What Is IBS?
IBS, stands for irritable bowel syndrome. It is a group of very common symptoms such as:
· Gas
· Chronic bloating
· Cramping
· Constipation
· Diarrhea
We all experience mild gastrointestinal (GI) discomfort every now and then with the symptoms I listed above. It’s when these symptoms last for months and years that IBS is diagnosed.
IBS can be very disruptive depending on the severity of your symptoms. Some, a lucky few, have mild discomfort every now and then. While others find it difficult to enjoy a normal lifestyle due to their symptoms.
Emotional Anxiety and IBS
IBS can cause fear of embarrassment, this can lead to anxiety. Anxiety and IBS interfere with quality of life. Most with IBS inherently know to look for the closest rest room and know where one is at all times. This can make a Sunday drive, a plane ride or a leisurely stroll problematic. Uncontrolled IBS takes a toll emotionally, affecting relationships, intimacy and your ability to socialize. Financially, IBS can lead to medicine cabinets full of over-the-counter (OTC) products that worked one time but no longer offer relief. Physically, well, it should be obvious, any disruption of your digestive system for any length of time will affect every other aspect of your health; fatigue, pain, weakness, thinning hair, poor sleep and anxiety are common.
When does occasional GI symptoms become IBS symptoms?
Irritable bowel syndrome, like most syndromes doesn’t have a clear cause and is ultimately diagnosed by its many symptoms. About 20% of the population have IBS.
If the above symptoms go from occasional to frequent over a few months, with changes in the consistency of your bowel movements, you may be looking at a diagnosis of IBS. In this time belly pain increases and can be felt above or below the belly button. Pain and cramping are common.
IBS, irritable bowel syndrome, is a constellation of various symptoms with no specific test to diagnose it. Digestive symptoms are caused by dysfunction. And dysfunction occurs when an organ doesn’t work as it should due to irritation, having too little of what it needs or becoming overwhelmed. With this in mind let’s dig a little deeper.
Do I have IBS?
As we’ve discussed earlier IBS symptoms:
✓fluctuate over time
✓range from mild to moderate or severe
✓last longer than four to six months
✓are not diagnosable as another condition
For these reasons I look for a cause of symptoms in the hope that IBS flares or frequency and severity of symptoms can be minimized.
3 Key IBS Symptoms
How long you have symptoms is a primary focus. Symptoms of a few days or weeks is not indicative of an IBS diagnosis. Symptoms of months and years definitely comes into consideration. Other than time and duration there are three functional categories I use for IBS symptoms:
1. IBS Pressure, experienced as gas and bloat
2. IBS Pain in the form of abdominal cramping
IBS Stool Consistency, of which constipation is much more common but diarrhea or constipation alternating with diarrhea are frequently present as well.
IBS Pressure
In my practice I associate gas and bloating with an upper digestion issue. As you’ll see later in this post our digestive function is dependent on what happens in the previous step.
Pain and cramping are caused further down the length of the digestive system. If gas and bloat are created in the upper digestive system, pain and cramping increase as the pressure builds as pockets of gas passes further along the colon.
The digestive system feels pain with distention, as when full of gas or in spastic muscular contraction. (Think of the last time you ate at your favorite burrito shop and said “more beans please!”)
IBS Pain
Pain and cramping can be present when the digestive system is trying to push through hard lumpy stools but also when trying to eliminate when infection, inflammation and irritation is present.
Your gut only has two ways to get rid of things, especially in a hurry; it’s coming back up or it’s going down and out! If the gut is infected, inflamed or irritated it’s going down and out quickly, as in diarrhea!
IBS Stool Consistency
Constipation is more common than diarrhea and is the hallmark of IBS-C. diarrhea is more predominant in IBS-D but you may be experiencing constipation followed by diarrhea, then you would have IBS-M or IBS-A, these are the same condition. “M” stands for mixed and the “a” for alternating, respectively.
