Diarrhea Isn’t Normal!
As a digestive naturopath I hear about the following scenario from my patients often:
“Well, the good news is your tests came back normal, it’s just your IBS acting up.”
Upset, confused and dumbfounded you leave the 60 second consult that took over 3 months to get an appointment for as you reflect on the words echoed by your specialist:
“There’s nothing wrong with you.”
At this point, things have never felt worse and you find yourself doubting whether things will ever improve.
Sound familiar??
Today’s article explores what it really means to have IBS and what else could be going on. We’ll discuss when to consider further investigations and treatment with a naturopathic doctor. We’ll also explore some options for further testing and how to go about getting them from your GP without sounding like a hypochondriac!
Explosive Epidemic…
Make no mistake about it; irritable bowel syndrome is by far the most common digestive disorder on the planet! In fact, IBS affects up to a whopping 20% of North Americans. This sh*t is no joke!
The classic symptoms of IBS are diarrhea, constipation (or both) and abdominal pain. Of course, IBS comes in many flavors. It’s often accompanied by significant gas and bloating. Stress and foods are often common triggers. They are often accompanied by a disruption in gut motility and something called visceral hypersensitivity (not sure what this is? Check out my article on this topic here).
When in Rome…
So there’s actually a panel of gastroenterology experts that gather in Rome every few years. They sit and discuss how they should classify digestive disorders. They consider digestive conditions “functional” when symptoms are not caused by an underlying disease. Things like celiac disease or inflammatory bowel disease.
The result of this panel is something called the Rome Criteria, which is now in it’s fourth revision – apparently they’ve had a hard time coming to a consensus!
The criteria was designed to allow doctors to better classify a patient’s symptoms. Ultimately, to lead to more precise and effective treatments.
IBS Diagnosis:
For example the Rome IV criteria for IBS is as follows:
Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
After reading that, you may have thought to yourself: “Hey, that kind of sounds like me – I have the pain but my bowel movements are great”
Which Leads Us To Our Question:
Is it really just IBS? Is it even IBS?
Could there be something else going on?
Has every medical stone been turned over?
“Is it all in my head?”
Many patients, like you, may be left to ponder these questions.
So commonly, patients are labeled with IBS when tests are inconclusive or when digestive symptoms persist despite not being able to identify a cause. Sadly, this usually happens irrespective of the specific digestive complaints they are dealing with.
Here’s an example of a typical patient, we’ll call him Joe, who comes in to my office with a “diagnosis” of IBS:
After a brief conversation with Joe about the pain he’s been experiencing he points to the soft area just below his sternum (breast bone). Then, he tells me it’s worse after he eats a meal. Also, he often struggles to finish even smaller-sized meals because of the feeling of fullness and bloating. Finally, he tells me he often gets nauseous, sometimes experiences heartburn and that he’s unintentionally lost five pounds over the last month.
All tests are normal.
This is not IBS.
Joe actually suffers from a condition called functional dyspepsia, which is another functional disorder from our good friends in Rome.
Here’s Why It Matters…
Although functional dyspepsia & IBS often overlap, both a conventional doctor and naturopath should treat these two digestive conditions differently.
Please Note: If you have nausea and vomiting – that’s not your IBS flaring up – there’s something else going on you should probably have someone look at!
Ok, here’s another common example of a patient coming to me who was told they have IBS:
A lady in her forties – let’s call her Janet – she’s overweight and has been experiencing painless chronic diarrhea 4-5 times a day for the last two months. Conventional testing doesn’t reveal a thing!
She was diagnosed with IBS.
When questioned further, Janet tells me that she had her gallbladder removed two years ago. She has also been taking prescription antacids for heartburn for the last 6 months. She had to start the medication because of the hiatal hernia that formed from being overweight.
Janet developed something called bile acid diarrhea, which worsened when her gallbladder was removed and just never got better.
The prescription antacids she was taking for her heartburn were compounding the problem. The drugs were causing maldigestion of foods leading to a condition called small intestinal bacterial overgrowth (SIBO). This worsened her diarrhea even further.
Breath testing confirmed a diagnosis of SIBO.
It wasn’t all in her head, it was all in her gut!
That’s just a few examples of patients who felt powerless after a diagnosis of IBS, only to regain their health after a proper workup and the appropriate treatments.
That’s Just The Beginning!
Here are a few other reasons why someone may have IBS-like symptoms:
- Digestive enzyme deficiencies
- Fructose & lactose intolerance
- IgG food sensitivity
- Non-celiac gluten sensitivity
- Histamine intolerance
- Parasitic infection
- Fungal & bacterial dysbiosis
- Tropical sprue – (traveller’s diarrhea that doesn’t go away)
- Endometriosis & changes to your menstrual cycle
And as we found out with Janet, some medications (and even supplements) can cause or worsen diarrhea!
