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Is There Something More Serious Behind My IBS?

In this post, I want to address the question that I find comes up often for people struggling with chronic gut symptoms and that is, is there something more serious underlying my IBS symptoms? Now, obviously this isn't a question I can answer for you personally. This is more of a question I find tends to really come up on the journey of gut dysfunction, especially when you've been struggling for a long time.

I know this was a question that I grappled with even after I had been to the GI doc many times and after I had seen multiple different GI doctors. I think it's more pertinent to IBS because this does tend to be the camp of people that go through a battery of GI conventional tests and nothing really specific is found. This usually leads to an IBS diagnosis. You may be given a probiotic or other simple suggestions by the GI doc. And then when those things don't work well, you start to perseverate and worry because the symptoms will often go on. You’re not getting the relief you're looking for and start to wonder, “Gee, was something missed? Is there something else going on? Did my doctor just not do a thorough enough workup?” 

I know I struggled with that question for quite a while before I went back in and achieved a second diagnosis of IBD. But in many cases, people can struggle at quite a significant level and really never reach that more serious diagnosis.

So what I want to say in answer to this question, is something more serious underlying my IBS symptoms, is “yes and no.” If you've done the things like going in to see your doctor, which is obviously a very prudent first step, and all things serious have been ruled out, you have probably checked that box. I always recommend to my clients that, if we find something suggesting a potentially more serious concern on the functional stool test, to always follow up with a doctor just to rule out something more serious. Oftentimes, they've already been down that road, especially in the recent past. So if you've gone through the measures of having an endoscopy, a colonoscopy, some other GI tests done, and you've ruled out something more serious, then there's a good chance that there really isn't anything more serious on the spectrum of conventional diagnoses going on with the IBS symptoms.

Now the other side of that coin is, are there potentially significant things going on that are driving these symptoms from more of a functional perspective? And by that I mean asking the question, “What might be some imbalances or potentially problematic factors that are driving this symptom picture?” And so I'll often run different types of tests compared to conventional doctors, but often with gut clients especially, I'm going to be suggesting a good functional stool test, using PCR technology, which looks at the gut from a more microscopic and sensitive level. Other tests I might consider are tests like hormone testing, micronutrient testing, organic acids testing, toxin testing, as well as other things. These are examples of functional tests that might come up on my radar based on what comes out during an initial consultation with a client.

And believe it or not, beyond just stool testing, there are certainly a number of other things, whether these are imbalances in the body, micronutrient deficiencies, macronutrient deficiencies, energy blocks, and toxin exposure, all of which can impact gut function and add to gut symptoms. In my world, it's important to identify as many of those key factors as possible without running the whole kitchen sink of testing on people. So I'm going to lay the groundwork for how I would start to address this question of what's driving potentially an IBS picture from a functional lens, so long as the more serious diagnoses have been ruled out.

Now, in my opinion, I think it's really important to try to quantitatively measure and look at digestive function as much as possible. A good functional stool test will absolutely do that. Nutritional deficiencies can sometimes be identified on looking at a food journal and taking stock of what someone is eating. A lot of times patterns will jump out. I'll start to recognize that there might be some serious deficiencies in certain macronutrient groups. There might be some food quality issues and some inflammatory foods that are being consumed that are likely to lead to potentially problematic nutrient deficiencies.

And just doing that subjective work can actually be very productive in helping a client get clarity on good changes to make in their dietary approach. However, there are other times where it makes sense to literally try to get data on nutrient deficiencies, whether that's looking at blood, or looking at urine through organic acids, just to see if major deficiencies show up that might be important indicators of of cofactors for different enzymatic processes in the body that help to support digestive function or energy production. 

