IMAGINE 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). These people are plagued by uncomfortable and often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain.
I have many 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, anti-spasm drugs, or antidepressants.
That is NOT the answer. Most of those treatments don’t work, because they don’t address the underlying causes of why your digestion is not working. Emerging research has helped identify the underlying causes. For over 15 years I have been successfully treating irritable bowel syndrome and other digestive conditions using a very simple methodology based on functional medicine (www.functionalmedicine.org) that helps identify and remove the underlying causes and restores normal digestive function and health.
Today, I am going to share 5 steps you can follow to cure IBS. But first I want to tell you about a patient of mine …
Alexis and Her Lifelong Irritable Bowel
At age 45, Alexis had suffered from IBS for 33 years — almost all 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.
She had taken many antibiotics over the years and had many yeast infections. An upper endoscopy or scope into her stomach had shown that she had gastritis, or inflammation of the stomach. 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.
To help Alexis, I simply identified and treated the UNDERLYING CAUSES of her digestive problems! To understand how I did that, you first have to understand a little bit about how the gut works.
These are the two main causes of IBS: Food allergies and overgrowth of bacteria in the small intestine.
How Gut Imbalances Can Lead to IBS
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. And this sophisticated gut-immune system is just one-cell layer away from a toxic sewer — all of the bacteria and undigested food particles in your gut.
If that lining breaks down — from stress, too many antibiotics or anti-inflammatory drugs like aspirin or Advil, steroids, intestinal infections, a low-fiber, high-sugar diet, alcohol, and more – your immune system will be exposed to foreign particles from food and bacteria and other microbes. This will trigger and activate immune response, allergy, and will irritate your second brain (the enteric nervous system) creating havoc that leads to an irritable bowel, an irritable brain, and other system wide problems including allergy, arthritis, autoimmunity, mood disorders, and more.
The microbial ecosystem in the gut must be healthy for you to be healthy. When your gut bacteria are out of balance — when you have too many pathogenic bacteria and not enough healthy bacteria — it makes you sick. You’ve got about 3 pounds of bacteria — 500 species — in your gut. In fact, there is more bacterial DNA in your body than there is human DNA! Among 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) — 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 this bloating? The overproduction of gas by the bacteria as they have lunch on your lunch!
Small bowel bacterial overgrowth 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) The condition can be treated. In fact, a major paper was recently published in the Annals of Internal Medicine that showed 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.(ii) This medication is now under FDA review for approval as a new treatment for irritable bowel syndrome.
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. Not true allergies, but low-grade reactions to foods that drive so many chronic symptoms including IBS.
A landmark paper, was recently published in the prestigious British medical journal Gut that found 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)
So the research tells us that 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 a lack of digestive enzymes, parasites living in the gut, zinc or magnesium deficiency, heavy metal toxicity, and more.
And this is precisely why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS — the solution is most certainly not one-size-fits-all. But solutions can be found if we look carefully at the underlying causes and treat them.
Which leads me back to Alexis …
How I Helped Alexis Heal from IBS
I prescribed Alexis a non-absorbed antibiotic, an antifungal drug for her yeast problem, and had her eliminate the foods to which she was allergic. I believe in treatment that addresses the underlying cause of the problem. If there is a bacterial or yeast infection, then medications are often the best treatments. The key is to effectively treat the cause. If medications do that, then I use them.
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 bacteria).
What happened then may shock some, but I wasn’t surprised. It is the same result I have seen in patient after patient when the principles of functional medicine are applied …
Alexis came back to see me two months later, and she was 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 her PMS vanished.
She looked and felt 10 years younger and was free of the suffering she had endured for over three decades.
Do you have to suffer like Alexis did? No. We have the science, the understanding, and tools to deal with this chronic problem and the suffering it causes 1 in 5 people. There is no need to wait for any more studies. I have been treating IBS in my practice for over 15 years with dramatic success.
In fact, just recently, 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 previously been so bad that he had to have a phone installed in his bathroom!
To take advantage of these discoveries today, simply follow these five steps.
5 Steps to Curing IBS
1. Get tested. Try to get a test for IgG food allergies and eliminate the foods that test positive for 12 weeks. Or simply try an allergy elimination diet for a few weeks.
2. Test yourself. If you can’t afford the test mentioned above, then just eliminate the most common food allergens for 12 weeks — that’s dairy, gluten, yeast, eggs, corn, soy, and peanuts. And then reintroduce them to see if they cause symptoms. This is an effective way to isolate the foods that may be causing you problems. I have created a simple program to follow based on a comprehensive elimination diet called The UltraSimple Diet.
3. Get rid of the unwanted visitors in your small bowel. Ask your doctor to prescribe rifaximin (Xifaxin) and take two 200 mg tablets three times a day for seven to 10 days. This is often the best way to deal with the chronic bacterial overgrowth that causes bloating and irritable bowel syndrome. You may also need an anti-fungal such as nystatin or fluconazole for two to four weeks.
