What's Causing Your IBS And How To Heal Your Gut

Mark Hyman, MD

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Narrator: Coming up on this episode of The Doctor’s Farmacy. Dr. Mark Hyman: So, your ecosystem in your gut plays an enormous role in your health. And when your gut bacteria out of balance, you're out of balance and you don't have enough healthy bacteria. It makes you systemically sick. Hey, everyone. It's Dr. Mark Hyman. Welcome to Doctor's Farmacy, a place for conversations that matter. And today, I'm bringing you a new feature of The Doctor's Farmacy called Health Bites, where I teach you how to improve your health by taking small steps. It can lead to significant changes in your health over time. Today, we're talking about really important strategies to eliminate or fix or heal irritable bowel syndrome, which affects so many people. And also how to just help upregulate your gut health because we all have issues with our gut. In fact, gut health problems affect about 80% of Americans. It's the most common reason people visit the doctor, for their gut stuff, and everything from reflux to food allergies to inflammatory bowel disease to irritable bowel. These are just so common and basically, we're a population that has a really messed up microbiome. So, let's talk about how do we fix that? So, let's first start. What is irritable bowel syndrome? Syndrome is basically a thing that doctors don't know what causes. So, we can say, "Syndrome," like polycystic ovarian syndrome or irritable bowel syndrome or chronic leak syndrome, it basically means it's a collection of symptoms we have no idea what's going on and we just says, "Well, it's a syndrome." The truth is we do know a lot about what causes IBS or irritable bowel syndrome. I treat this all the time. In fact, I've had it. It's no fun. And it can can come in all kinds of sizes, shapes, and flavors from bloating and distension, getting what I call food baby. It can cause you to have diarrhea or constipation or alternating constipation/diarrhea, cramping, discomfort, distension. It's just nasty. Maybe you have to run to the bathroom after you eat. It's just not a good scene. So, what is the causes of this problem? And from traditional medicine, there's really no known cause. But, in fact, from a functional medicine perspective, there are really clear causes. And we now understand the gut more than we ever have from functional medicine, 15, oh, gosh, 30 years ago, we were talking about the gut and the microbiome. We didn't use that word back then, but we were talking about gut health and dysbiosis. And now that word dysbiosis is really now in the traditional medical literature. And essentially it means imbalances in the ecosystem of the bugs that live in your gut. And there are a lot of things that cause imbalances. It can be from the environment. Environmental toxins are a big cause. The use of a lot of drugs, antibiotics, big cause. A lot of people are born by C-section. Sometimes aren't necessary, but they still affect the baby's microbiome because they don't go through the vaginal canal and colonized. There's often challenges with breastfeeding that women have. And that formula feeding can often cause imbalances in gut flora because they actually feed the wrong bugs. And we see this in a number of different studies. There's often people who have an intestinal infection, for example, like parasite or traveler's diarrhea, and you can get irritable bowel after that because it destroys the microbiome. Obviously all the drugs and gut-busting drugs, we take antibiotics, the anti-inflammatories, the acid blocking drugs. Even the birth control pill can cause yeast overgrowth. Steroid drugs. Many, many drugs tend to cause gut imbalances. We can pick up different bugs like parasites and also we can get heavy metals. Heavy metals create a big injury to the gut. And I had that myself. I had irritable bowel for almost 10 years because I had high levels of heavy metals and it took me a long time to get them out. So, there's a lot of reasons. It can be bacterial overgrowth. That's a big one. We didn't even have a term for that when I was in medical school. But bacterial overgrowth is a really common phenomena where the bacteria migrate up into the small bowel. You're supposed to have them in your large intestine, but there's not supposed to be a lot of bacteria in your small intestine, from your stomach, your small intestine, and when you get that, it basically causes your body to ferment the food that you're eating, all the starches and the sugars that you eat and you get this food baby bloating after you eat. It's a really common symptom and we'll talk a little bit more about that in a minute. So, there's all these different conditions that can happen that drive problems. And then often food sensitivities are a big factor. There's a lot of reasons for that. We get leaky gut. We get damage to our gut lining and that creates this whole