Millions of people suffer from irritable bowel syndrome (IBS) which generally include miserable, often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain. IBS can be caused by a host of drivers, including food allergies and sensitivities, overgrowth of bacteria in the small intestine (SIBO), a lack of digestive enzymes, parasites living in the gut, zinc or magnesium deficiency, and heavy metal toxicity. That’s why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS.
The conventional medicine approach to treating IBS involves “naming” the disease and then blaming” the name for the problem, and then “taming” it with a drug. Patients may be prescribed a pharmaceutical to address the symptom, but these don't fix the root cause of the IBS. For example, taking fiber may definitely help with the symptoms, but it’s merely a band aid. Additionally, pharmaceuticals can have unpleasant or even harmful side effects that can simply add to the symptom presentation.
The functional approach considers diet, lifestyle, sleep, stress management, hydration, activity level, hormones, health history, etc. to be important pieces of the puzzle. Even though all humans are homo sapiens sapiens, we are all individuals, which requires a personalized approach specifically tailored to you. Functional medicine is the medicine of “why” whereas conventional medicine is the medicine of “what” - “what disease, and what drug.”
Let’s take a deeper dive into some of the possible root cause(s) and/or contributing factors of IBS.
Stress and IBS
The gut and the brain are connected to each other via the vagal nerve which functions like a communication superhighway between the brain, gut and other organ systems in the human body. Recently discovered neuropod cells can activate or deactivate the vagus nerve, which interfaces with neurons in the brain. Research shows that certain gut bacteria help activate those neuropod cells.
While researchers continue to map the workings of what they’ve dubbed the “gut-brain axis” — the two-way communication link between the GI tract and the central nervous system, the role of psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain. Evidence from clinical and experimental studies show that psychological stress has a definite negative impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alterations in central nervous system, and gastrointestinal microbiota. Stress-induced alterations in neuro-endocrine pathways act on the gut-brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in IBS. IBS is a stress-sensitive disorder, therefore, the treatment of IBS should always focus on managing stress and stress-induced responses. Repairing gut health may alleviate or lessen the severity of depression, anxiety, and OCD. 1
Irritable bowel can cause irritable brain, and irritable brain can cause irritable bowel.
History of colic as a baby
The latest evidence is that babies who have colic have high levels of Klebsiella. Klebsiella is a bacteria that is actually associated with other inflammatory conditions and autoimmune conditions. Additionally, Klebsiella excess in the gut is also associated with a condition called ankylosing spondylitis, which is a form of inflammatory bowel disease which manifests systemically as arthritic symptoms. 2
Vaginal birth vs. cesarean section
Scientists confirmed that the babies born vaginally had received most of their gut microbes from their mother’s gut as opposed to their vagina, whereas C-section babies presented bacteria usually associated with hospital environments. Interesting to note, those differences tend to disappear by the time the children reach between six and nine months. Whether those early differences have further implications for health in later life is unclear at this time, although C-section delivery had previously been associated with an increased risk of developing asthma, allergies, and autoimmune conditions. 3
Past antibiotic use
As we know, antibiotics definitely have their place and purpose in treating severe bacterial infections. However, we also know that antibiotics wipe out ALL of the bacteria in the gut microbiome - good and bad, so should be used with caution and not prophylactically. It’s really the “nuclear” version of addressing a bacterial infection, but may be absolutely necessary. It’s always best to take a probiotic OPPOSITE of the antibiotic, so opportunistic bad bacteria don’t repopulate the gut after the round of antibiotics is complete. I only wish I had known this when my children were younger. Our pediatrician prescribed antibiotics 30 times for my daughter’s recurrent ear infections between the ages of 2 and 5. As an adult, she has digestive distress, food sensitivities, and IBS which we are currently working to address.
Small Intestinal Bacterial Overgrowth (SIBO)
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive bacteria in the small intestine, and is frequently implicated as the cause of chronic diarrhea and malabsorption in addition to intestinal hyper-permeability.
Patients with SIBO may also suffer from unintentional weight loss, nutritional deficiencies, and osteoporosis
Symptoms associated with SIBO include
Abdominal pain/discomfort
Bloating
Diarrhea
Excessive gas
Fatigue, especially after meals
Brain fog
Worsened symptoms when consuming carbohydrates and fibrous vegetables
Unexplained weight loss
The presence of bad bacterial overgrowth in the small intestine damages the microvilli - those finger-like projections that propel your food along it’s journey like a conveyor belt. This is known as peristalsis, and when it isn’t happening, your “migrating motor complex”(MMC) slows down or quits which leads to constipation. There’s an antibody test for the MMC, called ‘IBSSure’ .
