We have all heard about probiotics, and how good they are for us. We have probiotic yoghurts, fermented foods, kefir, and probiotic gum easily available to us. After taking antibiotics, many of us know that it’s a good idea to replenish our good bacteria and load up on probiotics. As a naturopathic doctor, a recommendation for a good quality daily probiotic is very common for most of my patients.
However, there is a subpopulation of my patients for which this is NOT a good idea. At least, not initially. These patients actually have an overgrowth of bacteria in the small intestine, and giving them probiotics can actually make them worse if we don’t treat the underlying condition first.
Most of these patients have already been diagnosed with Irritable Bowel Syndrome (IBS). However, the diagnosis of IBS doesn’t actually tell them what is causing it, just that their bowel is irritable and that they most likely don’t have a more serious condition. Since I have started testing for it, I have found that many of my IBS patients actually have Small Intestinal Bacterial Overgrowth (SIBO) as the underlying condition. Furthermore, even if you have a diagnosis of Celiac disease, Colitis, or Crohn's, you may still have SIBO: those with these conditions actually have a 3-fold increased risk of developing SIBO, because of all of the gut inflammation, and its effect on the nervous system surrounding the digestive tract.
So, what might be some indications that you might have SIBO?
5 Key Clues That May Indicate SIBO
1) Bloated all the time
You may start off the day with a relatively flat stomach, but as the day progresses, you go up a few sizes and may look pregnant! This might happen no matter what you eat. Or, you may have identified a few foods that make things worse, but even when you avoid them, you still get some digestive symptoms.
2) You feel worse with high fibre and/or sugary foods
A diet high in fibre can lead to increased fermentation of food by bacteria in the small and large intestines, and if you already have an overgrowth of bacteria, you can imagine that this could lead to increased gas. Sugary foods, and/or foods high in certain types of carbohydrates (high FODMAPs foods), also feed the bacterial overgrowth, and can worsen symptoms. And it’s not just bloating that you could experience. Depending on the predominant type of bacteria present, hydrogen-producing of methane producting, you could also experience diarrhea and/or constipation, or even heartburn.
3) You have a history of bacterial gastroenteritis
If you’ve had a bad stomach bug, or haven’t been well after “traveller’s diarrhea”, this may have set off the fine balance in your gut and contribute to SIBO. You may have also been put on strong antibiotics, which can kill off some of your good bacteria and allowed less beneficial bacteria to thrive.
4) Your thyroid is sluggish
You may have been diagnosed with hypothyroidism, or have sub-laboratory hypothyroidism (your thyroid function may not be slow enough to be prescribed Synthroid for it, but you have symptoms). Either of these can slow down your digestive system and the transit time down the digestive tract, allowing bacteria more time to ferment it.
5) Taking probiotics makes you worse
This makes sense, as, if you have an overgrowth of bacteria in the small intestine, populating with more bacteria, even the “beneficial” ones, could make things worse. Not everyone with SIBO gets worse with probiotics, but most SIBO patients don’t feel significantly better on them if we don’t get rid of the overgrowth first and make sure that the sweeping function (migrating motor complex) of the small intestine is working properly beforehand.
Does this sound like you?
Have you been struggling with ongoing digestive issues but haven’t had a breakthrough yet? Come on in for an assessment, and we’ll see if testing for SIBO would be a good idea for you!
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Khangura, P. (2017). Superseding SIBO. Webinar 2017 May 13.
Dealing with the symptoms of irritable bowel syndrome (bloating, gas, diarrhea or constipation or both, a tender or painful abdomen, and a sensitive stomach) can be exhausting! If you are an IBS sufferer, you probably have tried several things in an attempt to manage your symptoms. The cause of IBS can be different for different people, so what may work for others may not work for you!
Here are 5 things you can begin doing now if you have IBS, which can start to get you on the right track to manage your symptoms.