Once again, we shouldn’t consider any symptoms of the gut without taking a closer look at how things are functioning in the organs before. We’ll discuss this more below but here’s a couple examples:
1. If you have an irritated stomach care should be taken to evaluate the foods you are eating
2. If you are gassy and bloated care should be taken to look at what you are eating and how well your stomach is functioning and are able to digest it.
Food (leads to) => Acid reflux, Gas, Bloat
Acid Reflux, Gas, Bloat => Pain, Cramping
Pain, Cramping => Constipation, Diarrhea or Both
3 Overlooked IBS Causes
There are 3 frequently overlooked causes of IBS, they are:
1. Depleted Acid and Enzymes
2. Irritation, Inflammation and Infection
3. Weakened Microbiome
These causes can be brought about by:
· Stress
· Aging
· Injury or surgery
· Medication
· Poor diet
· Chronic dieting
· Genetics
To understand IBS symptoms and causes further let’s review how the digestive system should work, normal digestion.
IBS Symptoms vs. Normal Digestive Function
The digestive system is made up of the following organs; salivary glands, stomach, gallbladder, liver, pancreas, small intestine and large intestine.
I like to consider the functions of the digestive system and specific organs to better understand your symptoms. You eat food, certain organs digest your food, in other words break the food down into smaller bits and pieces. Then this ball of food moves to where the nutrients are absorbed. Finally, what is left, waste, that’s not needed is processed and eliminated from the body.
Let’s take a look at the digestive organs and their function below:
Foods Organs of Digestion Organs that Absorb Organs of Elimination
Meat Salivary glands Small intestine Large intestine
Fat Stomach Large intestine
Vegetables Gallbladder & liver
Water Pancreas
Fruit
Acid and Enzymes Necessity of Digestion
The stomach produces hydrochloric acid (HCl) to break down dense foods. Think of a steak versus a piece of baked fish that falls apart. Having sufficient HCl in the stomach allows the steak to be broken down just as the baking of fish does.
The stomach has a valve, known as a sphincter at the base of it, to keep food in the stomach while HCl is released in enough of a quantity to digest and breakdown food, including tightly held proteins like steak.
Sufficient HCl is important for a couple reasons:
1. Digest steak, chicken, turkey and other food
2. Breakdown of for absorption of calcium needed for bone health
3. Stimulates food and ultimately fecal matter to move through the rest of the digestive system
4. HCl is protective for our immune system, it’s a guard to our digestive system. HCl is caustic and destructive. It can eat through the paint on your car, it can probably eat through your car! Only the stomach is able to handle the caustic HCl without damage due to special cells that line the stomach, parietal cells.
Depleted Acid and Enzymes
Insufficient HCl release is know as hypochlorhydria and no HCl is known as achlorhydria. These conditions are more common that you might think and disrupt the ability of the stomach to:
1. Digest food especially proteins
2. Inhibit calcium absorption
3. Move food through the digestive system, leading to constipation
4. Allow bacteria, yeast and parasites to enter the digestive system and survive
Symptoms associated with hypochlorhydria or achlorhydria are:
· Feeling full quickly
· Indigestion that starts soon after eating and can last 30 to 45 minutes
· Bloat or pressure under your ribs
· Constipation
· Burping
· Vomiting
· Nausea
· Fatigue due to malnutrition
· Acid regurgitation
IBS Symptoms
>>Low HCl Symptoms
Gas and bloating
✓Gas and bloating
✓Cramping and pain
✓Constipation/ diarrhea
You might be wondering how low or no HCl might cause constipation or diarrhea?
That’s a very observant question and here’s your answer.
We’ve discussed how the stomach holds food by closing the valve or sphincter and releasing HCl into the stomach. This is the normal process and the sphincter stays closed until enough HCl is released to trigger histamine in the lining of the stomach to stop producing more HCl, then the valve would open and allow food to move on.
