Updated: Feb 1
Welcome to the Gut Honest Truth blog where a Certified Functional Medicine Practitioner gives you digestible information to tackle your chronic health concerns.
That’s me, Katie Morra;
Side note- If you want an even deeper dive into understanding and resolving Irritable Bowel Syndrome - check out my "How to Get Rid of Your IBS" e-book.
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The (dreadful) Irritable Bowel Syndrome diagnosis.
Here’s the scenario: You’ve been dealing with gastrointestinal issues and discomfort for a while but have tried to ignore and remedy the situation for yourself. Perhaps you tried some alternative therapies, relaxation techniques and dietary changes.
Reluctantly, you’ve just recently decided to see a gastroenterologist to get to the bottom of it in hopes to reduce pain and symptom relief.
After spending a max of 15 minutes with your physician, trying to really explain your symptoms and concerns, you quickly get diagnosed you with Irritable Bowel Syndrome. Maybe they recommended trialing the low FODMAP diet, added in fiber supplements like Metamucil, trialed peppermint oil like IBgard or certain probiotics like VSL#3 to try to treat irritable bowel syndrome. If you were one of the chosen ones they even could have ran blood tests, stool tests and helped to determine your intestinal transit time. But here you are, reading this article with no significant improvement in symptoms.
Allow me to define and clarify a few things about Irritable Bowel Syndrome.
What is IBS?
Firstly, IBS stands for irritable bowel syndrome which is a disorder that is understood as a chronic (or long-term) condition in which a person experiences recurring issues associated with abdominal pain or discomfort.
The pain or discomfort is often accompanied by/with changes in bowel movements. IBS symptoms affect 10-15% of the American population and is the most common complaint in Gastroenterologist offices.
How is irritable bowel syndrome diagnosed?
The IBS diagnosis has become a way of labeling a person when there’s no true understanding of what is the root cause of the abdominal issue the individual is experiencing. IBS is diagnosed using the Rome II criteria, which then further categorizes the condition as IBS-C (IBS-constipation) and IBS-D (IBS-diarrhea).
Formerly known as spastic colon, spastic bowel, mucous colitis, colitis, and functional bowel disease, irritable bowel syndrome is a bit of a catch-all term for a condition in which a slew of symptoms are thrown under the same diagnosis. Pretty much if you have abdominal pain along with other IBS-adjacent bowel disorders then you'll be diagnosed with irritable bowel syndrome.
For this reason, at Gut Honest Truth we refer to IBS as a trash can diagnosis.
What are the common signs and symptoms of IBS?
Some common IBS symptoms:
Frequent bowel movements or diarrhea symptoms
Undigested food in stool
Mucus in stool
What are the common causes of IBS?
There is no single cause for the development of IBS. Different people can be triggered by different things: and in my clinical practice, I hear from patients with providers that are not looking deep enough to see any real connections.
The above signs and symptoms can be the result of a multitude of issues, so at Gut Honest Truth we find it’s more helpful to look at areas of possible digestive dysfunction.
A couple worth highlighting:
Low digestive output (stomach acid, enzymes and bile)
Gut infections (H pylori, SIBO, parasites and candida)
Food sensitivities and allergies
Thyroid and hormone imbalance
Common IBS Treatments
In order to really treat IBS symptoms, you need to get to the root cause. Which is why I highly recommend scheduling with a functional medicine practitioner to dive in deep. By the time a patient reaches our office they have usually tried an initial treatment or two with the following (having little to no long term success):
Increasing fiber intake through food or a product like Metamucil
Starting certain probiotics
Trialed an acid reducing medication like Omeprazole
Trialed or was told to try a low FODMAP diet (not sustainable or healthy long term)
Told it was all in their head and referred for mental health therapies and even possibly have been prescribed tricyclic antidepressants or selective serotonin reuptake inhibitors
Possibly prescribed Xifaxin for severe IBS symptoms for severe symptoms
Irritable Bowel Syndrome vs. Inflammatory Bowel Disease
A common misunderstanding is that IBS will cause Inflammatory bowel disease (IBD). Fortunately, that’s not usually the case.
Unlike IBD, IBS doesn’t cause tissue inflammation and damage. IBD, however, is a disease detectable via diagnostic imaging as there are visible discrepancies in the health of intestinal tissue. People with IBS won’t automatically develop IBD, though those with IBD generally have IBS-like symptoms.