4. Repopulate your digestive tract with good bacteria. I don’t usually recommend brands, but when it comes to probiotics the quality varies so much that I suggest taking two specific brands. Take one packet of VSL3 or other high potency probiotic twice a day for one to two months. This probiotic has over 450 billion organisms per packet. I also recommend a probiotic called S. boulardii take two capsules twice a day for two months. This is a special probiotic that helps to further normalize gut function.
5. Try digestive enzymes with meals to help break down food while your gut heals. You also may benefit from nutrients that help heal the lining of the gut including fish oil, GLA (from evening primrose oil, zinc, vitamin A, glutamine and others.
By taking these steps and seeking out the underlying causes of IBS, you can dramatically improve your health and overcome your digestive disorder.
To your good health,
Mark Hyman, M.D.
References
(i) Lin, H. (2004). Small intestinal bacterial overgrowth. The Journal of the American Medical Association. 292:852-858.
(ii) Pimenetel, M., Park, S. Mirocha, J. Kane, S., and Y. Kong. (2006). The effect of nonabsorbed oral antibiotics (rifaximin) on the symptoms of irritable bowel syndrome. Annals of Internal Medicine. (145)8:557–563.
(iii) Atkinson, W., Sheldon, T.A., Shaath, N., and P.J. Whorwell. (2003). Food elimination based on IgG antibodies in irritable bowel syndrome: A randomized controlled trial. Gut. 53:1459–1464
(iv) Shanahan, F. and P.J. Whorwell, M.D. (2005). IgG-mediated food intolerance in irritable bowel syndrome: A real phenomenon or an epiphenomenom? The American Journal of Gastroenterology. 100:1558–1559.
Dr. Hyman, this was a fantastic article (like all your others). Stories, like the one you’ve shared about Alexis, give me hope that I can also treat my chronic health issues I have dealt with over the past eight years. I have scheduled an appointment at the Ultrawellness Center in October and I have been counting down the days until I can finally talk to you and your colleagues about how to get my health (and life) back on track. I look forward to reading your articles for many many years, as they always give me renewed hope that there are great doctors out there that really do want to heal the whole person.
I just ordered your book and am looking forward to reading. I wholeheartedly believe gluten sensitivity is the cause for many people. I developed Crohn’s disease a few years ago in my mid-30′s but have had irritable bowel problems for many years. The Crohn’s flair-ups were bad enough to hospitalize me for several days on 3 different occasions. I started seeing an MD here in south jersey who practices alternative medicine and he immediately determined I had a sensitivity to wheat. After getting off wheat and taking the high doses of fish oil he recommended the symptoms vanished quickly. Avoiding wheat is hard because it is in everything. I notice when I cheat and eat a pizza or something symptoms come back. I stopped taking the Humira my Gastroenterologist prescribed because i think it will cause problems long term. But I think changing to a gluten free diet permanently will either cure or keep the crohn’s in remission.
I developed IBS with constipation, even while eating a clean, whole foods diet. An extreme stressor six years ago completely damaged my digestion and I have gone from doctor to doctor for relief with no success. I was skeptical that this case–a women with IBS-diarrehea and consuming a poorer quality diet–would have any value for me. Still I duitifully tried the protocol recommended by Dr. Hyman and I am now cured. I could not be happier! And grateful! If you have IBS-whether with diarrhea or constipation–this is the cure.
Hello Dr. Hyman,
I suffer from IBS about two years and at the begining, the syptoms show themselves gradually and after 1 year the symptoms became worse. and all doctor that I refer to them, diagnose IBS because all test was normal. Some foods triggers but mostly Iknow all of them and I avoid them and this causes me to feel better. and my stomack can not tolerate some drugs like mitronidazole, Colpermine, Colofac and so on. Now my using drugs are XANAX, PANTOPRAZOLE. also I can not tolerate milk ( Lactose).
Now I want you to help me, please.
Thank you,
Vahid kokabi
Iran
Thank you, Vahid, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
To locate a practitioner of functional medicine in your area see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website. Here you will find a place to enter your zip code and look for practitioner’s in your area that have completed the institute’s five-day training course in functional medicine. Understand that not all of the doctors listed here will fit your particular needs. Many different medical professionals complete this training, and you will have to do additional research on your own regarding a particular practitioner’s approach and whether or not it fits your specific medical requirements. This may include calling the practioner’s office, visiting his or her website, and/or scheduling a consultation.
Wishing You the Best of Health!
Thank you to tell us more useful information. I am looking forward to reading more of your articles in the future.
I was treated with Xifaxin for IBS, but it did not help. I’ve had it for 3 years now. Any advice?