reactivity to foods that leak across the gut lining and your immune system reacts to them, creating inflammation and all these other symptoms. So, it's not fun. Irritable bowel is not fun. And also, it's been linked to things like fibromyalgia and all kinds of other issues. So, we're going to talk about what you can do about it, how to identify the big triggers. Now, and we'll talk about a few pieces of this. A lot of times, food sensitivities are a big factor and often it can be dairy, lactose intolerance is a big one. It can be a gluten, which often cause a lot of gut issues. A lot of things that people eat in their food like food additives can cause problems, carrageenan, which is a thickener in gum can cause a lot of leaky gut issues and leads to more food sensitivities and more irritable bowel. Also sugar alcohols. I remember once someone gave me a chocolate bar. It was full of maltitol, which is a sugar alcohol. It has no sugar in it and zero calories, but caused huge fermentation problems in my gut when I was quite sick. So, it's not good. So, how do you do that? Well, how do you know what to eliminate, what foods are reactive? I created something called the 10-day detox diet, which gives you most of the common allergies, gluten, dairy, sugar, obviously processed foods, grains and beans for a short time. And often it gives the gut a rest, reboot. And then you can add things back and see how you do. We call this an elimination diet. And there's many forms of it, but it's the best really test for our food sensitivities. There's also lab testing. We can do lab testing for different antibodies against foods that can be helpful, but it's not definitive. The most common foods that I find people have and ideally you should, I say, tend to detox, but they should be about three months to get off these foods: Gluten, dairy, eggs, corn, soy, peanuts, they're most common. Grains and beans, yeasty foods often are a problem. And then you can kind of introduce them one at a time. So, let's talk about how gut issues or we'll call it dysbiosis leads to problems in the gut. Now, your small intestine is basically this absorptive surface. It's a size of a tennis court if you laid it out flat, maybe two tennis courts and it's one cell thick. And it takes basically the food that you break down inside your stomach through digestive enzymes and all kinds of other things. And the basic building blocks, the amino acids, sugars, fatty acids, they get absorbed across the gut lining and they get absorbed through the cells. But sometimes when there's damage to the gut from all the reasons I said, you get the separation of the cells. We call that leaky gut and then food particles and bacteria particles leak in between those gaps. We call them tight junctions, that kind of get loose. And then you get this reactivity to food because 60 to 70% of your immune system is in your gut. Why? Because that's where you put all this foreign material every day and your immune system's supposed to help you deal with foreign material. So, that's really important to understand that you have this really delicate lining and it can be disturbed. And that leads to this whole imbalance. And when that one cell layer is sort of disturbed and you get breakdown in the mucus layer or the lining breaks down from too much stress, too many antibiotics, and you get inflammatory drugs like aspirin, ibuprofen, steroids, maybe have crappy diet, processed food usually affects it, sugar, starch, food additives, alcohol. Then your immune system starts to get exposed to all these particles from food and bacteria. And that creates inflammation throughout the body, that can cause weight gain, fluid retention, headaches. It's not just irritable bowel. It can cause widespread problems, arthritis, asthma, immunity, mood disorders, cognitive problems, hormonal disorders. It's huge. So, your ecosystem in your gut plays an enormous role in your health. And when your gut bacteria out of balance, you're out of balance and you don't have enough healthy bacteria. It makes you systemically sick. So, one of the things that I find most helpful as I treat my patients is I always start with the gut. We really help them get a healthy gut because when you do that, a lot of other problems go away. Autoimmunity, mood disorders, hormonal disorders, weight disorders. I mean, even in animal studies we have imbalances in the gut flora, you can see that these animals will gain weight. When you fix it up, they lose weight and they've done even fecal transplants from nondiabetics to diabetics and it improves their blood sugar simply by changing the gut flora. So, it's super important. Now there's another thing that's really important is how do you test for this? Now, I do a lot of stool testing. I do what we call organic acid testing, food sensitivity testing. So, I do a lot of different things to look at what's going on in the gut. I check for gluten antibodies. I check for