December 13, 2022

IBS FAQ Part 2 – How to Solve the IBS Mystery

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This month we’re digging into the most common questions I get about IBS. Last week in Part I of IBS FAQs, we answered these questions:

What is IBS? ✔

What are the symptoms of IBS? ✔

What causes IBS? ✔

How common is IBS? ✔

Is IBS curable? ✔

Do stress and anxiety play a part? ✔

Does what I eat make a difference? ✔

This week we’re going to continue our FAQ adventure as we dig into the most common IBS questions people ask me about IBS diagnosis and treatment.

IBS FAQ #1: Who is at risk for IBS?

If you suspect that you may have IBS, but you don’t have a diagnosis, it can help to look at IBS risk factors. And if you go to a physician who is knowledgeable about IBS, they will look at these as well. You are at higher risk of IBS if you:

✔ Are young. The onset of IBS is usually before age 50.

✔ Are female. About ⅔ of the 25‒45 million people in the United States who suffer with IBS are women.

✔ Have family members with IBS. Research shows that there may be a genetic component to IBS.

✔ Have mental health issues such as depression or anxiety.

IBS FAQ #2: How do I know if I have IBS?

If you read last week’s Part I of the IBS FAQs, you already know that there is no definitive test for IBS. That’s because IBS just isn’t that simple. Since it isn’t caused by the presence of a specific pathogen, it doesn’t show up in blood work or other lab tests.

If you have strep throat, you can find out by taking a lab test that detects the streptococcus bacteria. If you have high cholesterol, you probably know because the numbers in your blood work were high according to the standardized charts your doctor looks at. Even more complex conditions like diabetes can be detected with lab tests.

But IBS is different. It’s a multi-factorial condition. This means it has many causes. Different people develop IBS by different means. So you can’t run a lab test — or even a series of them — to get a definitive IBS diagnosis.

That’s part of the reason IBS is so misunderstood, and often missed. But it is possible to get a reliable diagnosis. The key is working with a practitioner who knows what they’re looking for.

IBS is characterized by a group of symptoms. So a diagnosis will rely heavily on what you report to your doctor.

IBS FAQ #3: If there is no IBS test, why did my doctor run so many labs?

While there is no test that will tell a doctor that you have IBS, there are tests your doctor may use to eliminate other possible conditions that may have similar symptoms to IBS.

Stool test — to detect parasites or bacteria that might be causing your symptoms.

Lower GI series — to look for intestinal blockages.

Blood tests — to look for Celiac Disease, a gluten-related autoimmune disease.

Bacterial overgrowth breath test— SIBO (small intestinal bacterial overgrowth) is closely related to and often present alongside IBS.

Lactose intolerance tests —to determine whether or not your body produces lactose (the enzyme that breaks down milk sugars).

Colonoscopy — to rule out colon cancer.

CT Scan — to rule out pancreatic or gallbladder problems.

Endoscopic procedures with tissue biopsy — to rule out ulcerative colitis.

IBS FAQ #4: Are there different types of IBS?

Yes. This part of what makes it a complex condition to diagnose and treat. Some IBS patients suffer with chronic diarrhea, plagued by frequent bathroom emergencies. But some people with IBS lean toward the opposite side and struggle with painful constipation. And some people have both issues.

To address these differences, IBS has been broken down into different types:

IBS-D

You guessed it. “D” stands for diarrhea. If your issues tend towards diarrhea at least 25% of the time and your bowel movements land between 6 and 7 on the Bristol Stool Scale, you may have IBS-D.

IBS-C

In this case “C” isn’t for cookie. It’s for constipation. If you experience constipation with 25% of your bowel movements, and they fall between 1 and 2 on the Bristol Stool Scale, then you may have IBS-C.

IBS-M (or IBS-A)

“M” is for mixed. “A” is for alternating. This means you meet both of the above criteria and suffer with diarrhea and constipation.

IBS-U

Even if you don’t fall into one of the above categories, you may still have IBS. In fact, most people land in the ‘unspecified’ group. This just means that you don’t consistently fall into the 25% range on either constipation or diarrhea.

