IBS is a serious disorder and must not be taken lightly. Dr. Trish Murray, Doctor of Osteopathic Medicine, shares her extensive knowledge of IBS or Irritable Bowel Syndrome and its diagnosis and treatments. Being one of the most undiagnosed conditions in the US, its prevalence is one in every four people, and because of the stigma of its diagnosis, digestive discomfort related to it is considered normal already. Dr. Murray discusses in greater detail some of the causes and explains the role of functional medicine on IBS and how it differs from other medical models used today. In this episode, know more on how to prevent and combat IBS using the food elimination diet, the five categories of FODMAP foods, and adhering to the Four R approach to gut healing.
Listen to the podcast here:
What is IBS?
What is IBS? Irritable Bowel Syndrome often referred to as IBS is a chronic gastrointestinal disorder. It is characterized by a host of different digestive dysfunctions and discomfort such as frequent abdominal pain, gas, bloating, indigestion and constipation or diarrhea. You can have either/or and it can wax and wane back and forth between the two. The symptoms and level of severity vary greatly between individuals, but the digestive disorder can be quite disabling. For some, IBS may mean mapping their day around every single public bathroom that they know of, limiting their social life to avoiding going to unfamiliar places and rejecting travel plans due to the behavior of their large intestine. Anxiety and depression are often associated with dealing with IBS and it has the ability to negatively affect one’s emotional, social and professional life. Doctors define IBS as a “functional gastrointestinal disorder,” because although the GI tract isn’t functioning properly, there is no apparent physical damage.
People have colonoscopies or people have upper endoscopies and there’s no structural physical damage found in the gastrointestinal tract. This attitude can encourage a lack of initiative in further research, searching for a cure or questioning the cause of the dysfunction. Instead, most medical professionals are trained to medicate to alleviate symptoms but unfortunately, this does not solve the long-term health problem that people are suffering with. Functional medicine doctors, however, work to discover the why behind the disease as IBS is a collection of different symptoms specific to the individual. The root cause will also likely not be the same for everyone. Ignoring the diversity in this disorder is dangerous because leaving the underlying cause untreated can escalate to a more serious condition such as an autoimmune condition.
Functional medicine is revolutionizing healthcare by empowering patients to better understand imbalances in their bodies. How these imbalances affect your health and the solutions available to support the normal healing mechanisms in the body. Functional Medicine uses conventional medicine practices for acute care but also incorporates complementary and integrative healthcare approaches for prevention and treatment of chronic diseases. Functional medicine differs from other medical models used now due to its defining principles of one, personalized care specific to the individual. Two, focus on the causes of discomfort rather than simply the symptoms. Three, educating and empowering people to use diet and lifestyle changes to heal themselves and four, a deep-seated trust in the body’s ability to heal if the cause of the dysfunction is identified and modified.
IBS is one of the most underdiagnosed conditions in the United States. In fact, studies have shown that the prevalence of the disease ranges anywhere from 10% to 25% of adults. That’s one in every four people. It is unclear the accuracy of these figures. However, due to the stigma and ignorance around an IBS diagnosis, some obstacles include people not consulting with a physician, patients being written off as experiencing psychosomatic symptoms, the attitude that digestive discomfort is “normal.” Regardless, Irritable Bowel Syndrome is the most common functional digestive disorder. Some reports estimate between 38 million and 96 million Americans suffer from IBS in their lifetime. Yet, only 5% to 7% of these people receive a proper diagnosis. IBS is one of the most under-diagnosed conditions in the United States.
IBS Diagnostic Tests
IBS is diagnosed through the process of what’s called exclusion in medicine. This means that extensive lab testing, diagnostic workup and procedures are performed and recorded. If everything comes back normal and the doctors are unable to accurately identify a diagnosable condition, then the patient is categorized by exclusion to having IBS or Irritable Bowel Syndrome. A more straightforward diagnostic system is difficult due to IBS’s lack of apparent one, anatomical or structural problems and two, physical or chemical findings that would be abnormal. What happens is this process strengthens the conventional medicine methods of symptom management versus looking further or working with someone to uncover the true cause of the dysfunction.
