Crush IBS Symptoms: Get Relief & Fix Your Gut Health

What is IBS?

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by recurrent abdominal pain associated with altered bowel habits, in the absence of structural or biochemical abnormalities detectable by standard investigations. It affects approximately 11% of the global population and is diagnosed twice as often in women as in men.¹ Despite being labelled “functional,” IBS has demonstrable biological underpinnings, and identifying which factors are driving symptoms in any individual patient is where a naturopathic approach adds real clinical value.

If you are suffering from Irritable Bowel Syndrome (IBS), then you know how uncomfortable this condition can be.  To better understand what is happening in IBS, we need a basic understanding of digestion.

What is Digestion?

Digestion is a complicated process that starts even before you put food in your mouth.  The smell or sight of food starts your digestive juices flowing.  Taste and chewing stimulate the release of saliva, digestive enzymes, and other digestive juices while your teeth accomplish the mechanical breakdown of your food.

When you swallow, the food travels down your esophagus to your stomach.  Once in your stomach, the food mixes with your stomach acid.  This helps with the absorption of minerals and vitamin B12, the digestion of protein, and the sterilization of what you put in your mouth.

When that acidic mixture passes out of your stomach and into your small intestine, your pancreas secretes digestive enzymes, and your gallbladder secretes bile.  The enzymes break down fats, starches, and proteins.  Bile helps digest fats, improving the absorption of fats and fat-soluble vitamins.  Bile is a bit of an irritant, and so the digestive tract moves it along to get it out. This keeps your bowels regular.

The digestion and absorption of nutrients take place as the food passes through your small and large intestines.  Beneficial bacteria help to keep the surface of your digestive tract healthy so that harmful bacteria or yeast can’t overgrow.  These good bacteria also help maintain a healthy immune system.

As this simplified description shows, digestion is a complex process.  If any of the steps don’t work properly, everything downstream can be affected in a domino-like fashion.

What Are the Symptoms of IBS?

IBS symptoms exist on a spectrum of severity. The Rome IV criteria (the current diagnostic standard) define IBS as recurrent abdominal pain occurring at least 1 day per week over the past 3 months, associated with 2 or more of the following: improvement with defecation, change in stool frequency, or change in stool form.² The clinical presentation is divided into subtypes:

• IBS-C (constipation-predominant): Fewer than 3 bowel movements per week; hard, lumpy stools
• IBS-D (diarrhea-predominant): Loose, watery stools occurring more than 3 times per day
• IBS-M (mixed): Alternating constipation and diarrhea
• IBS-U (unsubtyped): Does not fit any of the above patterns

Associated symptoms include bloating, abdominal distension, excessive gas, mucus in stool, urgency, and incomplete evacuation. Many patients also experience extraintestinal symptoms, including fatigue, fibromyalgia-type musculoskeletal pain, bladder symptoms, and mood disturbances, reflecting the systemic nature of the gut-brain-immune axis dysfunction underlying IBS.³

How Do You Test for IBS?

The diagnosis of IBS is considered to be a diagnosis of exclusion.  This means that if other, more serious causes of the above symptoms have been excluded, the diagnosis is deemed to be IBS.  Other diseases to exclude include inflammatory bowel diseases affecting your colon, such as Crohn’s disease and ulcerative colitis.  A colonoscopy may be needed to rule these out.

While IBS is clinically diagnosed, testing is useful for ruling out conditions that mimic it and identifying treatable root causes. Relevant investigations include: CBC, CRP/ESR, celiac antibodies (anti-tTG IgA), H. pylori testing, stool testing for ova and parasites, lactulose or glucose breath test (SIBO), comprehensive stool analysis including microbiome profiling, secretory IgA, calprotectin (to distinguish IBS from IBD), and thyroid panel (hyperthyroidism can mimic IBS-D; hypothyroidism can mimic IBS-C).

What Causes IBS?

IBS does not have a single cause; it is a syndrome with multiple overlapping pathophysiological mechanisms. Identifying which ones are dominant in your case determines the most effective treatment approach.

