Digestion & GI health
Irritable bowel syndrome — is it all in your head?
Women with irritable bowel syndrome (IBS) often tell me their lives are being run
by their bowels. They’ve stopped going out to dinner, taking trips or doing
much of anything. It feels like they have tried everything — from increasing
fiber and loading up on Metamucil to finally filling a prescription for antidepressants
out of desperation. By the time these women get to my door, they’re fed up
and don’t know what else to do.
The US Department of Health and Human Services reports that up to one in five Americans
has irritable bowel syndrome (sometimes also called “spastic colon”),
and 75% of them are women. But the problem is poorly understood by general practitioners,
and many women with IBS come away from their doctors feeling little is being offered
to truly help them. Instead of getting at root causes, conventional medicine too
often depends on medications that simply mask the symptoms. What’s worse is
the fact that some practitioners are claiming irritable bowel syndrome is all in
the patient’s head.
I know irritable bowel syndrome can completely rule a woman’s life. I also
know that it stems from more than just our thoughts or from daily stress. While
there is clearly a mind-body connection at play, IBS arises for many different reasons,
and in the same way, there are many successful alternative approaches to relieve
it. You don’t have to focus your life around irritable bowel syndrome anymore.
Your life can be different — I promise.
Let’s go beyond the symptoms and take a closer look at what might be leading
to your discomfort, so you can begin to
heal your gut problems at the source and enjoy the health you deserve.
Irritable bowel syndrome: a catch-all diagnosis
Irritable bowel syndrome is just what the phrase implies — a syndrome. That
means that not only is the bowel irritated, but a whole constellation of symptoms
and causes is found in association with IBS, not just one specific pathology. Scientists
haven’t discovered physiological evidence of disease in the bowel, so a clear-cut
definition has yet to be developed. Without recognizable pathology, IBS has been
classified as a functional disease — an umbrella term encompassing
bowel dysfunction that can play out in numerous ways, for numerous underlying reasons.
This is why the functional medicine model provides the most useful approach for
Conventional diagnostic criteria for irritable bowel syndrome
Below you’ll find the criteria conventional healthcare practitioners consult
when making an IBS diagnosis. With several different sets of criteria plus a range
of additional associated symptoms, it’s no wonder IBS is often poorly understood
- Abdominal distention
- Relief of pain after bowel movement
- More frequent and looser stools at onset of pain
- A sense of incomplete rectal evacuation
- Passage of mucus with the stool
Rome criteria (includes above bullets plus the following):
- Constant presence of abdominal pain and altered bowel habits
- Presence of remaining symptoms 25% of the time
Here are some other symptoms frequently associated with IBS:
- Pain with bowel movements
- Painless diarrhea
- Alternating constipation and diarrhea
- Loss of appetite
- Early satiety
- Poor nutrient absorption
Some scientists propose that IBS might exist on a continuum with inflammatory bowel
disease (IBD). IBD, which includes ulcerative colitis and Crohn’s disease,
is known to cause visible changes to the body: the intestines become inflamed to
the point where they are red and swollen. Some studies are now being done to pinpoint
molecular and structural changes within the bowels of various IBS patients, but
there are still no definitive answers. As Dr. Michael Gershon writes in his book,
The Second Brain, “Today functional bowel disease is a complex
of symptoms lacking a link to pathology. Tomorrow, I am sure the list will vanish
and be replaced by an assortment of evident disease entities.”
In an attempt to organize a complicated problem, conventional providers have different
preferences for diagnostic criteria (see list at right), and there are at least
four main types of IBS to choose from. There is diarrhea predominant IBS
(IBS-D), constipation predominant IBS (IBS-C), IBS with alternating stool
patterns (IBS-A) and postinfectious IBS (IBS-PI) — and the
newest criteria divide IBS subgroups differently again. With so many criteria and
categories to keep track of, it’s no wonder women and their clinicians are
So what causes irritable bowel syndrome?
