The Root Causes of IBS & Stomach Digestive Problems

Mark Hyman, MD

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Dr. Mark Hyman
Coming up on this episode of The Doctor's Farmacy. In fact, an 8% high risk of irritable bowel is associated with every 10% increment in ultra processed food. And we had about 60% of our calories as ultra processed food. That's a 48% increase in irritable bowel given the dye eat that together, the under eating of the good stuff and the over eating of the bad stuff increases the risk of nutrient deficiencies. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, There's simply not enough time for me to do this at this scale.

And that's why I've been busy building several passion projects to help you better understand. Well, you, if you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website supplement store for a summary of my favorite and tested products. Welcome back to another episode of The Doctor's Farmacy and health bites where we take juicy little bites into our current health topics.

I'm doctor Mark Hyman. And today, we're diving deep into a topic That affects millions of people worldwide, and yet often goes undiscussed in public. Stomach issues. In the social media world, there's a trending hashtag. Hot girls have IBS, and it's caught the attention of over 28,200,000 viewers on TikTok.

The reason why is it reflects a shift in how women are addressing their digestive health issues using humor and community bring light to what many have kept hidden for way too long. Now by poking fun at their experiences with IBS and bloating and constipation, other gut troubles, women are challenging the stigma around these taboo bodily functions. Now it's empowering to see these conversations happening openly, but really critical to remember these symptoms are not just everyday annoyances to laugh off. They're real concerns that need to be addressed seriously. And today, we're gonna discuss why it's important to move beyond the normalization of this to understanding and treating the issues effectively, whether it's bloating, constipation, diarrhea, or just an uncomfortable feeling of fullness that just won't go away.

These symptoms can be more than just a nuisance. They can seriously impact the quality of your life and a whole slew of chronic illnesses. Now when we talk about stomach issues, we're really opening up a conversation about a range of conditions from irritable bowel syndrome to with constipation diarrhea to indigestion or what we call dyspepsia. Or to what some people jokingly refer to as a food baby. I heard that first from one of my patients, and I knew exactly what she was talking about.

You know that swollen stomach you get after indulging in a big meal that bloating just feel full and your stomach pooch is out. Very normal. Okay? Something's going on. We're gonna talk about what it is and how to fix it.

Now behind these common experiences lies a complex interplay of dietary habits, hormone fluctuations, and even stress, and toxins, all of which of affect our gut health. Now our gut is our second brain. There's more neurons in our gut than our spinal cord. The bidirectional relationship between irritable bowel and inflammatory bowel and anxiety, depression, stress is really clear. They make each other worse.

Okay? Gut bacteria produce hormones and neurotransmitters like serotonin gab and dopamine. And if we don't have the right gut bacteria, we can't produce these neurotransmitters that help regulate our nervous system and our immune system. So all that kinda sets the stage. Right?

So what what then causes irritable bowel and stomach issues? Well, it's different for everyone, and we'll go through the reasons. Poor diet and lifestyle are at the top of the list, right, the biggest driver. A population based prospective cohorts study published in the journal of clinical nutrition found that an unfavorable lifestyle looking at modifiable lifestyle factors like weight and BMI, smoking status, diet, physical activities, sleep, and alcohol consumption were associated with this 56% higher risk for irritable bowel compared to a favorable lifestyle versus a 12% high risk among those who are at higher genetic risk compared to those at low genetic risk. So, basically, lifestyle had a greater impact on IBS than genetics.

So maybe some will have families with irritable bowel, and there may be some genetics there, but combined genetics and lifestyle has a cumulative effect. Also, people are under eating real food. They're under eating nutrient dense whole foods with the right amount of protein, good fats, and and all the amino acids they need to function. They're overeating ultra processed foods, right, even healthy, quote, plant based vegan plant meats. You know, I call it a plant meat plant based meat because it's made in a plant, not grown in a and gluten free foods, which are often junk food.

