IBS Treatment and Causes - Dr Justin Gallant ND

IBS causes and treatment by Dr Justin Gallant ND

Irritable Bowel Syndrome (IBS) is a condition that I see on a daily basis. Just like most conditions, there are several different possible causes and contributors. It takes a thorough, directed investigation to figure out what could be causing your symptoms. I hear so many patients tell me that their doctor told them it’s all due to stress but I disagree. Stress can definitely worsen the symptoms of IBS but it’s rarely ever the cause. Blaming stress for IBS frustrates me because it puts the blame on something that is not under your control and patients get upset with themselves thinking that stress is the cause. They can’t reduce their stress so they think it’s their fault they have IBS, which stresses them out even more. It’s obvious to me that stress isn’t the cause of IBS because I have so many patients who I’ve helped, and even though their stressors are still present, their digestive symptoms are gone. IBS is just a label given when the cause of digestive symptoms has yet to be identified. Click on "Read more" to read more juicy info about IBS.

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IBS symptoms

• Abdominal bloating
• Abdominal pain
• Abdominal cramping
• Constipation
• Diarrhea
• GERD (or acid reflux)
• Loud gurgling (or Borborgymus)
• Mucous or yellow bubbly slime
• Blood on the toilet paper can be a symptom due to constipation causing hemorrhoids but if there is blood mixed within the stool or in the water, that usually means it’s something a bit more serious like Crohn’s Disease and Ulcerative Colitis which are forms of Inflammatory Bowel Disease (IBD). 

IBS - How to figure out the cause of your symptoms

​I like to make the joke that they should rename IBS to IDK (I don't know). There usually is a cause, but since the healthcare system is so overburdened it’s difficult for doctors to spend the time needed to determine what the actual cause is. As a naturopathic doctor I have the precious liberty of time (visits are an hour long), which enables me to ask all of the right questions. Sometimes all it takes is getting the patient to track their symptoms, what time symptoms occur and what they’re eating. It’s common for patients to come in with the nutrition log I got them to do over the past week and tell me what’s causing their IBS. If you’ve lived with something for long enough it will just become a part of who you are. Having someone take a look from the outside, or tracking yourself, and taking a step back to look from the outside can give you a different perspective. Tracking symptoms has been by far one of the best ways to determine the cause of IBS in my practice. My favourite IBS-tracking story was when a patient came in after having 3 years of diarrhea. We realized that the only day she didn't have yogurt was the only day she had a formed bowel movement. I got her to cut yogurt out completely for 2 weeks and she got about 50% better. I then got her to cut dairy out completely and after about 2 weeks her diarrhea went away completely. She has not had diarrhea for over 2 years now. There are apps like IBS tracker that you can use or you can use excel to make your tracking sheet, or just use plain old paper. If tracking isn’t enough, after asking the proper questions based on clinical experience it’s usually pretty easy to figure out the cause. 

Common causes of IBS

• Dairy: Removing dairy for 2 months and re-introducing it should give you a pretty sure sign of whether that was the cause or not. If you remove it for 2 months, start feeling much better and then reintroduce it and all of the sudden you have your digestive symptoms come back with a vengeance, we’ve found the culprit. It could be the lactose, whey, casein, not too sure, so you’re best off avoiding all dairy. The lactose-free stuff won't quite cut it if it's something aside from the lactose you're reacting to. I’ve seen removing dairy get rid of so many symptoms. Digestive-wise, it’s usually constipation, diarrhea, lower abdominal pain and GERD.
• Wheat: Wheat is difficult to cut out for most but for some it changes their entire life.. I’ve seen wheat removal, in numerous cases, get rid of constipation and right lower quadrant or RLQ pain.  I’ve even seen it get rid of back pain that ended up being due to constipation. It’s tough to say if this is due to the gluey-like nature of gluten, other proteins in wheat like gliadin, the fact that wheat has been modified so much that our body doesn’t recognize it, the pesticides wheat is soaked in or the fluctuations in blood sugar it causes. Wheat has been the culprit for a large number of symptoms in my practice. 
• Antibiotic use: Not very many people put it together until I ask them when the symptoms started and correlate it with their antibiotic history, but it seems very common that IBS comes on right after a course of antibiotics. There are several different reasons why this could be. It could be because the antibiotics killed off the bacteria that were responsible for breaking down certain foods or it could be because we killed off some of the good bacteria and the bad bacteria are starting to win the war now. A microbiology stool tests will show which good bacteria are thriving and which bad bacteria are thriving. Treatment differs with each case here. Some just need a good probiotic, others need to avoid foods that they are now sensitive to indefinitely. 
• Caffeine: Caffeine puts us into that fight or flight mode where our blood is shunted to our muscles rather than our digestive system. If you’re not getting proper blood flow to the digestive system you’re not going to produce those digestive juices to break the food down and you won’t be absorbing nutrients very well. Also if you’re not getting adequate blood flow you’ll start getting cramping feelings since the intestines are muscular. 
• Hypoglycemia: When our blood sugar gets low, we secrete the stress hormone cortisol. Cortisol simulates stress. If we're stressed, digestion is not going to be a priority. I"ve had so many patients' digestive symptoms go away once we regulated their blood sugar. The top digestive issues caused by low blood sugar are lack of appetite, nausea and acid reflux. 