1) Start a diet diary
Being aware of what you put in your body and how you react to your food can be an important first step to help you identify if specific foods are a trigger for your symptoms. Most IBS patients have IgG food sensitivities, which can lead to symptoms anytime from eating the food, up to 72hrs after. Write down everything you eat every day for a week, along with the timing of any symptoms you may have. Then, go back and highlight when you ate foods that tend to be triggers: wheat and gluten, cow’s dairy, eggs, soy, corn, yeast, and high FODMAPs foods. Can you see a pattern between what you eat and your symptoms?
If things get confusing, bring in your diet diary to your appointment with me, and we can discuss the best avenue to proceed with. Food sensitivity testing may be a good option, or my 7-Day Detox Program.
2) Take a good quality probiotic
Did you know that about 3lbs of your weight is due to the crucial bacteria that you carry around in your gut? These bacteria need to be in a fine balance in order to play their role in decreasing your reactions to foods, maintaining a good intestinal barrier, keeping your immune system strong and balanced, and even improving your mood! Each strain of probiotic has its own effects on the immune system, so formulas can get pretty specific. Most of the time, I usually recommend a probiotic blend that includes Lactobacillus acidophilus, Bifidobacterium longus, and Bifidobacterium lactis. If you feel worse on a probiotic, stop taking it and talk to a naturopathic doctor. It could be a sign of something that’s going on in your body, such as a dairy allergy, a FODMAPs sensitivity (depending on what is included in the probiotic), or an overgrowth of bacteria in the small intestine (SIBO).
3) Introduce a regular exercise routine
You may not feel like exercising if your IBS symptoms are severe, but if you can, start small but get moving! Exercise has been shown to significantly improve the quality of life of patients with IBS. Exercise helps keep your bowels regular, changes gas transit time in the intestines, improves mood, and overall makes people feel better! A regular exercise routine is good not only for IBS symptoms, but also for overall health. Why not give it a try?
4) Cut out lactose from your diet
Since lactose intolerance is common in people with IBS, and can be confused with IBS, try cutting out lactose in your diet for 1-2 weeks. That means trying lactose-free milk, yoghurt, cheese and other dairy products instead of the regular cow’s dairy products. If your symptoms resolve, then you’ve got your culprit, lactose! However, if your symptoms get better but aren’t completely gone, then you may be lactose intolerant but still have other things going on at the same time. Often times, patients with IBS cannot tolerate casein, a protein in milk products which is found in both regular and lactose-free dairy products.
5) Eat real food
Remove the processed and sugar-laden foods from your grocery cart, and instead shop mostly the perimeter of the grocery store, where the fresh produce is found (skip the bakery isle if it is found there too). That way, you will be eating nutritious food that is naturally high in fibre, and you’ll be avoiding the sugar which feeds unhealthy bacteria in the gut. If your digestive system is currently very sensitive, you may want to eat more liquid foods in the form of home-made soups, stews, or smoothies. Just keep in mind that you could react to some of the foods listed in Tip #1.
Starting to implement some of these tips should help you get some relief from your IBS symptoms. However, it’s always best to work with your naturopathic doctor if you want to feel better faster and avoid much of the guesswork. Some critical tests can really help pinpoint the treatment that you need, and specific naturopathic treatments and supplements can speed up your healing process.
Helping patients with IBS is a passion of mine. If you are ready to get lasting relief from your IBS symptoms, I’ll be delighted to help you!
Cuomo R., Andreozzi P., Zito F.P., Passananti V., De Carlo G., Sarnelli G. (2014). Irritable bowel syndrome and food interaction. World J Gastroenterol., 2014 Jul 21;20(27):8837-45. doi: 10.3748/wjg.v20.i27.8837.
Johannesson E., Simrén M., Strid H., Bajor A., and Sadik R. (2011). Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol., 2011 May;106(5):915-22. doi: 10.1038/ajg.2010.480. Epub 2011 Jan 4.