But when the stomach can’t produce HCl easily the sphincter stays closed longer and the food keeps churning in the stomach and more and more HCl is released. This continues until enough HCl is ultimately produced to trigger the sphincter to open. These are fascinating mechanics but the delay in stomach emptying means the food and increasing amount of acid can be:
· Regurgitated into the esophagus, causing burning, heartburn pain and esophageal ulceration over time
· Cause burping or belching
· Cause nausea and vomiting
· Since more HCl was released food speeds through the gut on to the small intestine
IBS and Enzyme Deficiency
Enzymes, bile and bicarbonate are released by the pancreas, gallbladder and small intestine, respectfully and are mixed in with the acidified food which lowers the pH of the food in the small intestine.
The small intestine really isn’t small, it’s about 20 feet long but is called the small intestine because of its diameter. Open your hand and put it over your belly button and your hand will cover your small intestine. It connects the acidifying stomach to the eliminating large intestine.
It is made up of three part the duodenum, jejunum and ileum. The duodenum helps reduce acidy food coming from the stomach.
The jejunum has the most functional portion of the small intestine by absorbing the necessary nutrients from food. These nutrients are the building blocks of your body and are necessary for normal function. Necessary nutrients include:
· Sugar
· Fatty acids
· Amino acids
As a catch all, the final part of the small intestine the ileum, absorbs B12, bile salts and whatever the jejunum missed.
The ileum then changes diameter to meet with the large intestine.
I can’t stress this enough the health of your small intestine health determines your overall health. Clinically, I see a strong IBS and enzyme and acid depletion connection.
Irritation, Inflammation and Infection
The small intestine absorbs all the nutrients we need to survive. The specialized cells lining the folds of the small intestine allow an increased surface area for high rates of absorption.
If the small intestine is compromised in any way common symptoms such as weight loss, tiredness and fatigue can affect the whole body.
Small intestine bacterial overgrowth (SIBO) can cause symptoms strikingly similar to IBS. Clinically, with regard to IBS, there is no reason to believe IBS can be caused by an infection or that an infection can cause IBS.
Conditions affecting the small intestine include:
· Inflammation, lower grade, due to irritating foods and stress
· Inflammation, chronic and severe as in Crohn’s and Celiac
· Infection
· Bleeding, a peptic or duodenal ulcer, noticing dark spots or coffee ground Bm
· Obstruction
Symptoms associated with conditions of the small intestine are:
IBS Symptoms
>>Small Intestine symptoms
✓Gas and bloating
✓Cramping and pain
✓Constipation/ diarrhea
It’s important to keep in mind that each organ of the Gi has specific functions. There is some overlap but not much! This is why it is important to be aware of each of the gut and the functions that are so important for sustaining a healthy energized lifestyle.
Now we move into the large intestine. It is an upside “u” shape and would run around the outside of your hand when again placed over your belly button.
As the small intestine’s ileum transitions into the large intestine, we will still have some absorption of vitamins, electrolytes and water. Any acid residue will be handled otherwise you’ll feel the burn, and not in a good way, on your next bowel movement (BM), ouch!
Other important functions of the large intestine (LI) are:
1. Immune function through vast lymph tissues
2. Formation and elimination of fecal material
3. Sustain and maintain your Microbiome’s effects on your whole-body health
Conditions that affect the large intestine include:
· Inflammation, chronic and severe as in Ulcerative Colitis, Crohn’s and Celiac
· Infection, by yeast, bacteria and parasites
· Bleeding, noticing bright red blood in your BM
· Obstruction, no BM at all
Symptoms associated with conditions of the large intestine:
IBS Symptoms
>>Large Intestine Symptoms
✓Gas and bloating
✓Cramping and pain
✓Constipation/ diarrhea
While the medical definition of IBS varies to some degree as to cause and if it is strictly a large intestine issue vs general GI issue, if you are afflicted with IBS reducing symptoms and treatment is most likely your primary goal.
