The Root Causes of IBS & Stomach Digestive Problems | Dr. Mark Hyman
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Coming up on this episode of The Doctor's Pharmacy. In fact, an 8% higher risk of irritable bowel is associated with every 10% increment in ultra-processed food. And we eat about 60% of our calories as ultra-processed food. That's a 48% increase in irritable bowel given the diet we eat. Now together, the under-eating of the good stuff and the over-eating of the bad stuff increases the risk of nutrient deficiency. Building a portfolio with Fidelity Basket Portfolios is kind of like making a sandwich.

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Welcome back to another episode of the doctor's pharmacy and health bites where we take juicy little bites into our current health topics. I'm Dr. Mark Hyman and today we're diving deep into a topic that affects millions of people worldwide and yet often goes undiscussed in public.

stomach issues. In the social media world, there's a trending hashtag, hot girls have IBS, and it's caught the attention of over 28.2 million viewers on TikTok. The reason why is it reflects a shift in how women are addressing their digestive health issues. Using humor and community bring light to what many have kept hidden for way too long. Now,

Now, by poking fun at their experiences with IBS and bloating and constipation and other gut troubles, women are challenging the stigma around these taboo bodily functions. Now, it's empowering to see these conversations happening openly, but it's really critical to remember these symptoms are not just everyday annoyances to laugh

off. There are real concerns that need to be addressed seriously. And today, we're going to discuss why it's important to move beyond the normalization of this to understanding and treating the issues effectively. Whether it's bloating, constipation, diarrhea, or just an uncomfortable feeling of fullness that just won't go away, these symptoms can be more than just a nuisance. They can seriously impact the quality of your life and

and a whole slew of chronic illnesses. Now, when we talk about stomach issues, we're really opening up a conversation about a range of conditions, from irritable bowel syndrome to with constipation or diarrhea to indigestion or what we call dyspepsia, or to what some people jokingly refer to as a food baby. I heard that at first from one of my patients, and I knew exactly what she was talking about. You know that swollen stomach you get after indulging in a big meal, that bloating, just feel full and your stomach pooches out? That ain't normal.

Okay, something's going on. We're going to talk about what it is and how to fix it. Now behind these common experiences lies a complex interplay of dietary habits, hormone fluctuations, and even stress and toxins, all of which affect our gut health. Now our gut is our second brain. There's more neurons in our gut than our spinal cord. The bidirectional relationship between irritable bowel and inflammatory bowel and anxiety, depression, stress is really clear. They make each other worse. Okay.

Gut bacteria produce hormones and neurotransmitters like serotonin, GABA, and dopamine. And if we don't have the right gut bacteria, we can't produce these neurotransmitters that help regulate our nervous system and our immune system. So all that kind of sets the stage, right? So what then causes irritable bowel and stomach issues? Well, it's different for everyone, and we'll go through the reasons. Poor diet and lifestyle are at the top of the list, right? The biggest driver.

A population-based prospective cohort study published in the Journal of Clinical Nutrition found that an unfavorable lifestyle, looking at modifiable lifestyle factors like weight and BMI, smoking status, diet, physical activity, sleep, and alcohol consumption, were associated with a 56% higher risk for irritable bowel compared to a favorable lifestyle versus a 12% higher risk among those

who are at higher genetic risk compared to those at low genetic risk. So basically lifestyle had a greater impact on IBS than genetics. So maybe some people have families with irritable bowel and there may be some genetics there, but combined genetics and lifestyle has a cumulative effect. Also people are under eating real food. They're under eating nutrient dense whole foods with the right amount of protein, good fats and all the amino acids they need to function. They're overeating ultra processed foods, right? Even healthy quote, plant-based vegan plant meats,

You know, I call it a plant meat, plant-based meat because it's made in a plant, not grown in a plant. And gluten-free foods, which are often junk food, they eat ultra-processed foods that are high in refined sugars and carbs and refined oils, low-quality protein like soy protein isolates and processed stuff. In fact, a large-scale prospective cohort study reported that compared to the lowest consumption of ultra-processed food, the highest consumption of ultra-processed food had a significantly higher risk

for irritable bowel. In fact, an 8% higher risk of irritable bowel is associated with every 10% increment in ultra-processed food. And we eat about 60% of our calories as ultra-processed food. That's a 48% increase in irritable bowel given the diet we eat. Now together, the under eating of the good stuff and the over eating of the bad stuff increases the risk of nutrient deficiencies like B12, iron, zinc, omega-3s. And that actually affects how our gut functions and heals.