Gut-Brain Axis Dysregulation

The enteric nervous system (ENS), often called the “second brain,” communicates bidirectionally with the central nervous system via the vagus nerve, neuroendocrine signals, and the immune system. In IBS, this bidirectional signalling is dysregulated. Visceral hypersensitivity (heightened pain perception in response to normal gut distension) and altered gut motility are central features.³ Chronic stress activates the HPA axis and alters gut permeability and motility, which is why psychological stressors can precipitate or worsen IBS flares.

Intestinal Dysbiosis

Alterations in the gut microbiome, reduced microbial diversity, decreased abundance of Bifidobacterium and Lactobacillus species, and increased abundance of potentially pathogenic species are consistently documented in patients with IBS compared with healthy controls.⁴ Dysbiosis contributes to altered gut motility, increased intestinal permeability, and low-grade mucosal inflammation.

Small Intestinal Bacterial Overgrowth (SIBO)

A subset of IBS patients (estimates range from 30–85% depending on diagnostic method and IBS subtype) have SIBO, particularly IBS-D.⁵ SIBO contributes to bloating, gas, and altered motility through excessive bacterial fermentation of carbohydrates in the small intestine and methane or hydrogen gas production.

What causes SIBO?

There are many possible factors that cause or contribute to bacterial overgrowth in the small intestine: IBS, pseudo obstruction, lower rate of migrating motor complexes, visceral neuropathies/myopathies, narcotic drugs, GLP-1 agonists, adhesions, bowel obstructions, strictures (e.g. Crohn’s disease), bariatric surgery, scleroderma, hypothyroidism, diabetes, cirrhosis, Parkinson’s, diarrhea in the elderly, low acidity in stomach (achlorhydria/hypochlorhydria), possibly Proton Pump Inhibitor (PPI) use, chronic pancreatitis, Crohn’s disease, and Celiac disease.

This is an important diagnosis to identify because treatment differs from standard IBS management.

Post-Infectious IBS

IBS can be triggered by a prior gastrointestinal infection (PI-IBS). Approximately 10–30% of patients develop IBS following an episode of bacterial gastroenteritis (Salmonella, Campylobacter, Shigella).⁶ PI-IBS is characterized by increased intestinal permeability, mucosal immune activation, and enterochromaffin cell hyperplasia affecting serotonin signalling.

Food Sensitivities and Dietary Triggers

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed in the small intestine and rapidly fermented by colonic bacteria, generating gas and drawing fluid into the lumen via osmosis. A low-FODMAP diet has the strongest evidence base of any dietary intervention for reducing IBS symptoms.⁷ While a low-FODMAP diet may help, it is a very restrictive diet and is not advisable long-term.

Food sensitivities drive intestinal inflammation. An inflamed gut lining is weakened tissue, more susceptible to bacterial or fungal overgrowth. The inflamed tissue also fails to function in its various capacities – producing stomach acid, digestive enzymes, allowing easy passage of bile, movement that propels stool through, and absorption of water and nutrients.

Low-Grade Mucosal Inflammation

Some IBS patients, particularly those with IBS-D, show evidence of increased mucosal mast cell density and intestinal permeability. This “leaky gut” state allows bacterial lipopolysaccharide (LPS) and other luminal antigens to cross the epithelial barrier, triggering immune activation.⁸

Natural Treatment Approach for IBS

1. Low-FODMAP Diet

The low-FODMAP diet has been evaluated in multiple randomized controlled trials. A 2014 meta-analysis found significant improvement in global IBS symptoms and individual symptoms including bloating, pain, and stool consistency with FODMAP restriction.⁷ The diet has three phases: elimination (2–6 weeks), reintroduction (systematic FODMAP reintroduction to identify individual triggers), and personalization. Working with a practitioner during this process is important to avoid unnecessary long-term dietary restrictions. A low-FODMAP diet is not a permanent diet; the elimination phase alone is not the goal.

2. Targeted Probiotics

Not all probiotics are equivalent in IBS. The most evidence-supported strains/combinations include:

• Lactobacillus plantarum 299v (DSM 9843): Demonstrated efficacy for IBS-D symptoms, including bloating and flatulence⁹
• Bifidobacterium infantis 35624: Reduced global IBS symptoms versus placebo in a large multi-centre RCT¹⁰
• Multi-strain combinations containing L. acidophilus, L. rhamnosus, and B. longum: Evidence for IBS-mixed presentations

Fermented foods (unsweetened kefir, yogurt with live cultures, kimchi, sauerkraut) support microbiome diversity as part of a broader dietary strategy.

