Yael* was a 32-year-old woman who started experiencing “stomach issues” after the birth of the second of her four children. Although she had always had somewhat of a sensitive stomach as a teen (“I would pay the price if I would eat pizza, fries, and ice cream at once like my friends all seemed to be able to do”), her symptoms did not interfere with her life too much until that point. After the birth of her second baby, her symptoms of diarrhea with occasional constipation, post-meal bloating and burping, and frequent heartburn and stomach pain exacerbated to the point of severely interfering with her quality of life.
Yael was fed up after two GI doctors diagnosed her with IBS, recommended trying Metamucil, a low FODMAP diet, and a medication, with minimal improvement. She consulted with me to see if my expertise on the subject would be able to provide her with relief of her symptoms.
Initial Assessment Significant Findings
Current medications/vitamins: None (“Nothing works anyway – I stopped everything”)
Past attempted diets: gluten-free, dairy-free, and low FODMAP (no improvement)
Significant findings: yeast infections on average 2-3x/year, history of mild gallbladder pain diagnosed as gallbladder sludge (tiny gallstones), worse nausea and reflux/burping after protein foods, mild lactose intolerance
Weight history: mild unintentional weight loss over the past three years due to fear of eating many foods
Yael’s case followed the classic storyline of many individuals who are diagnosed with “IBS.” Symptoms such as constipation, diarrhea, pain, gassiness, and bloating are often lumped under the general umbrella of Irritable Bowel Syndrome, which as I tell my clients, is basically a diagnosis of exclusion. Because there is no inflammation (as in Crohn’s or Colitis), detectable parasite, or motility issue, the mainstream medical world has little to offer aside from a “live with it – it’s IBS” attitude. While a few individuals are able to manage their symptoms with fiber supplements and laxatives, most continue to struggle with a reduced quality of life and are frustrated by the lack of solutions offered by their medical providers.
The reality is that when looked at from a functional perspective, there are often very real imbalances and deficiencies that are present in IBS cases, which are often even clinically observable through measurable lab testing. After working with hundreds of IBS cases, I almost always end up being able to identify the root cause from one or more of the following common factors:
- Insufficient stomach acid
- Poor bile quality
- Dysbiosis (imbalance in gut bacteria levels – often caused by over-use of antibiotics)
- Candida/yeast overgrowth
- SIBO (Small Intestine Bacterial Overgrowth – caused by excess bacteria in the small intestine fermenting food and causing severe post-meal gassiness and constipation or diarrhea)
- Deficiency in digestive enzymes
- Gluten, fructose, and/or lactose intolerance
The good news is that with testing, trial and error, supplementation and dietary intervention if necessary, and patience, almost all IBS cases can be successfully managed and even cured. In Yael’s case, after we treated her yeast overgrowth (confirmed through stool testing,) with supplementation and a special diet, and supplemented her suspected low stomach acid and digestive enzymes with apple cider vinegar and enzyme supplements, she felt a marked and dramatic improvement. She was eventually able to wean off the enzyme and stomach acid support once her gut bacteria and yeast levels returned to balanced levels and her body was able to produce enough digestive products on its own. I still receive an occasional email from her with a question or two, and she is so grateful that she is cured of the “IBS” that once controlled her life.
Tamar Feldman, RDN CDE is a Registered Dietitian/Nutritionist and a Certified Diabetes Educator and is co-founder of the app GI Trak. She maintains a busy virtual practice to an international clientele, specializing in balanced and sustainable weight loss and nutrition therapy for autoimmune and gut issues. She can be reached at 732-364-0064 or through her website: www.thegutdietitian.com.