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 contributing factors.
Integrative practitioners are like personal medical detectives, leaving no stone unturned when it comes to chronic conditions. We know there are many reasons for digestive discomfort. With a combination of a detailed questionnaire plus specialty lab testing, functional medicine practitioners may help patients identify factors contributing to 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 Contributing Factors
Many patients who experience IBS may also experience dysbiosis (unbalanced gut bacteria), SIBO (small intestinal bacterial overgrowth), underlying food sensitivities, or EPI.
Dysbiosis
Dysbiosis is an imbalance of good vs. bad bacteria in the gut. When your body is in dysbiosis, your health may be affected. Your gut microbiome influences 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 type 1 and type 2.
Type 1. This form of dysbiosis is associated with a loss of good bacteria from your gut.
Type 2. When there is too much growth of harmful bacteria.
Type 3. Dysbiosis can also occur when there is a loss of overall gut microbiome diversity, meaning a loss of both good and bad bacteria in the 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 Management
Most functional medicine practitioners may 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, a practitioner may suggest a specific diet and antimicrobial herbs to help manage harmful bacteria along with probiotics and a fiber-rich diet to support 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 may create an environment conducive to 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 improve after certain treatments
- Feel worse after taking probiotics or eating fermented foods
- An uncomfortable feeling of fullness or gas immediately after eating
- Loose stools
SIBO Testing and Management
Practitioners may test for SIBO by doing a two or three-hour at-home breath test on patients. If patients’ results are positive, the practitioner may suggest specific herbs to help manage their type of bacteria overgrowth, nutritional therapy to support gut flora balance, and prokinetics to help increase small intestine motility. One of the most important things when it comes to SIBO is identifying factors that may have contributed to its development to help prevent future issues.
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 reacting to; this can contribute to digestive discomfort and inflammation in the gut.
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 Management
Food Sensitivity testing can be very useful to help identify foods your body may be reacting to. Most practitioners may suggest an elimination diet for 6-12 weeks to help manage symptoms and allow the body time to adjust. The good news is, after this period, many patients may be 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 may 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, contribute to nutritional challenges.
Exocrine Pancreatic Insufficiency Symptoms
People with EPI may have a challenging time absorbing fats from foods. This can lead to uncomfortable digestive problems, such as:
• IBS symptoms like gas, bloating, constipation, and diarrhea
• Fatty stools
• Unexplained weight loss
EPI Testing and Management
Most practitioners may 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 EPI.
Management focuses 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 manage. By utilizing specialty testing and developing a personalized plan, healthcare providers may help patients find relief and improve their quality of life.
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