3. SIBO Treatment (if present)

If breath testing (lactulose or glucose hydrogen/methane breath test) confirms SIBO, treatment requires targeted antimicrobial therapy, either pharmaceutical (rifaximin) or herbal antimicrobials, which have shown non-inferior efficacy in one prospective study.¹¹ Herbal protocols include berberine-containing botanicals, oregano oil, allicin, and neem in various combinations. Following SIBO treatment, prokinetic agents support migrating motor complex (MMC) function to reduce relapse.

4. Gut-Brain Axis Support

Psychological interventions with established efficacy for IBS include:

• Cognitive behavioural therapy (CBT): Demonstrated to reduce IBS symptom severity and improve quality of life in RCTs¹²
• Gut-directed hypnotherapy: Significant and durable IBS symptom reduction in multiple trials¹³
• Mindfulness-based stress reduction (MBSR): Reduces visceral sensitivity

From a naturopathic standpoint, adaptogenic and nervine botanicals support HPA axis regulation, which directly affects gut motility and visceral sensitivity. Relevant options include Rhodiola rosea, Withania somnifera (ashwagandha), and Melissa officinalis (lemon balm).

5. Intestinal Permeability Support

When increased intestinal permeability is a clinical feature:

• L-glutamine: Provides fuel for intestinal epithelial cells (enterocytes); supports tight junction integrity. A 2019 RCT found L-glutamine supplementation (5 g/day x 8 weeks) significantly reduced IBS-D symptoms, including stool frequency and intestinal permeability markers.¹⁴
• Zinc carnosine: Supports mucosal healing and tight junction integrity¹⁵
• Butyrate: Short-chain fatty acid produced by microbial fermentation of dietary fibre; essential for colonocyte health and mucosal immune regulation

6. Digestive Enzyme Support

In some patients, inadequate digestive enzyme production contributes to malabsorption and fermentation. Pancreatic enzyme supplementation or plant-based digestive enzymes may be considered where clinically indicated. Reducing gut inflammation helps pancreatic juices flow into the small intestine.

7. Stress Management and Sleep

Chronic sleep insufficiency and perceived stress are strong predictors of IBS symptom severity.¹⁶ Addressing sleep quality and stress physiology is not optional in IBS management; it is a core therapeutic target.

Benefits of Naturopathic Treatment of Irritable Bowel Syndrome (IBS)

1. Better eating habits
2. Improved digestion and absorption of nutrients
3. Better immune system function
4. Healthier digestive tract
5. Better stress coping skills and the ability to relax

FAQ About IBS

What is the difference between IBS and IBD?

IBS (irritable bowel syndrome) is a functional disorder; gut function is altered, but there is no structural inflammation or tissue damage on investigation. IBD (inflammatory bowel disease), which includes Crohn’s disease and ulcerative colitis, involves chronic, immune-mediated inflammation of the gastrointestinal tract that is visible on colonoscopy and biopsy. IBD is associated with blood in stool, significant unintentional weight loss, nocturnal symptoms, elevated inflammatory markers (CRP, ESR), and elevated fecal calprotectin. Fecal calprotectin is a useful test for distinguishing IBS from IBD; it is elevated in active IBD and typically normal in IBS.

Can stress cause IBS?

Stress does not cause IBS in a simple linear sense, but it is one of the most powerful modulators of IBS symptom severity through the gut-brain axis. Psychological stress activates the HPA axis (hypothalamic-pituitary-adrenal axis), which: alters gut motility via corticotropin-releasing hormone (CRH) signalling in the enteric nervous system; increases intestinal permeability through mast cell activation; heightens visceral sensitivity, lowering the pain threshold for normal gut distension; and shifts the composition of the gut microbiome. This is why IBS flares reliably track stressful life periods, and why psychological interventions, cognitive behavioural therapy, gut-directed hypnotherapy, and mindfulness have genuine efficacy for IBS symptom reduction. From a naturopathic standpoint, HPA axis regulation is a core treatment target, not an afterthought.

What is leaky gut, and how does it relate to IBS?