sometimes food sensitivities through Cyrex testing. I like that lab pretty much for looking at the IgA and IgG antibodies against food. So, the different antibodies your body makes against different food particles, you can kind of see what's going on. It's not a true allergy. It's more of a sensitivity. And then I look at stool. I really look at stool very carefully looking at digestive enzymes, the immune system in the gut, something called short-chain fatty acids, which are important for keeping the gut healthy and I mean food for the gut lining and regulates immunity and they're produced by healthy bacteria. So, when you don't have healthy bacteria, have very low short-chain fatty acids like butyrate. And this is something we can measure on a stool test. We also look at genetic testing. We call it PCR testing for microbial RNA. We can tell what species of bugs are there or not there. I look, for example, Akkermansia is a very important keystone species that make sure you have a good mucus lining, regulates immunity. Your response to chemo drugs can help in regulating weight and so many different things. So, it's a really important bug. I also do stool cultures, so you can look at how much healthy bacteria, if there's weird bugs growing, if there's yeast growing. We do PCR testing and antigen testing for various parasites, so we can get a really good comprehensive look at the stool and see what's going on in there. And it's changing obviously from day to day in what you're eating, but we can get a really good handle on the overall ecosystem. And then I can optimize treatment. It's not just looking at the bacteria, it's all the other factors. And then we look elsewhere to organic acid testing because in your urine, we can find metabolites from the bugs that get excreted, if they're bad bugs. So, we can look at metabolites from yeast or various bacteria. They're not human metabolites. We can see if they're there in your urine. We know there's this overgrowth of bacteria. So, I use a lot of different things. We also do breath testing because we want to know if you have bacterial overgrowth, we give you a drink of a fermentable sugar, and you can see by clicking your breath, whether you make too much hydrogen gas or methane. We talk about cows and methane, but humans also can produce methane. And it's this fermentable byproduct that comes out of your body having too much starch and sugar and fermentable carbohydrates that get basically fermented just like beer or wine, or it's like if you have an apple cider container in your fridge and it gets big, it blows up and you leave it there for a while. Basically is because the yeast are fermenting all the sugars in the apple cider. So the same thing happens in your gut and you get this food baby thing so we can tell. And the treatment's different for different bacterial byproducts like methane or hydrogen we'll talk about in a minute. So, SIBO is huge. It's a big cause of IBS. There's more and more research on this over the years. And if you have bacterial overgrowth, you can have that with other things. You can have parasite issues. SIBO, which is small intestinal bacterial growth, but you can also have SIFO, which is small intestinal fungal overgrowth and we're going to talk about that in a minute. It's so common. So, most of your bacteria, like I said, should be lower down, but they migrate up and we really have to take care of them. And there's a lot of ways to treat the bacterial overgrowth with herbs and medications. And I'll talk about that in a minute. So, when you have yeast overgrowth, which is also common, you actually can tell people have that from a lot of other clues. They might eat a lot of sugar. They might have diabetes, they might be on antibiotics. They might have been on steroids. They might have other fungal symptoms like dandruff or fungal nails or anal itching or various kinds of skin rashes that are fungal. And you can tell from someone's history about the likelihood of fungal overgrowth, but it's pretty common and it can cause constipation, more SIBO or irritable bowel. And there's a lot of ways to treat it. I use a lot of herbs, it responds to oregano and thyme and other really great herbs you can use for fungus. There's great probiotics like Saccharomyces that work against yeast. And sometimes you need to use an antifungal like a Diflucan, or a statin, Sporanox. If you have bacterial overgrowth, you might need other herbs as well. Use Biocidin, Candibactin-BR from Metagenics. But sometimes you need antibiotics like rifaximin, which is a non-absorbed antibiotic, is now approved for irritable bowel syndrome and also something called neomycin. If you have more methane, I use trantho, which is just a combination of herbs. It also works for methane SIBO. And methane SIBO tends to cause more constipation. So, you can tell kind of if you have diarrhea, irritable bowel, constipation irritable bowel. They had different phenomena