These are:
- Proton pump Inhibitors (antacids) – I see this VERY Often!
- Antibiotics (many)
- Senna & other laxatives
- Magnesium (especially magnesium oxide)
- Vitamin C – generally doses below 2 grams/day are safe
So you can see that it’s more complicated than “just your IBS acting up”. A naturopath can do a thorough investigation into what’s causing your digestive symptoms.
Testing:
The following section is a list of conventional and functional lab testing that may be useful for someone with IBS-like symptoms. It contains some of the finer points on how to increase the likelihood that your doctor might run these. Naturopaths can order many of these digestive tests as well!
Colonoscopy/Upper Endoscopy
These are very useful for ruling out the scary stuff – things like inflammatory bowel disease and bowel cancer. They can also rule out celiac disease, peptic ulcers and Helicobacter pylori infection, to name a few.
The testing is invasive so your doctors won’t order this unless they feel there is a compelling reason to do so.
Some of the reasons you’re doctor or specialist may order a scope:
- Recent unintended weight loss
- Chronic severe abdominal pain
- Trouble swallowing or painful swallowing
- Chronic diarrhea or sudden change in bowel habits
- Blood in the stool
- Over the age of 50 – screening colonoscopy
- heartburn that doesn’t respond to prescription antacids
If any of the above applies to you then please talk to your doctor immediately!
Comprehensive Digestive Stool Testing
For those with chronic unexplained diarrhea, stool testing can be extremely valuable. Stool testing can identify inflammation suggestive of Crohn’s & Colitis. It can detect overgrowth or infection by identifying microbial DNA from bacteria, parasites, viruses, and fungus. Testing even reveals when we have blood in the stool we can’t see. Lastly, stool testing can reveal disturbances in the gut-immune system and the guts abilities to digest and absorb nutrients.
This comprehensive digestive testing is not typically something your family doctor will have access to, so talk to your naturopath about this!
Food Sensitivity Testing
Although currently a controversial topic, food sensitivity testing can be a valuable tool especially for patients with IBS. There have now been three clinical trials showing sustained symptomatic relief. In these studies, patients strictly followed an elimination diet guided by their food IgG tests. When they re-introduced these foods they had a return of symptoms.
This is a good test to consider.
I don’t recommend asking your family doctor or specialist for this test unless you want to see their eyes roll. Unfortunately, many don’t believe in it and there’s often no amount of research that will change their mind on the topic. Save your breath on this one.
SIBO Breath Testing
Some Gut doctors are becoming more familiar with SIBO. They may even test you if you ask politely!
You could make a good case for SIBO testing if:
In addition to having symptoms of gas, bloating and diarrhea (or constipation) you also:
- Have had previous abdominal surgeries (hysterectomy, gallbladder, appendectomy, C-section)
- Have a history of gastroenteritis like food poisoning, traveller’s diarrhea or even a stomach flu prior to the appearance of your symptoms.
These are two strong risk factors for developing SIBO.
Another connection I’ve seen is those who have developed symptoms after a concussion. After all, an injury to the brain is an injury to the gut!
When In Doubt, Hire A Digestive Naturopath!
There’s perhaps no better example of how naturopaths can help with chronic health issues than with digestive conditions like IBS.
Research is now confirming what naturopaths have always known – food and stress DO matter to your digestion!
Conventional first-line therapies are now things like changing your diet – whaaaaat?! And mind-body practices – too woo-woo, right? Heck, even gastroenterologists are (quietly) starting to talk about peppermint oil as a an evidenced-based treatment!
All this to say you’ve never had more options for managing your digestive health concerns than you do now!
There are knowledgeable naturopaths out there (like me) that can help you with your digestive issues. Get the answers you’re looking for!
Don’t lose hope!
References:
- Palsson, Olafur S., et al. “Development and validation of the Rome IV diagnostic questionnaire for adults.” Gastroenterology 150.6 (2016): 1481-1491.
- Guo, Hong, et al. “The value of eliminating foods according to food-specific immunoglobulin G antibodies in irritable bowel syndrome with diarrhoea.” Journal of International Medical Research 40.1 (2012): 204-210.
- Atkinson, W., et al. “Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial.” Gut 53.10 (2004): 1459-1464.
- Drisko, Jeanne, et al. “Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics.” Journal of the American College of Nutrition 25.6 (2006): 514-522.