Long-term use of acid blockers (PPI's - protein pump inhibitors)
There is definitely a role for short-term use of acid blockers like Pepcid AC, Omeprazole and the like. Studies have shown they’ve been very helpful to prevent stress-induced ulcers and hospital-acquired pneumonia. But they’re really intended to be used in the short-term only. When used long-term, they become very toxic in that they contribute to increased intestinal permeability (“leaky gut”), cause malabsorption of nutrients, vitamin B-12, iron, other trace minerals, such as magnesium and zinc, and contribute to osteoporosis in women.
Food sensitivities aka “Leaky Gut”
It all boils down to digestion. Stomach acid and digestive enzymes may be insufficient to digest your meals properly. A leaky gut can also be caused by an inability to break down and emulsify fats. Are the liver and gallbladder functioning optimally? If food is entirely broken down, the immune system is far less likely to activate. A leaky gut is all about undigested foods traveling through the jejunum and ileum in large molecular size and irritating the microvilli. Once the microvilli become damaged, the tight junctions open up. Then these undigested food particles escape through the wall of the small intestine and get into the bloodstream becoming “foreign invaders' in the eyes of your immune system. Your body produces antibodies to that food causing autoimmune disease/reactions and sensitivities to these foods.
Gluten is particularly problematic as it is able to act on the cells of the intestinal lumen, through the production of zonulin, to open the tight junctions, which will then lead to food sensitivities. Common culprits include dairy, eggs, nightshades, soy, corn, and gluten, but without testing, it’s impossible to know. You may also suffer from histamine intolerance. For additional information about food allergies, intolerances and sensitivities, check out my 3-part series from March 2021.
Part 1
Part 2
Part 3
Heavy metals toxicity - specifically mercury poisoning
Mercury affects all your enzymes. It basically interrupts the enzyme function of many different enzymes throughout your body, including your gut. Additionally, too much exposure to radiation can cause radiation colitis, and radiation enteritis.
Digestive Dysfunction and /or dysbiosis and inflammatory bacterial overgrowth
Dysbiosis is caused by any kind of imbalance in the microbiome such as bacterial overgrowth such as Entamoeba histolytica and Blastocystis, parasites, fungi, or simply a lack of adequate beneficial flora. Dysbiosis often results from antibiotic use, over-consumption of processed carbohydrates, a diet that is too heavy in sugars and starches for too long, or alcohol overuse. Symptoms can include constipation, diarrhea, bloating, and gas or any combination of these symptoms. Other dysbiotic factors include stress, coffee, food sensitivities, and dysfunction from the north. The gastrointestinal tract is an isolated terrain. Keep in mind that somehow, something in the gastrointestinal environment has become so imbalanced that it has become a suitable place for pathogens to settle in.
Tests to determine IBS
GIMAP DNA stool test aka The Gastrointestinal Microbial Assay Plus (GI-MAP) is an innovative clinical tool that measures gastrointestinal microbiota DNA from a single stool sample with state of the art, quantitative polymerase chain reaction (qPCR) technology. It detects pathogens (bacterial, parasitic, and viral) that may be disturbing normal microbial balance or contributing to illness as well as indicators of digestion, absorption, inflammation, and immune function.
MRT170 Food Sensitivity Test is a functional measurement of diet-induced sensitivity pathways through a simple blood draw that doesn’t require fasting. MRT simplifies a highly complex reaction and translates that into the most useable clinical information you can get – quantifying the inflammatory response to 170 foods and food-chemicals.
IBSSure Test - a simple blood test that detects two antibodies which are indicative of bacterial-pathogen-induced motility dysfunction, which can lead to increased incidence of SIBO. CdtB toxins (cytolethal distending toxin B) are released by gastroenteritis-causing bacteria, against which antibodies are produced by the immune system. These antibodies interact with a protein, vinculin, present in the intestinal cell-lining matrix. This interaction compromises and impairs digestive motility. This pathological breakdown of the gastrointestinal motility complex is foundational to chronic SIBO development and recurrence and has been well-studied and documented.
Genova SIBO hydrogen methane breath test is a non-invasive breath test which captures exhaled hydrogen (H2) and methane (CH4) gasses following patient ingestion of a lactulose solution to evaluate bacterial overgrowth of the small intestine.
Foods to avoid that contribute to IBS
Common inflammatory foods include sugar, refined flour carbohydrates such as white bread, pizza, etc, and highly processed foods like fast food, microwave meals, soda, etc., because there are so many chemicals, food colorings, sugar alcohols, emulsifiers, titanium oxide. Who knew that an artificial whitener such as titanium oxide found in chewing gum and over the counter supplements could contribute to IBS?
