Patient Stories: Functional Medicine Treatment for Irritable Bowel Syndrome (IBS)

Heather Robinson is one of our Naturopathic Doctors here at the London Clinic of Nutrition and has recently shared this patient story of how functional medicine treatment for irritable bowel syndrome helped a patient to improve IBS symptoms naturally.

Due to the nature of our work, we’ll keep the patient anonymous and refer to her as Louisa. Louisa is a mid-30s female who outside of the symptoms presented in her initial consultation was otherwise fit and healthy.

Having tried the clinical medicine route and having little success she arrived at the London Clinic of Nutrition. Here’s how we helped her with functional medicine tretment for Irritable Bowel Syndrome and how it lead to her saying ‘I’m living much more freely which is something I never thought would be possible!’

Initial Consultation: Have I got IBS?

Louisa arrived at the London Clinic of Nutrition stating that her primary goal was ‘to be able to eat out freely and comfortably’. She’d noticed that her continual stomach discomfort was impacting her everyday life, and that along with that she seemed to be experiencing vaginal discomfort and recurring urinary tract infections (UTIs).

When consulting her doctor after some regular episodes of abdominal pain, they investigated this as a case of Endometriosis with inconclusive results. So without knowing if it was IBS or Endometriosis, we listened carefully to what she was experiencing.

We concluded that all symptoms pointed towards it being more digestive in nature given:

• Louisa had a condition called ulcerative colitis, which she was managing by getting Vedolizumab infusions every two months. It helped keep her symptoms under control.
• The problems started after a really bad case of constipation in October 2020, and they got even worse after taking strong antibiotics for a long time in January 2021.
• There was pain after eating, a dull ache in the stomach, loss of appetite and change in bowel habits.
• She noticed an improvement whilst on a low FODMAP diet which restricts specific types of fibers and carbohydrates, removing primary fuel for bacteria and therefore, it can help with bloating and bowel habits.

What is a Low FODMAP diet?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are types of carbohydrates (sugars) that can be hard to digest for some people.

The Low FODMAP diet involves avoiding or limiting foods that are high in these carbohydrates. This is because these carbs can cause digestive symptoms like bloating, gas, stomach pain, and diarrhea in some people. By reducing the intake of high FODMAP foods, people can find relief from these uncomfortable symptoms.

• Examples of High FODMAP Foods: Apples, Cherries, Garlic, Mushrooms, Bread
• Examples of Low FODMAP Foods: Bananas, Strawberries, Carrots, Yoghurts

The idea with a diet like this is that by process of elimination you can identify which foods it is that trigger you personally. After which you can return to a more regular pattern of eating and just avoid the foods that make you feel uncomfortable.

Getting to the Root Cause of Irritable Bowel Syndrome (IBS)

With the information gathered in the initial consultation we concluded that what Louisa was experiencing was indeed Irritable Bowel Syndrome (IBS).

However, using a functional medicine approach this is only the starting point for our diagnosis.

IBS is a symptomatic diagnosis, which means that we have diagnosed the symptoms but it doesn’t tell us what is behind the symptoms and why Louisa was suffering with IBS. We need to get to the bottom of this to identify what would be her best treatment for Irritable Bowel Syndrome.

What can cause Irritable Bowel Syndrome?

There are a multitude of contributory factors for IBS. An individual can have one or multiple of these processes at play that cause them digestive symptoms. Whist there are often significant driving factors of IBS, some of the most common include:

• SIBO: Small Intestinal Bacterial Overgrowth

  This occurs when there is too much bacteria in the small intestine which results in those bacteria feeding on the food ingested, often causing bloating, gas and a change in bowel movement function.This is why low FODMAP diets can yield good results for individuals with IBS; the fuel for the bacteria is removed. Factors that drive SIBO are stress, low stomach acid, and very often, a case of food poisoning or something affecting motility.

  Motility is like the superpower of your digestive system. It’s all about the way your muscles work together to move food along and do their job. They help break down the food you eat, take out the good stuff your body needs, and get rid of the stuff you don’t need. So basically, it’s what keeps things running smoothly in your belly!

• Food sensitivities:

  This is an immune reaction to foods; very often, this occurs because there is some extent of ‘leaky gut’ or intestinal permeability. This can be the result of dysbiosis, SIBO, stress or environmental burden.

• Deficiency Dysbiosis:
  

  Deficiency dysbiosis means there’s a lack of good bacteria in your belly, which can mess up the natural balance. Having enough of these helpful bacteria is important for a healthy gut. When there’s deficiency dysbiosis, it can cause digestive troubles and other problems. Taking care of your gut with a balanced diet and healthy habits can help keep those good bacteria happy and your tummy feeling good.

• Dysbiotic or Pathogenic Infiltration:

  This can be a myriad of factors including inflammatory bacteria, overgrowth of yeast or parasites. Dysbiotic or pathogenic infiltration happens when bad or harmful microorganisms invade your body and throw things off balance. They disrupt the natural harmony inside you and can make you sick. This can happen if food is undercooked, or care is not taken in preparation, from an insect bite or transmitted from person to person.