They eat ultra processed foods that are high in refined sugars and carbs and refined oils, low quality protein, like, soy protein isolates and processed stuff. In fact, the large scale perspective cohorts that he reported that compared to the lowest consumption of ultra processed food. The highest consumption of ultra processed food had a significantly higher risk for irritable bowel. In fact, an 8% higher risk of irritable bowel is associated with every 10% increment in ultra processed food. And we have about 60 percent of our calories as ultra processed food.

That's a 48% increase in irritable bowel given the diet we eat. Now together, the under eating of the good stuff and the over eating of the bad stuff increases the risk of nutrient deficiencies like B12, iron, zinc, omega threes. And that actually affects how our gut functions and heals. Also, our diets, are often causing disturbances in our gut, and that can affect those stomach acid. It can be from taking acid blocking drugs What else can cause disruption of the gut?

Food sensitivities, food allergens, environmental allergens, all can be a factor. And one of the most common food sensitivities, gluten, dairy, eggs, corn, soy, often grains and beans. Alcohol is not a sensitivity so much as it's just a gut toxin. What these do is they tend to lead to the overgrowth of bad gut bacteria. We call dysbiosis.

And dysbiosis is basically the phenomena of the imbalance of bugs in your gut that creates more bad bugs and less good bugs.

Dr. Mark Hyman
And

Dr. Mark Hyman
what does that do? Well, that leads to a leaky gut and inflammation in the body. It can lead to motility issues. It can lead to overgrowth of bacteria, the bad bugs in the wrong spot. It can lead to what we call a seafower small intestinal fungal overgrowth, but some people refer to as candida, but it can be many species of fungus.

And a lot of these symptoms overlap with IBS, right, bloating, gas, cramping diarrhea constipation. So let's get into a more detailed conversation about Cboe because this is really at the root of so many people. Now whether you have IBS D or C constipation or diarrhea, there may be different bugs involved. And there's there's a dump of different gas as we measure. Because what we're seeing is when you have overgrowth of bacteria, they ferment the food you're eating, particularly starches and sugars and fermentable carbohydrates.

And and that causes the production of gases. And those gases are what causes distension and the food, baby. The first thing we that goes wrong is what we call this biosis. We talked about that briefly, but there's a lot of reasons for that. It's our poorial ultra processed diet.

It's our lack of fiber. It's too much starch and sugar. Alcohol, artificial sweeteners, all kinds of stuff. And from drugs too, antibiotics, steroids, the birth control pill, acid blockers, which are so common, like Prolosek or Pravacit, all these balance of gut flora, psychological stress, high carb diet, alcohol, environmental toxins, all these things cause this problem of dysbiosis, and they also can affect, the motility of the gut. And there's a lot of things that cause motility issues.

It can be diabetes, it can be GLP 1 agonist, by the way, and I worry about how they're affecting people's GI tract. It looks like it was epic, and we're seeing even things like small bowel overgrowth. And also also we're seeing a risk of a bowel obstruction because of the the way in which it affects the gut. So I'm a little worried about that, but they can be a helpful cause of drugs. I just think they're overused.

But when you have important mortality from stress or from, different kind of inflammatory bowel disease, it can it can again cause a backup and growth of bacteria in the wrong spot. Basically, you've got, like, 10, 12 feet of a large intestine and about 22 feet of small intestine. And mostly the small intestine should be mostly sterile, but when the bacteria migrate up to the top of it and then the food ends up hitting it first, that's when you get this food baby stuff. Now stress also will have an effect on your bacteria. They they actually are listening to your thoughts, right, your bacteria listening there.

When you have stress also, it increases permeability of the gut. It causes leaky gut. It affects motility, slows it down and affects immune system functions. So it's quite common. One of the things that happens is is a die a low stomach acid.

A low stomach acid is not that common, but it can be in degrees. The more severe form is aclar hidria, which happens when you get older and you get atrophy of your stomach or if you have b trump deficiency and so forth, that can that can really affect this. But there's a lot of reasons for it, but a lot of the reason is because we we take these asset blocking drugs, right, And that leads to low stomach acid, and that leads to changing the pH, and that leads to the pH of the small intestine changing and the overgrowth of fungus and bacteria that shouldn't be there because of the change in climate. About aging itself leads to this, chronic stress leads to low stomach acid, certain intestinal infections like H. Pylori, autoimmune diseases, like hypothyroidism, certain medications, obviously,

Dr. Mark Hyman
for blocking stomach acid with acid blockers or PPIs and acids, certain nutrient deficiencies, which

Dr. Mark Hyman
are important for the production of gastric. Acid like zinc and b vitamins. If you're lowering those, that can cause low stomach acid. Also, poor diet will cause Cboe. Right?

