60 million Americans (20% of our population) suffer from Irritable Bowel Syndrome (IBS), a condition so severe that often prevents them from leaving their home even for short trips. Often, these patients are told this condition is “psychosomatic”, which in plain language means “it’s all in their head”. They may be prescribed antidepressants, sedatives, anti-spasmodic drugs, told to take more fiber, and left to suffer for years. Some of my patients have suffered from these symptoms for decades. However, this illness is very real with its incapacitating symptoms of bloating, cramps, diarrhea, constipation, and pain. All the prescription meds given for IBS do not improve patients’ condition because they disregard the underlying causes of this syndrome. I have been successfully treating IBS and other digestive conditions by using a science-based, functional medicine approach.
Our Digestive System
Our intestine is designed to digest and absorb nutrients. Its inner lining has the surface of a doubles tennis court and the thickness of one single layer of microscopic cells. Up to 70% of our immune system is located in the intestinal wall, creating a sophisticated gut-immune system. Together with the single layer of cells, the gut immune system creates a protective barrier against bacteria, viruses, undigested foods, and many other particles present in our gut.
Stress, a low-fiber, high-sugar diet, alcohol, too many antibiotics or anti-inflammatory drugs (i.e., ibuprofen, aspirin or Advil, steroids), intestinal infections, and more – damage this intestinal defense barrier. Exposure to foreign particles from food and bacteria and other microbes can trigger and perpetuate the gut immune response, potentially causing allergy, irritating our intestine, leading to what we call irritable bowel syndrome. This immune activation may extend beyond the intestinal environment, causing system wide problems such as allergy, arthritis, autoimmunity, mood disorders, and even ADHD do to the disruption of the enteric nervous system (the second brain).
Unbalanced Intestinal Bacteria
It is important to maintain a healthy intestinal bacterial flora (microflora), which prevents opportunistic bacteria from thriving and participates in the regulation of the gut-immune system. When your gut bacteria are out of balance, either by having too many pathogenic bacteria or not enough healthy bacteria, you can become sick. You have approximately 3 pounds of bacteria, roughly 500 species in your gut. In fact, there is more bacterial DNA in your body than there is human DNA. Among all that gut bacteria, there are good and bad bacteria.
If you have predominantly bad bacteria or if they move into the small intestine, which is normally sterile, they can start fermenting the food you digest, particularly sugar or starchy foods. Bacterial flora thrives in this environment, causing small bowel bacterial overgrowth (1), which is a major cause of IBS. Patients suffering with IBS complain of bloating, feeling of fullness after meals, or increase amounts of gas (flatulence). These symptoms are caused by the thriving intestinal bacteria enjoying their lunch. SBBO can be easily diagnosed by either a breath test of a urine test. The breath test measures the gas produced by the bacteria, while the urine test measures the byproducts of the bacteria, which have been absorbed into your system.
IBS and SBBO are real syndromes. A recent review article published in the Journal of the American Medical Association (JAMA) (1) described the causes and mechanisms responsible for the development of these syndromes. Another articled published in the peer reviewed journal Annals of Internal Medicine presents effective treatment options for clearing out the overgrowth of bacteria (SBBO), thus dramatically improving the IBS symptoms in only 10 days. (2)
Often, I find patients with significant yeast overgrowth, especially when their beneficial bacteria are depleted. It is important to remove the yeast and replenish as many species of the good bacteria as possible using specific prebiotics and probiotics.
While this is great news for many IBS patients, there are some that have more than one cause for their IBS symptoms. These patients have several food sensitivities, which are not true allergies, but low-grade reactions to foods, causing many chronic symptoms including IBS. These symptoms occur 2 hours up to 72 hours after exposure to the offending food, making it difficult to identify the specific trigger.
A breakthrough paper, was recently published in the prestigious British medical journal Gut that found eliminating foods identified through delayed food allergy testing (IgG antibodies) resulted in dramatic improvements in IBS symptoms.(3) Another article, an editorial in the American Journal of Gastroenterology, stated clearly that we must respect and recognize the role of food allergies and inflammation in IBS.(4)
Other causes of IBS may be insufficient digestive enzymes, presence of parasites living in the gut,deficiency of nutrients such as zinc, magnesium or fiber, even heavy metal toxicity, and more. If IBS stays untreated for long time, patients may develop a local (gut) inflammatory response, which in time may become systemic.
And this is precisely why it is so critically important to receive a personalized treatment based on your unique circumstances. It is essential to identify your underlying causes and treat them. The key is to effectively treat the cause. The science is clear, and we have the tools to treat this chronic problem which affects 1 in 5 people. There is no need to wait for any more research. Every week, patients tell me how much better they’ve been feeling since their IBS symptoms are gone.
Healing Irritable Bowel Syndrome
I recommend that you follow this 5 step by step protocol:
- Get tested for food allergies (IgE) and sensitivities (IgG)
- Eliminate all positive foods (according to your blood test results) for 3 months. If testing is not an option, try an elimination diet for 2-4 weeks. We can provide you an easy to follow comprehensive elimination diet.
- Balance your intestinal bacteria – get rid of the bad bacteria and/or yeast and reintroduce the beneficial bacteria.
- Improve digestion – use digestive enzymes with every meal to properly break down your food and prevent new food sensitivities. We can recommend specific products for your particular condition.
- Reduce intestinal inflammation – some patients may need specific nutrients that help heal the intestinal lining.
By seeking out your underlying causes of IBS and following the above recommendations, you can dramatically improve your health and overcome your digestive problems.
(1) Lin, H. (2004). Small intestinal bacterial overgrowth. The Journal of the American Medical Association. 292:852-858.
(2) Pimenetel, M., Park, S. Mirocha, J. Kane, S., and Y. Kong. (2006). The effect of nonabsorbed oral antibiotics (rifaximin) on the symptoms of irritable bowel syndrome. Annals of Internal Medicine. (145)8:557–563.
(3) Atkinson, W., Sheldon, T.A., Shaath, N., and P.J. Whorwell. (2003). Food elimination based on IgG antibodies in irritable bowel syndrome: A randomized controlled trial. Gut. 53:1459–1464
(4) Shanahan, F. and P.J. Whorwell, M.D. (2005). IgG-mediated food intolerance in irritable bowel syndrome: A real phenomenon or an epiphenomenom? The American Journal of Gastroenterology. 100:1558–1559.