Could gastroenteritis have caused your IBS?
BY Marilia Chamon, registered nutritionist and gut health specialist
Irritable Bowel Syndrome (IBS) is a functional gut disorder that affects 1 in every 7 people, or 15% of the world population, where 2/3 of treatment seekers are women. IBS is characterised by chronic, relapsing symptoms including lower abdominal pain and discomfort, bloating, wind, and altered bowel habits - ranging from diarrhoea to constipation. Although much has been talked about IBS in recent years, very few health professionals bring to attention the possible causes that underlie its collection of symptoms. It is widely known that stress and anxiety are some of the main triggers for most individuals but food poisoning is another leading known cause of IBS.
Post-Infectious IBS
It is estimated that 10 million food-borne illnesses occur each year around the world and 1 in every 9 people who experience food poisoning happen to develop Post-Infectious IBS, a form of IBS that is caused by food poisoning. Post-infectious IBS almost always has a diarrhoeal component, a hallmark symptom of traveller’s diarrhoea and gastroenteritis and symptoms can persist for ≥10 years following the infectious episode.
How does food poisoning lead to IBS?
The most common bacteria that cause food poisoning (Salmonella, E.Coli, Campylobacter and Shigella), release a toxin called CdtB. When CdtB enters the body, the immune system fights back with an antibody called anti-CdtB. Due to molecular similarities, CdtB can look similar to vinculin, a naturally occurring protein in the body that is critical for gut function. Because of this similarity, the immune system gets confused and thinks it needs to fight back against vinculin and starts to produce another antibody, called anti-vinculin. This consequently leads to an autoimmune response where the body starts to attack itself.
The production of anti-vinculin antibodies leads to gut nerve damage and improper functioning of the Migrating Motor Complex (MMC), the housekeeping waves that play a critical role in gut motility. When gut motility is impaired, the gut microbiome is consequently disrupted leading to all sorts of digestive symptoms. Another consequence of a disrupted gut microbiome is increased visceral hypersensitivity (a fancy word for an overly sensitive gut), a hallmark of IBS symptoms which alters the gut-brain axis communication and increases brain response to abdominal pain.
How is Post-Infectious IBS diagnosed?
Until recently IBS was a diagnosis of exclusion, meaning that GPs and medical specialists would rule out any medical condition such as Inflammatory Bowel Disease, Coeliac Disease, and most recently Endometriosis, before concluding your digestive symptoms are caused by IBS.
It is of course of extreme importance to go through this process to make sure nothing more serious is going on, and if you get cleared from any medical condition and think your digestive symptoms started after an episode of food poisoning/gastroenteritis, you are a strong candidate to have developed Post-Infectious IBS.
Post-infectious IBS is the only form of IBS that has a diagnosis test called IBS Smart - a blood test developed in the USA that measures the levels of two validated IBS biomarkers providing a positive or negative result. If the measured biomarkers are elevated, it is then confirmed that your IBS developed from food poisoning/gastroenteritis.
Symptom management
Regardless of what triggers your IBS symptoms, and if it happened due to food poisoning or not, a multifactorial approach is needed to keep symptoms at bay - diet, lifestyle and supplementation all play an important role.
Individuals that suffer with IBS have altered communication between the gut and the brain, resulting in an abnormal response to the fermentation of specific carbohydrates called FODMAPs. Fermentation is a normal process of digestion and happens when beneficial gut bacteria break down dietary fibre. For that reason the low FODMAP diet is usually the starting point for symptom management as it decreases the amount of fermentable carbohydrates for a limited time. The low FODMAP diet involves 3-steps (elimination, reintroduction and personalisation) and should be done with the guidance of a FODMAP trained nutritionist otherwise it can become very restrictive and difficult to implement.
Yoga, meditation and gut-directed hypnotherapy have also shown to be effective in rewiring the gut-brain communication and are a good alternative for those who do not respond well to the low FODMAP diet and have their symptoms triggered by stress and anxiety.
In addition, there is growing scientific evidence that suggests an alteration in the diversity and composition of the gut microbiome plays a fundamental role in the development of IBS. IBS sufferers tend to have a lower percentage of beneficial gut bacteria. This alteration has been linked to symptoms such as visceral hypersensitivity, anxiety and depression, and they also seem to impact the communication between the gut and the brain resulting in alterations in brain response towards abdominal distention (bloating).
Supplements can also be helpful - carminative herbs such as peppermint have been extensively studied and help reduce muscle spasm. Probiotics can also be a useful tool but it is important to look at strains that have been clinically researched to help mitigate symptoms of IBS.
Next Steps
I know first hand how IBS can be a tricky and debilitating condition to navigate - it can affect many aspects of everyday life such as work, social events, relationships as well as self-confidence. One study with nearly 2,000 IBS sufferers found that they would be willing to give up 25 percent of their remaining lifespan to be symptom free - that reinforces how debilitating this condition can be.
If you are suffering with IBS symptoms, get in touch - there is so much that can be done to improve them as well as quality of life. And if you think food poisoning was the trigger to your symptoms, I am one of the few licensed practitioners in the UK to offer IBS smart.
About the author:
Marilia Chamon is a London based registered nutritionist and gut health specialist, founder of Gutfulness Nutrition. Marilia is a SIBO Approved Practitioner, who is certified in applying functional medicine in clinical practice from the world renowned institute For Functional Medicine, who has undergone extensive research and training on the pathophysiology of IBS. In addition to completing the Monash University 'Low FODMAP Diet for IBS' training course for health professionals.
Marilia came to Nutritional Therapy as a result of her own health journey having struggled with unexplained digestive symptoms for nearly a decade. After an episode of food poisoning she developed a condition called Post-Infectious Irritable Bowel Syndrome (PI-IBS) which affects 1 in every 9 people who suffers an episode of gastroenteritis.
Like most of Marilia’s clients, she undertook every medical test under the sun but could not get to the root cause of her chronic digestive symptoms. Her determination to solve the root cause of her problem sparked an immense interest in gut and digestive health and led her to qualify as a Registered Nutritional Therapist.
A decade later, Marilia now dedicates her life to supporting others in similar situations; a pioneer of the application of evidence-based nutrition, her practice is rooted in evidence-based science. She works closely with her clients to unravel the root cause of imbalances and dysfunctions that underlie chronic digestive symptoms.
Connect with Marilia here: Gutfulness Nutrition | Instagram.