It’s Time to Rethink How We Treat IBD vs IBS - Dr. Michael Ruscio, DC

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It’s Time to Rethink How We Treat IBD vs IBS

Why We Should Take Another Look At How We View These These Chronic Gut Disorders

Key Takeaways:

  • When comparing IBD vs IBS, they are both chronic digestive disorders that have some similar symptoms, including abdominal pain and altered bowel movements.
  • IBD is often considered to be an autoimmune disorder of the gut that can lead to GI bleeding, rashes, joint pain, and a heightened risk for lung disease and colon cancer.
  • IBS has no conventional laboratory markers, is diagnosed on symptoms alone, and has a better prognosis than IBD.
  • IBD is often misdiagnosed as IBS, and an IBS diagnosis can lengthen the time it takes to get worked up for IBD.
  • Though to varying degrees, inflammation is the hallmark of both IBS and IBD, which can be worsened by stress, gut dysbiosis, food allergies, and/or a leaky gut.
  • Standard treatments focus on stress management for IBS and immunosuppressants for IBD, though an anti-inflammatory diet, probiotics, and a healthy lifestyle can benefit both.

From a conventional perspective, the similarities between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) disappear at their nearly-identical acronyms. Though both are chronic digestive disorders, their diagnosis, symptoms, prognosis, and standard treatments are thought to be drastically different. 

There’s even a notable difference in the beliefs surrounding IBD and IBS, including those of physicians, that can make it difficult to receive proper care. Unlike IBD, many believe IBS to have no physiological cause, and the treatment of IBD is thought to be restricted to immune-suppressing drugs and anti-inflammatories.

Despite these disparities, many functional and natural medicine circles have realized that these two conditions aren’t so different after all. When it comes to treating IBD vs IBS naturally, their similar underlying causes make their treatments fairly alike. Both of these disorders are driven by chronic inflammation, and their triggers have significant overlap. Inflammatory foods, toxins, bacteria, and environmental stressors can all play a part in the development and progression of IBS and IBD. 

A treatment approach that focuses on lowering inflammation and eliminating modifiable triggers through diet, gut-balancing supplements, and a healthy lifestyle extends beyond conventional care and is highly effective for both of these conditions. 

In this article, I will cover how we can reconcile the differences between IBD and IBS and how that can provide long-term relief — not just suppress the symptoms.

Running Through the Basics of IBD vs IBS

IBD and IBS have many differences when it comes to their presentations, diagnosis, standard treatments, and even disease outcomes. And a great way to truly understand how these conditions differ (and how they are alike) is by discussing the unique challenges they face. Let’s start with IBD.

Living With IBD at a Glance 

Inflammatory bowel disease (IBD) is an umbrella term used to describe two disorders: ulcerative colitis and Crohn’s disease. These two types of IBD often exist separately, but some people are diagnosed with both.

As its name implies, IBD is characterized by a significant level of inflammation in the small intestine and/or large intestine. It’s perhaps the degree of inflammation that primarily distinguishes it from its similar counterpart of IBS and can hinder your overall health [1]. 

The inflammation in the intestinal tract can be so severe that it impedes nutrient absorption, potentially leading to anemia and numerous other symptoms. Rectal bleeding, which is not present in IBS, can also be present and can worsen anemia. Severe diarrhea, abdominal pain, rectal fissures, and abscesses are other common GI symptoms that may accompany an IBD diagnosis.

Many consider IBD to have a strong autoimmune component that’s, in part, due to your genetics. In autoimmunity the body’s immune system attacks the wrong tissues [2, 3], and allows inflammation to spread and cause body-wide symptoms. IBS has symptoms that are commonly believed to be restricted to the gut (more on this later), while IBD has well-recognized symptoms of [2]:

  • Eye pain
  • Arthritis
  • UTIs
  • Weight loss
  • Appetite loss
  • Nausea
  • Fever 
  • Rashes
  • Fistulas (an abnormal passage between body tissues)

While the evaluation for IBD is more straightforward than IBS as it relies on concrete markers and not just symptoms, it’s more invasive and typically requires extensive bloodwork, stool samples, and a colonoscopy. IBD treatments are immunosuppressive and/or anti-inflammatory and come with a high possibility for side effects like frequent infections or unwanted weight gain [1]. 

