Sarah (names changed to protect client confidentiality) had just returned from the trip of a lifetime. She’d spent weeks traveling around North Africa and the Middle East and was finally back on American soil. But something wasn’t quite right. She’d briefly been very sick for a day or two while she was in Africa and assumed it was food poisoning. Sarah recovered and forgot about it, but her digestion had been off ever since. She suffered random bouts of diarrhea and suddenly had uncomfortable gas and bloating when she ate certain foods. She could no longer eat gluten or dairy without an unpleasant reaction. Her doctor gave her a round of antibiotics, but that made her feel worse. After numerous tests, she still didn’t have an answer. Her doctor said she probably had post-infectious IBS and that it might go away in time, but Sarah felt angry and powerless after hearing there was not much she could do meantime.
Paul was a 20something tech guy with a 60 hour a week startup job and a busy social life. He never gave much thought to his diet until he began to experience severe stomach cramps and irregular bowel movements, especially after nights out. Most concerning were the sudden, crippling anxiety attacks that would strike without warning. Paul saw his doctor who told him he was probably just stressed, but his digestive problems and anxiety worsened. Finally, after a colonoscopy and blood work, Paul was told he had some gut inflammation and that he probably had IBS. Paul was confused because he’d never had any digestive problems before. He thought IBS sounded pretty serious. Paul’s constipation and abdominal cramps worsened, and he was losing weight because he was afraid to eat; it seemed like everything gave him a painful flare-up. His anxiety worsened, and his job wasn’t happy about all the sick days Paul had been taking.
I hear stories like Paul’s and Sarah’s weekly in my nutrition coaching practice. Some are healthy young people who have never given much thought to digestion until they felt their gut was turning on them. Others have been struggling with digestive issues as long as they can remember. Often they are afraid to go out in public because they never know when they’ll urgently need a bathroom. What they all have in common is being bounced around between too many doctors and gastroenterologists with an IBS diagnosis and not much else to go on.
By the time they get to me, these folks are fed up. They’ve been put through the ringer with invasive tests that haven’t revealed much and a vague diagnosis. Most find that it’s not just their digestion that’s gone awry: They’re likely experiencing anxiety, insomnia, fatigue, and other symptoms that are affecting all areas of their lives. Some have been told to change their diets but that their condition is chronic, and this is their new normal.
I call bullshit on that. What if I told you that it’s possible to heal your gut and get rid of your IBS symptoms?
What is IBS?
Irritable bowel syndrome is a chronic condition that affects the large intestine (colon) and causes cramping, abdominal pain, bloating, gas, and altered bowel habits: sudden or recurrent bouts of diarrhea and/or constipation. IBS-C refers to IBS with constipation, and IBS-D is IBS with diarrhea. Post infectious IBS occurs suddenly after food poisoning or gastroenteritis. IBS affects between 25 and 45 million people in the United States, or about 1 in 6. That is a staggering 20 percent of us, the most common GI condition in the world.
IBS is a symptom-based disorder which means there is nothing we can clearly see that’s causing the problem. It has historically been considered a “diagnosis of exclusion.” That means extensive testing has ruled out other conditions and causes of symptoms, such as Crohn’s or Celiac disease. Because of the range of symptoms and varying causes, IBS is notoriously difficult to treat. I still find it common that my IBS clients have seen five, maybe even 10 doctors, and have had colonoscopies and other invasive tests. Nowadays, IBS is more common, and less diagnostic testing is needed. It typically presents with well defined symptoms and patterns.
I recently heard that IBS was second to colds and flu in keeping people out of school and work, so you can see just how impactful the condition is to one’s life.
What Causes IBS?
The million dollar question. The answer? We don’t exactly know. What we do know is that IBS can be caused by bacterial imbalance, such as small intestine bacterial overgrowth (SIBO), which is common after a bout of food poisoning. SIBO is an overgrowth of bacteria in the small intestine that digest and ferment starches from the carbohydrates you eat, producing gas that causes painful bloating. Around 80 percent of IBS cases are a result of SIBO. Other causes include food triggers, food intolerances, gut motility issues, a breakdown in the gut-brain communication, stress, trauma, pathogens, and poor gut bacterial diversity known as dysbiosis, an overgrowth of bad bacteria. If you have frequent antibiotic and NSAID use in your past, along with a high sugar, low fiber diet and a stressful lifestyle, your gut lining suffers, and bad bacteria overtake the good guys in your gut, setting the stage for inflammation that is present with IBS.