going on. So, we use a combination of things and not just the antibiotics or any fungals, but a whole gut repair program. So, it's not just about killing the bugs, it's how do you heal? And I see this a lot. People have various kinds of treatments for SIBO, but conventional doctors, they'll just give me antibiotics and won't do a whole gut repair program. So, in order to reboot your gut, you need to get really clear about how to get rid of the bad stuff and put in the good stuff. So, to get rid of the bad stuff is we call this the five bar program or I call it the weeding, seeding, and feeding program. We weed out the bad stuff. So, that's food sensitivities. If you have a parasite, we treat that or SIFO or SIBO, we treat that. That's a first step. And second step is to replace the things that need to be replaced. You might need digestive enzymes, you might need hydrofluoric acid. You might need some prebiotics to kind fertilize the good bugs. So, it's really important to do that and then you clearly get rid of all the things that you need to treat, whether it's the bacterial overgrowth, yeast overgrowth, the parasites. And then you want to kind of repopulate the gut with healthy bacteria. That's the repopulate or reinoculate phase of the repair program. And that's where we give probiotics. And there's all kinds of different probiotics out there. And we're learning so much about how to customize probiotics treatment, how to personalize it. It's really different depending on what's going on for you and what your health issues are. There's a lot of science now on how we can personalize probiotics. So, you basically want to sort of start slowly. By the way, if you have SIBO and you take a lot of probiotics or prebiotics, it's going to make you sick because the bacteria in your small intestine are going to fight with the bacteria you're putting in there and maybe fertilized by the prebiotics because they'll eat that stuff, too. And so, you'll end up getting worse. So, the first thing is to get rid of the bad stuff. And so, it's an elimination diet, it's killing all the bad bugs. It's getting more enzymes and probiotics. And then we do kind of a gut repair program. We use a lot of compounds like polyphenols, which are really important for feeding the good bugs, green tea, pomegranate, cranberry, all these extract, prickly pear, all kinds of compounds that we use from phytochemicals that help feed the good bugs. We use zinc, fish oil, even primrose oil or GLA, glutamines. There's all sorts of compounds. We use immunoglobulins, like I use SBI Protect from Ortho Molecular. It's a really good dairy-free immunoglobulin colostrum that helps rebuild the gut. So, we use a whole series of things that help restore or repair and renew the gut. So, the key is, if you really want to have a healthy gut, you kind have to figure out what's going on. You might need help with a functional medicine doctor. You might need a stool test, but often just elimination diet, some basic herbal therapies, some pre- and probiotics are great fun. And the way I approach this is I start with getting rid of the things that people need to stop, which is an elimination diet, getting rid of processed foods, getting our sugary foods. Sometimes I recommend digestive enzymes and I recommend adding fermented shoes. I recommended dealing with your stress because the mind/body connection's huge. So, there's all these really simple ways that you can reboot your gut on your own. And I can't tell you how many people have just followed these guidelines and gotten better. That's not to say that if you really are struggling with bad overgrowth or parasites or yeast, that you don't need some medical care. Sometimes you do. But most of the time you can fix your gut on your own. And I've created a product called Gut Food, which is a combination of prebiotics, probiotics, and polyphenols that I invented after I had severe gut issues. Not only irritable bowel, but I ended up having inflammatory bowel disease after antibiotic I took for a dental infection. So, I had to really figure this out. And it's really simple. All you should do is just pay attention to what you're eating, eat a whole foods diet, eat pre- and probiotic foods and, if you're struggling, make sure you get help because this is a really a fixable problem. And so, I think ... I'm sorry for all you, irritable bowel's pretty common, but the good news is it's one of those things that functional medicine that can really help and really fix. And that's it for this Heath Bite. And if you enjoy this episode, be sure to share with your friends and family, leave a comment. We'd love to hear how you've dealt with your gut and we'll see you next week on The Doctor’s Farmacy. Narrator: Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find A Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed health care practitioner, and can help you make changes, especially when it comes to your health.