I Think I Have IBS … Where Do I Start?
If you are experiencing chronic digestive symptoms, you are probably wondering if something is “off” in your gut. You may have sought advice from other health professionals or started your own research into what may be causing these uncomfortable and sometimes embarrassing symptoms. It is common to feel overwhelmed and frustrated in not knowing where to begin or by the amount of conflicting advice that is available.
First Things First, We Must Check for Serious Causes
There are symptoms that require seeing your primary care physician without delay, including seeing mucus and blood in your bowel movements, severe pain in your abdomen, sudden onset abdominal pain, unintentional weight loss, change in appetite, recurrent vomiting, shortness of breath, or trouble swallowing. Your primary care physician should be consulted to run the appropriate tests and imaging to check for inflammatory bowel disease (Crohn’s & colitis), ulcers, celiac disease, diverticular disease and cancer. If your testing comes back normal or your symptoms are inconsistent with the above-mentioned, more serious conditions, you may be given the diagnosis of Irritable Bowel Syndrome (IBS).
So, you have “IBS”
Irritable bowel syndrome (IBS) is a diagnosis of exclusion, meaning that it is diagnosed when the more serious digestive conditions above have been ruled out. Many of our patients are told they will need to live with IBS and there are no treatment options other than managing stress and paying attention to potential bothersome foods. But we are here to correct this notion. Being diagnosed with IBS is not the end of the line for your digestive health and you don’t have to endure these symptoms for the rest of your life.
Our Naturopathic Doctors are digestive health detectives and will help you get to the bottom of your digestive concerns. The digestive system is complex and requires many steps and different organs to properly digest and absorb our food. A healthy digestive system requires the following physiology to work properly together:
- Optimal food digestion, which includes adequate production of stomach acid, digestive enzymes, and bile.
- A healthy digestive lining devoid of inflammation, irritation, erosion, and epithelial dysfunction.
- A balanced immune system that does not overreact to the food you are consuming.
- A balanced microbiome with healthy levels of “good” bacteria and the absence of “bad” microorganisms such as yeast, fungi, bacteria and parasites.
- Proper transit of food from table to toilet (sorry for the visual!), which requires healthy stomach emptying, sphincter tone, migrating motor complex (MMC), peristalsis, and colon tone.
A thorough health investigation including a detailed medical history, physical examination, and appropriate testing can help to identify which of these systems are not in optimal health and may be contributing to your IBS. Every case is unique and the reasons for your discomfort can be as varied as the symptoms themselves.
The Importance of Digestive Health Tests for IBS
Digestive health tests help to pinpoint the cause(s) of your IBS. Although there is a cost to each of these tests, we have found they can save you money and wasted time guessing about your symptoms. Without the appropriate testing, you may get frustrated with a trial and error approach, lack the motivation to follow through and may not get the full relief from your digestive symptoms.
Our Most Common Digestive Health Tests
Below are some of the top digestive health tests we use within our IBS & SIBO Program. (Please note – this is not an exhaustive list of available digestive health tests used at Whole Medicine. Your ND will guide you through which, if any, tests are appropriate for you.)
1. SIBO Breath Test
Small Intestine Bacterial Overgrowth (SIBO) is the cause of over 80% of cases of IBS and is one of our most commonly used digestive health tests to get to the root cause of your symptoms. This is a simple, non-invasive breath test completed in the comfort of your own home. After following the 24-hour prep instructions, you will take a breath sample every 20 minutes for 3 hours. SIBO produces excess hydrogen and/or methane gases through fermentation in the small intestine that are easily detectable via the breath.
SIBO breath testing has become more accurate as the guidelines for what we consider a positive result have recently changed. In the past, many cases of SIBO were missed because the guidelines were too stringent.
Furthermore, some breath tests use glucose instead of lactulose as the drinkable solution. Glucose is absorbed rapidly through the intestinal wall and most of it doesn’t make it all the way through the small intestine to feed the bacteria in order to generate an accurate test. In the SIBO & IBS Program, we use lactulose breath kits to ensure even distribution and reduce false negatives.
2. Comprehensive Digestive & Microbiology Stool Tests
There are a few options available, depending on your symptoms and needs. Comprehensive stool tests can provide valuable information regarding the health of your large intestine (colon):
- measures key markers of digestion, absorption, and inflammation
- evaluates the status of beneficial and pathogenic microorganisms including aerobic and anaerobic bacteria, yeast and parasites
- and performs antimicrobial and antifungal susceptibility testing to prescriptive and natural agents for any dysbiotic flora found
3. Celiac Disease Testing
This is a simple blood test and is vital to help differentiate celiac disease from gluten intolerance. Celiac disease is an autoimmune condition in which the consumption of gluten can result in serious damage to your digestive tract. This disease can also limit your ability to absorb nutrients and, if left untreated, puts you at risk of developing other health conditions, such as heart disease, bowel cancer, infertility, miscarriage, migraines, neurological disorders and autoimmune diseases (to name a only a few!). You must be consuming gluten regularly prior to this test for accurate results. Gluten intolerance can still result in unwanted symptoms and complications; however, the consequences of consuming a small amount of gluten are reduced when you only have an intolerance, compared to those with celiac disease. For some, being tested for celiac disease before removing gluten from their diet provides vital information for their wellbeing.
4. Food Intolerance Testing
Undiagnosed food sensitivities can cause a broad range of symptoms, including IBS, eczema, mood disorders, colic, migraines, fatigue, and brain fog. Testing can help to identify the trigger food(s) that may be aggravating your symptoms. Once these foods are avoided for a period of time, your digestive system may begin to heal.
At Whole Medicine, we have found food intolerance testing to be more helpful than elimination diets for a few reasons:
- We can quickly pinpoint the problem foods and design a manageable plan for how to incorporate these results into your diet.
- Elimination diets can be challenging. For an elimination diet to be a successful diagnostic tool, it must be completed without any cheats and may take months to complete.
- We can assess the “level” of reactivity to foods, thereby helping to design a plan that focuses on only the most significant intolerances.
If you have any questions or would like some further information about how testing may help you get to the bottom of your digestive concerns, contact us or book an appointment with one of our Registered Naturopathic Doctors.