magine having a condition with symptoms so severe that you can't leave the house.
Yet your doctor calls it a functional, or psychosomatic, disease -- meaning that it's all in your head.
But it's a very real problem for the 60 million people -- that's 20 percent of Americans -- who have irritable bowel syndrome (IBS).
They're plagued by uncomfortable and often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain.
I have lots of patients with IBS, some of whom have suffered for decades without relief.
Their previous doctors couldn't find the cause of the illness, so they were told to just get more fiber or take Metamucil, or were prescribed sedatives or anti-spasm drugs or antidepressants.
That is NOT the answer.
I've found a better way.
Let me tell you about my patient Alexis.
At age 45, she'd suffered from IBS for 33 years -- almost all of her life!
Her major symptom was sudden, painful, cramping diarrhea.
She was doing the best she could to prevent it. She didn't consume dairy, didn't drink or smoke, and took Citracel every day.
Yet nothing helped.
She would go to the bathroom 4 to 5 times before she even left the house in the morning.
And she couldn't go out of the house at all without knowing where all the closest bathrooms would be in case she had what she called "s--- attacks."
That wasn't Alexis' only problem.
She also felt full and bloated after every meal, which starchy foods made worse.
An upper endoscopy had shown that she had gastritis, or inflammation of the stomach, and she had taken many antibiotics over the years.
She also had severe premenstrual syndrome (PMS), with irregular periods, breast tenderness, sugar cravings, headaches, and agitation.
She also had unusual symptoms like rectal itching (often a clue to yeast infections or food allergies).
And she was tired all the time.
Alexis tried to eat healthy, but her diet was less than ideal.
She had a bran muffin and coffee in the morning and a salad for lunch. But her "drug of choice" was sugar -- in the form of cakes, ice cream, Jell-O, diet sodas, and other junk food.
Not surprisingly, she was also about 20 pounds overweight.
So how did I help Alexis?
All I really did was identify and treat the UNDERLYING CAUSES of her digestive problems!
How did I do that?
Well, first you have to understand a little bit about how the gut works to know how fix it if it's broken.
Imagine a tennis court.
That is the surface area of your small intestine, where food is absorbed.
Your small intestine is also the site of about 60 percent of your immune system.
The bad news?
The small intestine is also just one cell layer away from a toxic sewer -- all of the bacteria in your gut.
If that lining breaks down -- from stress, too many antibiotics or anti-inflammatory drugs, intestinal infections, a low-fiber, high-sugar diet, alcohol, and more -- look out!
Your immune system will suffer and you can develop all sorts of digestive problems.
But that's just what can happen in IBS.
Let's talk a little more about all that bacteria.
You've got about 3 pounds of it -- 500 species -- in your gut.
In fact, there is more bacterial DNA in your body than there is human DNA!
Of all that gut bacteria, there are good guys, bad guys, and very bad guys.
If the bad guys take over -- or if they move into areas that they shouldn't, like the small intestine (which is normally sterile) -- then they can start fermenting the food you digest, particularly sugar or starchy foods.
This is called small bowel bacterial overgrowth -- and it's a major cause of IBS.
The major symptom it causes is bloating, or a feeling of fullness after meals.
What causes the bloating?
It's the overproduction of gas by the bacteria as they have lunch on your lunch!
This can be diagnosed by a breath test, which measures gas production by the bacteria, or by a urine test that measures the byproducts of the bacteria after they are absorbed into your system.
Bacterial overgrowth is a real syndrome and was recently described in a review paper published in the "Journal of the American Medical Association."(i)
And it can be treated.
Just last week, a major paper was published in the "Annals of Internal Medicine" (ii) that showed that using a non-absorbed antibiotic called rifaximin for 10 days resulted in a dramatic improvement in bloating and overall symptoms of IBS by clearing out the overgrowth of bacteria.
That's great news for many IBS patients.