IBD is viewed as a life-long disease with symptomatic episodes (flares) that alternate with periods of remission. However, many who take daily medications and are in “remission” still continue to experience bothersome symptoms. 

The prognosis for IBD is considered to be poor due to the effect of the disease on the quality of life and the increased risk for conditions like lung disease and colon cancer [1]. That being said, many IBD patients will have a less severe presentation, long periods of remission, and a more favorable disease outcome and quality of life

An IBD diagnosis is no longer as scary as it seems, as there are many other ways for it to be managed naturally, safely, and effectively. Before we jump into that, let’s cover some lesser-known issues surrounding IBS.

IBS: Why Beliefs Aren’t Everything

While the symptoms and prognosis are typically more favorable than IBD, carrying a diagnosis of irritable bowel syndrome (IBS) comes with its own set of challenges. It’s a functional GI condition — meaning there’s no medically identifiable cause of IBS, and is thus diagnosed by symptoms [4]. 

IBS is often attributed to stress and, like other functional disorders, this means it comes with a stigma that frequently creates a barrier to proper care [5]. Many doctors view IBS through a somatic lens (one of psychological origin), which isn’t helped by the fact that, unlike IBD, there are no laboratory or structural markers that can identify IBS. 

Diagnosing IBS is also frustrating due to its similarities to other digestive conditions. Even gastroenterologists have a low accuracy of 68% when attempting to identify IBS [6]. 

It’s diagnosed through the Rome IV criteria, which assesses the presenting symptoms and how long they’ve been present. Similar to IBD (though typically to a lesser severity), common symptoms of IBS are cramping, gas, bloating, stool changes, and abdominal pain.

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IBS is categorized into three different types:

  • Type 1: IBS-C (constipation-predominant)
  • Type 2: IBD-D (diarrhea-predominant)
  • Type 3: IBS-M (mixed/ both diarrhea and constipation)

As opposed to IBD, which has well-recognized body-wide symptoms, those that accompany IBS (or rather the underlying cause) are often overlooked. Headaches, fatigue, and skin conditions often occur, but the extraintestinal symptoms typically have a less severe presentation compared to IBD.

Often the challenges don’t stop once you receive a diagnosis, as it, in itself, can become an obstacle. For example, it takes significantly longer for IBS patients to be diagnosed with IBD when compared to those without a prior IBS diagnosis [7]. Considering IBD is commonly misdiagnosed as IBS, this is highly consequential and can also delay proper care for IBD [8]. 

These issues surrounding the perception, diagnosis, and management of IBS have direct consequences on patient health outcomes and contribute to more widespread issues. Though IBS is over 100x more common than IBD, it’s 4x less studied in medical research and education [5, 9, 10].

Despite these challenges, it typically (but not always) has a less severe impact on long-term health and quality of life than IBD. Like IBD, IBS can present with episodes of heightened symptoms alternating with symptom-free periods.

Like in Crohn’s and ulcerative colitis, the options for medical management are palliative and focus on symptom relief through laxatives and/or anti-diarrheals. Since it’s believed to have a predominant psychological cause, antidepressants are also used to address any co-existing mental health concerns.

Fortunately, when we look beneath the surface, there are highly effective, long-lasting ways to treat both of these troublesome health conditions.

IBD vs IBD: At a Glance

A quick guide to the factual differences between IBS and IBD:

