This is 3 of 5 series:
- Part 1: Don't Take Resistant Starch Alone and Other Precautions; RS2 Needs to Be Taken With Other Fiber To Spread Fermentation Completely Across the Entire Colon
- Part 2: Real Food Resistant Starch (RS3) Trumps High-Dose Potato Starch Diet To Expand the Lean and Immunoprotective Core Microbiota (Roseburia, Eubacteria, F. prausnitzii, Bifidobacteria)
Moderate to Severe IBS: Don't Take RAW RS2
IBS is a common syndrome marked by alternating diarrhea and constipation or mainly constipation (IBS-C) or mainly loose stools (IBS-D). The 7 Steps are very effective for IBS whether IBS-C or IBS-D because the 7 Steps embody functional medicine which finds the root problem and fixes it. HERE are successful cases for 7 Steps and functional medicine.
"Many of the faecal microbiota taxa that have been shown to be associated with IBS, such as Ruminococcaceae and Clostridium cluster XIVa, are known to be enriched for species that produce SCFAs ." Jeffrey et al, 2013. Source.Caged vipers live in the zoos of individuals with IBS and these are RS2/starch eaters. Vipers are a relative term. Rumino and Clostridium cluster XIVa are notorious RS2, RS3, starch and inulin eating monsters. They love RS2. They love inulin. They love RS3 and starches (see Tim's 26-fold expansion of XIVa/Roseburia eating whole, real resistant starch, low GI starches). If these creatures are overgrowing in your small intestines, don't take resistant starch until the situation is improved.
Members of the Ancestral Core are OVERGROWING in the Foregut
We need lots of Ruminococcus and Clostridia cluster XIVa which are prominent members of the ancestral core I talked at length about in the AHS14. Cluster XIVa is one of the vital groups of gut microbiota that protect and recovered an rodent model of peanut allergy recently.
However in IBS, there are excessive amounts of these 'good' ancestral bacteria in the small intestines (SI) where the surface is relatively sterile with only rare microbes compared with the hot, fermenting compost in the colon. They are invading because the gatekeepers are gone (soil organisms, bifidobacteria, etc). Too many bugs inhabiting the SI cause small intestinal permeability (SIBO). If yeasts and fungi are involved as a result of overgrowth after antibiotics wipe out the symbiont bacteria, this is known as SIFO, small intestinal FUNGAL overgrowth. This is a hidden and prevalent condition and leads to intestinal permeability, then, subsequent auto-immune disorders, inflammation, cancer, strokes and heart attacks.
Ruminococcus may favor RS2 in rhizomes and tubers over any other food because of a preference etched in their DNA from 1 to 2 million years ago or even longer. Raw tubers, wild carrots, roots of cattails and water chestnuts contain granules of RS2 that Ruminocccus bromii will physically attach to with ancient machinery and ferment the f*kc out of.
How Do You Know If Ruminococcus and Clostridia XIVa Are In the Small Intestines?
Intolerance for inulin, starches or resistant starch are often loud TMIs and uncomfortable cramps or bloating. These are the 'hallmarks' for IBS and are triggered by diet, stress or other factors.
"High levels of acetic acid and propionic acid were associated with poor QOL and negative emotion in this study." Tana et al, 2009. Source.In IBS, butyric acid and other SCFAs (acetic acid and propionic acid) are ironically high. We don't want to really make these higher. The more SCFAs, the worse mental function research has found. The gut-brain axis is broken. This is a modern triad: IBS, depression/anxiety and migraines/headaches. Body aches or fibromylagia are not uncommon as well.
FODMAPS, sugar, fructose and digestible starches are consumed by Lactobacillus which is a common species found to be elevated as well. More lacto probiotics and fermented foods which are rich in lactobacillus will make IBS symptoms and mental function worse. Again until improved digestion and the 7 steps helps to improve the health and function of the small intestines, following a full-on or semi GAPS, SCD or a lower fermentable fiber diet is prudent until the weeds are thinned out. Long term these special diets compromise gut function by depriving the guts of fuel and energy for the microbiota.