Removing these foods from your diet would be a great place to start, but for an individualized, targeted approach, I highly recommend the MRT170 food sensitivity test and the GIMAP DNA stool test. With these two tests, we can easily identify and remove your food triggers and then immediately address any and all issues identified on the stool test, including “healing and sealing” the small intestinal lining. This is what will prevent you from developing new and different sensitivities and eradicate your GI distress once and for all.
Ways you can support healing and encourage a diverse microbiome of “good bacteria”
Eat a colorful diversity of vegetables and fruits
The more color you have in your diet, the healthier your diet is going to be. The pigment in fruits and vegetables provide polyphenols which are important plant chemicals and strong antioxidants that defend against oxidative stress and can play a key role in preventing a wide range of chronic diseases. Polyphenols aren’t a single nutrient. Instead, “polyphenol” is an umbrella term that covers several types of protective phytochemicals or phytonutrients. The most important probably, are “Flavonoids” These are pigmented antioxidants found in many brightly colored fruits and vegetables, and are the most widely consumed type of polyphenol in the human diet. The flavonoid family includes anthocyanidins, which are found in red, purple, and blue foods like blueberries, pomegranates, and purple grapes; flavonols like quercetin and kaempferol, which are found in cruciferous vegetables, alliums, and beans; flavanols found in cocoa, red wine, and green or white tea; and the isoflavones in legumes.
Bottom line: for improved gut health and a robust, healthy microbiome, eat as many colors as you can each and every week.
Stimulate the vagus nerve
There are many ways to do this, but probably the most important thing we can do before we eat a meal is to get our body into parasympathetic mode - otherwise known as “rest and digest” mode.
Of course, depending on your IBS, eating a diet rich in prebiotics and probiotics may be beneficial. If you have SIBO for example, your gut may not tolerate prebiotics and consuming these foods would stimulate increased bloating. Ideally, testing for food sensitivities (MRT170 food sensitivity test) and gut dysfunction/dysbiosis (GIMAP DNA stool test) will provide the exact information to address and resolve your GI issues through dietary modification, stress management, nutritional therapy protocol, adequate sleep, hydration, and activity.
Recommended supplements
If your diarrhea is severe and has been going on for a prolonged period of time, you may want to consider Metagenics brand medical food, UltraInflamXPlus 360°® which provides strategic macro- and micronutrient support for those with compromised gut function resulting from inflammatory bowel disease, including ulcerative colitis and Crohn’s disease. It features CurQfen®, a clinically studied, patented curcumin blend designed for greater bioavailability and more reliable clinical outcomes. Provided in a vegan pea/rice protein base, this formula addresses increased nutrient needs and potential deficiencies.
High quality fish oil such as Nordic Naturals brand - my personal favorite and the one I take. You will not burp this fish oil.
Vitamin A, zinc, a spore-based probiotic, and L Glutamine are also very nourishing and healing for the gut, but before you head to your favorite store to stock up on any of these supplements, please check in with a professional for advice on brands, dosages, and formulas that are right for you. A nutritionist can guide you based on your current medications and/or supplements, health conditions, symptoms, and provide an easy to follow, step by step individualized plan for you.
IBS is not a death sentence or something that should limit your activities or lifestyle. Organizing your errands around bathroom stops, or avoiding travel due to your bowel issues shouldn't be your new normal because it's NOT normal and should be addressed immediately.
Likewise, don’t ever settle for a provider turning you away or telling you that they can’t help you. Despite the many potential causes, there are numerous ways to address and resolve your IBS, or at the very minimum, minimize or reduce your symptoms to a more manageable level. Often, it takes a team of providers to restore your health. If you are turned away, keep looking and don’t shy away from including more professionals in your care team. It may take a combination of providers to get you back on your feet again. Sometimes it takes several “heads” to get to the bottom of it, but no matter what, your providers must have your health at heart and should not stop investigating / treating you until you are well. Ask questions, and be your own best advocate so you can live your best life without abdominal distress.
This article does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their “Find a Practitioner” database. For additional information about obtaining and completing tests, and getting a nutritional therapy protocol specifically designed for you, contact me directly at 360.790-9680, email me at carole@carolelayton.com, or simply book a free 20 minute consultation.
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1 Qin, Hong-Yan et al. “Impact of psychological stress on irritable bowel syndrome.” World journal of gastroenterology vol. 20,39 (2014): 14126-31. doi:10.3748/wjg.v20.i39.14126
2 University of Texas Health Science Center at Houston. "Colic In Babies May Be Caused By Gut Bacteria." ScienceDaily. ScienceDaily, 25 July 2009. <www.sciencedaily.com/releases/2009/07/090724144520.htm>.
3 Saez, Cristina. “Babies Gut Microbiota Is Affected by Delivery Methods.” European Society of Neurogastroenterology and Motility. February 5, 2022. www.gutmicrobiotaforhealth.com