I still chuckle to myself when I recollect learning about the word “idiopathic” in medical school. My professor said that it meant that the doctor was an idiot, and the patient was pathetic. We all realized that it was funny because it was sadly, partially true.
The medical term basically means that the cause for the patient’s problems could not be found. The diagnosis of irritable bowel syndrome (IBS) is idiopathic, because it is a diagnosis of exclusion. This means that doctors can only give the diagnosis of IBS when all other possible causes of the symptoms have been ruled out.
Meaning, your bloating, abdominal pain, constipation, diarrhea, urgency, or incomplete evacuation of stool cannot be attributed to any inflammatory, infectious, or other diagnosis that is recognized by the medical community thus far.
Since no cause is found, that basically means that you’re **** out of luck. You might get sent home with a few palliative medications to ease your symptoms, but the chances of you spontaneously having what’s considered normal digestion without the use of pharmaceutical medications are slim to none.
The problem with endowing someone with an idiopathic diagnosis is that once it is given, the search for the answer concludes. The term “IBS” has been in use since the 1940s. I was also taught in medical school that just about 50 percent of the information you learn in medicine will be obsolete in 10 years. So why are we still using a diagnosis that is more than 50 years old when we have come so far in our knowledge of the gastrointestinal tract?
We know in Functional Medicine that the gastrointestinal tract governs how the rest of our body functions. If the digestive system is not functioning properly, then nothing else in the body will — that includes the mind and brain, immune system, hormones, nerves, muscles, bones, etc.
The main reason for this is that the digestive tract is where we assimilate and interact with our environment. The skin also does this; however, although it is permeable to an extent, it is nowhere near as selectively permeable as the gastrointestinal tract. The one-cell-layer-thick lining of our gastrointestinal tract must decide what gets incorporated into our bodies and what gets eliminated through our stool. This is a very important and intricate task, and if we are suffering symptoms associated with IBS, then we can assume that this imperative role is not being conducted properly.
Therefore, these seemingly benign gastrointestinal symptoms that the patient presents with may cause the development of more serious ailments in the unforeseen future. These symptoms are best not to be ignored, brushed off, labeled as idiopathic, or “controlled” with pharmaceutical medications.
Luckily, Integrative and Functional Medicine doctors have been helping patients with IBS for decades. Having an extensive knowledge of other possible diagnoses, additional testing to do, and executing empirical treatment options when reliable tests may not exist, we have been able to work diligently and persistently with patients on getting rid of these symptoms the majority of the time.
If you are suffering from IBS-type symptoms, and don’t feel that your doctor is giving you enough attention or investigation, then you may want to reach out to an Integrative or Functional Medicine doctor to look into what might be the underlying cause. There are a multitude of gastrointestinal conditions that are associated with IBS symptoms which can be treated and actually cured. Here is a list of some of them and a little information about each one:
SIBO, or small intestinal bacterial overgrowth: This diagnosis can be made by testing one’s breath or, more recently, blood. SIBO can be caused by hypochlorhydria (lack of stomach acid), induced by long-term use of acid-blocking medications like Nexium or Prevacid, or related to aging. Other causes can be antibiotic usage, poor diet, or stress, among others. The treatment consists of either antibiotics or antimicrobial herbs, both of which have been shown to be just as effective by a study done at Johns Hopkins University. The incidence of recurrence after treatment is high, so it’s best to work closely with your doctor on this.
Fructose malabsorption: Most people can absorb about 25-50 grams of fructose from one meal; however, some can absorb less than 25 grams. This can lead to excessive fructose in the GI tract and IBS-like symptoms. This has become more of an issue recently due to the addition of high-fructose corn syrup to so many processed foods. Avoiding these and high-fructose fruits can certainly help with symptoms. Testing can be done with a breath test by certain gastroenterologists.
Yeast/candida overgrowth: This is a giant issue that is frustrating on multiple levels. For one, it is not recognized as a diagnosis by the conventional medical world. Secondly, it is rampantly increasing due to liberal and overuse of antibiotics and excessive sugar in our diets. Third, no reliable testing exists to diagnose it. And last but not least, it can be very difficult to get rid of.
Food sensitivities: For many reasons, including astronomical changes in our food industry and production over the past 50 years, we are becoming more sensitive to multiple foods and additives (gluten, dairy, soy, corn, nightshades, preservatives, emulsifiers, etc).
Parasite infections: Another diagnosis that is difficult to make and treat. However, if this is highly suspected, many times we will empirically treat patients with herbs or medications that are well tolerated, benign, and effective.
Gut-brain axis disturbances: We know now that there is direct interplay between our emotions and the microbes that live within our GI tract. If we are chronically stressed, for instance, certain neurotransmitters will dominate our brain, nerves, and blood, and cause maladaptive changes in our microbiome which can lead to IBS-type symptoms. Ensuring that mental health is being addressed is imperative to our gastrointestinal health.
Hormonal imbalance: In addition to the gut-brain axis, there is also a direct interplay between our hormones and our gut bacteria. There is bi-directional communication happening between all our sex hormones (i.e., estrogen, progesterone, and testosterone), and thyroid hormones and the bacteria that live in our GI tracts. If our hormones are imbalanced, then our microbiome’s bacterial environment will likely also become imbalanced, and visa versa.
This is not a complete list of all the pieces of the puzzle that make up our gastrointestinal health. As you can see, there are multiple factors that should be addressed when a patient presents with gastrointestinal upset. The key is finding a doctor to work with you.
It can sometimes take a lot of investigative work, and certainly takes lots of patience and diligence to get to the answer. But believe me, to heal your gut, the center of your health, it will all be worth it.
Soyona Rafatjah, MD is a board-certified Family Medicine physician who practices Integrative and Functional Medicine at Dr. Frank Lipman’s Eleven Eleven Wellness Center. She is also certified in Sublingual Immunotherapy for environmental, food, and mold allergies.