“Leaky gut” refers to increased intestinal permeability, a state in which tight junctions between intestinal epithelial cells become compromised, allowing bacterial lipopolysaccharide (LPS), undigested food antigens, and other luminal contents to cross the epithelial barrier into the subepithelial immune tissue. This triggers low-grade mucosal immune activation, mast cell degranulation, and systemic inflammation. In IBS, particularly IBS-D, increased intestinal permeability is measurable and correlates with symptom severity. It is not a fringe concept; it is supported by peer-reviewed research in journals including Gut and Gastroenterology. Key interventions for intestinal permeability include L-glutamine (5 g/day – RCT evidence for IBS-D), zinc carnosine, butyrate, and removal of dietary triggers that disrupt tight junction integrity.

Can food sensitivities cause IBS?

Food sensitivities, distinct from IgE-mediated food allergies like a peanut allergy, can contribute to IBS symptoms through several mechanisms: FODMAP intolerance (fermentation-driven gas and motility changes), non-celiac gluten sensitivity (immune-mediated gut permeability changes independent of celiac disease), histamine intolerance (impaired histamine metabolism driving gut motility disturbance and visceral hypersensitivity), and delayed IgG-mediated reactions.

What is the difference between IBS and celiac disease?

Celiac disease is an autoimmune condition in which gluten ingestion triggers immune-mediated destruction of small intestinal villi in genetically susceptible individuals (HLA-DQ2/DQ8). It causes malabsorption of iron, B12, folate, calcium and other minerals, and fat-soluble vitamins, and is diagnosed by positive anti-tTG IgA and/or anti-EMA antibodies confirmed by small bowel biopsy. IBS does not cause villous atrophy. However, the two conditions share overlapping symptoms (bloating, diarrhea, abdominal pain), and Celiac disease is a known IBS mimic. It is estimated to be present in approximately 4 times the expected rate in patients diagnosed with IBS. All patients presenting with IBS symptoms should be tested for Celiac disease before a functional IBS diagnosis is accepted.

How does a naturopath approach IBS differently from a conventional doctor?

Conventional IBS management typically focuses on symptom control: antispasmodics, laxatives or anti-diarrheal agents, low-dose antidepressants for visceral hypersensitivity, and dietary advice (often generic). A naturopathic approach focuses on identifying the primary biological mechanism: SIBO, dysbiosis, intestinal permeability, food sensitivity, HPA axis dysregulation, post-infectious changes, or a combination and treating it specifically. This involves considerably more diagnostic testing than is standard in primary care, including SIBO breath testing, comprehensive stool microbiome analysis, fecal calprotectin, celiac antibodies, and thyroid panel. Treatment is individualized to the patient’s subtype, root cause profile, and symptom pattern.

Can IBS affect mental health?

Yes, significantly. The gut-brain axis is bidirectional; just as psychological stress worsens gut symptoms, chronic gut dysfunction affects brain function and mood. Intestinal dysbiosis alters neurotransmitter precursor availability: approximately 90-95% of the body’s serotonin is produced in the gut by enterochromaffin cells, and dysbiosis disrupts this production. Short-chain fatty acids (SCFAs) produced by beneficial gut bacteria regulate vagal nerve signalling and have direct effects on mood and cognition. Elevated intestinal permeability drives systemic production of inflammatory cytokines, which cross the blood-brain barrier and contribute to neuroinflammation. Anxiety and depression are significantly more prevalent in IBS patients than in the general population, not solely as a psychological response to a chronic condition, but as a mechanistic consequence of gut-brain axis dysregulation.

Is IBS a lifelong condition?

IBS does not have to be a lifelong condition. With identification and treatment of root causes: SIBO eradication, microbiome restoration, dietary trigger identification, intestinal permeability repair, HPA axis regulation, many patients achieve sustained remission or full resolution of symptoms. Symptom management without root-cause treatment typically yields incomplete, temporary relief with high recurrence rates. The duration and completeness of recovery depend on how long the condition has been present, how many contributing factors are identified, and how consistently the treatment protocol is followed.

For help with this or any other health problem, book an appointment here or call the clinic at 416-481-0222 for more information.

by Dr. Pamela Frank, BSc(Hons), ND, updated April 12, 2025

Dr. Pamela Frank has been in practice as a naturopathic doctor for over 26 years. Since 1999, she has earned acclaim as a leading naturopath in Toronto, amassing multiple awards.

