Diagnosis and treatment. That used to be our goal. Identify a constellation of symptoms and determine a diagnosis. Give it a name. Find a drug to treat it. “Name it, blame it and tame it” as they say. But in the case of IBS, focusing on a diagnosis caused us to ignore what was really going on inside the gut. Irritable bowel syndrome or IBS is a diagnosis. And a diagnosis of exclusion at that. In other words, after an exhaustive (by conventional standards) search for a cause for your abdominal pain, bloating, diarrhea and/or constipation everything turned up “normal.” You may have been given Metamucil, sedatives, anti-spasm drugs or antidepressants. But you still have abdominal pain, bloating, diarrhea and/or constipation. What now?
While the understanding of IBS appears to be (hopefully) changing, it has long been considered a “psychosomatic” disorder, which is a way of suggesting it’s all in your head. With functional medicine, however, we have so many tools to understand the root cause of these symptoms and fix them, rather than resorting to an ineffectual diagnosis. We don’t believe in IBS; there is something going on causing your symptoms and we believe that we can find it.
In Functional Medicine, we know that one disease can have many causes. In other words, we may see 5 patients with IBS and each of them may have a different cause of their symptoms. For example, your GI symptoms may be related to a food allergy or sensitivity. Someone else may have bloating and constipation caused by overgrowth of bacteria in the small intestine. Yet another person may have the same symptoms stemming from a deficiency of digestive enzymes. This is why it is so important to look for the root cause of the symptoms in each individual. IBS is extremely common and there are many culprits that contribute to this disorder. Our GI system is bombarded with things like too many antibiotics, anti-inflammatory drugs like NSAIDs or aspirin, steroids, intestinal infections, alcohol, tons of sugar and very little fiber. Add stress on top of that and it is no wonder we see this problem so often. These insults damage the lining of our gut, interfere with our immune system that is lining our gut, and lead to an unhealthy mix of bad bacteria and yeast living there. More simply put, IBS may be caused by food sensitivities, toxins, poor diet, stress and an imbalance of bacteria or microbes in the gut.
Let’s focus on the two major causes of IBS—food sensitivities and overgrowth of bacteria in the small intestine, or SIBO. Food sensitivities are caused by an IgG antibody immune response and are different than a food allergy as you may think of with peanuts or shellfish. They are very common with the most notorious culprit being gluten. And while the most serious sensitivity to gluten occurs in those with celiac disease, even if all your tests for gluten antibodies or celiac are normal, you may still have a major reaction to gluten (a.k.a. non-celiac gluten sensitivity). Other very common offenders are dairy, corn, soy, and eggs. So, the first step to uncover the root cause of IBS is a comprehensive elimination diet. A comprehensive elimination diet is the gold standard for diagnosing food sensitivities and is relatively simple (although not easy!) to perform. First, we eliminate the most common foods that people are sensitive to for a period of at least 21 days. This is followed by a reintroduction period to determine if any of these foods are the problem. An elimination/reintroduction process can be very helpful in both discovering and treating food sensitivities. SIBO, another major cause of IBS, stands for Small Intestinal Bacterial Overgrowth. Standard American Diet, antibiotic use, stress, and certain medications can contribute to the development of SIBO. This causes bacteria to grow in the small intestine which is usually relatively sterile. These bacteria feed on certain foods that you eat, particularly ones that are in the FODMAP category. This results in gas production which causes severe bloating, diarrhea, and even constipation. Treating SIBO with dietary changes, antimicrobial herbs, or antibiotics can greatly relieve IBS symptoms. If you have SIBO, avoiding high FODMAP foods can improve your symptoms as well. FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides And Polyols, and if these particular groups of foods cause you bloating and GI discomfort then SIBO may be your problem. If you are struggling with IBS symptoms, an elimination diet or a low FODMAP diet should be your first step. You may also need lab and stool testing to determine if there are other factors contributing to your condition.
We would love the opportunity to work together with you in uncovering the true cause of your “IBS” and formulate a comprehensive treatment plan that get rid of your symptoms and improve your gut health.
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