Irritable Bowel Syndrome-the underlying cause- part 1

I wanted to begin this series on Irritable bowel syndrome by talking about the various types of IBS from which you might be suffering. In the last couple of years, more and more patients have come to me complaining of IBS symptoms. I’ve been able to help so many of these patients change their lives by helping to elucidate the differences between IBS types and other disease associations. The subtypes are underdiagnosed as it requires specialized testing and therefore left untreated optimally.

So, what is IBS? People with IBS often know prior to diagnosis  because they experience these symptoms: abdominal pain, bloating, varying stool patterns of unformed stools to hard pellets, a feeling of incomplete evacuation, alternating diarrhea and constipation or tendency to diarrhea and tendency to constipation. It often is associated with weight gain that is stubborn to leave or weight loss that persists even with good diets. In short, it can take over the lives of those living with it. Patients’ will often tell me that they map out every bathroom in the vicinity of their travels and shopping expeditions. Others have told me that they have to get up 1-2 hours earlier to coax their bowel to expel waste. Either way, their lives are dominated by their bowel symptoms and social activity comes to a standstill.

This picture is from Liver and Digestive diseases, Henderson, Tennessee. It is missing weight gain , reflux disease known as GERD, and alteration in stool consistency and pattern as  important symptoms.

Your PCP or a referral to a gastroenterologist leaves you with this diagnosis if all your blood work is normal, and a colonoscopy is normal. Often, the latter is not done and it is treated based on your symptoms and history lacking other diseases associated with bowel problems.

The next step is to treat with the use of motility agents to either slow your gut or to make it move faster and alongside it some form of anxiolytic or antidepressant drug.

Why is this? Because for the longest time doctors felt that IBS is a functional disorder caused by stress and anxiety and therefore treating it with antianxiety agents and symptom management is  warranted. But, what if I told you that there is so much more we can do to help you if we only knew how to dissect it down to the underlying cause of your IBS symptoms and therefore narrowed it down to one of the subsets that need treating?

That is correct. We know a lot more and I have benefitted from watching Dr Mark Pimentel’s webinars on this complex syndrome and along with the functional medicine way of practicing, I have helped  many patients. It is now your turn to benefit from this information.

This is a slide is taken from Dr. Mark Pimentel’s webinar on the causation of about 60% of all IBS that can potentially be treated with a combination of antibiotics and other agents that are being discovered to break down biofilm, stop the production of methane or hydrogen sulfide or at least slow it down.

Today, we know that fully 60% of IBS diagnoses is related to an infection that you experienced in the past chiefly with 4 bacteria- E.Coli, Campylobacter, Salmonella and Shigella. This then leads to mounting an immune response to a protein that is common to them. If this protein persists, it can lead to an autoimmune reaction to your small intestine’s nerve - muscle complex, particularly a protein called vinculin that helps create the peristaltic wave which cleans up your small intestines after a meal. Breath testing will help me differentiate between the IBS microtypes that cause the diarrhea form of IBS called IBS-D aka  ISO-intestinal sulfanogen overgrowth due to hydrogen sulfide in the breath test , SIBO- small intestinal bacterial overgrowth due to Hydrogen in the breath test or IBD-C aka IMO- intestinal methanogen overgrowth post breath testing if methane is present leading to the constipation subtype of IBS.

This is a slide is taken from Dr. Mark Pimentel’s webinar on the subject that refers to the subtypes of IBS that follow  bacterial gastroenteritis. It accounts for about 60% of IBS that can potentially be treated.

The other 40% of IBS is attributed to other factors that we have to sort out- these can be due to systemic diseases such as autoimmune diseases, low thyroid, toxins such as mold toxins, Ehlers Danlos syndrome or other disorders of connective tissue and collagen, neuromuscular diseases, mast cell activation, stress, poor diet, food “allergies”,  food poisoning, parasitic diseases and an impaired immune system.All of these  can be diagnosed by various tests available to us.

How can I help you? It starts with a detailed history which can help me figure out what triggered your IBS and then determine which tests to run. I often will check your intestinal barrier function for autoimmunity to 2 proteins called zonulin and actin and your immune reaction to gluten and non gluten wheat proteins as well as celiac disease; a stool test that examines inflammation, digestive function and looks at your microbiome; a test that looks for anti vinculin and anti cytodistending peptide B called IBS.smart;  a 3 gas SIBO breath test to determine if you are a hydrogen, hydrogen-sulfide or methane producer, blood tests to look for liver issues and electrolyte disturbances , autoimmunity, and perhaps a referral for Endoscopy or colonoscopy.

When the data comes back, I educate you on what I found as the cause of your IBS and start treatment personalized to your testing. This often involves using a combination of drugs, diet and supplements. Depending on how long that you have experienced IBS, you may find that it takes up to 3 months to feel the relief. If you do not experience relief, I will progress on my next round of testing to further narrow down your IBS type. I usually do not test all the items listed above at your first visit due to the cost of testing.

More than anything, I want to give you hope that you can get control and even eliminate some forms of IBS. Please reach out to my clinic at faimhealth.com if you are interested in becoming a patient. All you have to do is fill out the form called “let us get started” to initiate the new patient inquiry.