Conventional treatment is primarily based on symptom suppression. Your doctor may prescribe meds such as anti-inflammatories, antispasmodics, or anti-diarrheal agents. Many of my clients feel depressed about having to take meds for the rest of their lives, and the drugs often cause side effects that are as bad as the original symptoms. And these drugs don’t solve the underlying cause of the problem.
My IBS clients also often struggle with anxiety. There is a well established connection between the health of the gut and the health of the brain, so gut inflammation can trigger brain chemical imbalance or low neurotransmitter levels that affect mood, sleep, and even sex drive. High cortisol caused by chronic stress may also trigger IBS and certainly contributes to flares.
4 Steps to Healing IBS
So let’s get into the good stuff. You can take back your life and overcome IBS. What would it feel like to go out with your friends, worry-free? To not immediately scan every location for a bathroom? To have normal bowel movements again? Be free from anxiety?
Not gonna lie, it takes work. But most worthwhile undertakings do.
STEP ONE: test for unwanted critters and bacteria that are IBS triggers. Consider getting a lactulose breath test for SIBO and a stool test for pathogens, h pylori, dysbiotic bacteria, parasites, candida, and fungus. Read my post on SIBO to see if it sounds like you. An overgrowth of bad bacteria and pathogenic bacteria are main causes of IBS, so you’ll need to rule that out or treat it to reverse IBS once and for all. If you do have SIBO or another gut infection, you can start a protocol to get rid of that while you start step two. Speaking of testing, I’ll often recommend saliva testing to see if high cortisol is a contributing factor. High cortisol erodes the lining of the gut, making you more susceptible to leaky gut and dysbiosis.
STEP TWO: determine your food triggers. Remove gluten, dairy, soy, corn, high FODMAP foods, coffee, and alcohol. Most people feel relief fairly quickly after eliminating these foods. You can also do at-home food sensitivity testing to see if you are reacting to any foods. These reactions trigger inflammation. I like this company for easy testing (choose the food sensitivity test). Many people with IBS are FODMAP intolerant, meaning they have trouble digesting the fibers and starches in certain carbohydrates. A FODMAP diet is restrictive but only meant for 60-90 days while your gut heals. Equally important is to include healing foods during this time. You’ll want to focus on an anti-inflammatory diet rich in omega 3s found in fatty fish, sardines, and leafy greens; easy to digest, cooked veggies like winter squashes and greens; good fats like coconut oil, olive oil and ghee; fermented foods such as raw krauts and water kefir for their probiotics and enzymes; bone broth and gelatin to heal and seal the gut lining. Avoid sugar.
Aside from food, learn your other triggers for IBS flares. Stress is usually a big one. If that’s the case, try yoga and meditation (it works), and make stress relief a priority. You’ll need to work on healing adrenals and HPA axis dysfunction, which is linked to IBS (source).
STEP THREE: heal your gut. Leaky gut is a factor with IBS, and the goal is to seal the gut lining and reduce inflammation. While you’re working on changing your diet, you can add in supplemental support with nutrients that speed healing. Glutamine-based supplements that contain zinc and soothing herbs help heal the gut lining. I recommend this one. Probiotics are key here, but use caution. If you have SIBO, you’ll need to use a soil-based probiotic like MegaSpore. You can also try this one; make sure to add it in slowly. Vitamin D and essential fatty acids are needed to combat inflammation and boost immune health, and a digestive enzyme helps you digest to prevent belching and bloating. IBS folks are usually enzyme deficient.
STEP FOUR: address lifestyle habits. I cannot stress this enough, as this is the category most people skip. It means you’re going to take a good, long look at your stress levels and how you’re living your life. If you’re like Paul, it’s time to cut down on the partying and time to focus on getting 8-9 hours of sleep every night. Sleep is critical for healing. We all have stress in our lives, but we can mitigate the effects by focusing on feeding ourselves high quality, nutrient dense foods and eating in regular intervals (blood sugar control!) so our bodies don’t think food is scarce. Put yourself on a schedule and become a champion sleeper. I’ve had many clients that were working 60 or even 80 hours a week when their digestive problems hit. Some cut down to part time to heal. Build in time for self care and stress relief. Our culture prioritizes work over self care, but your lifestyle factors are the most important for successful healing.
Oh, and Paul and Sarah? Sarah’s been following my program for 6 months now and just completed her first half marathon, faster than she projected! Paul made a commitment to changing his lifestyle and diet and started a meditation practice. His anxiety is under control and he’s surprised by how much better he feels, both mentally and physically.
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Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. In addition to her coaching practice, she offers courses to help you heal your gut and kick nagging digestive issues for good. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.