Unfortunately if you have these benign but HUNGRY RS- and inulin-chomping critters living where they are not supposed -- the small intestines, a mostly sterile place -- more IBS signs and symptoms will be present (bloating, gas, pain, bloating and even brain fog and fatigue). Think of the small intestines as a freeway. It doesn't want to be congested or a city-wide buffet for millions of critters. It wants its contents to flow and be absorbed and move along.
Concomitant GERD and IBS
GERD and IBS often go hand in hand. The very pharmaceuticals that 'treat' GERD make small intestinal congestion worse. Without acid, digestion halts and gases back up, producing symptoms of heart burn, epigastric pain, fullness and GERD. The gases make the sphincter loose. Drugs like NSAIDs, ibuprofen, acid blockers, PPIs, 'the purple pill Prilosec/omeprazole' all increase pathogenic growths and lower Bifidobacteria. Without the trigger of massive normal acidity in the stomach, not only do pathogens thrive, but protein digesting enzymes will be defunct. Our ancestral core probiotics in our gut play vital roles in making sure digestion rolls forward without a hitch. Antibiotics, stress and high sugar/refined diets compromise their environment in our guts. It is not wonder so many people have to reach for TUMS or Mylanta for transient relief. Try to identify root causes as these solutions actually make the problem far worse.
- Omeprazole induces altered bile acid metabolism
- The effect of long-term omeprazole on the glucose-hydrogen breath test in elderly patients. ('The omeprazole group had significantly lower serum albumin concentrations' NO PROTEIN DIGESTION meaning protein is putrifying somewhere)
- Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly. [drugs cause SIBO]
- Interaction between vitamin K nutriture and bacterial overgrowth in hypochlorhydria induced by omeprazole.
- Effects of long-term PPI treatment on producing bowel symptoms and SIBO. [drugs cause SIBO]
- Bacterial infections in cirrhosis: role of proton pump inhibitors and intestinalpermeability. [drugs cause SIBO]
- The innovative potential of Lactobacillus rhamnosus LR06, Lactobacillus pentosus LPS01, Lactobacillus plantarum LP01, and Lactobacillus delbrueckii Subsp. delbrueckii LDD01 to restore the "gastric barrier effect" in patients chronically treated with PPI: a pilot study. PROBIOTICS CAN RESTORE THE GERD BARRIER EFFECT. 'A significant decrease in fecal enterococci, total coliforms, E. coli, molds, and yeasts in subjects treated with PPIs was recorded at the end of probiotics supplementation (d10) compared with baseline (d0) in group B. This is a further confirmation of the barrier effect also exerted at the stomach level.'
Fixing the Root Problem(s)
Our small intestines are carnivorous; to breakdown fats and meat/seafood/vegetarian protein, 3 things are mandatory -- (1) high acid, (2) bile acids, and (3) clever cutters, known as pancreatic enzymes, to degrade everything to smaller parcels.
Without adequate acid, fat and protein malabsorb and putrify. This can stink up stools (but not always, test...don't guess). Farts too, no longer making flatus pleasant and compost-y. It is not obvious for some unless functional medicine labs are done to detect fat and triglycerides in stools that travel unbroken and fully intact instead of being absorbed and providing energy to the host.
If acid is impaired consideration for the below helps optimal digestion:
--walking 10-20 minutes after meals
--kombucha, kraut, kefir, diluted raw apple cider vinegar with most meals
--betaine HCl (Robb Wolf has a fantastic protocol he has used for years)
--digestive enzyme supplementation
--bile acid supplementation (Hat tip: Lola)
For optimal gut health in the improvement of IBS, consider not taking any resistant starch or inulin temporarily if IBS symptoms are triggered. Yes that includes version A (potato starch) and version B (GBF which contains ~5 grams RS2 + inulin) of bionic fiber. Consider rehabilitating the gut by seeding with symbionts (like soil probiotics and bifidobacteria), feeding what is appropriate and to select what you need (not Ruminococcus or Clostridia XIVa) and what is MISSING.