Still Struggling with IBS? Here’s What You Can Do

Being told by your healthcare team that you have IBS (irritable bowel syndrome) doesn’t tell you much more than you already know: you live with irritating gastrointestinal symptoms.

This may include any combination of the following:

• bloating/abdominal distention
• constipation
• diarrhea
• abdominal pain.
• There are some further classifications listed for IBS diagnoses: IBS-C (constipation), IBS-D (diarrhea), and IBS-M(mixed/both).

Common patient IBS story:

Your “work up” to come to the conclusion of IBS may have included your doctor following the Rome IV Criteria, performing a colonoscopy and/or blood draw to rule out other medical conditions. Next, you were probably told  “you don’t have colon cancer, Crohn’s disease or ulcerative colitis.” This is good news.

However, you may still have emotions surrounding your IBS diagnosis even though the “serious stuff” has been ruled out. Your doctor may have recommended some version of this: “Start taking Metamucil, here is a prescription for Bentyl, and you should start a food journal and learn to avoid your triggers. See you in a few months.”

Sadly, this is often not helpful per many patient reports and surveys. According to AAFP, “At five-year follow-up of IBS patients, 5 percent report complete recovery and up to 30 percent report partial recovery”

Sharing this is not to bash clinicians or healthcare; IBS is tricky, multi-faceted, not straightforward. Also, our healthcare system is spread thin, resources are lacking, time in office visits are minimal, and humanity is stressed out to say the least.

It could truly could be a functional disorder, and if so it should be treated as such. Conventional IBS treatment can yield relief when individualized and specific plans are given.

BUT when the standard IBS treatments aren’t effective, it’s worth asking:

• “Can we try a more individualized approach and specific nutrition care plan?”
• “Have other root causes to GI symptoms been fully explored?”

When a part of care team, Registered Dietitians are often the set of eyes who recommend additional testing, can order said testing, or refer out to other specialties.

What else could potentially be contributing to ongoing and irritating gastrointestinal symptoms?

• SIBO; estimates say 30-80% of patients diagnosed with IBS patients have SIBO
• SIFO (small intestinal fungal overgrowth) or candida overgrowth
• H. Pylori
• Parasitic infections (CDC estimates tens of millions of Americans)
• Low stomach acid
• Motility issues
• Undiagnosed or poorly managed celiac disease
• Undiagnosed or poorly managed hypothyroidism or hyperthyroidism
• Poor stress management/unresolved trauma
• Living in toxic indoor mold and you have a low MSH hormone
• Endometriosis
• Lyme disease

It doesn’t hurt to ask questions and to keep digging for answers, especially when something is still wrong. Constipation, bloating, diarrhea are too normalized and typically signify something is off in the body. “Test, don’t guess.”

If all “culprits” have been ruled out, better and more individualized plans need put in place. But truth be told, often when we dig a little more, we find more answers which can lead to a for sure diagnosis and consequently an effective treatment plan. If not, patients continue to suffer unnecessarily. This undoubtedly leads to worse quality of life, it can negatively impact mental health, and sometimes sexual health too. And even bigger physical problems can develop when gastrointestinal symptoms fester which include but not limited to:

• Anal fissures
• Hemorrhoids
• Fecal impaction
• Ileus
• Malnourishment (decreased or altered intake due to GI symptoms)

We can do more for our GI patients.

The bottom line is that many people who have been told that they have IBS are overall still living with life altering gastrointestinal symptoms. Can more be done to help patients? Yes! Help is out there in the form of:

• Working more closely with your doctor and scheduling appointments at closer intervals; second opinions may be needed. Do not be afraid to speak up or seek out another doctor.
• Further testing (GI map fecal testing, breath testing, hormone testing, thyroid testing, etc.)
• Checking the house for toxic indoor mold in clinically significant amounts via an ERMI test, the medically recognized way to assess the home for health deterring levels of mold. Self order the ERMI Test Kit #1. If the score if >5, hire a certified mold inspector asap.
• Better nutritional guidance performed by a registered dietitian; cookie cutter diet education sheets given at office visits usually don’t help patients
• Accessing behavioral healthcare if stress/trauma is exacerbating the GI situation

Dietitian care for patients:

When it comes to nutrition related care for GI symptoms, Telehealth has made it a reality to work more closely with your registered dietitian: more appointment availability, less commuting, less time off work for patients. Really diving deep can gets pinpointed answers, and consequently a better care plan in place.

What does a registered dietitian do?

In conversation during your appointment, your registered dietitian will ask questions to learn about your health history, current concerns, meal habits, supplement and drug usage. After this assessment, a plan will be created that gives specific advice on how to proceed with food and drink consumption. The plan may also include recommendations on additional testing, or referring out to specialists for more evaluation. Follow up appointments include going over barriers and successes to the initial plan, and then continuing to refine the plan especially when new information becomes available.

Interested? New Patients can self schedule an appointment package online. Let’s zoom out more with your gut symptoms.