High intake of processed foods, sugar, unhealthy fats also has a negative impact on Cboe and also stomach acid. Also, If you're not eating properly, irregular meal times, eating too quickly, overeating, you'll tend to potentially get Cboe. And this this allows bacteria to colonize the upper intestine, which is supposed to have low levels of bacteria. Alright. So this is sort of what it is.

Basically, bad bugs growing in the wrong spot fermenting the food you're eating, causing you to have a food baby and be miserable and have all sorts of other consequences on your mood, your energy, your cognitive function. It's not just your stomach that's being affected here. Now how do you diagnose it? Well, we use a breath test. There's a number of different kinds of breath tests.

There's lactulose, there's glucose, and another test called Trio Smart Test. But, essentially, we're looking for 3 gases that are produced after we give you a digestible sugar, like lactulose or, like, glucose. And and what these

Dr. Mark Hyman
do is they actually help you to identify whether or not you're producing extra forms of these gases because the small intestinal bacteria. The Trio smart test looks at

Dr. Mark Hyman
for 3 different gases. Developed by Mark Finintell and others at UCLA. Looks for methane, which is commonly associated with constipation, hydrogen, more likely to have diarrhea, and hydrogen sulfide, which is often not tested for, but it can be important to find that particularly in tough cases of Cboe. And I particularly use the Geo Smart Test. You can learn about it online.

Your doctor can order it. But it's it's a really important test. There are stool tests that help, and that'll help you identify what's going on in the gut. Maybe helps you look at the overall health of the microbiome. 6 underlying issues.

It can help you identify you suffer growth, lack of short chain fatty acids, lack of important bacteria, like ECCromancy, low growth of bacteria. So all that is sort of like clues that's go things are going on. Also use organic acid testing and urine test because a lot of the metabolites from overgrowth of fungus or bacteria will show up in the urine and you can measure these. And it's another clue. And there's certain blood tested important to

Dr. Mark Hyman
look for nutrient deficiencies that can affect your that can affect

Dr. Mark Hyman
Cboe or your body like B12 or iron that maybe also include malabsorption. So what's a traditional approach? Well, it's pretty good approaches, in traditional medicine, but they kind of like stop short. They give you an antibiotic to clear out the bacteria that's that's kind of an advance from what we used to do when I was in training, but it doesn't really address the full spectrum of what's going on with the gut. So what's a good comprehensive functional medicine approach to treating irritable bowel and also the related GI stomach issues?

Dr. Mark Hyman
Well, we have a methodology. It's basically a

Dr. Mark Hyman
system of how we approach people with gut issues. It's called the 5 r program. The first is to remove, remove the bad stuff, remove foods that might be bothering you, bacteria, parasites, yeast, get rid of the bad stuff. The second is replace replace what's missing, probiotics, antibiotics, enzymes, and so forth. The third is to re inoculate, which is use probiotics.

The 4th is to repair. That was repair the gut lining with the right nutrients that heal the leaky gut and repair your gut lining. The 5th is to restore, which means to regulate your nervous system and stress. So let's go through the 5 hour program in more The first r is to remove. Move common triggers for problems with the gut.

These are commonly known as food sensitivities, not true allergies, or just things that your body shouldn't be eating that much of. Gluten, dairy, corn, soy, Sometimes eggs for people. Certainly ultra processed foods, certainly refined carbs and sugars, and alcohol.