Also, our diets are often causing disturbances in our gut and that can affect those stomach acid. It can even be from taking acid-blocking drugs. What else can cause disruption of the gut? Food sensitivities.

food allergens, environmental allergens, all can be a factor. And one of the most common food sensitivities, gluten, dairy, eggs, corn, soy, often grains and beans. Alcohol is not a sensitivity so much as just a gut toxin. What these do is they tend to lead to the overgrowth of bad gut bacteria we call dysbiosis. And dysbiosis is basically the phenomena of the imbalance of

of bugs in your gut that creates more bad bugs and less good bugs. And what does that do? Well, that leads to a leaky gut and inflammation in the body. It can lead to motility issues. It can lead to overgrowth of bacteria, the bad bugs in the wrong spot. It can lead to what we call a CFO or small intestinal fungal overgrowth, what some people refer to as candida, but it can be many species of fungus. And a lot of these symptoms overlap with IBS, right? Bloating,

gas, cramping, diarrhea, constipation. So let's get into a more detailed conversation about SIBO because this is really at the root of so many people. Now, whether you're IBSD or C, constipation or diarrhea, there may be different bugs involved. And there's an undumped different gases we measure because what we're seeing is when you have overgrowth of bacteria, they ferment the food you're eating, particularly starches and sugars and fermentable carbohydrates.

And that causes the production of gases. And those gases are what causes distention and the food baby. The first thing that goes wrong is what we call dysbiosis. We talked about that briefly, but there's a lot of reasons for that. It's our poor ultra-processed diet. It's our lack of fiber. It's too much starch and sugar, alcohol, artificial sweeteners, all kinds of stuff. And from drugs too, antibiotics, steroids, the birth control pill, acid blockers, which are so common like Prevosec or Prevacid.

All these can imbalance the gut flora. Psychological stress, high-carb diet, alcohol, environmental toxins, all these things cause this problem of dysbiosis. And they also can affect the motility of the gut. And there's a lot of things that cause motility issues. It can be diabetes. It can be GLP-1 agonist, by the way. And I worry about how they're affecting people's GI tract. Drugs like Ozempic. And we're seeing even things like small bowel overgrowth. And also we're seeing...

of bowel obstruction because of the way in which it affects the gut. So I'm a little worried about that, but they can be a helpful class of drugs. I just think they're overused. But when you have important mortality from stress or from different kind of inflammatory bowel disease, it can again cause a backup and growth of bacteria in the wrong spot. Basically, you've got like 10, 12 feet of lobe

large intestine and about 22 feet of small intestine. And mostly the small intestine should be mostly sterile, but when the bacteria migrate up to the top of it, and then the food ends up hitting it first, that's when you get this food baby stuff. Now, stress also will have an effect on your bacteria. They actually are listening to your

thoughts, right? Your bacteria listening there. When you have stress also, it increases permeability of the gut. It causes leaky gut. It affects motility, slows it down and affects immune system function. So it's quite common. One of the things that happens is, is a low stomach acid. A low stomach acid is not that common, but it can be in degrees. The more severe form is, um,

aclar hydria, which happens when you get older and you get atrophy of your stomach, or if you have B12 deficiency and so forth, that can really affect this. But there's a lot of reasons for it. But a lot of the reason is because we take these acid blocking drugs, right? And that leads to low stomach acid, and that leads to changing the pH, and that leads to the pH of the small intestine changing and the overgrowth of fungus and bacteria that shouldn't be there because of the change in climate.