There can be other blocks to energy production as well. That's one of the reasons why I love doing organic acids testing in certain cases. It can really get clear on some different inhibiting factors that are preventing overall energy production. In fact, deficiencies in cellular energy production are linked with just about every chronic illness. So we could say that when function starts to break down at the cellular level, sooner or later, we're going to see that play out in the tissues and systems of the body. And that will just depend on every individual's weak link and genetic predisposition as to which of those switches get flipped because of these energy deficiencies. There can often be things like hidden gut infections contributing and most practitioners in the functional space (myself included) like to work with DNA PCR stool testing, which is more sensitive to latent infections than just the regular stool culture testing that conventional medicine likes to run. And that can be very helpful.

I've seen time and time again correlating those clues on functional stool tests with a client's symptoms, helping a client to work on a protocol to balance the microbiome, and then getting very good results.

Other things that might come into play, toxic exposure, which is actually quite widespread in our world, and it's not something that most of us are even aware of. I think the truth of it is most of us are getting exposed on a greater and greater level as time goes on because toxins are being incorporated into more consumer goods, the homes we live in, and the materials we handle every day. Believe it or not, today's generation is being born into a more toxin heavy environment than our parents were or our grandparents were. And I believe this is going to become more and more of an inhibiting factor in terms of allowing the body to function at a healthy level. In those prone to gut disorders toxins can be another contributing factor to signal those genes. 

Hormone imbalances are also very much connected to chronic gut symptoms. Often I see HPA (hypothalamic pituitary adrenal) axis dysregulation. Generally speaking, this the axis of three glands that helps to regulate the stress response, which is really something that gets over activated for most of us in the day-to-day modern world. I would argue that the majority of the clients I've worked with have a pretty significant stress load, whether that's coming from work stress, home stress, the stress of being a parent, relationship stress, or other things. This is a reality that I feel has to be looked at and addressed as part of a holistic health optimization plan. Not only adrenal hormones, but eventually sex hormones get impacted in chronic illness. Thyroid can get also impacted very easily. I see a very strong connection between thyroid dysregulation and gut disorders, as well as thyroid dysregulation and autoimmune conditions. It's very, very common.

Along with the whole hormonal balance picture, nervous system dysfunction is a big part of gut disorders as well. Our nervous system is the most sensitive system of the body. It has the capacity to pick up information, especially at the subconscious brain level, often before we even consciously are aware of it. Whether it's because of modern technology, being in wifi rigged environments, being surrounded by technology that gives off strong signals all day, having a lot on our plates, the overwhelm of day-to-day living - all of that is going to overload and tax our nervous system in a way that just didn't happen 50, 100 years ago. And so it's another driving factor that's going to put a barrier in place when it comes to optimizing gut function that does need to be considered in the context of IBS, especially where we're not getting obvious answers from the conventional side of things.

In my initial consultation with a client, I do try to get a very good handle on multiple different areas of health, including stresses and environment, just so I have more clarity on what I think would warrant further functional testing. I’m always thinking, “What clues do we need to go gather to confirm or discard some potential hypotheses we might have here?” Everyone's situation is a bit different, but I think that doing that type of Q&A process and investigation at a pretty thorough level with a client really helps to point us in some good directions to get to the root of what might be some of the contributing factors here.

I think just going on that journey of discovery starts to alleviate that stress and that anxiety around the diagnosis of IBS and the question of “Okay, nothing’s really been found technically wrong with me, but I still worry there might be something more serious going on." I do want to reinforce the point that, certainly, if there are latent imbalances, dysbiosis, infections in the gut, if there is toxin accumulation, if there's been toxic exposure, could those things over time eventually contribute to a more serious health issue? Absolutely! Absolutely.

In my opinion, the real value of doing this kind of work is that it allows you to proactively try to identify some things that might be driving imbalances and chronic disease processes in the body at an earlier stage before things progress. This is really important, because, as you get older, it becomes harder to bring things back into balance. So there's a very proactive aspect to doing this work from a functional standpoint. 

However, things like toxins and latent gut infections that aren't going to show up on stool culture tests wouldn't necessarily be considered serious issues through a conventional medicine lens. So, it all kind of depends on the eye of the beholder and how proactive you want to be around your health and and trying to help the body correct imbalances at an earlier stage in the development of disease versus letting things go and potentially snowball into a more serious thing.

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