If you’ve been suffering from irritable bowel syndrome (IBS) and want to get to the bottom of your symptoms, there are some crucial tests that you may want to consider running through your naturopathic doctor. You’ve probably tried many different things already to help with your symptoms through trial and error, without significant or lasting relief. Testing eliminates much of the guesswork and helps us target our treatment so that you can get better faster!
During your initial visit with me, your medical history will give us a clue to what might be causing your symptoms. It could be one of the ones outlined in my previous blog. I’m giving you a list of the most common tests to consider, but most people only need to invest in one or two of these tests. By far, the most common test that I run with IBS patients is the first one, IgG Food Sensitivity Testing.
1) IgG Food Sensitivity Testing
This is a blood test that measures levels of IgG antibodies to 120-200 foods, depending on which panel we run. It allows us to identify objectively which foods are the most likely to be causing the most inflammation in your digestive system. If we run this test, you will receive a printout of which foods you reacted to highly, moderately, or not at all. If you end up having a large number of reactive foods, you most likely have a condition called leaky gut, where the intestinal barrier becomes excessively permeable, leading to reactions to many foods. Repairing that leaky gut through naturopathic treatments can often allow you to eventually bring more foods back into your diet.
2) Candida IgG Test
This is also a blood test, and can be added on to the IgG Food Sensitivity Test, or run on its own. It would be run if we suspect a yeast or Candida overgrowth which could contribute to IBS-like symptoms. If your results turn out positive, then we would treat the overgrowth with dietary changes and targeted supplements.
3) SIBO Breath Test
Unlike the two tests above, this test is a breath test. You are given a lactulose solution to drink, and at timed intervals, take breath samples in the comfort of your home. The lactulose feeds bacteria in your intestine, and they will then produce hydrogen and/or methane gases as they break the lactulose down. These are the gases that are measured in your breath. If unusually high levels of those gases are found in your samples, you probably have Small Intestinal Bacterial Overgrowth (SIBO), a common cause of IBS. There is a multi-step process to treat SIBO, but the good news is that it CAN be treated!
4) Comprehensive Stool Analysis (+/- Parasitology)
This test requires a stool sample, usually taken from 3 different bowel movements. It gives a comprehensive assessment of your digestive health, including which bacteria (beneficial and harmful) are present and their relative amounts, any yeast overgrowth, parasites, and other information on how well your digestive system is working. If we suspect parasites, this would be the test to run, but it can also be run if we suspect an imbalance in the beneficial bacteria in your digestive system, or if your digestive system is a mess.
If you’ve been suffering from IBS symptoms for a while, testing could be a lifesaver, preventing you years of trial and error with different supplements and medications!
Ready to start feeling better now? Book your initial visit with me today, and we’ll start investigating so that you can get to the bottom of your IBS.
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In my last blog, I shared with you some background information about what a diagnosis of irritable bowel syndrome, or IBS, means. The symptoms and diagnosis are just the tip of the iceberg. The bottom line is, if you’ve been diagnosed with IBS, you will want to dig deeper in order to find out what is causing your symptoms, and modify the factors you CAN control in order to get your symptoms under control.
I’ve had countless patients go from having daily diarrhea and bloating to having happy bowels that no longer cause them daily anxiety and stress, once we find and treat the cause! This is a very personalized process, as what causes IBS for one person doesn’t necessarily cause it for another. Additionally, many times there is not just one cause, but a combination of factors that must be addressed.
When a patient comes in to see me with IBS, I have a running list of possible causes going through my mind, trying to fit the pieces of the puzzle together for that person as I listen to their particular story. Here are the top 5 causes of IBS that I consider. This list is by no means exhaustive! Working with a naturopathic doctor and ordering the appropriate testing will help you get long-lasting relief for your symptoms!
