A Functional Medicine Approach To IBS

IBS (irritable bowel syndrome) affects between 25 and 45 million people in the United States and is the second most common cause of missed work each year. Yet, it is commonly dismissed in the medical world.  

But integrative medicine practitioners may have an edge up on finding the root cause.

Integrative practitioners are like personal medical detectives, leaving no stone unturned when it comes to chronic disease. We know there are many reasons for digestive discomfort. With a combination of a detailed questionnaire plus specialty lab testing, functional medicine practitioners have a good chance at helping patients narrow down their exact cause of IBS.

IBS Signs & Symptoms

IBS is considered a functional GI disorder that features recurrent abdominal pain or discomfort associated with bowel changes and other possible symptoms such as gas or bloating.

IBS is broken down into two types IBS-D (Diarrhea) and IBS-C (Constipation). Patients can have a combination of both IBS-D and IBS-C, as well as a host of other digestive symptoms.

IBS patients may also experience mood and anxiety disorders due to the gut-brain connection.

Common IBS Symptoms

• Constipation
• Diarrhea
• Inability to empty bowels (or feels incomplete)
• Indigestion
• Nausea
• Passing excessive amounts of gas
• Urgent need to defecate
• Abdominal cramping or discomfort
• Anxiety
• Depression

IBS Possible Causes

Many patients who suffer from IBS may also suffer from dysbiosis (unbalanced gut bacteria), SIBO (small intestinal bacterial overgrowth), underlying food sensitivities or EIP.

Dysbiosis

Dysbiosis is an imbalance of good vs. bad bacteria in the gut. When your body is in dysbiosis, your health may decline. Your gut microbiome affects many things in your body, including immunity, digestive health, and mental health.

There are three main types of dysbiosis, and it is not uncommon to have a combination of of type 1 and type 2.

Type 1. This form of dysbiosis is caused by a loss of good bacteria from your gut.

Type 2. When you have too much growth of harmful bacteria.

Type 3. Dysbiosis can also happen when you lose your overall gut microbiome diversity, and this means you lose both the good and the bad bacteria in your stomach.

Dysbiosis Symptoms

• Chronic fatigue
• Digestive problems
• Acid reflux or heartburn
• Food intolerance, gas, and bloating
• Inflammation and aching joints
• Acne, skin rashes, and psoriasis
• ADHD or issues with concentration
• Anxiety or depression

Dysbiosis Testing and Treatment

Most functional medicine practitioners will utilize a specialty stool test to get an overview of the good versus bad bacteria balance in your gut.

Depending on the type of dysbiosis you have, a practitioner may recommend a specific diet and antimicrobial herbs to kill off harmful bacteria along with probiotics and a fiber-rich diet to improve good bacteria.

SIBO (Small Intestine Bacteria Overgrowth)

SIBO can affect up to 80% of patients with IBS and is a variation of dysbiosis where the bacteria meant for your large intestine has overgrown and set up in the small intestine.

Unlike your large intestine, your small intestine typically has relatively few bacteria due to the rapid flow of contents and the presence of bile. But if the small intestine’s function has slowed, it causes an ideal breeding ground for the overgrowth of bacteria.

SIBO Symptoms

• Bloating worse at the end of the day
• Constant Burping
• Patient feels better on Low FODMAP diet
• Patients’ symptoms get better after antibiotic treatment
• Feel worse after taking probiotics or eating fermented foods
• An uncomfortable feeling of fullness or gas immediately after eating
• Loose stools

SIBO Testing and Treatment

Practitioners will test for SIBO by doing a two or three-hour at home breath test on patients. If patients’ results are positive, the practitioner will treat the overgrowth with specific herbs that kill off their type of bacteria overgrowth, nutritional therapy to balance the gut flora, and prokinetics to help increase small intestine motility. One of the most important things when it comes to SIBO is getting to the root of what caused it in the first place to prevent future relapse.

Food Sensitivities

Food sensitivities are extremely common and seem to be on the rise; in fact, it is estimated that up to 20% of the world’s population may have a food intolerance.

Food sensitivities differ from allergies as they won’t trigger an immediate immune response. Food sensitivities symptoms can show up days after the ingested food. If a patient continues to consume the food, the body is attacking; this can cause digestive disorders and inflammation in the gut leading to more severe long-term issues.  

Food Sensitivity Symptoms

• Bloating
• Abdominal pain
• Diarrhea or constipation
• Headaches
• Brain Fog
• Fatigue
• Joint pain
• Skin conditions (eczema, psoriasis, acne)
• Depression or anxiety
• Anemia
• B12 Deficiency

Food Sensitivity Testing and Treatment

Food Sensitivity testing can be very useful to help narrow down the exact foods your body may be reacting to. Most practitioners will put their patients on an elimination diet for 6-12 weeks to ease symptoms and allow the body time to stop making antibodies against these foods. The good news is, after treatment, most patients are able to reintroduce those foods again into their diet.

Exocrine Pancreatic Insufficiency (EPI)

(EPI) is a condition when the pancreas does not make enough digestive enzymes. Without the proper amounts of digestive enzymes, patients struggle to break down foods and absorb nutrients properly. As a result, the food that passes through your intestines is not entirely digested and can lead to bloat, gas, loose stools, and, eventually, lead to malnutrition.

Exocrine Pancreatic Insufficiency Symptoms

People with EPI have a challenging time absorbing fats from foods. This leads to uncomfortable digestive problems, such as:

• IBS symptoms like gas, bloating, constipation, and diarrhea

• Fatty stools

• Unexplained weight loss

EIP Testing and Treatment

Most practitioners will rule this out with a comprehensive stool test. They commonly use this test to check the stool for the presence of the elastase enzyme. Little (or no) elastase can indicate EPI. It can also show if there is any fecal fat in the stool sample, another indicator of EIP.

Treatments focus on helping the patients get the proper enzyme levels and nutrients needed to maintain good health.

Pancreatic enzyme replacement therapy (PERT): Finding the ideal dosing of PERT for a particular patient can be challenging because the response to treatment is widely variable from patient to patient. In general, enteric-coated formulations are preferred because of gastric acid protection.

Higher-calorie, high-fat diet: It’s essential to get enough calories and fat with your meals. Fat helps your body absorb nutrients.

Multivitamins: Patients may need to take prescription vitamins to help maintain proper nutrient levels.  

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Summary

IBS is a common GI disorder that is often overlooked and can be challenging to diagnose and treat. By utilizing specialty testing and developing a personalized treatment plan, healthcare providers can provide patients with relief and improved quality of life.