• Stress:
  

  This is almost always part of the IBS picture. Stress affects motility of the gut, stomach acid and enzyme production, and even reshape the bacterial environment.

Differential Diagnosis in This Case: Functional Medicine Testing for Irritable Bowel Syndrome Causes

The functional medicine approach takes the individual’s concerns and history into account while trying to uncover the underlying driving factor for these symptoms.

This is particularly true when it comes to IBS as it tells us nothing about the mechanism driving symptoms.

In Louisa’s case, given her presenting concern, evolution of symptoms and history, I considered these causes as possible underlying mechanisms:

• SIBO: given her improvement on the low FODMAP diet when she presented to the clinic, history of antibiotic exposure, Ulcerative Colitis (affecting motility due to scar tissue) and nature of her symptoms.
• H.pylori: H. pylori is a type of bacteria that can live in your stomach and cause digestive problems. It can lead to issues like stomach inflammation, gastritis, or ulcers. You can get infected with H. pylori through contaminated food, water, or close contact with an infected person.

  Given the symptoms of pain after eating, pain in the middle of stomach/chest, nausea, loss of appetite and change in bowel function. This bacteria is commensal, however can be pathogenic at high levels.

• Deficiency Dysbiosis/Dysbiotic Bacteria: Antibiotics disrupt the balance of the gut bacteria which allows for overgrowth of pathogenic bacteria/yeast. Even with SIBO, you can have too little bacteria present further along in the digestive tract which can compromise digestion.
• Inflammatory effects of Ulcerative Colitis: having had UC that was not controlled for a period in her life, it’s important that we assess inflammatory markers (calprotectin) and fecal occult blood to see if this is contributing to her current digestive symptoms

What tests can help identify the causes of irritable bowel syndrome?

As such I decided to carry out the following functional medicine tests:

1. GI Ecologix by Invivo: This is a stool test that reveals quantitative data about beneficial and dysbiotic bacteria, parasites and yeast as well as insight into gut function (stomach acid,
   inflammation/calprotectin, immune function etc.). In addition it assesses h.pylori as well (stool antigen which is the gold standard for diagnosis).
2. SIBO Breath Test: Gold standard for diagnosis of SIBO, testing hydrogen and methane gasses.

Testing for Causes of IBS: Here’s what we found

Following the submission of our samples, Louisa’s test results arrived promptly and revealed the following:

1. GI Ecologix:
   a) Low levels stomach acid (pancreatic elastase)
   b) No signs of inflammation, blood, major leaky gut, immune dysfunction.
   c) Low levels of akkermansia (protective bacteria for gut integrity)
   d) Low levels of Commensal Bacteria: These are beneficial bacteria that act as the first line of defense and are essential for preventing pathogenic infiltration, improving intestinal integrity (leaky gut) and managing inflammation.
   e) Elevated imbalance/dysbiotic bacteria: These are bacteria that can have an inflammatory effect, affecting intestinal integrity and causing symptoms such as bloating, gas, diarrhea or constipation. They can also be a major factor in food sensitivities or reactions. Strains like desulfovibrio, enterobacter cloacae, strep and methano brevibacter (can be associated with SIBO) were found.
   f) Negative for h.pylori
2. SIBO Breath Test: Positive for hydrogenic SIBO, negative for methanogenic SIBO.

   a) Hydrogenic SIBO: In hydrogenic SIBO, the overgrown bacteria in the small intestine produce excess hydrogen gas. This can happen when there is an imbalance in the gut microbiota or when bacteria from the large intestine migrate to the small intestine. Symptoms of hydrogenic SIBO often include bloating, gas, abdominal pain, diarrhea, and nutrient malabsorption.

   b) Methanogenic SIBO: In methanogenic SIBO, the overgrown bacteria in the small intestine produce excess methane gas. Methane gas is typically produced by a specific group of bacteria called methanogens. These bacteria convert hydrogen gas, produced by other bacteria in the gut, into methane. Methane gas can slow down gut motility and may result in constipation rather than diarrhea. Symptoms of methanogenic SIBO often include bloating, abdominal discomfort, constipation, and slower transit time.

Follow ups and Functional Medicine Treatment Plan For Irritable Bowel Syndrome

During the first 6 months of Louisa’s treatment for irritable bowel syndrome we would have regular consultations every 4-6 weeks.

Within these appointments we would update on symptoms and continue to build on treatment protocol.

From there, we had check-ins as needed over the following 8 months to troubleshoot (travel, stomach viruses, supplement changes etc. as they came up). Throughout these appointments we got to understand how Louisa’s response to supplements/interventions evolved and are now at a point of relative symptom stability with a core protocol.

Here’s the functional medicine treatment plan we implemented

As previously mentioned, IBS is a symptomatic diagnosis which means it doesn’t actually give us information about what process is at play.

So, the ‘IBS Treatment Protocol’ will vary drastically person-to-person based on symptoms, history and investigative findings (what’s the root cause?).

