Irritable bowel syndrome is a gastrointestinal (GI) disorder characterized by chronic abdominal pain, bloating and irregular bowel habits in the absence of any identifiable cause. It is the most commonly diagnosed gastrointestinal condition in this country affecting approximately 60 million people. That amounts to 20% of our total population, in fact, IBS related symptoms are the second most common cause of lost time at work in the country after the common cold.
The difficulty with evaluating and treating IBS is that there is no known cause and no test to confirm a diagnosis. When certain symptoms are present such as abdominal pain, diarrhea, or constipation, IBS can be diagnosed if no other condition is identified. In other words, once all other diagnosable conditions have been ruled out, IBS becomes the diagnosis by virtue of exclusion.
For this reason I believe there are several functional conditions that are likely being grouped together inappropriately as IBS. This is likely due to only partial understanding of the disease.
There are a few common causes of IBS that we have found that once addressed, will dramatically improve the health and well-being of people suffering from this condition.
- Microbial imbalance in the large intestine
- Food Sensitivities
- Bacterial overgrowth in the small intestine
- Yeast overgrowth in the GI tract
Under production of digestive secretions such as hydrochloric acid and pancreatic enzymes.
There are 10-20 times more bacteria living in your gut than total cells in the human body. In fact, there is more bacterial DNA in your body than human DNA! These microbes play a vital role in proper GI and immune health.
Some of these microbes are beneficial to your health and some of them are destructive. A healthy balance of beneficial intestinal microflora is responsible for maintaining the gut lining and keeping your immune system functioning correctly. The gut lining determines what nutrients are able to pass into your blood stream and what becomes waste. When there is overgrowth of bad bacteria in the large intestine, inflammation ensues and the intestinal barrier becomes porous allowing larger food particles and pathogens to enter the blood stream.
Most antibiotics are not selective between beneficial and harmful bacteria and will destroy the good flora which help maintain the gut lining. This provides the opportunity for pathogenic bacteria and yeast to grow in the large intestine resulting in many negative effects throughout the body including the symptoms associated with IBS.
A functional stool analysis can assess the bacterial balance in your large bowel and determine if there is overgrowth of pathogenic microbes including yeast. This is a vital test for anyone that has a history of antibiotic use. Treatment then consists of killing off the identified harmful pathogens and then repopulating the GI tract with high potency probiotics.
Food Sensitivities
It might be surprising to learn, but roughly 70% of your immune system is located in your GI tract. This immunity is what determines what is safe to assimilate and what needs to be destroyed. At birth and throughout the first few years of life your immune system is becoming programmed to determine what is safe and what is harmful and needs to be destroyed. Increasingly, we are seeing immune systems that are programmed to destroy common foods in the diet leading to food sensitivities.
Corn, gluten, dairy, nightshade vegetables, eggs, and soy are some of the most common food sensitivities. When your immune system is programmed to destroy a certain food molecule and you continue to eat it on a regular basis it will fatigue your gut immunity and result in inflammation of the gut lining.
Identifying and removing food sensitivities through IgG/IgA antibody testing or through an elimination diet dramatically improves symptoms associated with IBS in the majority of my patients.
Bacterial Overgrowth in the Small Intestine
The small intestine is normally free from bacteria. The acid in your stomach serves as a barrier to the bacteria you consume with your food helping to keep the small bowel sterile. Acid blocking drugs like Prilosec, Prevacid, or Nexium remove this vital barrier and allow bacteria to move through the stomach and set up shop in the small intestine.
These bacteria can ferment food as it travels through your small intestine causing a production of hydrogen and methane gas that results in bloating, cramping and a feeling of fullness after meals. The bacteria in your small intestine are having lunch on your lunch!
Small Intestinal Bacterial Overgrowth (SIBO) is diagnosed with a simple breath test. Treatment consists of killing off the bacteria in the small bowel with an antibiotic called Rifaximin and then repopulating with probiotics. Reestablishing optimal acid production in the stomach helps to prevent the problem from coming back.
Conclusions
People who have symptoms of IBS do not need to suffer. Following these three simple steps has helped the majority of my patients be free of IBS and improve their quality of life.
Get a stool analysis to assess the balance of bacteria in your large intestine. If there is overgrowth work with your doctor to eliminate the bad guys, heal your gut lining and repopulate with good guys.
Get an IgG/IgA antibody test for food sensitivities and eliminate the offending foods from your diet. Following a hypoallergenic diet for 6 weeks and then reintroducing suspected foods is another option for determining food sensitivities.
Do a hydrogen/methane breath test to assess for Small Intestinal Bacterial Overgrowth (SIBO). If it is positive, ask your doctor to prescribe Rifaximin (two 200 mg tablets BID for 7-10 days). Repopulate the gut with a high potency probiotic and reestablish optimal acid levels in the stomach.
