You probably don't just have "IBS"
Even though 95% of centralized digestive health "experts" will say you do.
Went to your doctor because you were experiencing symptoms like gas, bloating, stomach pain, constipation or diarrhea?
Told you had IBS, given some extremely surface level advice and then sent on your way only to have the situation not get much better or even worse?
While this is unbelievably annoying, don’t worry, you’re not alone. And I have good news: your situation is probably not as hopeless as you think.
The unfortunate reality is that most digestive health “experts” provide very little value beyond using a system to match up the symptoms you’re telling them about with the right medication.
Perfect example: the IBS diagnosis processes.
IBS is one of the most commonly diagnosed digestive disorders, yet its diagnosis, understanding and treatment are extremely flawed. Misdiagnosis is common and many cases attributed to IBS actually stem from underlying conditions that are frequently missed.
This results in treatments failing to address the true root cause and people continuing to suffer indefinitely.
IBS is a symptom-based diagnosis, not identified through specific tests. It requires recurring abdominal pain/discomfort at least once a week for 3 months, linked to 2 of these: defecation, stool frequency changes or stool appearance changes (more on the criteria used to diagnose it here).
There are rarely any tests done to rule out other conditions. Even among functional doctors.
The issue with IBS is that its symptoms overlap with every other digestive health condition. Without testing, symptoms can be labeled as IBS, even if another condition is the true cause.
When there is another issue there causing symptoms (not just IBS) it can lead to substantial damage being done to your health over time.
I’ve worked with more people than I can count that were told they had IBS, given some very basic advice and sent on their way. No deeper discussion on diet or lifestyle, no thorough analysis of symptoms and definitely no testing.
When we dug deeper, we found that it wasn’t simply IBS but instead deeper issues that needed attention. Not surprising why they weren’t getting better… they were overlooking the real causes of the symptoms entirely.
Conditions like colitis, overgrowth, celiac, leaky gut and many others all can have symptoms that match up perfectly with IBS. But they’re not being caused by “IBS”.
When people with IBS are tested for these other issues, we often see that they test positive. And when they treat these other conditions, we often see their “IBS” symptoms disappear.
Interesting.
One study with 202 people with IBS showed that 78% has abnormal breath test results indicative of SIBO while another found that 84% were positive. (PMID: 11151884 & 12591062)
There are a concerning amount of gastroenterologists that immediately diagnose anyone with digestive symptoms with IBS. This approach is dangerous.
And no, that’s not dramatic. Issues in your gut going unaddressed for years will absolutely wreck your health.
Skin issues, hormonal imbalance, insulin resistance, autoimmunity and much more.
So many people feel frustrated, lost and hopeless because of this approach. They’ve cleaned up their diet and made positive lifestyle changes but still have symptoms.
Many people even go through protocols to try to heal their gut and still… nothing sticks.
While these improvements may be positive and may be moving things in the right direction, they’re not enough.
Why? Because doctors are not doing their job.
When you’re dealing with the acute health issues that often cause IBS symptoms, they require a targeted approach.
Yes, cleaning up your diet or making lifestyle improvements can be objectively beneficial. But the appropriate changes needed to resolve SIBO aren’t the same as what’s needed for MCAS or leaky gut or colitis.
This is especially true with specific protocols.
So while people in this situation feel like they’ve done a lot and are doing everything right, they might just not be doing the appropriate things for their situation.
In an ideal world, professionals would be equipped with the knowledge, experience and empathy to actually help people with the issues they are supposed experts in. We unfortunately do not live in that ideal world.
Now, it is entirely possible that someone is experiencing IBS symptoms as a result of surface level issues. For example: you’re eating unhealthy, your stress is out of control, you get poor/insufficient sleep, circadian rhythms are a mess, etc.
In these situations, doing an honest assessment of your situation and simply addressing these issues may be all that’s needed.
But judging on my interactions with many of you, this is not the case. You’ve considered and addressed the low hanging fruit but are still having issues. Because the true causes of those issues are deeper.
So, first and foremost, you need to get a better understanding of what’s going on. We need to come to terms with the fact that IBS is simply a label for a set of symptoms and patterns of symptoms. It is not a specific condition that can be tested, treated or resolved.
The underlying causes of IBS symptoms on the other hand can be.
Step 0: Clean up diet & lifestyle
As I said already, in most of my conversations with you guys, you’re well aware of this step. But it’s worth still repeating because although we know it’s important, sometimes we forget or don’t give it the full attention it needs.
If you have not already cleaned up your diet and cut out things like these, that’s priority 1.
Refined carbs
Gluten
Artificial colors & sweeteners
Seed oils
Dairy (while it can have benefits, in my experience, most people dealing with underlying digestive issues tend to do better by removing it temporarily. Once the gut is in a healthier state, it can often be reintroduced without issues. If you tolerate dairy well, that’s great, but I’ve found that a significant number of people with deeper gut disruptions experience inflammation, bloating, skin problems, or other symptoms when consuming it… even if not blatantly obvious)
Coffee (even if it’s organic, low acidity, mycotoxin-free, etc., coffee can still be extremely irritating. Some people tolerate it better than others, but again, in my experience, the overwhelming majority of people are better off (many times even required to) cut out coffee until their digestive issues have been resolved or else it is a roadblock)
Alcohol
Nuts & seeds
Raw veggies
Inorganic pesticides
Tap water
MSG, HFCS, preservatives, gums
Silicon dioxide, titanium dioxide, carrageenan, glycerin & other additives/fillers in many foods and supplements
Beyond this, other adjustments that can help include:
Cutting out any foods you’re not digesting/tolerating well (using tracking below)
Running a elimination diet and reintroduction phase
Keeping FODMAPs and antinutrients low
Looking into nutrient gaps in your diet and addressing them
Chew thoroughly and eat slowly
Do not be on your phone or doing stimulating things while eating
Walk after every meal
Leave 3+ hours between consuming meals or snacks
Reduce plastics, forever chemicals and other household toxins
The same is true on the lifestyle side of things. If you’ve not already established at least a baseline level in these areas, they should be addressed expeditiously:
Sufficient quality sleep
Daily exercise / movement
Managing stress
Morning, mid-day and evening natural light exposure
Avoiding artificial light at night
Consistent sleep & eating schedule
Support nervous system with things like deep breathing, meditation, grounding, hydrating properly, reducing stimuli and vagus nerve stimulation with things like humming, singing, cold exposure, etc.