Some of the diagnostic tests that would be done and are used to identify Irritable Bowel Syndrome include everything in medicine starts with a medical history and a physical exam. Comprehensive blood tests can be done, a stool analysis can be done. There’s a big range in how a stool can be tested. The basic tests that are done by, for example, the typical traditional primary care doctor is not necessarily the test that’s going to tell any definitive answers. There is a comprehensive stool analysis that can really tell a lot about someone’s microbiome, such as the bugs that live in your colon that are supposed to be there versus the wrong ones. Will it also tell about the function of someone’s upper GI tract such as is there enough acid to digest the foods properly? The type of stool testing that’s done is important whether it’s a basic test or a more comprehensive functional test.
IBS Risk Factors
Another test that can be done is testing someone’s inflammation levels. One way to test that is with blood, one test is called the sedimentation rate and the other is called the CRP, C-Reactive Protein. These are general measures if someone’s body is inflamed. Upper endoscopy is where they go with a tube and they look in a camera and go down and look at someone’s upper GI tract. Another is IgG antibody testing to test for food sensitivities or inflammation. Another would be breath testing to assess for what’s called SIBO. SIBO stands for Small Intestinal Bacterial Overgrowth. Everyone’s experience with IBS is highly individualized, so are the initial causes of the disease. Not everyone fits in the same box as to why they have IBS.
Although IBS is not formally classified as an autoimmune disease, it shares many of the same risk factors, potential causes and complications of the inflammatory conditions we know of now. Some of these include a poor diet such as the Standard American Diet and you’ll notice that if you take the SAD, that stands for an acronym of SAD. Another cause could be leaky gut which the Standard American Diet, which is SAD leads to leaky gut, Small Intestinal Bacterial Overgrowth, another cause could be dysbiosis in the large intestine. We have bacteria in our colon. We have to have bacteria in our colon. We have as much as three pounds of bacteria in our colon and they must be there because we live in a symbiotic relationship with them. If the wrong gang is running the colony of bacteria in your colon and they are not healthy ones, then that could lead down the path to IBS.
Causes Of IBS
Yeast overgrowth or parasites could also be the cause of IBS, food intolerances, antibiotic use. When we do a timeline with people and they talk about in their teens, their childhood or in their early adulthood they were put on antibiotics over and over again for chronic or recurrent infections. That could lead down the path in the future towards Irritable Bowel Syndrome. Toxin exposure can cause IBS. Chronic infections, stress is a big cause of leaky gut and also hormonal imbalances can cause leaky gut. Genetics can also put someone at an increased risk of Irritable Bowel Syndrome. This is a very extensive list of possible causes and if you have multiple of them that they add up on each other and make things even worse. Up next, let’s discuss some of these causes in greater detail.
Leaky gut, the GI tract is naturally permeable meaning that things are supposed to pass through it to be absorbed such as nutrients. It also serves as a barrier to prevent substances that aren’t supposed to enter from entering the bloodstream, such as undigested food particles are not supposed to be digested, microbes such as bacteria, yeast or viruses and as well as toxins. It is supposed to allow the absorption of nutrients such as vitamins, minerals, phytonutrients, proteins, fats and carbohydrates. One of the most vital and basic duties of the cells that line the intestinal wall is to regulate this intestinal permeability. However, when these cells become damaged, they begin to break apart and in turn, allow particles to leak into the bloodstream that is not supposed to.
As this happens, the immune system, which is your military, attacks these substances as they are seen as invaders or pathogens. This results in inflammation and this goes on unchecked can be the initial problem that initiates many different chronic diseases. This dysfunctional process is what is known and called leaky gut. Food intolerances, infections, stress and age, are all factors that affect the gut’s permeability and integrity. As we age, we get more and more at risk for leaky gut. The best way to address leaky gut syndrome is to participate in functional medicines for our program. Studies have reported that approximately 80% of people with IBS suffer from SIBO. SIBO occurs when bacteria migrate from the large intestine up into the small intestine that is not supposed to be there. This results in an overgrowth of bacteria where they’re not supposed to be.