Thanks
Thank you, Yona, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
geart information. i am a IBS suffer
i cant find no one in my surrounding area togive a IGG food Allergy test. my allergist office siad they could not help me with that tes and right away asked me who had referred me to take that test.
Thank you, Cosme, for your message and your interest in Dr. Hyman’s work. To locate a practitioner of functional medicine in your area see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website. Here you will find a place to enter your zip code and look for practitioner’s in your area that have completed the institute’s five-day training course in functional medicine. Understand that not all of the doctors listed here will fit your particular needs. Many different medical professionals complete this training, and you will have to do additional research on your own regarding a particular practitioner’s approach and whether or not it fits your specific medical requirements. This may include calling the practioner’s office, visiting his or her website, and/or scheduling a consultation.
Wishing You the Best of Health!
Are there other more natural ways to rid yourself of unwanted bacteria or fungi besides the medications that need to be prescribed by your MD?
hi,im a 27yr old who has been suffering with ibs for years,have not been diagnosed with it by a doc but i have all the symptoms of it.sometimes i get so sick nd feel like an helpless old women,i dont know which doctor to go to i dont want to take drugs that can do more harm than good,pls can u ref me to a doctor that you know of in Durban,South Africa,thanks.
Thank you for your message and your interest in Dr. Hyman’s work. To locate a practitioner of functional medicine in your area see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website. Here you will find a place to enter your zip code and look for practitioner’s in your area that have completed the institute’s five-day training course in functional medicine. Understand that not all of the doctors listed here will fit your particular needs. Many different medical professionals complete this training, and you will have to do additional research on your own regarding a particular practitioner’s approach and whether or not it fits your specific medical requirements. This may include calling the practioner’s office, visiting his or her website, and/or scheduling a consultation.
Wishing You the Best of Health!
My daughter is 17 and has Alexa’s symptoms – only for the last year, but she knows she does not feel good, and the spastic dirrerehah just started for her. She was doing some self help research on line and decided she has IBS. After reading this article I have to agree she is right< and I feel bad for her because she is so young. Unfortunately, I can not always control what my kids eat, when and how much, since all of my kids work at restaurants. On the bright side, we have the Ultra Simple Metabolizm cookbook at home, (since I have a sluggish thyroid), so if she would choose to eat the healthier foods we serve at home, we can help her to start healing, and she will not have to suffer for years! Thank you so much Dr. Hyman for all the work you do to educate and heal us!
Thank you, Liza, for your message and your interest in Dr. Hyman’s work. To locate a practitioner of functional medicine in your area see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website. Here you will find a place to enter your zip code and look for practitioner’s in your area that have completed the institute’s five-day training course in functional medicine. Understand that not all of the doctors listed here will fit your particular needs. Many different medical professionals complete this training, and you will have to do additional research on your own regarding a particular practitioner’s approach and whether or not it fits your specific medical requirements. This may include calling the practioner’s office, visiting his or her website, and/or scheduling a consultation.
Wishing You the Best of Health!
Thanks for being awesome, Shimelle, and patient and understanding… And for offering this class—I cannot WAIT!
I have seen over eight doctors in the last year. When I first started having digestive issues, the doctors said it was all in my head. They gave me an anti-depressant and anxiety medication because I was diagnose with depression and anxiety. Boy those doctors were wrong. Now, I know I have ibs c and d. In addition, I was taking antibiotics for h pylori and for years have suffer from yeast infections. After reading your article and others online, I am starting to see that taking probiotics is the key to restoring the gi tract. Thank your for letting me see this is not all in my head and my body was fighting me back due to the stress and sugar addiction I suffered for years. I think more doctors should listen to their patients and do not start prescribing meds without first trying natural alternatives.
Veterinarians have been treating this for years. We treat SIBO and food allergies using science and food elimination as well as a specific antibiotic. We can eliminate type 2 diabetes in cats with diet as well. Why do we have to spend millions reinventing the wheel? We should be talking to each other!
Dr Hyman,
In step 4 you recommend VSL3 and S. boulardii. Are those to be taken concurrently or just one brand at a time?
In step 3 you recommend rifaximin and an antifungal. Can either or both of those be purchased without a presciption somewhere else such as a health food store, on line from Canada or another country, or at a pet supply Center?
Although I hve been eating gluten-free for years, my IBS has continued. Needless to say, I daily live with the same life altering inconveniences that your patient Alexis experienced. I so need relief!
Hi Lili, thank you for your message and you interest in Dr. Hyman’s website. In step 4 of this article this refers to two different products, you only need one at a time. In step 3 you will need prescription from your doctor.
Wishing you good health!
I have been having IBS for 40 years. The only medication prescrible for treating the disease IBS was Bentyl all these years. Bentyl only treated the symptoms and NOT the CAUSE!!! Thank you so much for the article on IBS. This article has informed me so much I want to cry. I will follow your advise for treating IBS, because it makes so much sense..
