Breakthroughs in Irritable Bowel Syndrome

IBS pictureIrritable Bowel Syndrome or IBS as it’s commonly called, may not be the most exciting topic to read about. But for the 5 million Canadians who suffer from it, learning about breakthroughs in treatment is definitely news worth reading. Medical research has made the connection now between IBS and the microbiome, the immune system and the nervous system. While stress and food intake may confound an IBS problem, breakthroughs in our understanding of the microbes in our intestines are helping to solve the deeper issues that can drive this health condition.

IBS symptoms can include bloating, excess gas and burping, some degree of constipation, diarrhea or both, and often an element of abdominal pain or discomfort. As a naturopathic physician, I regularly treat patients who have been told they have IBS, and that there’s not much they can do about it. The fact is, there are potential solutions to these issues. My first step is to explain that IBS is a diagnosis of exclusion, meaning we must rule out overt infection, cancer, inflammatory bowel disease, reproductive issues and more. Once we’ve done that, we can take steps to find out what is causing that person’s IBS.

Some of my patients respond well to avoiding certain foods, so we usually work to identify food triggers. Some MDs are sharing the research out of Monash University about the FODMAP diet which are foods known to cause IBS symptoms in some people. These foods can provide the fuel to our intestinal bacteria to make gas. But people with a healthy gut can handle those foods just fine, and many FODMAP foods are healthy foods, like broccoli, apples and garlic. If someone feels better on a FODMAP elimination diet, I see that not as a solution, but as a clue that their intestinal microbiome needs work.

By far the most common cause of IBS in my experience is an imbalance in the bacterial lining of the intestines called the microbiome. The large intestine is supposed to have a lot of bacteria and it is normal to ferment the leftover foods there. But the 12 feet of the small intestine are supposed to be relatively bacteria-free. Even if bacteria that is normal to have in the large intestine ends up growing in the small intestine, these bacteria will ferment the normal healthy foods we eat and create gas, intestinal irritation and nutritional issues.

What can cause bacterial overgrowth in the small intestine? There are many factors, but the most common one is a history of gastrointestinal infection. Even a case of traveller’s diarrhea, food poisoning, or viral gastroenteritis that resolves nicely can trigger an autoimmune reaction in about 20% of people. That autoimmune reaction can attack the nerves that stimulate the muscles that cause the sweeping motion inside the small intestine that moves food along between meals. Without this motion, food pools in the small intestine, bacteria can migrate upward from the large intestine, a ‘compost’ is formed, and excess bacteria blooms. Studies of military personal showed that prior gastrointestinal infection was a much stronger predictor of who would get IBS than stress level. Other studies have shown that GI infections can lead to motility disorders in the esophagus and intestines.
Brain injuries are also a potential cause of Small Intestine Bacterial Overgrowth (SIBO). The brain orchestrates the motility of the small intestine, so a brain injury can hamper its ability to coordinate the flushing of the small intestine, allowing a bacterial overgrowth to ensue. Autoimmune disease can also be connected, as well as abdominal surgeries, long term diabetes and more.

Fortunately, there is a specialized test for SIBO that can be ordered through naturopathic physicians. The gold standard test is a series of breath tests that looks for hydrogen and methane gases that have formed in the gut, been absorbed into the blood and are then breathed out. If a test comes back positive, I coach my patients on a four-step program. The first step is to prepare the intestine by opening up the biofilm that the bacteria hide out in. Then we use prescription or herbal antibacterial agents that exclusively target the bacteria in the small intestine. When that phase is complete, patients’ IBS symptoms are significantly better and we work on addressing the underlying cause, which is the motility disorder in the small intestine. There are prescription and herbal “pro-kinetic” agents that rehabilitate the muscles of the inner small intestine so the problem will stay away for good. In addition, we work to heal the intestinal lining to make it more resilient using natural medicines and SIBO specific probiotics.
People who live with IBS deserve to understand why they have these symptoms and what they can do about it. The goal is to repair the gut once and for all, not just manage symptoms. When we understand and treat the underlying issues, lasting resolution is possible.