While conventional practitioners do their best to address IBS symptoms, we at Women
to Women have learned that true healing of functional bowel disease can take place
only when you treat the root causes. We take this approach because there is wide
overlap between the causes and symptoms seen in irritable bowel syndrome and those
of other problems, including yeast overgrowth,
and food sensitivities, to name just a few. (See our diagram of
IBS.) All these other disorders can cause, influence, or exacerbate IBS,
and they also lead to frequent misdiagnosis. For example,
celiac is frequently overlooked when an IBS diagnosis is handed down, and
it’s worth investigating carefully before you rule out celiac as a causal factor
of your symptoms.
Eventually mainstream providers will catch up and recognize that IBS can arise for
many different reasons, and when we address all the factors one by one, patients
can see real results.
Here are some of the major triggers I’ve seen for irritable bowel syndrome:
Imbalanced gut flora. The flora that populate our guts
are so important to every aspect of our health. Many women don’t realize that
when they take an antibiotic, especially repeatedly, it can wipe out their bacteria
— good and bad. Once the friendly bacteria that help digest your food and
protect the gut lining become imbalanced, digestive and immune capabilities are
compromised, potentially leading to IBS. Certain steroid medications can also disturb
floral balance in the gut, as does an overgrowth of yeast such as
Candida in the intestines. Both can lead to or worsen IBS.
GI infection. Along the same track, research clearly shows
a much higher incidence of IBS following GI infection — twice as high, by
some reports. Some women develop IBS after contracting a case of food poisoning
or any one of numerous other intestinal
parasites. Most of these pathogens can be easily treated with herbs or antibiotics
once recognized, but resistance in certain bugs is becoming increasingly worrisome,
so I generally don’t hand out antibiotics to patients complaining of IBS without
first sending a stool sample for
Food sensitivities/intolerances. Over half of the women
I see with irritable bowel syndrome have unidentified food sensitivities or intolerances.
Some of the most common food triggers are wheat,
gluten, dairy, corn, sugar, chocolate, coffee, tea and citrus fruits. Although
food sensitivities and allergies can
be complex and change over time, we use sensitive allergy antibody tests and an
elimination diet to identify and treat them effectively. Once the problematic foods
are discovered and eliminated from the diet, the gut will quiet down and the symptoms
of IBS often disappear.
Hormonal imbalance. Lots of women notice that their IBS
symptoms are worst just before their periods. Why this occurs is not clear, but
it may have to do with the pattern of hormonal fluctuation in the second half of
the cycle: estrogen is lower for several days, whereas progesterone is relatively
high at the end of the cycle, then drops off suddenly just before menses. Progesterone
in general slows gut motility, and lower-than-normal estrogen levels have been identified
in women with IBS. It’s possible that when the ratio between these two sex
hormones is off, sluggish bowels could in turn worsen pelvic congestion, cramping,
and abdominal distention.
Stress and anxiety. As anyone with IBS knows, stress and
anxiety can affect the body in many ways. When we’re stressed, changes occur
in the autonomic nervous system — the system of nerves that make up the sympathetic
(governs our “fight or flight” responses) and parasympathetic
(regulates the “rest and digest” responses) nervous systems. In patients
with irritable bowel syndrome, input from the brain sends a message to decrease
digestion and increase motility of the colon, resulting in the rapid passage of
incompletely digested stool.
But there are many other disease processes that can lead to IBS-like symptoms, and
we practitioners and our patients have to be mindful about checking that nothing
more serious is at the core of an irritated bowel. For example, endometriosis, ovarian
and colon cancer, and inflammatory bowel disease can often cause or exacerbate bloating
and other symptoms that resemble IBS, which can lead to a misdiagnosis. To be safe,
these more serious disorders should always be ruled out by your healthcare practitioner
before settling on a diagnosis of irritable bowel syndrome.
Causes and symptoms of irritable bowel syndrome
© 2008 Women to Women
The gut–brain connection — a piece of the picture
Patients often ask me if it’s true that IBS stems from imbalances in the brain.
And the answer is yes — and no. Most women know what it feels like to get
butterflies before an important event, or to run to the women’s room before
a test or interview. It’s no surprise that the things on our minds can affect
what happens in our guts — we’ve known this since the beginning of time.
