome in past research, but in this study, urinary metabolites from the microbiome weren’t different between IBS patients and controls save for those associated with inflammation.
The problem with focusing on the microbiome is that people assume the microbiome is driving the problem, not that the problem is driving the microbiome. It’s becoming more and more clear that a healthy microbiome flourishes in a healthy gut, and that the relationship is driven primarily in that direction, although it’s definitely a 2-way relationship. Addressing the inflammation, collagen breakdown, and cell turnover is how you want to address this problem, dropping probiotics and prebiotics in to an inflamed ad 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, and most aspects of digestion including motility, enzyme secretion, and mucosal defense. You can’t skip this step, particularly if you have insulin resistance and blood glucose regulation problems, 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.
Following this plan generally yields excellent results, particularly in people with diarrhea pre-dominant IBS. This study, although small, provides evidence that the focus on addressing IBS-D, IBS-M, and IBS-U should be on building a healthy gut, building resilience, and restricting inflammatory triggers until you accomplish the first 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.