1) Food Sensitivities
Many patients’ IBS symptoms resolve or significantly improve after we identify specific problematic foods, either through IgG food sensitivity testing, or through an elimination diet. Food sensitivities can cause IBS symptoms since they increase inflammation in the gut and irritate the gut lining. It can be difficult to identify your food sensitivities just by keeping a diet diary, since you can notice digestive symptoms from a food up to 72hrs after eating it! The most common problematic foods tend to be gluten, dairy, eggs, corn, and soy.
2) Small Intestinal Bacterial Overgrowth (SIBO)
Bacteria can overgrow in the small intestine, as a result of many things, including lots of antibiotics, low stomach acid, and a dysfunction in the movement of muscles surrounding the intestines. It’s actually a very common cause of IBS, being present in from 35-80% of IBS cases! If your IBS symptoms come with lots of bloating, you’ve been on strong antibiotics or antacids, and probiotics make you feel worse, it might be a good idea to get tested for SIBO.
3) Lactose Intolerance
Many people figure this one out by trial and error, as drinking a glass of milk makes them run to the washroom within half an hour. However, many people go undiagnosed for years, as the symptoms can be just shrugged off as IBS. There is a test available for this as well, if you’re unsure.
4) Yeast Overgrowth
Just like bacteria can overgrow in the digestive system, so can yeast! Candida albicans is a yeast that is commonly found in the digestive tract in small amounts, but if the opportunity arises, it can overgrow and cause a variety of symptoms that can fall under the umbrella of IBS. The most typical triggers for Candida overgrowth are chronic antibiotic use and/or a diet high in sugar, but there are others, including chronic stress and the use of the birth control pill. If you’re a woman and have IBS symptoms along with frequent vaginal yeast infections, getting tested for Candida overgrowth would be an important step to find out if it’s causing your IBS symptoms.
5) FODMAPs Intolerance
FODMAPs foods are made up certain types of sugars and short chain carbohydrates that can be difficult to digest. The acronym stands for Fermentable-Oligosaccharide-Disaccharide-Monosaccharide-And-Polyols. Unlike food sensitivities that are due to a reaction to the protein portion of a food, in this case, you may be unable to break down and digest the carbohydrate portion of certain foods. Avoiding high FODMAPs foods has been shown to improve IBS symptoms. Sometimes, however, patients cannot tolerate these foods because they already have an overgrowth of certain bacteria or yeast which thrive on these foods and ferment them to create more gas! See how different causes can be related?
There are many other factors which cause or aggravate IBS, including chronic stress, low stomach acid, chronic use of certain analgesics, and a dysfunction in the action of the muscles surrounding your digestive tract (the migrating motor complex).
Do you want to get to the bottom of your IBS symptoms? In the next blog, I’ll be discussing in more detail about what crucial tests you should consider if you’ve been diagnosed with IBS.
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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. http://gut.bmj.com/content/53/10/1459.full.pdf
Dainese R1, Casellas F, Mariné-Barjoan E, Vivinus-Nébot M, Schneider SM, Hébuterne X, Piche T. (2014). Perception of lactose intolerance in irritable bowel syndrome patients. Eur J Gastroenterol Hepatol., 2014 Oct;26(10):1167-7. https://www.ncbi.nlm.nih.gov/pubmed/25089542
Halmos EP1, Power VA2, Shepherd SJ2, Gibson PR3, Muir JG3.(2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014 Jan;146(1):67-75.e5. https://www.ncbi.nlm.nih.gov/pubmed/24076059
Mann, N.S., and Limoges-Gonzales, M. (2009). The prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome. Hepatogastroenterology, 2009 May-Jun;56(91-92):718-21. https://www.ncbi.nlm.nih.gov/pubmed/19621689
You plan your trips based on the nearest washroom. You’ve limited what you eat because you’re constantly feeling bloated, gassy, or your tummy aches. You have diarrhea or constipation, or both! Your energy is down the drain from constantly dealing with your digestive issues. If you’re a woman, you may notice worse symptoms around the time of your period. You might be anxious or depressed because this is taking such a toll on you and nothing you do seems to work. You’ve limited your social life because you don’t feel energetic or you can’t eat out without feeling horrible afterwards... If you have IBS (irritable bowel syndrome), then you can probably relate!