Dr. Deidre Macdonald is a naturopathic physician practicing in downtown Courtenay. 250 897-0235 www.getwellhere.com

Gastrointestinal Testing: Take the Guesswork out of Gut Troubles

Many people have digestive systems that give them grief. Whether it’s indigestion, ulcers, acid reflux, bloating, gas, constipation, diarrhea, liver problems, IBS, colitis, Crohn’s, diverticulitis or colon cancer, digestive upset is one of the most common reasons that patients come to see me in my naturopathic medical clinic. Naturopathic physicians have many tools for helping people address digestive issues, such as nutritional advice, natural medicines and occasionally prescription medications. Prescription medications are limited in this arena, often just managing symptoms without dealing with the cause, and creating more problems the longer they are used.

In this article I’d like to explain how naturopathic doctors use testing to to help take the guesswork out of treating digestive issues.

Lactose intolerance testing: This breath test helps us determine if it is an inability to digest lactose, the sugar in milk products, that is causing gas, bloating, and/or cramps and diarrhea after eating some dairy products.

Helicobacter pylori testing: This breath test detects the presence of the H. pylori bacteria, which can create ulcers.

Celiac screening: This blood test looks for an antibody called Anti-Tissue Transglutaminase, which is a marker of Celiac disease, an autoimmune reaction to gluten containing grains. Symptoms can include digestive distress, or can manifest as headaches, fatigue, anemia, autoimmune, and psychiatric or neurological conditions.

Bacterial and parasitic infections: Infections such as food poisoning or traveller’s diarrhea can be detected with a stool test.

Colon cancer screening: The FIT test can detect blood in the stool. Everyone should have this test done at least once every two years. Blood tests for anemia can also pick up blood loss, which may trigger an investigation of colon cancer.

Fecal calprotectin: I really like this test as it helps me get an idea of how much inflammation is in my patient’s colon. It helps differentiate Inflammatory Bowel Disease (IBD) from Irritable Bowel Syndrome
All of the above tests can be run by an MD as well as an ND. Naturopathic physicians dig deep into the cause of digestive problems and sometimes need other, more subtle tests.

Food allergy/sensitivity testing: Food allergies can create a lot of grief in the gut. From inflammation to gas, bloating and diarrhea, I’ve seen hundreds of patient respond beautifully to a program of food elimination. There is no perfect test, but there are tests that can give us a starting point for an elimination / challenge process.

Intestinal permeability tests: If the intestines are too permeable, that “leaky gut” can allow toxins and large proteins into the blood and brain. Many inflammatory and immune conditions have been linked in scientific research to “leaky gut”.

GI Effects Comprehensive Stool Profile: This stool test gives us a lot of information about the ability of the digestive system to break down different types of food, the status of the microbiome (bacterial lining), and inflammation or infection in the bowel.

Small intestine bacterial overgrowth test: This breath helps us see if excess gas, bloating, bowel issues and more are due to the wrong bacteria being in the small intestine. Treatments can be targeted to regain balance and restore proper function.

With the right tests, combined with a thorough discussion of the symptoms and history, plus a good abdominal exam, we can often get to the root of the problem and start to design a plan for getting relief.

Call now to book an in-person or video appointment

250 897-0235  drdmac2@gmail.com

How to Overcome Irritable Bowel Syndrome

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Q:  I was diagnosed with Irritable Bowel Syndrome (IBS) 8 years ago and I am no closer to understanding why I have this problem.  Do I have to just live with it?

Laxatives for constipation, anti-diarrhea medications, and antacid pills are not the answer for Irritable Bowel Syndrome (IBS).  Over the last 20 years I have helped hundreds of patients become free from the troublesome symptoms of IBS without using medication to mask symptoms.  IBS is characterized by abdominal pain or bloating, constipation and/or diarrhea, gas, nausea, and is often accompanied by varying degrees of anxiety or depression. Since many other conditions can mimic IBS, I first make sure to rule out more serious diseases like cancer, colitis and ovarian cancer.  Then I interview, examine, and test my patient until I have an idea as to the real, underlying cause of their symptoms.