But aging itself leads to this. Chronic stress leads to low stomach acid. Certain intestinal infections like H. pylori, autoimmune diseases like hypersensitivity,

hypothyroidism certain medications obviously for blocking stomach acid with acid blockers or ppis antacids certain nutrient deficiencies which are Important for the production of gastric acid like zinc and b vitamins If you're low in those that can cause low stomach acid also poor diet will cause sebo right high intake of processed foods Sugar unhealthy fats also has a negative impact on sebo and also stomach acid also um

If you're not eating properly, irregular meal times, eating too quickly, overeating, you'll tend to potentially get SIBO. And this allows bacteria to colonize the upper intestine, which is supposed to have low levels of bacteria. All right, so this is sort of what it is. Basically, bad bugs growing in the wrong spot, fermenting the food you're eating, causing you to have a food baby and be miserable.

and have all sorts of other consequences on your mood, your energy, your cognitive function. It's not just your stomach that's being affected here. Now, how do you diagnose it? Well, we use a breath test. There's a number of different kinds of breath tests. There's lactulose, there's glucose, and another test called TRIOSMART test. But essentially, we're looking for three gases that are produced after we give you a digestible sugar, like lactulose or like glucose. And what these

do is they actually help you to identify whether or not you're producing extra forms of these gases because the small intestinal bacteria. The TRIO SMART test looks at for three different gases developed by Mark Pimentel and others at UCLA. Looks for methane, which is commonly associated with constipation, hydrogen, more likely to have diarrhea, and hydrogen sulfide,

which is often not tested for, but it can be important to find, particularly in tough cases of SIBO. I particularly use the Trio Smart Test. You can learn about it online. Your doctor can order it. But it's a really important test. There are stool tests that help, and that'll help you identify what's going on in the gut. Maybe helps you look at the overall health of the microbiome.

six underlying issues. It can help you identify yeast overgrowth, lack of short-chain fatty acids, lack of important bacteria like ecromancia, low growth of bacteria. So all that is sort of like clues that things are going on. Also use organic acid testing, a urine test, because a lot of the metabolites from overgrowth of fungus or bacteria will show up in the urine and you can measure these and

another clue. And there are certain blood tests that are important to look for nutrient deficiencies that can affect your, that can affect SIBO or your body like B12 or iron that maybe also are a clue to malabsorption. So what's the traditional approach? Well, it's pretty good approaches in traditional medicine, but they kind of like stop short. They give you an antibiotic to

to clear out the bacteria. That's kind of an advance from what we used to do when I was in training, but it doesn't really address the full spectrum of what's going on in the gut. So what's a good comprehensive functional medicine approach to treating irritable bowel and also the related GI stomach issues? Well, we have a methodology. It's basically a system of how we approach people with gut issues. It's called the 5R program. The first is to remove. Remove the bad stuff. Remove foods that might be bothering you, bacteria, parasites, yeast,

Get rid of the bad stuff. The second is replace. Replace what's missing. Probiotics, prebiotics, enzymes, and so forth. The third is to re-inoculate, which is to use probiotics. The fourth is to repair. That means repair the gut lining with the right nutrients that heal the leaky gut and repair your gut lining. The fifth is to restore, which means to regulate your nervous system and stress. So let's go through the five-hour program in more detail. The first R is to remove. Remove common triggers for stress.

problems with the gut. These are commonly known as food sensitivities, not true allergies, or just things that your body shouldn't be eating that much of. Gluten, dairy, corn, soy, sometimes eggs for people, certainly ultra-processed foods, certainly refined carbs and sugars.

and alcohol. Now a landmark paper published in the prestigious British medical journal Gut found that limiting foods identified through the delayed food allergy test, which is not typically well accepted by traditional medicine, it measures IgG antibodies, not true food allergy, but food sensitivity. When they were limiting those foods, they dramatically improved their IBS symptoms.

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six-week deep dive boot camps and free training sessions every week led by experts in the industry who provide an up-to-date overview of a lab, topic, or health concern. Rupa University is the number one educational institute for root cause medicine with over 20,000 practitioners a year learning about functional and specialty lab testing. If you want to level up your knowledge of functional lab tests, make sure to visit rupainiversity.com. The next thing we want to get rid of are the bad bugs, right?

And that means identifying what they are through testing. Maybe it's a breath test. Maybe it's stool testing, urine testing. But it involves getting rid of overgrowth of bacteria, overgrowth of fungus, overgrowth of parasites through sometimes medications or herbal therapies. Now, the typical medications used are antibiotics.