Real Root Causes of Irritable Bowel Syndrome
Low Digestive Output and IBS
Stomach acid isn’t the only secretion needed to optimize digestion.There are three completely separate yet connected outputs of the body: stomach acid, pancreatic enzymes, and bile.
Each has a specific job, and when in proper amounts aids in overall digestion. They rely on one another for both stimulation and completion of digestive output as a whole.
Digestive enzymes are produced by the pancreas and assist in the digestion of fats, proteins, and carbohydrates. These dietary supplements are often recommended as a boost to your digestive system to support healing IBS, but should not be used long term unless recommended as such by your practitioner.
A temporary stint of support from these can help minimize the amount of undigested food particles that may be a fuel source for pathogenic bacteria, yeasts, and parasites.
Bile acid is made and released in the liver, but stored in the gallbladder. If the gallbladder is not optimally functioning, inflamed, or has been removed, digesting fats may be a difficult feat.
If your stools float often, it’s likely a sign of steatorrhea or fat malabsorption and you can talk to your provider about supplemental support like lipase, ox bile or taurine to help aid in digestion of meals.
Stomach acid signals the release of pancreatic digestive enzymes and bile production. Your stomach acid is highly foundational in your ability to properly digest all food. It’s the great conductor of all digestion.
Meaning, any food we consume must be acted upon by adequate stomach acid in order to promote food breakdown. Most of us know that stomach acid is important for breaking down protein, but it also maintains further responsibilities.
Orchestrating your digestion
Breaking nutrients apart for increased availability
Stimulating the production of digestive enzymes
Stimulating the production of bile
Promoting nutrient absorption
Acting as your first line of defense against pathogens
Without adequate stomach acid, you can see how quickly your gut health can be negatively impacted. Stomach acid production relies on the availability of proper nutrients and a functioning parasympathetic nervous system.
The vagus nerve, in conjunction with the hormone gastrin, has a role in stimulating parietal cells to create gastric acid. All that to say, multiple things, ranging from nutrient deficiencies to emotional stress can suppress stomach acid production.
If you have inadequate levels of stomach acid, you run the risk of passing food along to your small intestine in a less than ideal form, impairing digestion and nutrient absorption. The small intestine is akin to receiving food in a partially digested rather than a largely undigested sum. If this occurs, your body is subjected to physiological responses, such as bloating.
Between stomach acid, digestive enzymes, and bile, your body has developed a foolproof system for properly digesting food and absorbing nutrients. A disruption in one (or multiple) secretions may be a contributing factor to the irritable bowel syndrome symptoms you’re experiencing.
Chronic stress and IBS
We already learned chronic stress can exacerbate the lessening of stomach acid production but it can also impair your judgment in other ways.
Stress and the fight or flight response
Back in the day, when our ancestors were being chased by a lion, the fight or flight reflex would kick in and all of their blood and energy would rush from their digestive tract to their extremities as they ran for their lives. When you're being chased by a not-so-friendly four legged friend, every ounce of energy counts.
In the present day, however, your body can not differentiate between a lion ready to maul your face off & your wife nagging you or your boss yelling at you regularly.
So every time your boss scolds you or gives you the cold shoulder and you’re about to have lunch, your energy and blood flow flees to your extremities like he’s a big bad lioness.
Impact of stress and IBS: lower stomach acid
As mentioned previously, when your stomach acid secretion is low your ability to digest food well, produce adequate digestive enzymes and bile to absorb food properly, and your ability to kill off every single bad bug you put into your mouth via food, your hands, that pen cap you probably were just chewing on at work and not realizing.
The acid level isn’t where it should be so now bacteria, parasites, etc. can make it past your stomach into your small intestine, and just like that there you are with even lower immune capabilities as a whole.
The goal isn’t to remove stress, that is impossible. The goal is to identify what in your life are big contributors to your stress level, how you manage it and how to improve your stress response. A great place to start is to start to be more compassionate with yourself around your dietary needs and restrictions.
Gut Infections and IBS
We won’t get into all the detail here but know that there are 5 main infections that may be the cause (or contribute to flares) of your IBS:
Dysbiosis (this really just means an imbalance in your microbiome)
Small intestine bacterial overgrowth (SIBO)
You’re experiencing IBS symptoms…it’s only right that something in your gut could be the culprit. Addressing these infections may be the key to understanding (and supporting) your IBS. At Gut Honest Truth we recommend comprehensive stool and SIBO testing with our patients to identify and address these specific infections.