• Constipation: if you have a mass of stool sitting in your intestines and you’re drawing fluid from it, it’s eventually going to become an unrecognizable mass. Our body will produce an inflammatory response and some mucous where this foreign object is. If the mass is blocking the intestine, all of the gas we produce will be redirected backwards and cause bloating.  It's difficult to get rid of this mass initially because we've been drawing fluid from it for a couple of days so it's all dry and not sliding out of the intestines very well. 
• Magnesium deficiency: Although difficult to prove via blood tests, magnesium supplements sometimes work wonders. This could be either due to a magnesium deficiency, since magnesium relaxes muscles in the intestines, or it could be because magnesium brings some fluid into the bowels which can act as a mild laxative.  
• Iron supplement: I’ve had so many patients come in on ferrous gluconate or ferrous fumarate for an iron deficiency anemia and they’re experiencing terrible digestive issues from it. I usually get these patients to switch to iron bisglycinate instead and it seems to be much less harsh on the digestive system. Their ferritin rises much quicker on it as well. You can’t expect to absorb a nutrient if it’s causing inflammation in the digestive tract.
• Holding it in: This is most common in kids who are new to school and nurses. The awesome term for it is "psychogenic megacolon". These patients will hold in their poop because they either fear public washrooms or because they won’t take the time from work to go. The stools get larger and larger, stretch the sigmoid colon, which is right at the end of your digestive tract between your belly button and pubic bone and eventually you have a large mass that’s way too large for your rectum to pass. Once a bowel movement happens, it's very painful so future bowel movements are held in out of fear of pain. 
• Food sensitivities: These are a bit more difficult to determine. There are food sensitivity tests that you can do but I find trials are the best. Food sensitivity tests on several occasions have came back negative but I'll guide my patients through cutting out common aggravating foods. I've seen certain foods cause any and every symptom of IBS. We all react differently to foods and I've seen people react to the most random foods that I never would've expected. Some common ones are dairy, wheat, eggs and tomato sauce. Some less common ones are melon, oatmeal, raw vegetables, but you could react to anything. These foods are difficult to identify but with my clinical experience and tracking, it becomes much easier. You can react to foods up to 3 weeks after eating it so it's important to avoid suspect foods for 1-2 months strictly to see if your symptoms improve. 
• Eating on the go: If we don't even realize we're eating we're not going to produce our digestive juices to break the food down. If we don't produce digestive juices we're not going to break food down properly and it's going to cause a whole range of issues. This is a huge problem these days. People are always eating breakfast on the go or eating while working. I always get patients to sit down and take 10 deep breaths before eating to get them into rest and digest mode and our of fight or flight mode. 
• Low stomach acid (hypochlorhydria): This is also a very common symptom in my practice. We're all constantly in fight or flight mode because we're constantly hypoglycemic, consuming caffeine, physically stressed, mentally stressed and emotionally stressed. If we don't produce proper stomach acid we won't break food down properly. Low stomach acid also leads to acid reflux or GERD. The lower esophageal sphincter (LES) which connects your esophagus to yours stomach stays open letting acid splash back up into the esophagus. It's a common misconception that we produce too much stomach acid. It is a lot more common to have low stomach acid compared to excess stomach acid. 

Less common causes of IBS

• Hiatal hernia: A hiatal hernia can cause issues in the epigastrium or what we used to call the solar plexus, right under the sternum. Chiropractors and osteopaths are a great option for this condition as well. 
• Taking zinc without food: I found this out  the hard way on the Toronto Subway
• Drinking chamomile tea if you have a ragweed allergy: Both are in the asteracea family so it would be similar to soaking ragweed and drinking it.
• Gallbladder disease: Gallstones and inflammation of the gallbladder can cause a whole range of symptoms similar to IBS.  
• Physical abnormalities: Some patients have spinal alignment issues which will prevent blood and nerves from functioning properly in the part of the digestive system that part of the spine is responsible for. A chiropractor or osteopath would be the best option here. 
• Candida: I have seen some cases of candida in stool tests where symptoms resolved after taking whatever that Candida was sensitive to.  
• Diverticulitis: Mainly causes left lower quadrant pain, worsens with eating nuts and seeds (sharp stuff), and most have a family history positive for it. A colonoscopy will tell you if you have it or not.
• Anxiety: if you’re constantly in fight or flight mode, blood is going to be shunted to the muscles and your digestive system will shut right off.
• Antidepressant use: Uppers will active your sympathetic nervous system and cause a whole range of symptoms like dry mouth, constipation, lack of appetite, etc…  There are several other medications that can cause digestive symptoms as well. 

