Digestive Health

The IBS-B Gone Program

The IBS-B-Gone Program is customized to you to determine what is causing your digestive woes. After taking a full history, I will recommend testing for one of the above conditions that I believe is at the root cause of your case. From there, a personalized plan will be developed based on the four R program of gut healing:

Small Intestine Bacterial Overgrowth (SIBO)

Bacteria are found abundantly on our skin and in our digestive tracts. In most instances, this bacteria is beneficial to our health and well-being. However, when a large amount of bacteria overgrow in the small intestine, this can result in a syndrome known as Small Intestine Bacterial Overgrowth (SIBO).

SIBO is thought to be involved in over half the cases of IBS; in fact, one study suggests that this number may be closer to around 84% of individuals with this condition! The same study found a 75% reductions in IBS symptoms with SIBO treatment.

Symptoms of SIBO

The bacteria that overgrows in SIBO include both anaerobes (Bacteroides, Lactobacillus, and Clostridium) and aerobes (Streptococcus, Escherichia coli, Staphylococcus, and Klebsiella). These bacteria produce both hydrogen and methane gasses which cause the typical bloating and flatulence associated with the condition. Often the volume of gas produced by the bacteria is sufficient enough to result in significant abdominal pain.

Hydrogen and methane gas also have an effect on motility within the bowel; hydrogen gas typically causes diarrhea whereas methane gas typically causes constipation. An individual with bacteria that produces both hydrogen and methane gasses will often experience alternating constipation and diarrhea, the typical presentation for people with IBS. The volume of gas produced is typically correlated with the severity of the symptoms of the disease.

The small intestine is where all of the nutrients from our food are absorbed into the bloodstream. Bacterial overgrowth in the small bowel will also typically impair digestion and absorption of nutrients, occasionally leading to secondary disorders such as anemia.

Associated Conditions

The following conditions have known to be commonly found in those who suffer from SIBO. If you have digestive disturbances and have been diagnosed with any of the following conditions, it increases the likelihood that SIBO is at the root of your digestive problems.

• Iron and B12 deficiency (anemia)
• Intestinal permeability (leading to rosacea, eczema, acne, joint pains, brain fog, etc.)
• Non-alcoholic fatty liver disease (NAFLD)
• Rosacea
• Interstitial cystitis
• Hypothyroidism
• Restless leg syndrome
• Histamine intolerance

Testing for SIBO

The Lactulose Breath Test is the gold standard for non-invasive testing to diagnose SIBO. The hydrogen and methane gas produced by the bacteria that overgrowth in the small intestine are not produced by human cells. We are able to detect these gases using this breath test and if there are elevations in either of these gases, you have SIBO.

Food Intolerances

Food reactions may be due to an intolerance, an allergy, or a sensitivity. An intolerance, such as lactose intolerance, is due to an inability to properly break down a food within the digestive tract due to an enzyme deficiency. This type of reaction does not involve the immune system and no antibodies are produced to the food.

Food Allergies

Food allergies occur when the immune system has created IgE antibodies against a particular food protein. If you have a food allergy, you may be at risk of a life-threatening allergic reaction called anaphylaxis. Other milder symptoms of a food allergy include hives, nausea, and itching. These reactions occur very quickly after consuming the food (within 3 minutes to 2 hours) and may even be in response to trace amounts of the offending food.

Food Sensitivities

Food sensitivities, like food allergies, are mediated by an immune response to food but involve the creation of an IgG antibody to the food, rather than IgE. It is thought that about 45% of the population suffers from food sensitivities with symptoms ranging from digestive disturbances such as bloating, IBS, and abdominal pain, to general symptoms like joint pain, fatigue, eczema, headaches, and weight gain.

Testing for Food Reactions

There are two main methods to determine if you have any food reactions. The first is an elimination diet which involves removing the most common foods that invoke reactions for a period of time and then the patient self-monitors for improvements in his or her symptoms. Foods are then re-introduced one at a time and if symptoms return on the reintroduction, a food reaction is then suspected.

