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Irritable bowel syndrome (IBS) affects almost 50 million Americans or almost one in every six people. You probably know if you have IBS, with its numerous symptoms including bloating or gas, distention, constipation, diarrhea, cramping, and most likely, running to the bathroom after you eat.
Forty percent of all visits to internists are for “functional bowel” disorders such as IBS, and the cost of treating these types of digestive disorders is $107 billion a year.
Still, I see many patients with IBS who have not had success with conventional doctors. That’s because most doctors have no clue how to treat it or what creates it.
Functional Medicine practitioners take a whole new way of thinking about solving the puzzle of chronic symptoms and diseases. IBS provides a fantastic model for illustrating how Functional Medicine works. Even though it creates needless misery for millions of people, this condition is entirely fixable.
Causes Of IBS
In Functional Medicine, we know that one disease can have many causes. On the flipside, one cause can create many diseases, such as with gluten. Put another way, if I see five people with IBS, each might have a different cause. In Functional Medicine, we get to the disease’s cause.
When you narrow things down, there are only five causes of all disease:
All of these can trigger symptoms and create thousands of diseases. Remember those five people with irritable bowel? Each one of them may have different causes for the same symptoms.
There’s a funny joke I always tell about how important it is to know what to do. One patient got his appendix out, and the doctor sends him a bill for $1,000. The patient says, “Wow! That’s a lot of money for such a simple operation.” The doctor replies, “You’re right.” And he sends him a new bill: $1 for taking out the appendix; $999 for knowing what needs to be taken out.
Functional Medicine is sort of like that. We know exactly what to do and how to take things out to make you better. We treat the system, not the symptoms.
The Gut-Brain Connection
An article in TheJournal of the American Medical Association by Dr. Henry Lin mapped out a new way of thinking about IBS and the psychological symptoms seen in irritable bowel patients.
Lin turns the current view on its head by saying that bacterial mischief in the small intestine (from bacteria that migrate up from the large intestine into a normally sterile territory) triggers an immune and nervous system response that sends messages back to the brain, which leads to insomnia, “sickness behavior,” anxiety, depression, and impaired cognitive function.
The gut immune system – sometimes referred to as the second brain – “speaks” to the brain, sending messages of inflammation, which increases levels of corticotropin-releasing factor (CRF) in the hypothalamus. That reaction increases stress hormones, like cortisol, and changes neurotransmitter levels.
Your gut is talking to your brain. And when these bacteria are involved, the communication isn’t good. Little bacteria in our gut start a cascade of immune and neurological events that stop our brain from doing what it was designed to do.
That creates poor connections and communication all around. This is one of the major ways your gut sends signals of ill health to your brain that can manifest as any broken brain and many problems like IBS.
While there are many underlying culprits, research tells us the two main causes of irritable bowel are food allergies and overgrowth of bacteria in the small intestine. Let’s briefly look at each.
Food Sensitivities and Allergies
A landmark 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.
Another article, an editorial in TheAmerican Journal of Gastroenterology, stated clearly that we must respect and recognize the role of food allergies and inflammation in IBS.
Simply put, certain foods can irritate your bowel and digestive system. We call these food sensitivities, and they are very common. They aren’t true allergies like a peanut allergy or shellfish allergy, but rather a more mild food sensitivity that can cause terrible symptoms.
Gluten is the most common food sensitivity. That’s the protein found in wheat, barley, rye, oats, and spelt. It’s a very common reaction even if you don’t have celiac disease, which is a full-blown reaction to gluten. Even if your doctor tells you your tests for gluten antibodies or celiac are normal, you can still have a severe reaction.
Dairy becomes another big problem. This can be caused by the lactose, which about 75 percent of people can’t digest, resulting in bloating, gas, and diarrhea.
Dairy can also create problems even if you don’t have lactose intolerance. Lactaid milk helps with lactose intolerance but not other dairy reactions. Dairy contains proteins, like casein and whey that also can cause irritation and inflammation in your gut.