Stress and IBS

Stress is often blamed for IBS but like I said before it may be an aggravating factor but is rarely the cause. Stress worsens IBS because it puts you into fight or flight mode, just like caffeine and anxiety do. If your brain thinks you’re running away from something it’s not going to all of the sudden kick into rest and digest mode. Check out the book, “Why Zebras don’t get ulcers” by Robert Sapolsky. There’s some neat info in there about this phenomenon. In a brutal study during the war, they had two groups of prisoners. One group was tortured and the other one wasn’t. The group that was tortured had no blood flow in their intestines, while the other group had full blood flow. This confirmed the suspicion that blood is taken from the intestines and shunted to our muscles in order to escape whatever threat we’re in.  If we're not getting proper blood flow to our digestive system we're not going to turn on our amazing digestive system to break food down and absorb nutrients. 

IBS Triggers

There are quite a few different variables for each condition that can lead to determining its cause. Some examples are:

• Timing: if symptoms come on about 15-60 minutes after eating it’s most likely due to a stomach acid issue or a specific food or ingredient. If you wake up feeling nauseous with no appetite it could be due to secreting cortisol for too long due to hypoglycemia. If you start getting digestive symptoms when it’s been longer than 4 hours since you ate it could also be due to hypoglycemia.
• Location: Pain in the epigastrium (top of the abdomen, below your sternum) is most likely due to reflux, pain in the left upper quadrant is most likely due to gas or gastritis, pain in the lower left quadrant is due to diverticulitis or constipation, pain right above the pubic bone is usually due to dairy (quite a few hours after consuming), pain in the right lower quadrant is usually due to wheat, while pain in the Right upper quadrant is usually due to gallbladder issues.These are just common examples, there are several different conditions that cause symptoms in each of these regions. 
• Stressful situations: if symptoms come on whenever you’re about to meet new people, anxiety could be the cause.
• Certain foods: If you’re getting symptoms after eating yogurt, it’s most likely dairy. If you're having symptoms after eating spaghetti it could be due to wheat or tomato sauce. It just takes tracking and a proper trial elimination to figure out which food is causing your symptoms. 
• Onset: if your symptoms came on after a course of antibiotics, you most like are having difficulty breaking certain foods down and might need to avoid them and take probiotics for a while. If symptoms came on after travel, you most likely picked up a foreign bug, virus, etc...
• These are just some examples. I could go on forever. This is why it’s important to have someone who is experienced and educated in determining the root cause of issues. If you ask the right questions, the answer is easily attainable. 

Natural treatments for IBS

The treatment for IBS will vary case by case. The most common treatment is to remove the offending foods but sometimes other treatments are necessary. Some treatments we use with success in naturopathic medicine are magnesium, bitters, stress reduction, probiotics, glutamine, encapsulated peppermint oil, fiber, DGL, antibiotics if pathogenic bacteria are present, referral for acupuncture, massage, osteopathy or chiropractic. There are so many options out there and unless you have someone directing you, you might waste a lot of time and money on trying to guess which treatments will work best.
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I was originally asked to write an article on how to live with IBS but I don’t think anyone should have to live with it. Work with your local Naturopathic Doctor to figure out what the actual cause is so you can just get rid of it. It’s also important to work with a healthcare professional so they can identify if something more serious is going on. There are several different conditions out there that can present like IBS but are much more serious and need referral or immediate medical attention. A couple of examples of conditions that mimic IBS are IBD, gallstones, diverticulitis, ovarian cancer, gastric ulcers, pancreatitis, duodenal ulcers and Celiac disease. 

As you can see IBS can be simple or complex. I could probably write a whole book about this topic but I figure these days people will only read for about 2 minutes so hopefully you were able to pick up the information needed that will help you figure out what’s causing your IBS or at least guide you to find someone who can help you navigate your IBS.

Thanks for reading!
If you have any questions or comments please comment below.
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Yours truly,

Dr Justin Gallant ND