The major advantage of an elimination diet is that there is a high level of patient involvement in their health and they can become more self-aware of their bodies. The most frequently discussed concern with the elimination diet is that it does involve (at first!) quite a restricted diet that can be expensive if you are purchasing allergen-free specialty foods. The diet may also not eliminate all potential sources of allergens.

The second way to assess for food reactions is to run a blood panel which looks for both IgE and IgG antibodies to specific foods. This panel provides a clear outline on which foods are safe, and which ones are likely to invoke symptoms.

I use the Alletess IgG & IgE Food Panel to assess for both food sensitivities and food allergies. This test looks for reactions to 96 different foods with a simple blood draw performed in-office.

Candida Yeast Overgrowth

The human body naturally has small amounts of yeast present in the digestive tract. The levels are kept in check by our healthy bacteria in our colon. However, candida is opportunistic by nature and will grow if allowed – for example, after antibiotic use or with an immune deficiency. This overgrowth can occur on almost any surface of the body including the oral cavity (thrush), the intestinal tract, sinuses, nails, skin, and vaginal tract.

Symptoms of Yeast Overgrowth

Candida species produce a carcinogenic toxin called acetaldehyde. With increased levels of acetaldehyde in the body, you may experience brain fog, poor memory, headaches, and fatigue. Further, some people may become inebriated easily when drinking alcohol and become more easily hungover. Often, people with yeast overgrowth in the digestive tract will also have other yeast overgrowth syndromes such as recurrent vaginal yeast infections, or oral thrush.

When yeast overgrowth occurs within the digestive tract, patients may experience mild bloating*, diarrhea, and constipation. Symptoms will often worsen with high sugar intake or refined carbohydrates.

* Note: excessive bloating is more characteristic of small intestine bacterial overgrowth (SIBO) rather than yeast overgrowth due to the nature of the gases that each produce.

Testing for Yeast Overgrowth

There are two ways that I would generally test for a candida overgrowth in my patients:

1. Serum Candida Profile which checks for three different types of antibodies to candida: IgG, IgA, and IgM. I choose to use this type of test when a patient has potential symptoms of candida overgrowth but I’m not confident that it’s in the digestive tract and will show up on a stool analysis.

2. Comprehensive Stool Analysis which will culture yeast present within a stool sample. This stool test is useful if I’m wanting to assess for intestinal yeast overgrowth specifically as it will tell me the type of yeast that is present, what agents will successfully treat it, and what the levels of healthy bacteria look like for future prevention.

Dysbiosis of the Large Bowel

Dysbiosis is a term that is used to describe a microbial imbalance within the digestive tract. There are normally trillions of bacteria within the large bowel that function in vitamin production, immune health, and weight management. Each person has a distinct and highly variable composition of gut microbes called the gut microbiota. Interestingly, there are about 10x as many bacterial cells in our body than there are human cells – something to think about!

After an illness, antibiotic use, or chronic poor diet, the levels of healthy bacteria may decline and pathogenic bacteria and yeast levels may start to rise. When this happens, you may experience digestive symptoms such as bloating, diarrhea, and constipation.

For people with a specific type of bacterial overgrowth called a hydrogen sulfide overgrowth, it is common to experience halitosis (bad breath) or pungent flatulence in addition to severe diarrhea and mucus in the stool.

Testing for Dysbiosis

A Comprehensive Stool Analysis can be used to determine the overall state of health of the gut. This test will culture stool to check for overgrowth of pathogenic bacteria and yeast, as well as checking for healthy bacterial levels that are needed for prevention of a future infection. Additionally, there is the option to add on a three day parasitology to the test to check for any parasites that may be growing in the gut contributing to your symptoms.

Malabsorption

Malabsorption is a condition characterized by a decreased ability to digest your food effectively and absorb the nutrients from that food. Digestion starts in the mouth with the mechanical breakdown of food with the teeth. From there, the food will pass through the esophagus, stomach, and intestines, where stomach acid, enzymes, and bile will continue the digestion process. In the small intestine, nutrients are absorbed across the intestinal wall and enter the bloodstream.