Dr. Mark Hyman
Now landmark paper published in the prestigious British medical journal gut found that eliminating foods

Dr. Mark Hyman
identified through the delayed food allergy tests, which is not typically well accepted by traditional medicine. It measures IgG antibodies. Not true food allergy, but food sensitivity. When they eliminate those foods, they dramatically improve their IBS symptoms. The next thing we wanna get rid of are the

Dr. Mark Hyman
bad bugs. Right? And that means identifying what they are through testing. Maybe it's

Dr. Mark Hyman
a breath test. Maybe it's stool testing. Urine testing. But it involves getting rid of overgrowth of bacteria, overgrowth of

Dr. Mark Hyman
fungus, overgrowth of parasites through, sometimes medications or herbal therapies.

Dr. Mark Hyman
Now the typical medications used are antibiotics. Rifaximin is the most common one now used. This is a non absorbed antibiotic approved for irritable bowel and a randomized trial published on the animal maternal medicine showed that using rifaximin for 10 days resulted in dramatic improvement in bloating and overall symptoms of irritable bowel syndrome by clearing out the overgrowth of bad bacteria. But sometimes you need to use combinations. For example, if you have methane, sibo, you might need neomycin.

Sometimes there's resistance. You need to use back trim or other antibiotics. It's important to work carefully with your doctor on this. Also, you might need an antifungal to get rid of the bad bugs, like diflucan, nystatin, or spornox. You might need an anti parasitic if you find you have a parasite like a linea or flagel.

And then there's some herbal therapies that can be really helpful. There's a product called Atranteal or Atranteal, which is a specific herbal formula that's designed for methane reccebo. That's if you have high methane on your test and and have constipation. Certain antibiotics like neomycin can be also important for methane cbo. There are certain herbs that I like to use like Candobactin AR and BR, which are, herbal, herbal therapies for bacterial and use overgrowth can be great.

Sometimes they use a combination of antibiotics followed by herbs for a while. And and I and I will treat people with a an antibiotic regimen and then follow it up with herbal and microbials. It include oregano, Burborine, wormwood, Yero, time, ginger, licorice, and other things. And that's the first r. And, also, we look at toxins.

So that's the that's the other thing is to remove toxins. So we have any metals. We have pesticides, chemicals. All those need to be reduced to or removed. Personally, I had 3 or sibo from mercury poisoning because it poisoned all my digestive function and enzymes, and it didn't work.

And I had to fix that. Now the next, are is to replace. So digestive enzymes and hydrochloric acid, and I used digestive enzymes. There's different kinds. Like, digestive enzyme Ultra from pure encapsulations.

There's, digest gold. There's a lot

Dr. Mark Hyman
of other ones. There's a

Dr. Mark Hyman
lot of other ones are Spectrotime 9X, which is an animal based enzyme for metagenyx. By the way, all these supplements I mentioned, you can find, they're usually through professionals, but I've I've curated some of the best in class that I've used for my patients, that are available through me. And you can just go to doctor hyman.com and go to the supplement store there, and you'll you'll be able to find it. Beta nitric chloride, which is kind of in a counterintuitive. If you think you have digestive issues, we're taking all these acid blockers, but this is actually giving you stomach acid, and it can help that just to food and actually help reduce Cboe.

And then we re inoculate, which is really important. And that involves giving you the right probiotics. It's just really important, and that is good bacteria. It can be lactobacillus, bifidobacterium, sometimes they'll use saccharomyces, which is a a yeast against yeast that helps with the obese overgrowth. We use a whole different combination of probiotics.

We also use polyphenols and prebiotics to to actually help fertilize the good bugs. And we now know that polyphenols are colorful compounds in plant foods are really important for helping to improve the growth of the good bacteria. And lastly, the next r is to repair, and that means repairing the gut lining using food as medicine, eating whole, minimal meal processed foods. Lots of good protein as proteins needed for outlining repair, pasture raised eggs, grass fed organic, non genetically modified sources of food. Lots of low mercury fish, like salmon, mackerel herring, sardines.

I I like Ctopia dot fish. It's got a great source of clean fish sometimes that are regeneratively farmed. So, you know, be careful of farm fish, but it's not a other protein options, grass fed beef, wild game, both Buffalo, elk, lamb, venison, all a great poultry. If it's, you know, pasture raised, turkey chicken, that that's really good. You also need gut healing nutrients.

