IBS: Why Nothing Has Worked and What to Do Instead
By Joana Amram, Registered Nutritional Therapist & Naturopath (ANP)Published on joana-amram.com · Lisbon, Portugal
You have a diagnosis. You have a label. You have been told — sometimes kindly, sometimes dismissively — that you have Irritable Bowel Syndrome.
What you probably have not been given is a reason. Or a real solution.
IBS affects roughly 10–15% of the global population and is one of the most common reasons people visit a gastroenterologist. Yet despite its prevalence, it remains one of the most poorly understood conditions in conventional medicine — largely because IBS is not a diagnosis in any meaningful sense. It is a description.
Irritable Bowel Syndrome means: your gut is irritable, and we don't know why.
The why is everything.
What IBS Actually Is — and Is Not
IBS is a functional gut disorder, which means the structure of the gut appears normal on standard tests but the function is impaired. This is why colonoscopies, endoscopies, and standard blood tests come back clear. The problem is not structural — it is physiological.
The frustrating reality is that IBS is diagnosed by exclusion. A gastroenterologist rules out inflammatory bowel disease, coeliac disease, and colorectal cancer, and when all of those are clear, the remaining cluster of symptoms gets the IBS label.
What this process does not do is investigate what is actually causing the symptoms. This is the gap that naturopathic and functional medicine approaches exist to fill.
The Most Common Root Causes of IBS
In clinical practice, IBS symptoms almost always have one or more identifiable drivers. The most common are:
1. Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is now thought to be the underlying cause of 60–80% of IBS cases. It occurs when bacteria that should be in the large intestine migrate into and establish themselves in the small intestine, where they ferment food, produce excess gas, and trigger inflammation.
The symptoms are almost identical to IBS: bloating, gas, alternating constipation and diarrhoea, abdominal pain, and post-meal fatigue. The key difference is that SIBO is a testable, treatable condition — and when it is properly addressed, many people who have suffered with "IBS" for years experience complete resolution.
2. Low Stomach Acid
Stomach acid is not just for digesting protein. It activates digestive enzymes, signals the rest of the digestive process to begin, and kills pathogens before they reach the small intestine. When acid is insufficient — which is common and often worsened by proton pump inhibitors — food is incompletely digested and bacteria are not properly controlled, setting the stage for fermentation, bloating, and gut dysbiosis.
3. Gut Dysbiosis
Dysbiosis means an imbalance in the gut microbiome — too many harmful bacteria, not enough beneficial ones, or simply a reduced diversity of species. The gut microbiome influences everything from immune function to mood, and when it is significantly disrupted, the digestive consequences can be profound.
Common causes of dysbiosis include repeated antibiotic use, chronic stress, a low-fibre processed diet, and high alcohol consumption. The resulting instability in the gut environment underlies many of the symptoms grouped under the IBS umbrella.
4. Intestinal Permeability (Leaky Gut)
The lining of the small intestine is a single cell thick in places. It acts as a selective barrier, allowing nutrients in and keeping pathogens and large molecules out. When this barrier is compromised — by inflammation, stress, certain medications, or chronic poor diet — particles that should not enter the bloodstream do so, triggering an immune response.
This systemic low-grade inflammation manifests as gut symptoms, but also as skin conditions, fatigue, brain fog, joint pain, and mood disturbances. Many people with IBS have intestinal permeability as either a cause or a consequence of their symptoms.
5. Food Sensitivities
Unlike true allergies, food sensitivities are delayed reactions — they can occur 2–72 hours after eating, making them very difficult to identify without systematic investigation. The most common culprits are gluten, dairy, eggs, corn, soy, and certain food additives — but in a gut that is already compromised, the list can be much broader.
Importantly, food sensitivities in IBS are often a symptom of underlying gut dysfunction rather than a permanent intolerance. Once the gut lining is healed and dysbiosis is addressed, many previously reactive foods become tolerable again.
6. The Gut-Brain Axis
The gut and the brain communicate constantly through the vagus nerve, the enteric nervous system, and circulating hormones and neurotransmitters. Chronic stress, anxiety, and trauma all affect gut function — slowing motility, increasing gut permeability, and altering the microbiome.
This does not mean IBS is "in your head." It means the nervous system is a legitimate driver of gut physiology, and that treating IBS without addressing the nervous system often produces incomplete results.
Why the Standard Approach Falls Short
Conventional treatment for IBS typically involves:
Dietary advice — usually a low-FODMAP diet
Antispasmodic medications for cramping
Laxatives or loperamide for bowel habit irregularity
Sometimes low-dose antidepressants for gut-brain modulation
None of these address root causes. They manage symptoms. For some people they provide useful short-term relief. But they leave the underlying dysfunction — whatever it may be — entirely untouched.
The low-FODMAP diet in particular, while evidence-based for symptom reduction, is one of the most restrictive therapeutic diets in existence. It was designed as a short-term diagnostic and therapeutic tool, not a permanent way of eating. I regularly see people who have been on it for years, becoming increasingly anxious about food and increasingly restrictive, because no one has investigated what is actually driving their reactivity.
A Better Approach: Investigating, Not Just Managing
A functional approach to IBS begins with a thorough case history — not just of current symptoms but of the full gut history. Key questions include:
When did symptoms begin? Was there a triggering event — food poisoning, a course of antibiotics, a stressful period, a move to a new country?
What is the pattern of symptoms? Do they worsen through the day? Are they worse with certain categories of food or with stress specifically?
What has been tried before, and what effect did it have?
What is the bowel habit pattern? Predominantly constipation, diarrhoea, or alternating?
Are there systemic symptoms — fatigue, brain fog, skin issues, mood changes?
This picture often points clearly toward the most likely root cause or causes, and guides the most targeted investigation and treatment.
Natural Treatment Options for IBS
Once root causes are identified, treatment is personalised. Common elements include:
Addressing SIBO if present — with herbal antimicrobials, dietary modification, and motility support.
Healing the gut lining — with nutrients including L-glutamine, zinc carnosine, and omega-3 fatty acids, alongside anti-inflammatory foods.
Rebuilding the microbiome — with prebiotic fibres, fermented foods (once the gut is ready), and targeted probiotic strains where appropriate.
Supporting stomach acid — with digestive bitters, apple cider vinegar protocols, or specific supplementation where needed.
Nervous system support — breathwork, structured eating patterns, sleep optimisation, and in some cases herbal adaptogens.
Removing reactive foods temporarily — not as a permanent lifestyle, but as a short-term measure while the gut heals.
How Long Does IBS Take to Resolve?
There is no single answer, because IBS is not a single condition. When the root cause is SIBO and it is properly treated, many people see significant improvement within 6–8 weeks. When the picture is more complex — dysbiosis, intestinal permeability, and nervous system dysregulation together — a more comprehensive protocol over 3–6 months is typically needed.
What I can say with confidence is that chronic IBS is not something you simply have to manage indefinitely. In most cases, when the underlying drivers are properly identified and addressed, meaningful and lasting improvement is possible.
Joana Amram is a registered Nutritional Therapist and Naturopath accredited by the ANP (Association of Naturopathic Practitioners) and trained at the College of Naturopathic Medicine in London. She specialises in gut health, IBS, SIBO, microbiome balance, and digestive disorders. Consultations available online worldwide and in-person in Lisbon, Portugal, in English, Portuguese, Spanish, and French.
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Disclaimer: This article is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare practitioner for personalised recommendations.