IBS FAQ #5: What are the different treatment options for IBS?

There are a variety of treatment options available for IBS. But I want to caution you. Treating a condition is not the same as curing it. And while there is no “cure” for IBS, it is possible to figure out the root cause of your symptoms so you can address the underlying problems. And once you improve the underlying issues, symptoms will go away (or at least lessen) on their own. Addressing the root cause — whether it’s SIBO, food sensitivities, or something else — does more than just help you feel better. It helps your body actually get better.

Pharmaceutical treatments often just mask your symptoms. And in the case of IBS, they often don’t even do that very well. There are times when medication makes sense. But treating the symptoms of IBS won’t help reverse the condition or even keep it from getting worse.

In my practice, I get the best results by finding the root cause of the problem, and then helping my clients make dietary and lifestyle changes that both address the underlying issue and help reduce their IBS symptoms.

If you’re struggling with stomach issues — whether you have an IBS diagnosis or not — I’m here to help. This is my specialty. And after working with over 1000 patients, I know how to help people get to the bottom of what’s causing their symptoms and help them feel better FAST. If you’re ready to take some action that will make a big difference in your health, click the button below. I’d love to help.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175559/

https://www.healthline.com/health/irritable-bowel-syndrome/tests-diagnosis

https://aboutibs.org/what-is-ibs/facts-about-ibs/

https://celiac.org/about-celiac-disease/what-is-celiac-disease/

https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326#:~:text=Ulcerative%20colitis%20(UL%2Dsur%2D,called%20the%20colon%2C%20and%20rectum.

https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs#:~:text=What%20are%20the,the%20same%20day.

https://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale

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Antibiotics are often used to clear out the bacterial overgrowth, but it's important to address any underlying factors that may have led to the overgrowth in the first place. But antibiotics will reduce the amount of bacteria in your small intestine — and also your symptoms. But antibiotics aren’t without a downside. Yes, they kill the excess bacteria that’s causing you problems. But they also kill the good bacteria that lives in your large intestine — where it belongs. Fortunately, there are other options. Some naturally-minded practitioners (like me), use options like herbal antibiotics that have fewer side effects. And don’t let the word “herbal'' fool you into thinking they won’t work. Herbal antibiotics have proven to be at least as effective as the antibiotic rifaximin. Can diet help with SIBO? Yes! Emphatically, yes. In fact, dietary adjustments are one of your most powerful weapons against this bacterial overgrowth. The bacteria that are partying in your small intestine are living things. That means they need food to survive. So a combination of medication and bacteria starvation will help you get rid of SIBO more quickly than medication alone. So your treatment plan should include some dietary adjustments. Some people do really well on the low FODMAP diet. Or your practitioner may recommend a SIBO specific diet like one of these: 💡 SIBO Specific Diet by Dr. Allison Siebecker This diet — also called the Specific Carbohydrate Diet (SCD) — involves avoiding certain carbohydrates that feed bacteria in the small intestine, in addition to limiting FODMAPs. Foods are color-coded as green (legal), yellow (limited), or red (avoided) to help navigate the restrictions. 💡 SIBO Bi-Phasic diet by Dr. Nirala Jacobi This diet combines the low FODMAP diet with the SCD, but is divided into two phases. The first phase involves eliminating all fermentable starches for up to 6 weeks — starving the bacteria in the small intestine. In the second phase, a few starchy foods are reintroduced to feed the beneficial bacteria in the large intestine. 💡 The low histamine diet This diet can be helpful for those with SIBO who are showing signs of histamine intolerance. This is when your body has trouble breaking down histamines — chemicals involved in the immune system. You foods with high histamine levels like fermented foods, tomatoes, eggplant, and spinach, while prioritizing fresh, unprocessed foods with low histamine levels. This diet may reduce symptoms like headaches, skin irritation, and diarrhea. 💡 Elemental diet This is the most restrictive SIBO diet and involves two weeks of liquid-only nutrition. Your nutritional drink will contain pre-digested nutrients. The idea is that you can quickly absorb the nutrients before they have a chance to feed the bacteria in your small intestine. 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