Irritable bowel syndrome affects millions of people, but an integrative approach may provide relief.
For most of his life, Rich Geldreich suffered gut distress. The 42-year-old San Diego–based software engineer had experienced recurring bloating, gas, and constipation since he was 13. His symptoms grew more severe as he aged and were exacerbated by his stressful job.
“Every time I had a big deadline at work, I’d hit a wall with my gut,” he says. The pain and gas felt “like a volcano erupting.”
After one especially bad bout in 2013 triggered by severe food poisoning, Geldreich saw five doctors, including a gastroenterologist. They all offered the same diagnosis: irritable bowel syndrome (IBS).
This didn’t bring relief.
IBS affects one in five Americans, yet its causes are a mystery to most health professionals, even those who specialize in gastrointestinal (GI) disorders. Unlike a disease, which has identifiable biomarkers, a syndrome is a collection of common symptoms — and can be devilishly difficult to treat.
“IBS is the most common diagnosis made by gastroenterologists, yet it’s the one we know the least about,” says Robynne Chutkan, MD, an integrative gastroenterologist at Georgetown University Hospital. Part of the problem, she says, is that root causes can be as varied as the individuals suffering from them, and doctors often don’t take time to search them out.
“Stopping with a diagnosis of IBS is too vague,” Chutkan explains. “If you take a good look, you find lots of potential explanations — gluten sensitivity, parasites, bacterial overgrowth, lactose intolerance, and leaky gut. But none of those can really be addressed in your typical 15-minute appointment.”
Most physicians are taught to view gut ailments as a problem with anatomy, but IBS is usually about biology and function, says Greg Plotnikoff, MD, coauthor of Trust Your Gut. “IBS doesn’t lend itself to quantification; it won’t show up on a CT scan, an ultrasound, or a biopsy. So people with IBS get passed from doctor to doctor like a hot potato.”
Geldreich was one such hot potato. When he visited his doctors in 2015, each one put him through a variety of tests. They all ruled out ulcers, Crohn’s disease, and cancer. After no one found an explanation for his chronic pain, Geldreich went home with a prescription for heartburn medication and the suggestion that he start supplementing with probiotics.
Doctors write nearly 6 million prescriptions a year for drugs to ease IBS symptoms. Yet GI specialists agree that these medications — usually laxatives, antidiarrheals, and antispasmodics for cramping — often provide little relief.
“The drugs we use to treat IBS only have a 10 to 40 percent efficacy rate compared with placebo,” says University of Michigan gastroenterologist Shanti Eswaran, MD. And they often produce side effects that can compound IBS symptoms. The antacids Geldreich’s doctors prescribed, for example, can lead to reduced stomach acid and poorer digestion. (For more on problems with antacids, go to “Natural Ways to Fight Heartburn.”)
Leaving the underlying causes of IBS untreated takes a toll. By 2015 Geldreich developed gastritis, a painful inflammation of the gut lining, as well as small intestinal bacterial overgrowth (SIBO), which can cause bloating and nutrient malabsorption. He couldn’t sleep. He struggled to find foods he could eat, and his weight dropped from 150 to 115 pounds.
It was at this point, after meeting a stressful deadline at work, that Geldreich made up his mind. He took his bonus, quit his high-pressure job, and devoted himself full-time to getting to the root of his gut problems.
“I had no choice,” he says. “This was a battle for my life.”
The Path to Healing
While every case of IBS is different, most functional-treatment strategies cover the same basic protocol. These are the steps Geldreich followed in his recovery.
1. Know Your Gut’s History
IBS can seem like a lifetime diagnosis, but it doesn’t have to be — especially if you work with a health practitioner who helps you address the root causes.
“It’s absolutely essential to figure out why you have IBS, rather than just accept the -diagnosis and resign yourself to a life of pharmaceutical intervention,” says Chutkan. “You have to be a medical detective.”
Geldreich enlisted the help of two Seattle healthcare providers: functional naturopath Dan Lukaczer, ND, and acupuncturist Avigail Cohen, LAc. Over the next 18 months, each would help him identify and treat the underlying causes of his IBS.
When he first met with Geldreich, Lukaczer asked for a detailed health history. “As a physician, I get a lot of clues from a patient’s story,” Lukaczer says. “Getting to the root cause of a condition like IBS isn’t like one of those medical TV shows, where you find out it’s one unusual thing, like the mercury from fish or lead from the pipes, that’s making a person sick. Usually it’s a combination of factors, and Rich is a good example of that complexity.”
Their discussion revealed several potential causes for Geldreich’s distress. He told Lukaczer about his pressure-cooker job and how he often worked 12- to 14-hour days. He also recalled getting sick after drinking water contaminated with raw sewage when he was 13. (Hostile microbes are a common trigger for chronic gut ailments, and they can persist in the gut for years.) By the end of the 90-minute appointment, Geldreich felt hopeful.
“Lukaczer was the first doctor who I felt was actually paying attention,” he recalls.
Most IBS patients feel unheard and disempowered, says Plotnikoff. “Asking a patient to ‘tell me your story’ often shines a light on the most important information.”
Geldreich’s health history also revealed a family connection: Both his mother and his brother experienced gut distress. Studies show that people who have a parent or sibling with IBS are three times as likely to suffer from the condition, though it’s unclear precisely why or how.
“We know genes play a role in IBS,” says Gerard Mullin, MD, associate professor of medicine at The Johns Hopkins Hospital in Baltimore. But we don’t know exactly how or how much.