For Louisa, this is the approach that was taken based on those factors and based on her response to intervention. In her case, we were treating SIBO, a history of ulcerative colitis (UC) and fecal impaction and gut function like low stomach acid and deficiency dysbiosis, all of which were contributing to her ‘IBS’ symptoms.

• Initially, we began with Magnesium citrate to help get stools moving more efficiently prior to any information from our investigative testing.
• We also prioritized mindful eating and engaging the rest and digest nervous system to support digestive function. Given Louisa had been on a low FODMAP diet, we didn’t implement any dietary restrictions at this point.

Our main treatment aims were to:

• Support digestive function (stomach acid, digestive enzymes)
• Keep inflammatory activity to a minimum (from bacteria and history of UC)
• Re-establish healthy bacteria balance; eradicate SIBO and support beneficial bacteria as well as reduce recurrence through supporting motility.
• As bacteria balance improves, expand the diversity of food.

Once we established that there was SIBO present, deficiency dysbiosis, and low stomach acid, we implemented:

• Stomach acid support in the form of Betaine HCl.
• HU58 which is a specific spore-based probiotic strain that has excellent research for SIBO, antibiotic rich environments and individuals with a history of Ulcerative Colitis/IBD.
• Motility support which is incredibly important in SIBO to reduce recurrence and encourage regular, healthy movement of stool through the GI tract.
• Rifaxamin: I had referred her to her GP regarding an antibiotic prescription for SIBO. Typically, I will begin treatment with antimicrobial herbs, however given the level of SIBO present and medication for Ulcerative Colitis, I opted for a SIBO-specific antibiotic.
• Dietary: Gut healing foods like oily fish, flax, bone broth/collagen, berries and cooked/warming veggies.

After the initial round of treatment for Irritable Bowel Syndrome

Louisa noticed a big improvement in baseline bloating and bowel movements. There were still reactions to certain foods and had stressful periods which caused a flare in digestive symptoms. As a result she had begun food reintroduction with higher FODMAP foods delivering mixed results; some were fine and others would trigger bloating still.

• She was encouraged to continue on supplements and complete the round of Rifaximin. – Put a hold on food reintroduction until digestion was more stable.
• We swapped HU58 for Restorflora which has HU58 in it along with other spore-based probiotics to recondition the gut in a SIBO-safe way.
• Since Rifaximin, digestion has improved considerably and consistently. She was also taking a combination of spore based and lactic-acid producing bacteria (lactobacillus/acidophilus) with success. UTIs and vaginal irritation have been kept at bay.
• We increased the dose and type of probiotic that has been specifically researched for IBD/UC (VSL3) given the positive response to lower dose lactic acid producing probiotics.
• Incorporated curcumin for inflammatory support and gut healing given underlying ulcerative colitis.
• Continued to increase diversity and higher FODMAP foods.

From here, there was general improvement with some setbacks from travel stomach bugs, food poisoning and transitioning from hormonal contraception to the copper IUD. The VSL3 proved to be too intense a probiotic, so we returned to previous probiotics (ProVeFlora and Symprove). Over the course of the following months, we addressed concerns outside of digestion and refined her supplement schedule to a maintenance plan.

Each time Louisa visited the London Clinic of Nutrition we would talk through the treatment protocol and her symptom progress. Remaining agile and flexible with our approach and really focusing on treating her as an individual whilst concentrating on the root cause of her IBS.

Did our treatment for Irritable Bowel Syndrome Work?

Following 14 months of care and attention from one of our expert team, we are please to say that aside from some very natural bloating around her menstrual cycle, Louisa has made a full recovery from all other symptoms.
She is no longer experiencing discomfort and is digesting foods much more comfortably. Her bowel movements are both regular and healthy, whilst being able to eat a wide variety of foods. In addition to the recurrent UTI’s and vaginal discomfort being completely resolved.

Plus, Louisa now knows a considerable amount more about her body and it’s unique reactions to gut health. She was so pleased with the outcome that she left us this glowing review.

Testimonial from Louisa:
“After a prolonged period of abdominal pain, chronic bloating and being unable to tolerate most foods, I was introduced to the functional medicine approach. I’ve never been a big believer in simply treating symptoms but in first understanding the causes to allow a tailored approach. This is exactly what I have done by working alongside Heather and my life has completely been transformed. It’s been a fascinating process, and a huge learning curve, which have yielded incredible results. My symptoms have disappeared and when I do have bloating and / or discomfort I know how to handle it. I’m able to follow a much more varied diet without negative implications on my bowel habits and abdominal discomfort. I’m living much more freely which is something I never thought would be possible!”

Could Functional Medicine Help Your Irritable Bowel Syndrome?

At the London Clinic of Nutrition we’ve supported over 20,000 patients in getting to the root cause of their health concerns. If, like Louisa, you’re experiencing discomfort after you eat, irregular bowel movements or indeed any of the IBS symptoms above, then contact us to book a discovery call and our expert team will be on hand to get you back to feeling your best.