This condition is often fueled by a diet heavy in sugar, alcohol and refined carbohydrates because many of the strains of bacteria indicative to SIBO feed off these anti-nutrients. The use of antibiotics, acid-blocking drugs and steroids can also disrupt the gut flora creating an attractive environment for SIBO. SIBO can be diagnosed by a breath test. This test provides information on the bacterial activity in your body and the best treatment protocol that would be most effective specifically for you. Treatment for SIBO also includes the four R program, dietary changes and sometimes if needed, a prescription of a particular antibiotic can be used called Rifaximin. Rifaximin is a unique antibiotic in that it does not get absorbed into your bloodstream. It stays directly in the GI tract and only has the antibiotic effect in the GI tract and kills the bugs there. That’s why Rifaximin can be used successfully in people with SIBO. Yeast overgrowth can be another cause of IBS symptoms such as bloating, gas, constipation and diarrhea. Instead of bacteria, it is a yeast or a fungus that is overgrown. It’s an out of balance in the gut flora and the most common form of yeast overgrowth is Candida. Candida is a type of fungus that is naturally present in our mouths and in our intestines to aid in digestion and nutrient absorption. Yeast overgrowth can be another cause of IBS symptoms such as bloating, gas, constipation, and diarrhea.
However, when it becomes in excess and it starts to run the neighborhood and becomes the most prominent gang, Candida contributes to the breakdown of the intestinal wall that is a common characteristic of leaky gut. This can lead to a variety of health problems specifically IBS symptoms. Candida feeds on sugar, which puts most Americans at risk due to the incredible increase in sugar in our food supply. Parasites are much more common than most people consider. Contrary to popular belief, you do not need to travel only to a high-risk area out of the United States to be exposed to parasites. In fact, it is not difficult to contract a parasite by the imported food at the local grocery store. Much of our food does not come domestically. It comes from other countries and travels thousands of miles to get to us. Since the parasites are usually ingested, the most common issue they contribute to is digestive damage and compromised nutrient absorption.
Unfortunately, the healthy bacteria in the gut is many times not strong enough to defend against the parasite’s rate of reproduction. The parasite reproduces and reproduces and starts to cause problems. The long story short, parasites are another type of bug that can cause GI dysfunction such as IBS but the good news is they can be tested for, and if present, eradicated. Food intolerances, allergies and sensitivities can contribute to significant digestive distress. They can be very hard to detect for a number of reasons, including you may stop or for more than one, meaning more than one food causes a problem for you. Elimination testing takes time and effort. It needs to be done correctly. Not everyone reacts the same to food sensitivities and symptoms of food intolerance can easily be misinterpreted. Luckily, there are several ways to test if you are suffering from a food allergy or intolerance.
First of all, immunoglobulins or antibodies are created by your immune system to fight against pathogens that invade the body and there are different antibodies. IgE is the antibody that typically rises when we have an allergic reaction. Allergic reactions to food such as peanuts or eggs are immediately obvious with breaking out on the rash or itching all over or hives, abdominal pain or even breathing problems. If a person has a food allergy, they typically know it right away and they know that they must avoid that food substance completely or anytime they get exposed to it, the reaction may even get worse. In Immunoglobulin G or IgG is different. This is a different antibody and it is the most abundant antibody in the human body. It is found in all of the body’s fluids and works as a protection mechanism against bacterial and viral infection. It is also the antibody that will be elevated in food what are called sensitivities, not allergy, but sensitivity.
It may not rise immediately in reaction to food. It can actually take up to 72 hours for this antibody IgG to rise and cause any GI dysfunction or other symptoms in other systems of your body. This time delay is why it is so difficult to many times identify what food categories we may be sensitive to. There are blood tests available to check for both IgE and IgG antibody levels to specific foods for allergies and sensitivities, but the IgG tests are not standardized from lab to lab. This is why doing a comprehensive elimination diet is considered the gold standard way to identify a person’s food sensitivities. An elimination diet refers to the process of eliminating foods that may be sabotaging your health to see if you feel better. Once you feel better and you’ve quieted your immune system, then you systematically re-challenge the different food categories to identify your individual food triggers.