So rifaximin is the most common one now used. This is a non-absorbed antibiotic approved for irritable bowel. And a randomized trial published in the Antelope Internal Medicine showed that using rifaximin for 10 days resulted in dramatic improvement in bloating and overall symptoms of irritable bowel syndrome by clearing out the overgrowth of bad bacteria. But sometimes you need to use combinations. For example, if you have methane SIBO, you might need neomycin. Sometimes there's resistance. You need to use

Bactrim or other antibiotics. But it's important to work carefully with your doctor on this. Also, you might need an antifungal to get rid of the bad bugs like Diflucan, Nystatin or Spornox. You might need an antiparasitic if you find you have a parasite like Alinea or Flagyl.

And then there's some herbal therapies that can be really helpful. There's a product called Atrantil or Atrantil, which is a specific herbal formula that's designed for methane placebo. That's if you have high methane on your test and tend to have constipation. Certain antibiotics like neomycin can be also important for methane placebo. There are certain herbs that I like to use like Candibactin AR and BR, which are

herbal therapies for bacterial and yeast overgrowth can be great. Sometimes I use a combination of antibiotics followed by herbs for a while. And I will treat people with an antibiotic regimen and then follow it up with herbal antimicrobials. I don't include oregano, berberine, wormwood, yarrow, thyme, ginger, licorice, and other things. And that's the first R. And also we look at toxins. That's the other thing is to remove toxins. So we have heavy metals, we have

pesticides, chemicals, all those need to be reduced or removed. Personally, I had severe SIBO from mercury poisoning because it poisoned all my digestive function and enzymes and it didn't work.

And I had to fix that. Now the next R is to replace. So digestive enzymes and hydrochloric acid. And I use digestive enzymes. There's different kinds like digestive enzyme ultra from pure encapsulations. There's digest gold. There's a lot of other ones. There's spectra time 9X, which is an animal-based enzyme from metagenics. By the way, all these supplements I mentioned, you can find, they're usually through professionals, but I've curated some of the best in class that I've used for my patients'

that are available through me. And you can just go to drhyman.com and go to the supplement store there and you'll be able to find it. Beta-nitrochloride, which is kind of counterintuitive if you think you have digestive issues, we're taking all these acid blockers, but this is actually giving you stomach acid and it can help digestive food and actually help reduce SIBO. And then we re-inoculate, which is really important. That involves giving you the right prescription

probiotics. It's just really important. And that is good bacteria. It can be lactobacillus, bifidobacterium. Sometimes we'll use saccharomyces, which is a yeast against yeast that helps with the yeast overgrowth. We use a whole different combination of probiotics. We also use polyphenols and prebiotics

to actually help fertilize the good bugs. And we now know that polyphenols, the colorful compounds in plant foods, are really important for helping to improve the growth of the good bacteria. And lastly, the next R is to repair. And that means repairing the gut lining, using food as medicine, eating whole, minimally processed foods,

lots of good protein because protein is needed for gut lining repair, pasture-raised eggs, grass-fed organic, non-genetically modified sources of food, lots of low mercury fish like salmon, mackerel, herring,

sardines. I like Seatopia.fish. It's got a great source of clean fish sometimes that are regeneratively farmed. So, you know, be careful of farmed fish. But there's a lot of other protein options, grass-fed beef, wild game, buffalo, elk, lamb, venison, all are great. Poultry, if it's, you know, pasture-raised turkey chicken, that's really good. You also need gut-healing nutrients like omega-3s and vitamin A. And you can get ghee, which has butyric acid, which also contains...

a gut healing compound. Bone broth is really great. It's rich in agglutamine, which can help provide you feeling full, but also it can help provide added minerals and collagen support that helps your leaky gut.

Also, there's certain supplements that are important like omega-3s. I like omega-3 rejuvenate from Big Bold Health. You can take evening primrose oil, magnesium, certain vitamins like D and A are important, zinc, a multivitamin, all help heal the gut. So these are just things that we use to help heal the gut. Now, after you've done this SIBO treatment, you don't want to be eating the diet that's going to cause you to reintroduce foods that are going to cause, again, the overgrowth. So you got to be careful.