Key Factors Irritable Bowel Syndrome (IBS) Inflammatory Bowel Disease (IBD)
Definition Functional gastrointestinal disease (brain-gut connection disorder) [4] Immune-mediated inflammatory disease (immune system attacks all layers of gut tissues) [2, 3]
General presentation Frequent abdominal pain or discomfort with altered bowel habits (diarrhea and/or constipation) [11]
  • Recurrent flare-ups of severe intestinal inflammation that damages the GI tract.
  • Can also damage other body tissues, including joints, eyes, and skin [1]
Possible causes/risk factors
  • Genetics [12]
  • Early life and psychosocial stressors [11]
  • Gut immune activation [11]
  • Microbial dysbiosis [11]
  • Food intolerances [11]
  • Antibiotic use [11]
  • Gut infections [11]
  • Genetics, Jewish/northern European ancestry [2, 3]
  • Abnormal reaction to gut flora [1]
  • Infections [2]
  • Leaky gut [13, 14]
  • Western diet/lifestyle [3]
  • Autoimmunity [3]
  • History of gut surgery [3]
  • Celiac disease [15]
  • IBS [16]
  • SIBO [17]
  • Excessive NSAID use [3]
Prevalence Very common: about 11% of the world population (851 million people) [9] Much less common: about 0.1% of the world population (7 million people) [10]
Diagnosis
  • Clinical presentation, Rome IV criteria
  • Family history [11]
  • Laboratory tests to rule out other conditions like IBD
  • Clinical presentation
  • Family history
  • Blood tests, including antibody testing
  • Fecal calprotectin
  • Colonoscopy [1]
Conventional Treatment 
  • Medications to manage abnormal bowel movements [11]
  • Medication to manage pain/spasms
  • Stress reduction [11]
  • Medications to induce or maintain remission like steroids, anti inflammatories, and immunosuppressants [1]
  • Surgery if severe [1]
Prognosis
  • Good, but for some can be a lifelong disease with periods of remission (no symptoms) [11]
  • Quality of life is typically poor to okay [1]
  • Lifelong with periods of active disease (flares) and remission.
  • Depends on disease severity and treatment response [1]
  • Higher risk of mortality from IBD, infections, colorectal cancer, and lung disease [1]

Where IBS and IBD Merge

Many of the above attitudes toward IBS are misconceptions, but they leave those with IBS with limited treatment options. And while IBD doesn’t come with the same degree of stigma, it certainly faces its own challenges of sometimes severe symptoms and detriment to overall wellness. 

Fortunately, stress and autoimmunity aside, other treatable physiological triggers of IBS and IBD exist, such as gut microbiome imbalances, infections, leaky gut, and food allergies [11]. This means there’s a significantly wider array of treatment targets for IBS and IBS than previously thought. 

This information is well-identified in the medical literature but is still making its way into healthcare education and standard clinical practice. At the Ruscio Institute for Functional Medicine, we have adopted these ideas into our practice and have seen significant success in our patients.

How One Patient Won His Battle With IBD

One of our patients, Kyle, went through his own struggle with IBD, having dealt with Crohn’s disease for years. He had significant gas, bloating, constipation, and appetite loss, but most detrimentally of all, severe pain whenever he ate. This led to a largely diminished social life and general well-being. Despite taking biologic medication, undergoing prior bowel surgery, and eating healthy foods, they had minimal to no effect on his symptoms. 

Fortunately, healing his gut with a targeted diet, triple therapy probiotics, abdominal massage, and an emotional reset with the Gupta program gave him significant and steady relief. He even benefitted from the resolution of his more minor concerns of low energy, headaches, and back pain.

Kyle has gotten his life back, and his success with healing his Crohn’s disease has inspired him to help others with similar issues into a full-time job.

Kyle’s response is truly inspiring and is not uncommon when you address the underlying cause of symptoms. So how does it work? It’s all about inflammation.

It All Comes Down to Inflammation

Both IBS and IBD are ultimately driven by unregulated inflammation in the gut. Inflammation isn’t necessarily a bad thing, as it is an essential function of our immune system to fight off pathogens and heal wounds. 

However, when it’s derived from repeated exposure to triggers like inflammatory foods, an unhealthy microbiome, or haywire antibodies in autoimmunity, it creates chronic GI inflammation. 

To worsen matters, inflammation in the digestive system doesn’t always stay there. When the intestinal tissues become inflamed, it allows bacterial toxins and food particles to slip through, creating a body-wide inflammatory response. This is, in part, how both IBS and IBD can cause symptoms all over the body.

This immune response is responsible for a significant number of disorders, like IBD and IBS, and to get to the root of these conditions, it’s pivotal to get a handle on this process. This is not a novel idea, and standard medical care is remarkably adept at suppressing inflammation and pain through medications like corticosteroids, NSAIDs, and biologics. 