The elimination portion of this diet takes three weeks, 21 days because that amount of time allows for any adverse food reactions to dissipate it. The goal is to bring your body and your immune system to a blank slate and allow your immune system to quiet down. During the first week of an elimination diet, you may not feel very well as your body is the detoxifying. Until week two and three, most people that do have food sensitivities have said to me time and time again, “I have not felt this good in the last several years of my life. I feel fantastic.” On day 22, you’re going to begin to reintroduce food groups individually or as categories. This gives you the opportunity to really recognize how each individual food or category makes you feel and therefore be able to identify which food makes you feel ill. The common food offenders as far as IBS, food intolerances and digestive stress include dairy, gluten, soy, corn, nightshade vegetables including peppers, potatoes, tomatoes and eggplant, eggs, refined sugar, peanuts, red meat, alcohol, caffeine, hydrogenated oils, and packaged and processed foods. Don’t worry, I know that sounds like, “What do I eat?”
There are plenty of foods you can eat during the three weeks of the elimination diet. Unless advised otherwise individually, the following foods are safe and encouraged to consume during the elimination diet. When you do an elimination diet, it is not about restricting calories. The volume of the food you eat is not restricted in any way. What is restricted is the categories I already listed, but you can eat gluten-free grains such as rice, quinoa, amaranth, tapioca, buckwheat and teff. You can drink all the dairy substitutes or eat the dairy substitute you choose, almond milk, coconut milk, hemp milk, rice milk. Vegetables galore except for the few I’ve mentioned such as corn and nightshade vegetables. You can eat all the whole fruit you want. It can be fresh, frozen and water-packed. Lean and clean animal protein such as wild game, lamb, organic chicken, turkey and fresh fish are all fine. Nuts and seeds are fine except for peanuts and peanuts are actually not a nut, they’re a legume. Beans and most legumes are acceptable except for soybeans and peanuts. You can also ingest high-quality oil such as coconut oil, avocado oil and cold-pressed olive oil.
Herbal teas are fine and sweetener alternatives in moderation such as black strap, molasses, brown rice syrup or monk fruit. Spices are allowed. During the reintroduction phase of the elimination diet, it is incredibly important to pay attention to how each food makes you feel. This is probably the most important part of the diet. You survived the three weeks and didn’t ruin it by going out and having a pizza and a beer because you’re going to lose the opportunity to reintroduce food groups one-by-one for 72 hours at a time. You would pick one food category to include into your diet again. Take note of how it makes you feel for the next three days. If any time during those three days you experienced negative symptoms, then this is your sign that you have a sensitivity to that food category and you should eliminate it again.
If you do not notice any issue for those three days, then you can choose to reincorporate that food into your regular diet as you do not have a sensitivity to that food. Continue following these steps with the remaining eliminated food category and if any seem to cause any discomfort, stop eating them and wait until any symptoms subside before continuing on with the re-challenging process. Note that it is imperative to allow the adequate amount of time for both the elimination and the reintroduction phases to ensure you receive the most accurate results possible. I explained this entire process in my book called Make a D.E.N.T in Chronic Disease and it is one of the first steps we support people within our DENT program at Discover Health Functional Medicine Center. The D in the DENT stands for Detox and involves implementing a comprehensive elimination diet I call the Detox Plus Program. Beyond the foundational comprehensive elimination diet concept, there is another diet that those with Irritable Bowel Syndrome need to consider and this is called the FODMAP diet. Digestive enzymes assist in the breakdown of food and aid in nutrient absorption.
FODMAP is an acronym that stands for the F is Fermenting, O for Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Oligosaccharides, disaccharides, monosaccharides, polyols are all a different type of sugar that in some people initiate the IBS symptoms of bloating, gas and inflammation in the intestines. At times, people with IBS, I recommend overlapping the FODMAP diet on top of the elimination diet. I get it that this makes the diet even more restrictive, but it can make all the difference in the world to a FODMAP-sensitive patient. There are five categories of foods within the FODMAP concept that consist of the following five categories. Fructose, certain fruits and sweeteners that are high in fructose will cause IBS symptoms. The next category is lactose, so milk, cheeses and dairy products. You’ll notice lactose, for example, in dairy products, you’ll already be eliminating in a comprehensive elimination diet. That one’s already gone. Certain fruits would also then be eliminated for the high fructose fruits like apples and pears, for example.