Many other food sensitivities exist, including soy, corn, and eggs. If you suspect food sensitivities contribute to your IBS or create other problems, I encourage you to eliminate dairy, gluten, and other problematic foods for six weeks and see if your symptoms don’t improve. For a more comprehensive protocol to eliminating food sensitivities, please see this blog.
Gut Ecosystem Imbalances
The surface area of your small intestine, where food is absorbed, is about the size of a tennis court. Your small intestine is also the site of about 60 percent of your immune system.
This sophisticated gut-immune system is just one cell layer away from a toxic sewer: all of the bacteria and undigested food particles in your gut.If that lining breaks down, your immune system will be exposed to foreign particles from food and bacteria and other microbes.
Many things can make your gut lining erode, including:
- Too many antibiotics or anti-inflammatory drugs like aspirin or Advil
- Intestinal infections
- A low-fiber, high-sugar diet
This erosion will trigger and activate an immune response, irritating your second brain that I described above and creating havoc that leads to an irritable bowel, an irritable brain, and other system-wide problems including allergies, arthritis, autoimmunity, mood disorders, and more.
This all makes sense when you consider that 100 trillion bacterial cells exist within your gut ecosystem. There are 10 times as many bacterial cells as your cells, making you only about 10 percent human!
In fact, there are 100 times as much bacterial DNA in your body as there is your DNA. These bugs have to be in the balance for you to be healthy. We call this the human microbiome. If you have bad bugs growing or a yeast overgrowth, or if you have parasites or worms, you can get IBS.
Bad bugs in the wrong spot is also a concern. Most bacteria are in your large intestine, but sometimes they move up and go into the small intestine. That’s not very good because your small intestine should be sterile.
When you eat food that’s starchy like bread, cereal, pasta, rice, or sugary food, the bacteria ferment the sugars in the food. What happens in your gut is very much like when apple cider blows up in an aplastic container in your fridge when it goes bad.
That’s why you get bloating right after meals, which is a very common symptom of bacterial overgrowth. We call that small intestinal bacterial overgrowth (SIBO). SIBO is a real syndrome and was recently described in a review paper published in the Journal of the American Medical Association. Studies show eliminating SIBO can reduce the symptoms of IBS.
How Can You Do This?
A major paper published in the Annals of Internal Medicine showed using a non-absorbed antibiotic called rifampin for 10 days resulted in a dramatic improvement in bloating and overall symptoms of IBS by clearing out the overgrowth of bacteria.
Studies also show that yeast overgrowth can contribute to IBS. It’s sort of like a garden where the weeds take over. Yeast overgrowth happens because of taking antibiotics, steroids, birth control pills, or acid-blocking drugs. It also occurs if you eat a lot of sugar, drink alcohol, or you have diabetes.
When your gut microbial ecosystem is healthy, you are healthy. When you have too many pathogenic bacteria and not enough healthy bacteria, you become sick, inflamed, and more susceptible to problems like IBS.
While research tells us the two most important causes of IBS are food allergies and overgrowth of bacteria in the small intestine, many others can also contribute to this condition, including:
- A lack of digestive enzymes
- Parasites living in the gut
- Zinc or magnesium deficiency
- Heavy metal toxicity
This is precisely why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS. The solution is most certainly not one-size-fits-all. But solutions can be found if we look carefully at the underlying causes and treat them.
I’ve had excellent results treating patients with IBS, and have developed a protocol that can help you address and eliminate this condition. Be sure to read next week’s blog where I will provide a comprehensive dietary, nutrient, and lifestyle protocol that helps address IBS.
Are you like millions of other sufferers who are looking for help? Join my April 10-Day Detox Diet Challenge, where I will be offering a bonus segment on IBS. Receive my NEW IBS Ebook, get support from my Registered Dietitians, learn what to eat and what to avoid, a sample eating plan and shopping list, supplements to heal your gut, and so much more. Click here to join us. Registration closes on April 22.
Wishing you health and happiness,
Mark Hyman, MD.