Perhaps more intriguing are the similarities researchers describe between the nervous
system of the brain and the nervous system of the gut (also known as the enteric
nervous system) and how this may play out for irritable bowel syndrome.
For one thing, 95% percent of our serotonin, the neurotransmitter most of us associate
with mood and brain function, is manufactured in the gut. Its main role there is
to stimulate intestinal movement and contraction, as well as to help with mucus
secretion. Women may find that eating too much of the kinds of food that cause a
spike in serotonin levels — food high in refined carbs — will trigger
an episode of IBS, especially if there are other pieces of the IBS picture already
in place (stress, a lack of
digestive enzymes, floral imbalance,
or other problems).
But the connection between gut and brain may not be as direct as it first appears.
The nervous system is divided into two broad categories: the central nervous system,
which is comprised of the brain and spinal cord, and the peripheral nervous system,
which makes up all the other nerves in the body and follows commands from the central
nervous system. The enteric nervous system is technically a part of the peripheral
nervous system, but it doesn’t always follow commands from the brain and spinal
cord, and it doesn’t necessarily send input back to the brain as the rest
of the peripheral nervous system does.
Some scientists even argue that the enteric nervous system is more of an equal to
the brain than its inferior. Dr. Gershon writes that the enteric nervous system
is “an independent site of neural integration and processing,” and can
keep the gut working without input from the brain. This is why it is called “the
second brain.” These insights raise the question of whether irritable bowel
syndrome has anything to do with the brain at all. Could it be simply caused by
a disturbance in the second brain? From what I’ve seen in practice —
and as brain imaging studies by neuroscientists are bearing out — this is
an oversimplification. IBS is often multifactorial, and it takes a combination of
healing the gut and the mind to get results.
Developing a healthy gut — the Women to Women way
Many years ago it was routine for healthcare practitioners to ask patients detailed
questions about their digestion and bowel health. The digestive system was considered
an excellent window through which they could view an individual’s whole health
picture. Though practitioners in Europe and in the East still place a primary focus
on the digestive system, here in the West many pay little heed to our bowels. Unless
we complain or something is identified on routine screening, most conventional practitioners
assume everything is working as it should. And some conventional practitioners will
consider it adequate if you move your bowels at least once a week. But this isn’t
normal — what goes in must come out! A woman with a healthy digestive system
should have a bowel movement once or twice a day.
At the clinic, we always ask women about their digestive health because we understand
it is central to nutrition, immunity, and overall balance in the body. When I see
a woman with symptoms of IBS, it tells me there are larger issues at play, and that
we need to explore the problem rather than covering it up or telling a woman it’s
all in her head. Solving irritable bowel syndrome takes time because it involves
some investigation and trial and error.
The bottom line is that each woman heals differently, particularly when it comes
to the gut, and the best course of action has to be tailored to her unique physiology
and situation. Here are some of the measures I’ve found helpful for women
- Add a probiotic. Research shows that healthy
probiotic flora like Acidophilus, bifidobacteria, and Saccharomyces
boulardii may alleviate some cases of IBS. If a trial of regular probiotic
use relieves your irritable bowel, your gut flora may have been out of balance.
But if you don’t get good results with your first choice within two weeks,
you may want to try another type of probiotic, because there is tremendous range
in the flora that play a part in IBS. Probiotics can also be found in fermented
foods like yogurt, kefir, and miso, as well as in
like the one we offer in the Personal Program. When floral balance is restored to
your gut, you will enjoy all the benefits of better digestion and improved immunity.
- Experiment with food allergy testing or an elimination diet.