Food Sensitivities or Allergies and IBS
Could your IBS be caused by leaky gut?
Leaky gut is a popular term in the internet space. Although leaky gut is a very real (and studied) issue happening in the intestinal lining, it’s not a diagnosis and is actually more of a symptom than anything. Initially, leaky gut also shouldn’t be receiving all of the energy, attention, or resources of your care. Uncovering triggers should be the first stop on the healing train.
As it pertains to leaky gut and IBS, triggers may look like food sensitivities and/or allergies. Food sensitivities can initiate a handful of inflammatory processes in the body in hopes to correct the problem aka the food you just ate. Long-term exposure to a food you’re sensitive to could be causing continual inflammation and offense on your gut, which may be impacting your IBS symptoms.
How to determine your food sensitivities
The gold standard and most recommended way to identify food sensitivities or how the food is affecting your body is to do a proper elimination and reintroduction program which I highly recommend you work with a functional nutritionist on. This can be as minor as removing gluten or as major as removing the top 9 food sensitivities at once; gluten, dairy, corn, soy, eggs, shellfish, beef, pork, and peanuts.
Identifying food triggers may allow your body the rest it needs to allocate resources to healing. This is a guided, strategic way to uncover and label those foods without feeling overwhelmed to just “figure it out” on your own. It’s an incredible tool to help discover your root causes.
Thyroid Hormone Imbalance and IBS
Your thyroid is considered the “master” of your metabolism. I like to think of it as the team captain. It controls how well you digest and absorb food, utilize energy, and store fat.
Decreased thyroid function, or hypothyroidism, can result in a wide range of symptoms such as fatigue, weak or brittle nails, various skin conditions, poor hair health, joint pain, slowed metabolism, constipation, and gas. It slows everything down. You read that right. A decrease in thyroid function slows the movement of food through your stomach and intestines, it creates an opportunity to potentiate gastrointestinal issues.
How to properly test your thyroid function
Unfortunately, thyroid issues often get overlooked. If you’ve had your thyroid labs run, and the only marker ordered was a TSH (thyroid-stimulating hormone)...maybe a T4 (thyroxine) level… you don’t have the full picture.
This happens frequently and is one of the top reasons people come to me for a second opinion. Only looking at an individual’s TSH and T4 is like looking at a piece of ice floating in the ocean but not seeing there’s a WHOLE iceberg below it that might cause some real damage. The truth is you need the following values: TSH, free T4, free T3, reverse T3, as well as thyroid antibodies.
What to look for on thyroid tests:
Optimal ranges can differ in the functional versus conventional medicine worlds. At GHT, we are looking to see how the whole team is working together, not just how the captain is performing (TSH). As you may be able to infer, there are a lot of players to look at which leaves a lot of room for sub-par performance.
What can you do about thyroid imbalance and IBS?
First and foremost, get all those lab markers tested! Advocate for yourself and really dig deeper into how your thyroid is functioning. Your thyroid relies on adequate nutrients and proper rest as well, so auditing your current intake and sleep quality is an excellent way to best support your overall thyroid health. If you need more thyroid support, check out my ebook How to Put the Fire Out On Your Thyroid.
How to Reverse Your IBS
Knowing what you know now, here are some very practical ways to start addressing your IBS. Remember, you’re your best health advocate. If you feel like there’s more to the story, go do some investigative digging.
Things to consider if you’re currently experiencing IBS:
Keep track of your bowel habits and associated symptoms
Keep a food diary and be privy to any patterns (you’d be surprised what you’ll start to notice)
If you want to do a self-test, refrain from absolutely any fruit and added sugars for 10 days. If you find the fruit and sugars do, in fact, make you feel worse, we recommend finding a practitioner to run diagnostic tests to dive deeper into the issue with you.
See a specialist for guidance on ways to support your body as you heal.
Irritable Bowel Syndrome does not need to be your end-all-be-all diagnosis. You don’t need to “just live with it” despite what you may have been told. There are very real things contributing to your very real IBS symptoms and you deserve to find some resolution. If you feel like you would benefit from more hands-on support, the team at Gut Honest Truth would love to support you. Book a consultation with us to get started on your health journey.