There are several potential causes of IBS that affect people in varying degrees. The most common cause of IBS that I have observed clinically is food allergies or intolerances. With proper identification of offending foods and coaching to change the diet, many of my patients have found lasting relief from their symptoms. New research shows that IBS is commonly caused by disturbances in the bacteria that line the intestine, called the microbiome. These imbalances can be corrected with the right interventions.  Some people with IBS have trouble digesting certain starches and artificial sweeteners.  Often IBS is a result of a poorly functioning upper digestive system. If the stomach lacks adequate hydrochloric acid, foods are not broken down properly and can cause symptoms in the lower digestion. IBS can occur after having gall bladder surgery since bile is now able to drip into the intestine in an unregulated fashion. The intestines become irritated by the bile which can cause IBS. So there is no need to suffer for years.  Address the root cause of IBS and you’ll be free from this challenging condition.

Irritable Bowel Syndrome: An Irritating Problem!

Cathy sought out naturopathic medical care for problems with her bowels. Ten years of problems had left her drained and frustrated. She knew where all the public bathrooms were everywhere she went and lived in fear of “accidents”. She suffered from alternating constipation and diarrhea, embarrassing gas, abdominal pain and bloating and she generally felt tired and toxic. Her conventional medical doctor had done tests to rule out cancer or serious disease and labeled her symptom picture Irritable Bowel Syndrome. She was given a variety of medications to counteract her symptoms. Laxatives for constipation, anti-diarrhea medications, antacid pills all helped in the short run, but after 10 years Cathy was no closer to understanding why she felt the way she did or how she could help herself get out of this painful cycle.

Cathy’s case is not unusual. Approximately 15% of the population has Irritable Bowel Syndrome (IBS) and many more people experience similar symptoms. IBS is characterized by abdominal pain or bloating, constipation and/or diarrhea, gas, nausea, and is often accompanied by varying degrees of anxiety or depression. Since many other conditions can mimic IBS, it is important to rule out more serious diseases like cancer and colitis.

The naturopathic approach to treatment is very different from the conventional methods because our goal is very different. While conventional medicine treats symptoms with drugs, naturopathic doctors seek to understand why the body is creating these symptoms and correct the underlying imbalance. There are several potential causes of IBS that affect people in varying degrees.

The most common cause of IBS that I have observed clinically is food allergies or intolerances. With proper identification of offending foods and coaching to change the diet, many of my patients have found lasting relief from their symptoms. Another common cause of intestinal distress is a disturbance in the bacteria that line the intestine. Antibiotic use coupled with a high sugar diet can result in an overgrowth of yeast and fungus in the intestine. The result is often gas, bloating and irregular stool, as well as fatigue and other mental symptoms. This condition can be rectified by specific dietary modifications and by working to re-establish the healthy bacterial balance in the intestine.

Often IBS is a result of a poorly functioning upper digestive system. If the stomach lacks adequate hydrochloric acid, foods are not broken down properly and can cause symptoms in the lower digestion. This condition is common as we age. Symptoms to look for of low stomach acid are:

  • Fullness after eating
  • Belching or flatulence after meals
  • Indigestion, constipation or diarrhea
  • Iron deficiency
  • Multiple food allergies
  • Weak fingernails

I have had many patients complain of IBS after having surgery to remove their gall bladder. The gall bladder stores and regulates the secretion of bile, the fluid used to digest fats. The bile is made in the liver but if the liver is toxic, the bile it makes will also be toxic and caustic. The “toxic bile” takes its toll on the gallbladder, and the conventional solution to gall bladder problems is to simply remove it. Now that same “toxic bile” is now able to drip into the intestine in an unregulated fashion. The intestine becomes irritated by the bile and lets us know by presenting with the symptoms we call Irritable Bowel Syndrome. The naturopathic approach to this health challenge is to treat the underlying cause by detoxifying the liver to help it to make better bile.

In Cathy’s case, after a thorough physical exam, we did some blood work and tested her for food allergies and yeast overgrowth. She had taken antibiotics for a series of infections many years ago and had a significant yeast overgrowth. She was allergic to wheat, rye and bananas. She did not have a personal history of gall bladder problems, but her sister and mother had had their gall bladders removed. Cathy was coached on a program to reduce her yeast, change her diet, cleanse her liver and soothe her irritated bowel. With natural medicine alone, she became symptom free for the first time in many years. Not only did her bowels improve, she reported feeling much more energy and mental clarity. She was able to take charge of her health by getting to the root cause of the problem!

Dr. Deidre Macdonald is a naturopathic physician with a natural family medical practice in downtown Courtenay. Her office can be reached at (250) 897-0235 or via this website