If you’re at your wits’ end and you’re about to give up, don’t! There’s a lot we can do to help you feel better! And, contrary to what you may have been told, it’s not all in your head.
Irritable bowel syndrome – it sounds harmless enough, but for those that deal with it on a daily basis, it has a serious impact on their quality of life. So many people have it (2.1-22% of the population, that’s almost a ¼ of the population!), yet most people have no clue what they can do about it and think they just have to “live with it”. It’s one of the most common conditions that I treat in my Nepean and Orleans practices. You may have been diagnosed with IBS, or you may be struggling with chronic digestive issues and be one of the 75% of people that goes undiagnosed. If you’re a woman, you’re 1.5-2x more likely to have it!
While a diagnosis is helpful to give your digestive troubles a name, unfortunately it doesn’t give your healthcare professionals a clear-cut answer to treating it. Why? Because a diagnosis of IBS doesn’t tell you anything about what’s actually causing it!
You might have chronic digestive issues, but you haven’t been diagnosed with IBS by your doctor. Could you still have IBS? Yes you could! IBS describes a group of symptoms commonly found together that are going on for a period of time, at least 3 months to be exact.
If you have these symptoms, you likely have IBS (Rome III criteria):
-For at least the past 3 months, you have had recurrent abdominal pain (it is often described as discomfort, not necessarily pain)
-These abdominal symptoms have to be present at least 3 days a week during the past 3 months
-These abdominal symptoms have to be accompanied by at least 2 of these 3 criteria:
That means that, if you’ve gotten a diagnosis through your medical doctor, your doctor has probably ruled out more serious conditions, such as Celiac disease, Crohn’s disease, ulcerative colitis, or colon cancer. You may have had a scope done to have a closer look at your bowels (likely a colonoscopy and possibly an endoscopy), but nothing abnormal could be found, except perhaps some spasticity in the muscles surrounding the digestive tract. You can breathe a sigh of relief that these more serious conditions are not likely playing a role in your symptoms. But that doesn’t change the fact that your symptoms are still with you!
So, what a diagnosis of IBS tells you is that you have to dig deeper to find out what’s causing it if you want to get better for good. The good news is that I can help you with that! In the next few blogs, I’ll be discussing what the possible causes of IBS are, common testing that I run with patients to guide their treatment, and things you can start doing to feel better.
If you want to start feeling better now, make sure to book an initial visit here with me. As I mentioned earlier, helping patients with IBS is a huge part of my Ottawa practice, and it would be a privilege to help you too!
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Yoon, S.L., Grundmann, O, Koepp, L, and Farrell, L. (2011). Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches. Altern Med Rev, 2011 Jun; 16(2): 134-51. https://www.ncbi.nlm.nih.gov/pubmed/21649455
If you’re wandering down any typical grocery store in Ottawa, you will usually come across one isle or two promising “freedom” from some of the typical things most people eat: gluten-free, dairy-free, egg-free, soy-free, and the list goes on. You may have wondered if those foods are healthier, and if you should also be filling your grocery cart in that isle.
Food sensitivities and allergies are on the rise in North America. It’s hard to plan a kids’ party without someone having some dietary restrictions. So, what’s the difference between food sensitivities, intolerances, and allergies?
Most people with food allergies found out the hard way. They ate some peanuts and had difficulty breathing, or ate some strawberries and broke out in hives. These reactions are usually severe, and are mediated by a type of antibody called IgE (antibodies are produced in the body and attach to specific protein sequences that they recognize). If you went to an allergist and got pricks in your forearms, you were most likely tested for IgE reactions.