The next category of the five FODMAP categories is fructans and certain vegetables are high in fructans. You would think broccoli is extremely healthy and I will share my experience and the fact I was eating broccoli numerous times a week before I ever learned of the FODMAP diet and I suffered for years with Irritable Bowel Syndrome. When I learned the FODMAP and I put myself on the FODMAP diet, within two weeks I no longer had any symptoms of IBS. There are galactans which are usually different types of beans such as black beans, chickpeas and lentils. Polyols is another sugar, cauliflower, mushrooms, any type of sweetener like xylitol are polyols. These are the different categories within the FODMAP diet that could be the ultimate cause of your IBS. These categories can be re-challenged, can be eliminated, then re-challenged similar to the elimination diet concept to identify which category or multiple categories of these five an individual is sensitive to.
Years ago when I started learning functional medicine and I was learning different things along the way, I had IBS for years. We all know that story of feeling bloated, full of gas, sitting on the toilet in the middle of the night and wanting to empty but never feeling like you’re emptying even though you feel like you need to go. I experienced this. I know what it feels like and I get it. When a patient came in on the FODMAP diet and that brought this concept that I had heard of, but I hadn’t learned or read about yet up to the top of the pile of things I was learning at the time. I said, “I eat this food just about every day.” When I put myself on a FODMAP diet, eliminating the different categories for three to four weeks, within two weeks, my symptoms of IBS were gone. I have followed essentially a low FODMAP diet for years now. I can get away now and then with some broccoli here and there now, but I can’t eat it every day for a week or three or four days. That’s going to cause a real problem. The point here is the FODMAP diet is another diet specific to IBS that could change your life.
The Four R Approach To Gut Healing
Let’s get down to besides the diets implementing the four R approach to healing your gut and the four R program is administered to heal from digestive distress, reverse gut complications, rebalance your gastrointestinal microbiome. It is an incredible tool to acknowledge and treat health issues, dysfunctions imbalances and personal health needs. What are the four Rs? First of all, the first R stands for Remove and what that means is to remove and eliminate problem foods, aka back to the elimination diet. It’s also eliminating toxins, eliminating any low-grade infections such as SIBO or other types of pathogens or yeast or things like that and also reducing and removing oxidative stress. Diet, detox, antimicrobial herbs, antibiotics sometimes, educating oneself about the clean fifteen and the dirty dozen. Educating oneself about clean, non-toxic cosmetics and home cleaning products are all part of the remove portion of the four R approach.
Number two, the second R stands for Repair. Begin reintroducing a clean diet with essential nutrients your body needs. Drink bone broth and take L glutamine or Slippery Elm, for example, to repair and heal the mucous membrane of your gut lining. The third R stands for Restore which means repopulate the gut with healthy bacteria to restore the proper balance of gut flora and that might mean taking probiotic supplements and/or eating fermented probiotic food and even prebiotic food. The fourth R stands for Replace. Replace digestive enzymes, replace antioxidants, replace immune-boosting vitamins and promote sustainable and healthy digestion. We as functional medicine practitioners are trained in this four R protocol and enthusiastic about making sure your individual needs are addressed during this process.
Probiotics are live bacteria that promote a healthy balance of bacteria throughout the digestive tract. They can be naturally found in food such as yogurt, kefir, sauerkraut, tempeh, miso, kimchi and kombucha. Prebiotics are a type of plant fiber and act as fertilizer or food for the probiotic bacteria that already live in your colon. In short, prebiotics is needed for probiotics to thrive within your digestive system. Prebiotics are found in food such as artichokes, garlic, onion, asparagus, beans and apples. These are some of the examples of high-fiber food. When we eat this high-fiber food, we do not digest them. The bacteria in our colon digest fiber for us. The bacteria that digest the fiber then give off what are called short-chain fatty acids and these short-chain fatty acids are the fuel that feeds the cells that line our colon. This process and this example I’ve explained is the perfect example of how we live in a symbiotic and mutually beneficial relationship with the good bacteria in our microbiome. Without them, we would not survive.