Both genetics and mic-robes have an influence. The microbiome is a pillar of gut health, so any inherent weakness ups the odds of a gut-related condition.
Meanwhile, the bulk of the 100 trillion microbiota that compose our gut microbiomes are inherited from our mothers, including some 1,000 species of bacteria and untold archaea, fungi, and viruses. This inher-it-ance is transferred from mother to baby in the birth canal. If a mother’s intestinal microbiota are imbalanced at the time of delivery, her child’s often are, too.
Studies have found that people with diarrhea-predominant IBS have lower-than-normal levels of Bifidobacterium and Lactobacillus; those with constipation-predominant IBS show flagging levels of Veillonella species.
While genes can’t be altered, the microbiome can be revitalized with nutritional and lifestyle interventions. A genetic predisposition is not a life sentence.
2. Balance the Microbiome
Like many people, Geldreich inherited a less-than-robust microbiome. And then life piled on.
For years he worked too much, rarely exercised, and ate a less-than-stellar diet: He often wolfed down energy bars for lunch and chain-restaurant fare for dinner. He’d taken multiple courses of antibiotics over the years, and Chutkan notes that a single course of a broad-spectrum antibiotic, such as ciprofloxacin (commonly prescribed for urinary- and respiratory-tract infections), can destroy up to a third of the gut’s good bacteria. “The process of repopulation may take months or even years,” she explains.
“Identifying and remedi-ating the cause of bacterial imbalance is essential to repairing and healing the gut,” Chutkan adds. “Your microbiome wasn’t built in a day, so rebuilding it will be a gradual process. But tangible improvements can be made.” (For more on this, see “Build Your Microbiome.”)
For her IBS patients, Chutkan often advises a 90-day course of high-quality probiotics to repopulate the gut with good bacteria. She recommends a formula with strains of Bifidobacterium, Lactobacillus, and Strepto-coccus, which “help crowd out pathogenic species.
“Probiotics aren’t a panacea,” she admits, “but for those suffering from microbial discord, they represent a glimmer of real hope for improved health.”
To get a glimpse of what was going on in his patient’s microbiome, Lukaczer reviewed the results of Geldreich’s comprehensive digestive stool analysis.
The results showed Geldreich was free of many of the parasites and yeasts common in people with IBS, though they did show he had difficulty digesting fats, which can lead to bloating, pain, and indigestion. Lukaczer put him on supplements containing fiber and bile salts to aid with fat absorption.
This allowed him to move forward to the next step of healing his gut’s lining.
3. Address Leaky Gut
In a healthy gut, the lining serves as a sophisticated filter. It’s composed of permeable cells that allow fully digested nutrients to pass through while deflecting larger food particles, chemicals, and toxins.
When those cells are -irritated — by food allergens, stress, toxins, and other sources — the cell junctures loosen and microscopic bits of undigested food leak into the bloodstream. The immune system attacks these invaders, leading to chronic inflammation that can perpetuate low-grade digestive discomfort for years. (For more, see “How to Heal a Leaky Gut.”)
Chronic inflammation is the long road to a leaky gut and IBS; the shortcut is intestinal infection. One in three cases of IBS begins with a severe bout of food poisoning or traveler’s diarrhea. The infection causes the immune system to target the gut directly. The resulting inflammation weakens the microbiome and, for some, unleashes IBS symptoms.
Geldreich took the long road and the short road. He had a family history of gut ills and a microbiome weakened by a childhood illness; then the bad bout of food poisoning in 2013 triggered his chronic gut distress. “After that, I was in near-constant stomach pain,” he says.
To heal a leaky gut, Chutkan follows the three Rs: remove, replace, and repair.
Remove the major dietary sources of inflammation, including dairy, gluten, refined sugars, alcohol, and artificial sweeteners.
Replace them with nutrient-rich vegetables and fermented foods, like sauerkraut and kefir.
Repair by eating anti-inflammatory foods, such as gut-healing bone broth, cold-water fish, flaxseeds, and walnuts.
Lukaczer put Geldreich on a comprehensive elimination diet for three to four weeks that cut out gluten, dairy, soy, corn, beef, pork, sugar, and processed foods. (See “Nutrition Protocols to Relieve IBS,” opposite page.) This offered Geldreich substantial relief, as it does for many IBS sufferers whose guts have become leaky and, by extension, hypersensitive to inflammatory fare.
Lukaczer also started him on gut-healing supplements, including probiotics and digestive enzymes.
Geldreich left his job to escape the stressful work environment, though he knew unemployment was not a long-term solution. He worked with his healthcare providers to develop a supportive plan: In addition to maintaining good nutrition and stress management, he committed to exercising at least 30 minutes a day, retiring between 9 and 10 p.m. to optimize restorative sleep, and scheduling a weekly massage and chiropractic adjustment. He also started walking up to three miles daily.
Geldreich moved to San Diego for its sunny, laid-back atmosphere. He is once again employed as a tech consultant but now works from home. This allows him to eat well and take breaks to exercise. He walks every day, and as his health has improved, he’s started jogging and weightlifting. After following an elimination diet for several months and using a rigorous, food-and-supplement-based approach to rebuilding his gut lining, he now eats most foods comfortably. His IBS symptoms have been absent for a year.
“The human body has quite a bit of resiliency if we unleash it,” Lukaczer says. Though the symptoms of IBS once nearly ruled his life, Geldreich is now living proof that the gut, when given the tools and support it needs, is built to heal.
This originally appeared as “Gut Feelings” in the January/February 2018 issue of Experience Life.