Many of my patients eliminate certain trigger foods, especially
gluten and lactose, and start to feel much better. So many women have undiagnosed
food allergies or sensitivities because of our increasingly toxic environment. You
might visit a holistic allergist for food testing or try an elimination diet. If
you decide on an elimination diet, take a look at our
Digestive Reset Program which guides you through an elimination diet and
offers support through probiotics, glutamine, and phone consultations. Keep in mind
that many women report feeling worse when they first remove foods to which they’re
reacting, so this approach takes commitment and patience for both women and their
- Get a stool analysis. Talk with your healthcare provider
about a digestive stool analysis with comprehensive parasitology. This may provide
answers about malabsorption, pH imbalance, parasites, or yeast overgrowth. If your
provider can’t perform such tests, you can work with a lab on your own (see
our page on testing options
for labs we recommend). When parasites or an abundance of yeast are treated, it
can dramatically reduce your IBS symptoms. Likewise, a practitioner versed in functional
medicine may recommend a protocol of functional foods and
digestive enzymes to reverse inflammation in the bowel and other causal
and related problems further up the digestive tract.
- Make stress relief a real priority. Stress is the IBS
trigger that is often most difficult to remove. If we’ve gotten into the habit
of feeling stressed and anxious, it’s difficult to simply stop — especially
if we’re dreading the onset of pain, discomfort, or embarrassment so common
in irritable bowel syndrome. Getting to the root of our stress can require a dramatic
change in the way we think about things. What we think and feel has so much impact
on our bodies. Give yourself permission to experiment with new ways of relieving
anxiety and stress. Consider meditation,
EFT, enrolling in a yoga class or getting regular massages. If you have
the time and money, many of my patients have had success with the
Quadrinity Process as a way to change old ways of thinking. Another form
of behavior modification known as cognitive behavioral therapy has also been helpful
for some women.
- Take a quality multivitamin. Digestive health is paramount
to extracting essential nutrients from the food we eat. If your digestive process
is compromised, you’re simply not receiving the micronutrients your body needs
every day for the basic functions of living. It’s always a good idea to shore
up your nutrition with a high quality multivitamin-mineral complex, and even more
important for women with IBS. Keep in mind that some women with IBS or other digestive
disorders may have difficulty tolerating a multivitamin at first. We recommend women
introduce vitamin supplements slowly when treating GI problems. Once the digestive
issue is addressed, a multivitamin can be taken without a problem.
- Eat fresh whole foods with plenty of fiber. Our bodies
were made to eat fresh whole foods, foods without hormones and additives, foods
that are not genetically modified or refined. The bacteria in our gut need dietary
fiber to do their jobs. They ferment dietary fiber to produce short-chain fatty
acids, including butyric acid, which is the primary source of fuel for
our colonic cells. So if you’re not eating enough fiber, you’re starving
both your beneficial flora and the cells in your colon!
- Try natural herbs. Herbs like deglycyrrhizinated licorice
root (DGL), enteric-coated peppermint, slippery elm bark, ginger, marshmallow, Swedish
bitters, and fennel seed can all be very helpful in calming the symptoms of IBS.
Many of these healing herbs have been used for generations and come with few side
effects. You may want to do some research to familiarize yourself with their use,
however, or seek consultation with a qualified practitioner, for best results.
Living with IBS — it doesn’t have to be this way
Not long ago one of my patients with IBS, Janine, who lives just two hours from
the clinic, rented an RV so she could come and see me. She told me she was afraid
to make the trip without having a bathroom nearby at all times. After our visit,
I told her I hoped she would never need to rent another RV unless she wanted to
take a driving vacation. So many women like Janine think they have to live with
the consequences of irritable bowel syndrome. But I remind them: This is an issue
we can do something about.
IBS is not a simple cause-and-effect disorder. Its intricacies reflect the complexities
of our own lives and bodies. To treat it, we have to look deeper than high-fiber
diets, Metamucil, antispasmodics and antidepressants. It’s neither just in
your head nor just in your gut. IBS can result from numerous stressors in our environments,
our diets, even our thoughts — and the best way to begin the healing process
is by understanding that your own symptoms have their own solutions. My clinical
experience proves that you don’t have to live with IBS forever. It may feel
like you’re stuck with the discomfort, but with some careful attention and
time, I know you can find your path to healthy, happy bowel function — naturally.
And I can promise the time and attention you invest will be worth it, because healthy
digestion delivers a healthier life on every level.
Related to this article:
References & further reading
Last Modified Date: 05/09/2011