Thank you very much Dr. Hyman for the wealth of knowledge you provide. While Rifamixin seems to be the prescription of choice for IBS-d what do you recommend for IBS-c -likely peristaltic?
Thank you,
Michele
(- mostly plant based organic diet very light in added sugars but cheese and bread -no milk, very little yogurt
- plenty of exercise
- but on venlafaxine -75 and now 150 for 10 years and GABA 500mg for 2 months)
HI Michele,
Thank you for your interest in Dr. Hyman’s work. In order to provide you the proper care you need we hope you will seek the attention of a local qualified Functional Med practitioner soon. To locate a doctor who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org and scroll down to where it says “locate a practitioner” and enter your zip. Progress accordingly from there.
I am still recovering from my last bout of IBS w/d. I know all to well what it is like to not be able to leave home. This is one of the longest lasting bouts I have had. Had to go on disability from work, and I still am not able to leave home without taking Imodium. It was Imodium and Pepto Bismal caps. I had a prescription for the spasms. The was the first thing I stopped taking. I lost over 20 lbs. which was not a worry, but the nutrient loss is scary to me. I have severe Osteoporosis and am desperately needing nutrional help. I have read Floride destroys the bones and milk and dairy destroy bones as they make the body acidic. My bone specialist is no longer available so I am no longer on any medications. My gastro. specialist retired so I now have no doctor there. Being on Medicare I am limited to whom I can see and what I can afford to do. The government does not approve nutritional help. I don’t know where to turn. I am 70, in pain from my spine and trying to eat better, but I don’t know what to eat. I will check out your books and recommendations for physicians. Any suggestions I would appreciate your help.
Hi Ann,
Thank you for your interest in Dr. Hyman’s work. We would be happy to give you some nutrition pointers. First of all, it is really important to limit and avoid processed carbohydrates as the sugar pulls minerals from your bones, making them more susceptible to breaking. We wouldn’t want that! Other bone stealers include: alcohol, stress, inactivity, citrus juice, sodium, and caffeine. To increase bone health you want to ensure healthy intake of phosphorous, calcium, vitmain K, vitamin D, and protein along with other microminerals (zinc, boron, manganese,copper, silicon etc…. Eating a diet rich in sea veggies, nuts (almonds, seeds (sesame), sardines and salmon (from a can, with bones!), dark leafy greens and calcium enriched tofu is a great place to start. Also, limiting the antiinflammatories is helpful if you can stand it… Also, you might see we dont suggest dairy, right? Here is why: http://drhyman.com/blog/conditions/dairy-6-reasons-you-should-avoid-it-at-all-costs/ In case you are interested in working with another doc we can provide some info! To locate a doctor who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org and scroll down to where it says “locate a practitioner” and enter your zip. Progress accordingly from there.
There are many tips you can follow and all are cost effective so not to worry! For more one on one nutrition support go to: http://store.drhyman.com/Store/List/Coaching-Programs
In good health
Lizzy
Try eliminating gluten from your diet. Check out symptoms of celiac disease through a google search. You will be so surprised that many people suffering from IBS really have celiac disease. I have suffered from IBS symptoms for many, many, many years. As soon as I eliminated gluten, my IBS symptoms subsided by about 85%! Do you know what a relief it is to be able to make plans and not have to revolve your day around the ROYAL THROWN?!!!!
Hi Dr Mark,
I am intrigued about your recommendation. I watched your vid on YouTube and I feel like this may be my issue exactly…
One problem though, I have been to 2 gastroenterologist’s and they basically shun my condition and say “it’s all in my head” yet my symptoms are excruciating and debilitating (I can’t keep anything in me!)
Would you (by any slightest chance) know of a specialist in Sydney Australia that you can recommend? I know this is unlikely but thought I would ask. I just need a Dr who knows what they’re doing. If I could afford a trip to the US I’d come see you!
Thanks
Forgot to tell you Dr Mark, I have been tested for Gluten and Lactose….I know I am lactose intolerant and I haven’t touched dairy since, but my symptoms haven’t gone away!! My specialist said I can gave wheat/gluten as my biopsy showed this is not a sensitivity…
Hi Alex,
We sure can help and hope you get the care you need soon. Yes, do elimminate all dairy and gluten, regardless of the biopsy as this is not a conclusive result. Your Func Med physician will guide you to the appropriate testing protocol and treatment. To locate a doctor near you in Australia who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org/practitioner_search.aspx?id=117 and scroll down to where it says “locate a practitioner” and enter your country and info. Progress accordingly from there. While we cannot provide direct patient care, Dr. Hyman’s nutrition program can certainly guide you with the appropriate diet to help soothe your system and heal your gut. For a personalized nutrition plan, please see:http://store.drhyman.com/Store/List/Coaching-Programs
In good health!
Lizzy