Dr. Pamela has a special interest in addressing hormone-related complexities, including but not limited to PCOS, endometriosis, acne, hair loss, weight management, thyroid issues, and fertility.

Residing in Toronto with her family and loyal companion, Dolly the rescue dog, Dr. Pamela seamlessly combines her professional commitment with a diverse range of interests.

Beyond her clinical endeavours, she actively engages in kickboxing, leadership roles within Scout Groups, yoga practice, podcasting, and outdoor pursuits such as backcountry camping.

Dr. Pamela’s comprehensive approach reflects not only her dedication to optimal health but also her passion for continual personal and professional growth.

DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested on this website.

References for Toronto Naturopath Treatment for IBS

1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi: 10.1016/j.cgh.2012.02.029. Epub 2012 Mar 15. PMID: 22426087.
2. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016 Feb 18:S0016-5085(16)00222-5. doi: 10.1053/j.gastro.2016.02.031. Epub ahead of print. PMID: 27144627.
3. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011 Jul 13;12(8):453-66. doi: 10.1038/nrn3071. PMID: 21750565; PMCID: PMC3845678.
4. Tap J, Derrien M, Törnblom H, Brazeilles R, Cools-Portier S, Doré J, Störsrud S, Le Nevé B, Öhman L, Simrén M. Identification of an Intestinal Microbiota Signature Associated With Severity of Irritable Bowel Syndrome. Gastroenterology. 2017 Jan;152(1):111-123.e8. doi: 10.1053/j.gastro.2016.09.049. Epub 2016 Oct 7. PMID: 27725146.
5. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020 Feb;115(2):165-178. doi: 10.14309/ajg.0000000000000501. PMID: 32023228.
6. Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007 Aug 15;26(4):535-44. doi: 10.1111/j.1365-2036.2007.03399.x. PMID: 17661757.
7. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906. doi: 10.1007/s00394-015-0922-1. Epub 2015 May 17. PMID: 25982757.
8. Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007 Jul;19(7):545-52. doi: 10.1111/j.1365-2982.2007.00925.x. PMID: 17593135.
9. Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012. PMID: 22912552; PMCID: PMC3419998.
10. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006 Jul;101(7):1581-90. doi: 10.1111/j.1572-0241.2006.00734.x. PMID: 16863564.
11. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Tomakin E, Mullin GE. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014 May;3(3):16-24. doi: 10.7453/gahmj.2014.019. PMID: 24891990; PMCID: PMC4030608.
12. Ford AC, Lacy BE, Talley NJ. Irritable Bowel Syndrome. N Engl J Med. 2017 Jun 29;376(26):2566-2578. doi: 10.1056/NEJMra1607547. PMID: 28657875.
13. Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol. 2013 Mar;11(3):208-16; quiz e22-3. doi: 10.1016/j.cgh.2012.10.031. Epub 2012 Oct 24. PMID: 23103907; PMCID: PMC3591464.
14. Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, Verne GN. Randomized placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019 Jun;68(6):996-1002. doi: 10.1136/gutjnl-2017-315136. Epub 2018 Aug 14. PMID: 30108163; PMCID: PMC9549483.
15. Mahmood A, FitzGerald AJ, Marchbank T, Ntatsaki E, Murray D, Ghosh S, Playford RJ. Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut. 2007 Feb;56(2):168-75. doi: 10.1136/gut.2006.099929. Epub 2006 Jun 15. PMID: 16777920; PMCID: PMC1856764.
16. Larauche M, Mulak A, Taché Y. Stress and visceral pain: from animal models to clinical therapies. Exp Neurol. 2012 Jan;233(1):49-67. doi: 10.1016/j.expneurol.2011.04.020. Epub 2011 May 6. PMID: 21575632; PMCID: PMC3224675.
17. Barlow GM, Pimentel M. Modern concepts of small intestinal bacterial overgrowth. Curr Opin Gastroenterol. 2025 Nov 1;41(6):399-408. doi: 10.1097/MOG.0000000000001135. Epub 2025 Sep 22. PMID: 40960427; PMCID: PMC12517734.