IBS affects between 25 and 45 million people in the United States and accounts for 40% of visits to Gastroenterologists. It is estimated that 10-15% of the population worldwide suffers from IBS (International Foundation for Gastrointestinal Disorders, https://www.aboutibs.org/ facts-about-ibs.html). It may surprise many to learn that as common and potentially debilitating as this disease is, the underlying causes of IBS are very poorly understood. The unfortunate outcome of this lack of understanding is that the symptoms of this disease can only be “managed” to various degrees with medications. This is problematic for several reasons. Patients who are sensitive may have side effects from these medications. Patients may not want to take medications for the rest of their lives. Lastly, the anxiety symptom that often occurs with IBS does not usually improve with medication.
So, let’s explore the underlying causes of Irritable Bowel Syndrome that can be addressed with a Functional Medicine approach:
Chronic infections and biofilms: Remember that time you took a chance and got some delicious tacos from a street vendor in Mexico and then proceeded to become severely ill? Or the time you developed Clostridium Difficile after taking a round of antibiotics? Or the time you got Giardia after camping? Or that stomach flu that lasted two weeks? Severe infections in the GI tract have the potential to stick around for a VERY long time after the worst of the symptoms subside. They do this by building a biofilm, which is a thick, gelatinous, cocoon-like structure that is designed to protect the infection from the immune system and from treatments that would otherwise be very useful. When an infection is hidden behind a biofilm, it will continue to provoke the immune system into a low-grade state of inflammation (aka IBS) until the biofilm is dissolved so that the infection can be properly treated. There are many methods of diagnosing chronic GI infections, dissolving biofilms, and treating with natural means - your well-versed ND can help you with this project.
SIBO: Many Conventional Doctors as well as most Naturopathic Doctors now refer to an IBS diagnosis as “SIBO” or “Small Intestinal Bacterial Overgrowth.” This is a condition in which the small intestine is inappropriately colonized by microbes that interfere with the absorption of nutrients and cause an ongoing inflammatory reaction resulting in the bloating, pain, and bowel irregularities associated with IBS. SIBO can be diagnosed with a breath test or a well-versed Doc’s best clinical judgment of symptoms. This condition is often treated with nutrition interventions such as the low-FODMAP, Specific Carbohydrate, and/or Elemental Diet as well as herbal or pharmaceutical antibiotics. Many who have received this diagnosis and undergone some sort of treatment for it have found that they improve markedly while undergoing treatment, but within weeks to months of finishing treatment, the symptoms begin to creep back. This is because SIBO (like IBS) is a symptom and not a final diagnosis and if the conditions that caused the overgrowth have not been addressed, the symptoms will come back. Causes of SIBO include underproduction of digestive enzymes, absence or dysfunction of the gallbladder, use of proton-pump inhibitors such as omeprazole, scar tissue that restricts the movement of the digestive organs, overconsumption of carbohydrates, sugar, alcoholic beverages, and many others.
Histamine is a neurotransmitter as well as an inflammatory chemical messenger that the immune system makes in response to an allergenic stimulus. The GI tract is dense in histamine receptors and excessive amounts of histamine in the body can lead to symptoms of heartburn, abdominal bloating, abdominal cramping, diarrhea, constipation, or an alternating pattern of the two. Histamine reactions in the GI tract can occur in response to food-based or environmental allergens and individual patients will have variable ability to clear histamine from the system once it is produced. You may have a histamine-based GI issue if you have other symptoms of histamine overproduction such as sinus congestion, asthma, or migraine headaches. Patients with histamine-based GI issues will often respond poorly to probiotics. Menstruating women with histamine-based GI issues will find that symptoms will often worsen before or during the menstrual cycle. Due to the effects of histamine on the brain, patients who struggle with histamine issues will most often have a component of anxiety, depression, and sometimes more serious psychiatric issues including Obsessive-Compulsive Disorder, Paranoia, and Schizophrenia. There are many ways, both natural and pharmaceutical, to reduce histamine in the GI tract, but determining which allergen(s) are causing the histamine response is crucial here. Again, your well-versed ND can help you get to the bottom of this mystery.
Dr. Corrie Marinaro, ND is the owner and Medical Director of New England Naturopathic Health in Waterville, Maine. Dr. Corrie specializes in the treatment of infections and histamine disorders as the underlying causes of chronic disease.