These pharmaceuticals are often a huge relief for people who are in an active IBD flare or even those with severe IBS. Unfortunately, while well-intentioned, this approach often misses the mark in actually stopping the inflammatory process, and is how IBD medications can become a life-long bandaid. 

Medications can lower existing inflammation but don’t remove the triggers that cause it. And that’s what long-term relief from IBS and IBD comes down to — treating and preventing the inflammatory response. 

Treating Inflammation

One of the best ways to stop IBS and IBD inflammation in its tracks is by removing what’s contributing to it. This means removing inflammatory foods, toxins, and other environmental factors like stress. 

This is why I find it most effective to treat IBS and IBD through an elimination-based, anti-inflammatory diet, targeted supplements, and removing any other obstacles to health, like a sedentary lifestyle. As they did with Kyle, these changes can make a world of difference by providing long-lasting relief from both physical and psychological symptoms.

We have many articles on how to choose and implement all of these therapies. But I’ll end this article by briefly running through our top therapies and the benefits that they can provide.

An Elimination Diet

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Diet is the foundation of healing your gut, as I cover extensively in Healthy Gut, Healthy You. Our approach starts with following a simple, not overly restrictive elimination diet to see if removing foods that often trigger inflammation in the gut, like wheat-based grains, corn, soy, dairy, sugar, and processed foods. 

Removing foods that provoke an immune response in the digestive tract also helps to lower inflammation throughout the body [18, 19]. A Paleo diet well-embodies these fundamentals, so we recommend starting there. 

However, this may not work for everyone, as some with IBD and IBS are fiber-sensitive, making a low FODMAP diet a great next step. Six weeks on a low FODMAP diet has been shown to decrease IBS and IBD symptoms, heal the gut lining, restore the gut flora, and reduce inflammation [20, 21, 22].

The Autoimmune Protocol (AIP) is a highly-restrictive option (which is why we recommend trying other options first), but it can provide significant IBD relief [23]. Controlling inflammation through diet creates a healthier environment for bacteria in the gut and helps correct imbalances that are further contributing to inflammation [24, 25]. 

The Power of Probiotics

Adding probiotics can double down on this approach by introducing healthy bacteria into the digestive tract. Probiotics can combat many triggers of IBD and IBS, including gut pathogens, bacterial dysbiosis, and a leaky gut [26, 27, 28, 29, 30, 31, 32, 33]. 

They lower inflammation in the GI tract, restore a normal immune response (essential for IBD) and encourage the growth of healthy bacteria [26, 27, 28, 34, 35, 36]. 

There is ample research evidence that shows that probiotics can improve both digestive symptoms and body-wide symptoms in IBS and IBS, making them a great option for healing these conditions [37, 38, 39, 40, 41, 42, 43, 44].

An Elemental Diet

When an elimination diet and probiotics don’t seem to resolve your symptoms, a gut reset can often clear things up. An elemental diet contains nutrients that are already broken down into an easily digestible form. It can work remarkably well for those in a bowel flare, and several studies show an elemental diet to be just as effective as anti-inflammatories in IBD treatment [45, 46, 47, 48, 49, 50, 51, 52, 53, 54].

You can use an elemental diet over 2-4 days as a meal replacement for a quick gut reset. However, it is safe and appropriate for longer use in those with persistent symptoms. One study showed that 2 weeks on an elemental diet reduced IBS symptoms in 65% of the participants [55]

Healing IBD and IBS is not limited to these options, so be sure to check out our many other articles on treating an unhealthy gut.

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IBD vs IBS: Not as Different As We Thought 

IBD and IBS may differ in their diagnosis, symptom severities, and conventional management, but they often have the same underlying triggers. 

Bacterial imbalances, a leaky gut, infections, toxins, and an unhealthy diet can all trigger the inflammation that is present in both of these conditions (though to a varying degree). Treating these through an elimination diet, healthy bacteria, and many other options can reduce the inflammatory response.

For more in-depth information on how you can health IBD vs IBS, you can get a copy of my book here. We also offer virtual visits at Ruscio Institute for Functional Medicine for more hands-on support.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

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