Step 1: Track everything
If you can’t answer basic questions like the ones below, you do not have a good enough grasp on your situation:
What time of the day do your symptoms occur?
How long do they last?
Do they follow a consistent schedule or are they random?
What foods are you consuming and what do your macros look like?
Are there any foods that set off symptoms whenever you consume them?
What is the consistency of your stool and how many BMs are you having per day?
Keep a symptom and food journal. Use meal tracking apps like Cronometer to understand the specifics of your diet. Keep a basic schedule to track things like sleep/wake time, meal time, etc. throughout the day.
The more information you have, the easier it is to start drawing conclusions. When all you have is a limited recollection of symptoms over the course of the last few days, it’s extremely difficult to draw any real conclusions and know what you need to do.
Step 2: Test and stop guessing
Again, there are some issues that can be resolved by some basic adjustments across diet and lifestyle. Or issues that popped up relatively recently, are pretty straightforward and may not require thorough testing.
But this post is not for those people. We’re specifically talking about the people who have already done these things, already tried protocols and are not seeing any real improvement.
About 80% of the people I talk to who are in this situation are unable to answer with certainty what is wrong. Within that group, over half have not even done a thorough analysis of symptoms or tracked anything, let alone run lab testing.
Even if you’re a seasoned practitioner with 10+ years of real world experience, there are still many issues in the body that simply cannot be fully analyzed based on symptoms alone.
Example:
Someone is dealing with histamine issues, bloating, food sensitivities and irregular bowel movements.
Could be dysbiosis. Could be overgrowth. Could be MCAS. Could be leaky gut. Could be nervous system dysregulation.
Within these issues, there could also be a number of contributing factors like abnormal thyroid function, heavy metals, low stomach acid, enzyme deficiencies, DAO enzyme deficiency, hormonal imbalance, nutrient deficiencies and a number of others.
Anyone who believes they can accurately diagnose someone in a situation like this, including all of the contributing factors involved, based solely on symptoms without running any testing is either dishonest, overconfident or misinformed.
I completely understand the roadblocks when it comes to testing.
Most doctors will outright refuse to run them
In some countries, there are not a ton of options
They’re not cheap
But these are not insurmountable roadblocks.
First off, you do not need a doctor to run testing in most places. I’ve worked with people in the US, Canada, Central America, South America, Europe, Australia and throughout parts of Asia and have only had a few people who were simply in a location where it was not possible for them to get access to functional testing or blood work.
They’re not exactly cheap, but neither is dealing with health issues over the course of several years.
Most people spend money on medications, supplements, doctors visits, protocols, etc. trying to resolve their issues without any success and end up far exceeding what they would have paid to run testing up front.
I did a post recently going through the different tests that I consider when trying to understand what is going on and what I look for in them. You can read the full post here.
To summarize, the tests that make most sense to run depend on the situation. What issues you’re dealing with, health status, history, etc.
Generally speaking, starting with comprehensive blood work and a stool test for most digestive issues is a great place to start. Beyond that, other testing looking into other areas and potential contributors like these can help:
Hair mineral analysis
Mycotoxin testing
Organic acid test
SIBO breath test
Micronutrient testing
If you either cannot access testing or cannot afford it, it doesn’t mean you’re out of luck. It just means you should be putting even more focus on tracking your meals, symptoms and general health.
You can go through protocols and address health issues without lab testing, it just often requires a more broad approach or a bit of trial and error since you don’t have as much data or certainty.
Step 3: Start addressing acute issues
Why wouldn’t this be step one? Isn’t this the key to healing?
Yes, it is. But you can’t address what you don’t know. And trying to address acute issues when the low hanging fruit haven’t been taken care of isn’t going to get you very far.
Way too many people try to skip ahead to this step without having any sort of baseline or foundation to support them and without having any clue what they’re actually trying to solve.
If you go about it the right way, tackle those things first and then focus on this, the whole process becomes much easier and clearer.
Now you have a better starting point and you have a solid or at least better understanding of what issues you’re trying to solve for and what disruptions are causing them.
There isn’t a single, evergreen protocol to follow here. It depends entirely on steps 1 and 2 if you’re doing it correctly.
I’ll be sending out posts covering what I’ve seen as the most common actual causes of “IBS” symptoms and what you guys told me you were struggling with in the post a few days ago.
So stay tuned for those.
But bottom line: If you’re been told you have IBS, you’ve implemented changes, supplements, protocols, etc. and you’re not seeing improvements… your attention is not on the right things.
Especially if you have not done a deeper dive into your situation, run testing or even done any sort of analysis beyond just your surface level symptoms.
IBS is not the big bad incurable wolf that doctors make it out to be.
It’s just poorly understood.
— Nick