Making Sense of Irritable Bowel Syndrome

By: Dr. Matt Lewis, D.C., DACBN, CFMP®

Irritable bowel syndrome (IBS) is even more unpleasant than it sounds — abdominal pain, bloating, cramping, gas, and diarrhea and/or constipation. Symptoms can be triggered by certain foods or by stress, infection, medications, or hormonal changes.

If you have IBS, you’re not alone, and you’re in good company. IBS affects between seven and 10 percent of the world’s population (it’s twice as common in women than in men), and like other illnesses, diseases, syndromes and disorders we’ve covered as of late here on my blog, it has a celebrity following; John F. Kennedy, Tyra Banks, Cybill Shepherd, and Jenny McCarthy have all been reported to have suffered from IBS.

If you are struggling with irritable bowel syndrome, I know how difficult it can be. Daily life is often interrupted or halted, time with family and friends can be unpleasant, and dealing with the condition at work can be unbearable. Even worse, you may be too embarrassed to discuss your condition with even your closest friends and family members; IBS isn’t a topic for dinner conversation. Understandably, anxiety and depression often accompany the illness.

The good news is that treatments for those suffering with IBS are available and very effective, even when traditional medical efforts have failed to produce results.

Irritable Bowel Syndrome Symptoms

The symptoms of an irritable bowel (colon) vary according to the nature and severity of the symptoms. I already mentioned some of these earlier in this post, but here is a more complete list of IBS symptoms:

  • Abdominal pain, cramping, or discomfort
  • Bloating
  • Diarrhea or loose stools
  • Constipation that may or may not respond to laxatives (some patients go days without a bowel movement, feeling uncomfortable and bloated all the while)
  • Hard or small dry stools that are difficult to pass
  • Chronic loose stools that seem incomplete
  • Gas
  • Mucus or blood in the stools (in more severe cases)

On their initial visit, many of my IBS patients are going to the bathroom three or more times in the morning or after meals. They tend to feel constantly bloated, and in many cases, have discomfort in the upper or lower regions of the belly. They also tend to feel anxious and depressed.

Irritable Bowel Syndrome Diagnosis

IBS is a syndrome not a disease. What’s the difference? A disease is a health condition that has a clearly defined cause (pathology), whereas a syndrome is a cluster of related symptoms without an identifiable cause. With a syndrome, doctors can run all sorts of tests and never identify a problem. I often see patients who have been to their internist and have seen several gastroenterologists who’ve ordered endoscopies, colonoscopies, and sonograms and still have no diagnosis or effective treatment.

A functional medicine diagnosis, like the one I perform, shifts the focus from the colon to factors outside the colon that may be affecting its function. First, I interview you (my patient) to gather information. I listen carefully to your story to see when the symptoms started and how they progressed and to determine what treatments have been tried before and whether any of those treatments improved symptoms or made them worse.

Because several factors can contribute to or trigger IBS symptoms, taking a more holistic approach to diagnosis reveals the contributing factors. Most commonly, I see problems stemming from food sensitivity, biochemical imbalance in neurotransmitters (brain chemicals), sluggish bile flow through the liver and gallbladder, leaky gut, yeast overgrowth, small intestine bacterial overgrowth (SIBO), elevated levels of histamine, genetic predispositions, dairy allergy, or gluten sensitivity.

My assessment includes a thorough physical examination, a detailed lab investigation, testing for food allergies, testing for infections, and dietary analysis.

Conventional Medical Treatment for Irritable Bowel Syndrome

Conventional medicine typically focuses on treating IBS symptoms — constipation and loose stools. Because both of these symptoms often occur together or alternate, I often see patients who take stool softeners and laxatives one day to relieve their constipation and then antidiarrheal medications when their stools are too loose. This solution is neither effective nor pleasant.

Functional Medicine Treatment of Irritable Bowel Syndrome

Considering each patient’s unique genetic predispositions, triggering events, dietary habits, and current symptoms, I develop a personalized treatment plan to restore healthy digestion.

Treatment typically begins with a stool analysis to identify pathogenic bacteria and levels of good bacteria, to analyze fat digestion and pancreatic function, to check for mucus or undigested food, and to analyze for markers of inflammation including calprotectin, Secretory IgA, and lysozyme. Commonly, patients with IBS have never had these tests performed. Fortunately, these tests are available and can help to guide appropriate treatment.

Treatment may include dietary changes along with supplements, specific probiotics, targeted prebiotics, antioxidants to reduce inflammation, support to the liver or gallbladder to improve bile production or flow, antibacterial or fungal agents to reduce overgrowth of infection or yeast, and specific supplements to support healing of the upper digestive tract and colon.

Caution: In some cases, probiotics will actually worsen the patient’s symptoms due to overgrowth of organisms in the small intestines. Beneficial bacteria or probiotics are supposed to be more plentiful in the large intestine or colon. Due to constipation and overuse of antibiotics, the bacteria are translocated to the small intestine causing bloating, more constipation, or loose stools. While probiotics are generally safe, in this scenario care should be taken to provide treatments to reduce colonization of bacteria in the small intestines and promote growth in the large intestine. This is often why patients trying to self-manage their condition often fall short even with the best intentions.

Treating IBS-related Depression

The digestive system contains more serotonin than does the brain. Serotonin keeps our moods stable and supports good sleep. Low serotonin production due to inflammation in the digestive tract creates fatigue, moodiness, and restless sleep. There starts to be a vicious cycle of anxiety/depression, which, in turn, further aggravates digestion.

Many patients will not respond to dietary changes alone and will require natural methods for increasing serotonin levels. While some patients respond well to SSRIs, the unfortunate side effect is weight gain. This is not the case with natural serotonin boosters, such as B6 or St. John’s Wort.

It’s About More Than What You Eat

Good digestion is about more than what you eat. Treatment must address how well you are digesting food, absorbing nutrients, assimilating those nutrients into your cells, and then finally how well you excrete waste products.

I commonly see patients with severe IBS feeling better within weeks of starting treatment. If you have IBS, don’t suffer needlessly. Take the first step toward feeling your best — call for an appointment.

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About the Author: Dr. Matt Lewis, D.C., CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Florida. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.

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