Symptoms of food allergies usually show up fast, usually starting within 15min of consuming the food, and can be quite severe. They are the type of food reaction that is usually immediate, and are associated with anaphylaxis. If you have a food allergy, you have to be very careful about avoiding even trace amounts of the food in question.
Food sensitivities are typically harder to pinpoint than food allergies, so many people go undiagnosed for years. They are delayed reactions to food mediated by a different type of antibody, IgG. Symptoms occur most commonly within the first day of eating a food, but can occur up to 3 days after. The symptoms of a food sensitivity tend to be more subtle than a food allergy. They can include:
-digestive issues (bloating, gas, diarrhea, constipation, etc.)
-feeling like food “just sits there” and doesn’t digest well
-difficulty losing weight
-skin issues (acne, eczema, psoriasis)
-behavioural issues in children
Food sensitivities can be identified either through an elimination diet, or through IgG food sensitivity testing. Many patients opt for IgG food sensitivity testing to get a more objective starting point of which foods to start eliminating. This involves a simple blood test that will look at the level of IgG produced with respect to 120-200 foods. However, food sensitivity testing is still controversial. It is not 100% accurate, must be interpreted in the light of what is going on with the patient, and possible cross-reactions (i.e. shellfish IgG can show up high in someone with a dust allergy because the body recognizes a similarity between them). False positives can occur if the patient has a condition referred to as leaky gut syndrome (where the bowels are hyper-permeable and allow too many undigested foods through). False negatives can occur if you have not been eating a certain food, so it is better to do the testing before you start eliminating foods from your diet.
In research studies, IgG-based elimination diets have been found to help with:
-both migraines and irritable bowel (Aydinlar et al., 2013)
-IBS (Drisko et al., 2006; Atkinson et al., 2004)
-Crohn’s disease (Bentz et al., 2010)
Despite the lack of conclusive research, I have found the test to be very clinically relevant in practice: most of my patients with the relevant symptoms improve quite dramatically when we remove their food sensitivities from their diet.
Reading through articles can be confusing, since the term “food sensitivities” and “food intolerances” is often used interchangeably. However, food intolerances are non immune-mediated reactions to food (no antibodies are involved). Typically, the body will lack something which will make it intolerant to a food. A common food intolerance is lactose intolerance, where one cannot tolerate lactose-containing dairy products because he/she lacks the lactase enzyme in the digestive tract necessary to break down lactose. With lactose intolerance, symptoms usually occur within 30min of consuming lactose, leading to stomach cramps, abdominal pain, and diarrhea.
An elimination diet can help identify both food sensitivities and food intolerances. It may take some further testing after that to identify if, for example, your reaction to dairy is due to a sensitivity or an intolerance.
What To Do About Them
Once you identify which foods are a problem for you, there are healthy and not-so-healthy ways to eliminate them from your diet. Many of the specialty foods free of common allergens/sensitivities are highly processed, and contain fillers, emulsifiers, and sugars to make the texture or flavour more similar to their regular counterparts. Your best bet is to stick with whole foods that are minimally processed most of the time, and only have the processed ones as an exceptional treat. You may also need additional supplements to help heal your gut barrier so that you can potentially tolerate your sensitivities more in the future.
Do you think you may have a reaction to a food you are consuming? If you have any questions or would like to get started on an elimination diet or IgG food sensitivity testing, please contact me at either of my Ottawa offices, in Nepean or Orleans.
Atkinson W1, Sheldon TA, Shaath N, Whorwell PJ.Gut. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004 Oct;53(10):1459-64.
Aydinlar EI1, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, Tozun N. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013 Mar;53(3):514-25.
Bentz S1, Hausmann M, Piberger H, Kellermeier S, Paul S, Held L, Falk W, Obermeier F, Fried M, Schölmerich J, Rogler G Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study. Digestion. 2010;81(4):252-64.
Drisko J1, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006 Dec;25(6):514-22.
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Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.