If any part of this system is impaired, such as through a lack of enzymes, a presence of bacteria/parasites competing for nutrient absorption, or a quick transit time, malabsorption will occur. Over time, this will lead to malnutrition and potentially symptoms associated with deficiencies of specific nutrients.

Symptoms of Malabsorption

The body needs a constant supply of nutrients to build, repair, produce energy, enzymes, hormones, proteins, cells, tissues, and bone. Also, our immune system needs nutrients in order to effectively fight infections.

If you have malabsorption or chronic nutrient deficiencies, it may result in any of the listed symptoms to the right.

Testing for Malabsorption

If you have signs pointing towards a single nutrient deficiency such as iron or vitamin B12, it is easiest to check serum levels of these nutrients with a simple blood test.

For more general symptoms of possible malabsorption, I use the Comprehensive Stool Analysis to assess your digestive function as a whole. This test not only looks into potential causes of malabsorption such as inflammatory bowel disease, parasites, and bacterial infections, but also looks for signs of improper digestion of food such as insufficient elastase (an enzyme from the pancreas), undigested fats, undigested muscle fibers, and carbohydrate malabsorption.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a term used to describe either Crohn’s Disease or Ulcerative Colitis, two conditions that involve chronic inflammation of the digestive tract. Ulcerative colitis only affects the colon whereas Crohn’s Disease can affect any part of the digestive tract from the mouth to the anus.

It is thought that IBD is caused by an improper immune reaction to specific types of viruses or bacteria in the digestive tract. Genetics are likely to play a role in increasing the risk of this happening as IBD is more common in those with a family history of the disease. However, most people with IBD do not have a family history.

Symptoms of IBD

Testing for IBD

Although a colonoscopy is the gold standard to diagnose inflammatory bowel disease, a stool test checking for levels of an inflammation marker called Fecal Calprotectin is an easy, non-invasive way to assess for IBD. High levels of calprotectin in the stool would warrant further investigation with a colonoscopy whereas low levels indicate that there is no active inflammation and prevent an unnecessary colonoscopy.

I am able to check Fecal Calprotectin levels either as a component of the Comprehensive Stool Analysis or as a sole marker of intestinal health.

Celiac Disease

Celiac disease is an autoimmune disease where the ingestion of gluten (a protein found in wheat, barley, and rye) leads to inflammation and damage in the small intestine. Over time, this damage can result in nutrient malabsorption. Celiac disease is quite prevalent and is estimated to affect 1 in 100 people.

The majority of those with celiac disease are unaware of their disease. Untreated, celiac disease may result in additional consequences from continuing to eat gluten such as anemia, osteoporosis, and certain types of cancer. Additionally, late diagnosis of celiac disease increases the risk of developing other autoimmune disorders such as autoimmune thyroid disease, and type I diabetes.

Symptoms of Celiac Disease

The signs and symptoms of celiac disease can vary greatly. In general, people with celiac disease may experience diarrhea, abdominal pain, bloating, nausea, vomiting and gas. However, more than half of people with celiac disease can experience symptoms outside of the digestive tract such as mouth ulcers, itchy, blistering skin (dermatitis herpetiformis), fatigue, and joint pain.

In children, celiac disease may manifest as anemia, failure to thrive, delayed growth, and behavioural issues including Attention Deficit Hyperactivity Disorder (ADHD).

The Celiac Disease Foundation has a symptom assessment tool to assess whether you have an increased risk for celiac disease.

Testing for Celiac Disease

Blood testing is the first step to confirm the diagnosis of Celiac Disease. The Celiac Evaluation Profile is a blood test that measures serum concentrations of IgA and IgG antibodies for Tissue Transglutaminase (tTG), Gliadin, and Deamidated Gliadin Peptide (DGP). In order for this blood test to be accurate, you need to be on a gluten-containing diet. If this test comes back positive, celiac disease is confirmed with a biopsy of the small intestine.