But, unfortunately, not all patients with the same diagnosis are created equal.
There's more than one factor that leads to IBS.
Another major cause of IBS is food sensitivities.
Another landmark paper, which was recently published in the prestigious British medical journal "GUT," found that eliminating foods identified through delayed food allergy testing (IgG antibodies) resulted in dramatic improvements in IBS symptoms. (iii)
Another article, an editorial in the "American Journal of Gastroenterology," stated clearly that we must respect and recognize the role of food allergies and inflammation in IBS. (iv)
These are the two main causes of irritable bowel -- food allergies and overgrowth of bacteria in the small intestine -- but there may be others, including the lack of digestive enzymes, parasites, zinc or magnesium deficiency, and more. And this is precisely why it is so critically important to personalize the treatment based on the unique circumstances that exist for each person who suffers from IBS - the solution is most certainly not a one-size-fits-all one.
Let's get back to Alexis.
I prescribed her the non-absorbed antibiotic, an antifungal drug for her yeast problem, and had her eliminate the foods to which she was allergic.
Then I gave her supplements of healthy bacteria to normalize her gut and zinc to help with her digestive enzymes (chronic diarrhea can result in zinc deficiency).
I also gave her extra fiber to feed the healthy bacteria, fish oil to reduce gut inflammation, a multivitamin, and herbs to balance her hormones (which are greatly affected by abnormal but bacteria).
So what happened?
Well, Alexis came back two months later a different person.
Not only did she lose 20 pounds, she had not had a "s---- attack" and was having normal bowel habits for the first time in 33 years!
She also had more energy, and no more PMS.
She looked and felt 10 years younger and was free of the suffering she had endured for over three decades.
Are you like Alexis was?
It doesn't have to be that way!
We have the understanding and tools to deal with this chronic problem and the suffering it causes one in five people.
There is no need to wait for any more studies.
I have been treating IBS in my practice for over 10 years with dramatic success.
In fact, just today, one of my patients told me that, for the first time in his life, he didn't have any more stomach pains or digestive problems.
He had been so bad that he had to have a phone installed in his bathroom!
So what do you need to do to take advantage of these discoveries today?
If you have IBS, follow these steps:
1) Take the test.
Get tested for IgG food allergies (see http://www.immunolabs.com for more information on this testing) and eliminate the foods that test positive for 12 weeks.
2) Or do it on your own.
If you can't afford the test, then just eliminate the most common food allergies for 12 weeks -- that's dairy, gluten, yeast, eggs, corn, soy, and peanuts. And then reintroduce them to see if they cause symptoms.
3) Get rid of the unwanted visitors in your small bowel.
Ask your doctor to prescribe rifaximin (Xifaxin) and take two 200-mg tablets 3 times a day for 7 to 10 days.
4) Repopulate your digestive tract with good bacteria.
I don't usually recommend brands, but for these probiotics the quality varies so much that I suggest taking two specific brands.
Take one packet of VSL3 ( http://www.vsl3.com ) twice a day for 1 to 2 months, which has over 450 billion organisms per packet. I also recommend one to two packets of Florastor ( http://www.florastor.com ) twice a day for 2 months, a special probiotic that helps further normalize gut function.
5) If you get stuck, read more about other options. My favorite book on the subject is "Digestive Wellness" by Elizabeth Lipski:
Do you have IBS? How long have you had it and how has it been treated?
Have you noticed whether stress, certain foods, or other factors affect your symptoms and how?
Have you tried any of the recommendations in this blog? How have they helped?
Do you have any other suggestion for successfully treating IBS?
Please let me know your thoughts by clicking on the Add a Comment button below and posting your comment:
To your good health,
Mark Hyman, M.D.
PS - Some of you have volunteered in the past to help beta test the new UltraMetabolism community that we've been developing for the past new months. Well, the time is finally here, so if you've volunteered in the past, keep your eyes open over the next few days for an email from me on how you can help us test the community.