Like omega threes and vitamin a. And you can get ghee, which has butyric acid, which also contains, gut healing compound. Bone broth is really great. It's reaching a glute immunity, which can help provide, you feel feeling full, but also it can help provide added minerals and collagen support that helps your leaky gut. Also, there's certain supplements that are important like omega threes.

I like omega threethree rejuvenate from big both health. You can take evening primozoil, magnesium, certain vitamins like d and a are important zinc, a multivitamin, all help heal the gut. So these are just things that you'd be used to help heal the gut. Now after you've done this sebo treatment, you don't wanna be eating the diet that's gonna cause you to re introduce foods that are gonna cause, again, the overgrowth. So you gotta be careful.

And you also wanna, learn how to regulate your nervous system because that also is important because both stress works to make it worse, but when you're having your bowel, it makes your stress worse. So it's kind of a vicious cycle. Meditation, breath work, yoga, whatever it is to help restore your nervous system. Also, exercise is great. Exercise, it's done regularly.

This is from randomized controlled trials actually helps reduce IBS even a 30 minute walk Now let's talk about diet. There's a whole diet that's being used. It's called a low fodmap diet, low in fermentable starches and sugars, essentially. Right? You're not giving the bacteria something to chop on and then produce gas and make you miserable This is crazy.

1 in 7 people in the entire world is affected by symptoms of irritable bowel syndrome, and many have 1 or more foods that are known to trigger symptoms like gas, bloating, or diarrhea. Now carbs and fiber are the most common because they can be fermented. So this diet is called the low fodmap diet, and it was developed in Australia, which was extensively researched with irritable, and it's basically considered a low carbohydrate diet. And it can be super effective for treating IBS. Like, basically, if you're protein vegetables, you'll be fine.

Okay. Except certain vegetables are not great. We'll talk about that. Now many of those earbust suffers, symptoms improved on this low fat phomab diet. And clinical research has shown that low fomab diets improve the symptoms of 70% of IBS patients.

So you you both wanna do the 5 r program and part of the first r is to remove it. It means removing some of these fermentable star real work studies continue to show that this works, right, in in improving abdominal pain, quality of life. So what does actually 5 map stand for? Stands are fermentable, all the saccharides, which are fricktens and galacto oligosaccharides, basically oligosaccharides, which means single sugars. Disaccharides like lactose, monosaccharides like fructose.

These are all types of sugars that are gut bacteria feed on and polyols, which are sugar alcohols, right, which is in all the kind of quote health foods that have artificial sweeteners or sugar alcohols to make them sweet like sorbitol, xylitol, melitol, isomaltol, mouth mouthitol, and these are terrible. When I had Cbo, I accidentally got Well, not accident. Like, on purpose, got a chocolate bar that was given to me by a patient says it's a no sugar chocolate bar. You should love it. And I'm like, great.

I I was, I don't know, at work, and I was a little tired stress. I I ate it. The whole thing and it was full of mouth at all. And I was in the bathroom, and I was miserable. It's really bad.

So you have to be careful. So how do phomemps foods cause IBS? Well, these carbohydrates and sugars are not readily absorbed in the gut. And, basically, they pass through the small intestines and they attract water, and they cause bloating and motility changes that can result in diarrhea constipation. But once they read the large intestine, they got bacteria ferment them, and they produce lots of gases like hydrogen, methane, carbon dioxide, and the accumulation of these gases leads to gas, boating, dissension.

So what are the foods that have the highest and the lowest amounts of fodmaps? And what are other things that have fodmaps like drinks? Right? So let's just go through the beverages. Apple Juice, mango juice, para juice, high fructose corn syrup sodas, certain alcoholic drinks like beer, wine, all that will make you worse.

Process foods, I should say no more, but you know those you should meet anyway, but cereals with high fructose corn syrup, snack foods, with high fructose corn syrup, protein bars, diet foods, often, they'll contain inulin or high fodmap ingredients. So what are the steps to try a low fadmap diet? Well, all these modern and high fodmap food should be eliminated for 4 to 6 weeks on the low fodmap food plan. So for the next, 4 to 6 weeks, you wanna basically do that. Why does a low 5 med diet eliminate healthy foods?