We must have them in our colon. You absolutely must optimize the probiotics that are living in your colon or you will not be healthy. Digestive enzymes assist in the breakdown of food and aid in nutrient absorption. According to a study published in 1999, taking digestive enzymes after a high-fat meal reduced many of the discomforts that people with IBS experienced such as gas, bloating and uncomfortable fullness. Another study that was done in 2011 studied IBS patients’ reaction to digestive enzymes compared to a placebo group, meaning a fake pill. Those taking the true digestive enzymes demonstrated a significant decrease in symptoms so they demonstrated an improvement in a decrease in symptoms including their gas, their bloating and their abdominal pain.
Other important nutrients and supplements suggested for those suffering from Irritable Bowel Syndrome may sometimes include supplements such as fiber such as Inulin, L glutamine and Slippery Elm, vitamin B complex, omega-3 fatty acids such as fish oil, magnesium, calcium, vitamin E, glutathione. Glutathione is not put out by your liver, that’s the number one thing that will help you detoxify any toxin in your body. Melatonin will also help improve your digestive tract, peppermint oil and ginger. Everyone’s needs are different, so it’s very important to get the proper nutritional testing and follow your functional medicine doctor’s recommendations for your individual supplement needs. The exposure to toxins we experience on a regular basis can build up in our systems, weaken our immune and digestive functions and truly deplete our body’s ability to heal. Different forms of toxic exposure include pesticides on our food, air pollution, water contamination and toxic chemicals in household products such as cleaners, cosmetics and exposure, for example, through someone’s employment in factories or this or that. Even if they do artwork with metals, you can be exposed to heavy metals.
Ways to practice prevention and help you detoxify include proper nutrition, hydration, proper amounts of water intake, particularly clean water. You do want to have your water filtered if you need it. You should have your water tested at your home. Air purification systems, exercise because it is going to cause you to sweat and also move things through your GI tract and through your urinary system better and so we’re going to eliminate the toxins that we take in. Sweating with hot baths or exercise or even infrared saunas. We’ve got an infrared sauna at Discovery Health Functional Medicine Center and the first infrared sauna for anyone is free because it’s a solo sauna where you lay comfortably on a massage table and you pull the sauna up over your chest. You sit listening to wonderful music all by yourself and it’s completely relaxing but you’re also sweating and detoxifying at a deep level. Another one would be toxin-free personal items, you want to learn about the different cosmetics that would not be toxic to you.
The last but certainly not least is stress relief. Managing stress is one of the most single-handedly important things you can do to support, optimize and sustain your health. Studies have supported that a high-stress level increases the rate of IBS complications. It aggravates symptoms, lengthens the time of an exacerbation episode and decreases the rate of repair of the digestive damage. As the gut and central nervous system are closely related, your gut is actually called your second brain and serotonin, people with depression who are put on selective SSRIs which stands for Selective Serotonin Reuptake Inhibitors. The majority of your serotonin comes from your gut, so it really comes from your second brain, not your first brain. It is incredibly important to find stress management techniques that will work well for you. Some examples include deep breathing, exercise such as yoga or walking in the woods, massage, meditation, creative arts, spending time with loved ones and relaxation time, going outdoors. Things like aromatherapy or also a modality called neurofeedback which is biofeedback for your brain, which is another modality that we have at Discovery Health Functional Medicine Center. There are many more.
Thank you for taking the time to read this blog on combating IBS. I hope you can tell that I am passionate about sharing this topic with people who are eager to transform their lives and finally achieve optimal health. This is everything that we’re about at Discover Health Functional Medicine Center. If you have any further questions, you could go to my website, DiscoverHealthFMC.com. There is a way on my website to schedule a free 30-minute phone consult with myself or our health coach, a person of one of our team, where you can get to know us so we can get to know you and see if there’s a fit and talk about what programs would be best to help you optimize your health. Take care.