Routine testing, listed below, is common but usually non-conclusive:
· Bloodwork: CBC
· Colonoscopy
It is important to consider the area of your digestive system and the symptoms you are experiencing.
Depleted Microbiome
We are gaining more and more insights into the microbiome and how it is our body’s second brain.
Our microbiome is made of a diverse environment of bacteria that protect us and our ability to:
· handle inflammation
· control our weight and body composition
· boost our immune system
· balance hydration
· and many more functions we are not aware of yet
Causes of a depleted microbiome:
· Problems higher up in the digestive system
· Parasitic Infection (more common than you may think!)
· Stress
· Aging
· Injury or surgery
· Medication: steroids, antibiotics
· High sugar diet
· Poor fiber diet
· Chronic dieting
· Chronic dehydration
· Genetics
Best IBS Testing a Functional Approach
I recommend a specialized stool test to evaluate the entire functioning of the gut. As you have seen as symptoms arise there appears to be an IBS cascade of symptoms further down the digestive system. Most gut testing is designed to visualize a problem, such as colonoscopy. True IBS detection can come through evaluation for function and biome health not only the standard medical procedures.
Interesting Case Histories:
IBS Case Histories and Outcomes
Woman with Severe Constipation
Case History #1:
A 52-year-old female presented with severe constipation of one year. She was eating a box of prunes a day with intermittent relief. She was happy when she had a BM every 7-10 days. She said the constipation came on quickly and that after seeing multiple gut doctors she was diagnosed with IBS and told to drink more water and take fiber. The fiber made her constipation worse.
It was revealed that her constipation started soon after receiving radiation for breast cancer. The radiation actually caused some burning of her skin and chest over the area of her stomach.
I surmised that potentially the radiation damaged the stomach lining and her acid producing cells.
Remember the cells in the stomach produce HCl which starts the movement of fecal material through the digestive system, known as peristalsis.
I decided to support her upper digestion with a combination of supplements to address HCl, enzyme and bile production. We started at a low dosage because remember we are dealing with hydrochloric acid which is caustic and can cause damage if the level in the stomach is too high.
Within three days she called and had some improvement. We adjusted the dose and more improvement. As we finetuned the dosage her chronic debilitating constipation diminished and ultimately stopped.
We supported her over the next year and then were able to slowly decrease the digestive supplements and finally remove them altogether. She keeps some on hand in case but has made a full recovery.
Woman with Gas, Bloat, Flatulence and Diarrhea
Case History #2:
A 42-year-old woman came to me with excessive and chronic bloating, gas, flatulence and occasional diarrhea. She also had meandered through the medical system and had a diagnosis of IBS. She had daily physical symptoms which had continued to progress and she was beginning to experience embarrassing symptoms of people thinking she was pregnant. She shared a picture of me of her abdomen from before breakfast that day. Looked completely normal. She then showed me a picture of her abdomen 30 minutes after eating breakfast, my goodness, if I didn’t know better, I would have to admit that I also thought she looked pregnant.
She had such sever distention in her abdomen after each meal that she had to wear elastic waisted pants, mostly sweats.
It was quite remarkable the difference in appearance pre eating to post that I decided we needed to order a specialized stool test. The results confirmed my suspicions, she had a chronic parasitic yeast infection known as candidiasis.
Candida is a type of yeast that thrive in the gut because it’s dark and warm and food is constantly floating by. Yeast love to eat sugar and other yeast. This woman had three small children and sugar was abundant in the house.
We had to:
1. Change her diet, remove all sugar sources
2. Support her HCl levels that were low which allowed the yeast to make into her gut, probably on a piece of fresh fruit. Here the yeast made a home and started a family multiplying because nothing was keeping them in check.
3. Use supplements and herbs to eliminate, kill off the yeast
4. Reinoculated her biome in her colon with healthy bacteria
It is imperative that each of these steps be taken or yeast, parasites and bacteria while continue to flourish!