Like, right? Seems like you shouldn't be eliminate health eaters, but but sometimes it says to, like, asparagus. Right? But that actually has a lot of fermentable starches in it. And you basically do this temporarily until your symptoms get better.

Now, it's careful if you have an eating disorder or whatever. You know, you wanna be be aware of of working with someone who can help you do this. Right? But still you might need to fix your gut, and that can be a factor in in even in eating disorders. 1 fed map group is interested at a time.

So you sort of go slowly to monitor your symptoms. 1 food at a time, you start small, and you sort build up your tolerance. Now some people can only tolerate food as specific quantity, so maybe they have a little bit. They'll be fine if they have a little more. They're gonna be in trouble.

But some people need to, avoid specific foods or fodmap groups indefinitely. Right? There's an app actually that the, fodmap group in in, Monash University in Melbourne, Australia put together, and it's for the public. And it provides a searchable database of foods low and high in fodmaps. It has recipes, recommended food products, and lots more.

And there'll be a link in the show notes and on their website for more information. You go to monashfodmap.com. It's m0nashfodmap.com. Now research shows that Pipedefan, which is the precursor to serotonin, which is a neurotransmitter that helps gut motility, can improve Constipation in IBS C because it helps increase intestinal transit time, intestinal motility, which means moving things through, and gastric emptying similar to fiber. So that's good.

If you have high levels of tryptophan, though, it could make IBS D worst, meaning if your diarrhea depends, predominant, you wanna be careful. If you're doing this, I encourage you to work with a practitioner. It's pretty restrictive. I don't think everybody needs to be on this, actually. I think there's ways of resending the gut use of the fiber program and helping, but eat more normally, but you wanna work with an experienced nutritionist or a functional medicine practitioner who can help you identify what's going on, what you should be doing.

And and the goal here is to improve digestion, not have a long term restrictive Diet. The good news is we now understand a lot more about irritable bowel than we did. We understand what is driving this food baby. It's called Cboe or CFO. We understand how to treat it.

In the right way with diet changes, lifestyle changes, the right medications sometimes, and gut repair program. And often traditional doctors will might give you the antibiotic, but they won't treat your, yeast or fungal issues. They won't put you on a full 5 hour program to reset you. They won't make a lot of dietary suggestions, so you'll get recurrence. So it can be a problem.

You can get recurrence if you don't do it properly. As we wrap up things today, I hope you have a better understanding of the complex world of digestive issues that unfortunately disproportionately affect women. And I really hope to underscore the importance of examining the intersection of diet, stress, and hormonal fluctuations in digestive health, particularly in women. And, hopefully, our discussion on the role of the menstrual cycle and irritable bowel syndrome symptoms, the impact of stress on gut function, the dietary habits that contribute to conditions like Cboe and dyspouses helps provide an, foundation for really understanding and addressing this Research highlights how hormonal changes affect GI motility and sensitivity emphasizing the need for tailored approach to treatment. By integrating this knowledge with functional medicine principles, we can really develop a more effective set of strategies to alleviate the symptoms and improve gut health overall.

It's crucial moving beyond just acknowledging these issues as common complaints that have to be tolerated toward really understanding their biological foundations so we can manage them better and treat them better. And if you're struggling with these symptoms, I would consider working with a functional medicine doctor or using some of these strategies we discussed and and get better. You don't have to suffer from this. So thanks again for joining me today and see you next Friday for another juicy episode

Dr. Mark Hyman
of health bites. Thanks for

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listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Doctor Mark Hyman. And we'll see you next time on the doctors For more information on today's episode, please check out my new video and audio podcast, Health hacks. It airs every Tuesday and includes a more detailed breakdown of these Friday healthbytes episodes.

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Thank you again, and we'll see you next time on The Doctor's Farmacy. This podcast is separate from my clinical practice at the Delta Walmart Center and my work at Cleveland Clinic And Functional Health, where I'm the chief medical officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorsement of views or statements of my 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.

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