You also want to learn how to regulate your nervous system because that also is important. Because both stress works to make it worse, but when you're having your bowel, it makes your stress worse. So it's kind of a vicious cycle. Meditation, breath work, yoga, whatever it is to help restore your nervous system. Also, exercise is great. Exercise that's done regularly. This is from randomized controlled trials. Actually helps reduce IBS. Even a 30-minute walk can help. Now let's talk about diet. There's a whole diet that's being used. It's called a low-carb.

FODMAP diet, low in fermentable starches and sugars, essentially, right? You're not giving the bacteria something to chomp on and then produce gas and make you miserable. This is crazy. One in seven people in the entire world is affected by symptoms of irritable bowel syndrome. And many have one or more foods that are known to trigger symptoms like gas, bloating, or diarrhea. Now, carbs and fiber are the most common because they can be fermented.

So this diet is called the low FODMAP diet, and it was developed in Australia, which was extensively researched with Irubal, and it's basically considered a low-carbohydrate diet. And it can be super effective for treating IBS. Like basically, if you eat protein and vegetables, you'll be fine, okay? Except certain vegetables are not great. We'll talk about that. Now, many of those Irubal sufferers' symptoms improved on this low FODMAP diet.

And clinical research has shown that low 5-meth diopts improve the symptoms in 70% of IBS patients.

So you both want to do the 5R program, and part of the first R is to remove, and it means removing some of these fermentable starches. Real-world studies continue to show that this works, right, in improving abdominal pain, quality of life. So what does actually FODMAP stand for? It stands for fermentable oligosaccharides, which are fructans and galactooligosaccharides, basically oligosaccharides, which means single sugars, disaccharides, like lactose,

monosaccharides like fructose. These are all types of sugars that our gut bacteria feed on and polyols, which are sugar alcohols, right? Which is in all the kind of quote health foods that have artificial sweeteners or sugar alcohols to make them sweet like sorbitol, xylitol, malitol, isomaltol, maltitol, and these are terrible. When I had SIBO, I accidentally got

Well, not accidentally. On purpose, got a chocolate bar that was given to me by a patient. Says, this is a no sugar chocolate bar. You should love it. And I'm like, great. I was, I don't know, at work and I was a little tired, stressed. I ate it, the whole thing. And it was full of maltitol. And I was in the bathroom and I was miserable. It's really bad. So you have to be careful. So how do FODMAPs work?

foods cause IBS? Well, these carbohydrates and sugars are not readily absorbed in the gut. And basically they pass through the small intestines and they attract water and they cause bloating and motility changes that can result in diarrhea or constipation. But once they reach the large intestine, the gut bacteria ferment them and they produce lots of gases like hydrogen, methane, carbon dioxide. And the accumulation of these gases leads to gas bloating dissension. So

what are the foods that have the highest and the lowest amounts of FODMAPs? And what are other things that have FODMAPs like drinks, right? So let's just go through the beverages, apple juice, mango juice, pear juice, high fructose corn syrup, sodas, certain alcoholic drinks like beer, wine, all that will make you worse. Processed foods, I should say no more, but you know those you should meet anyway, but cereals with high fructose corn syrup, snack foods,

with high fructose corn syrup, protein bars, diet foods. Often they'll contain inulin or high FODMAP ingredients. So what are the steps to try a low FODMAP diet? Well, all these moderate and high FODMAP foods should be eliminated for four to six weeks on the low FODMAP food plan. So for the next four to six weeks, you want to basically do that. Why does a low FODMAP diet eliminate healthy foods? Like, right? Seems like

You shouldn't be eliminating healthiest foods, but sometimes it says to like asparagus, right? But that actually has a lot of fermentable starches in it. And you basically do this temporarily until your symptoms get better.

Now, it's careful if you have an eating disorder or whatever. You know, you want to be aware of working with someone who can help you do this right. But still, you might need to fix your gut. And that can be a factor in even in eating disorders. One FADMAP group is introduced at a time. So you sort of go slowly to monitor your symptoms. One food at a time. You start small and you sort of build up your tolerance. Now, some people can only tolerate food a specific quantity. So maybe they'll have a little bit.

They'll be fine. If they have a little more, they're going to be in trouble. But some people need to avoid specific foods or FODMAP groups indefinitely, right? There's an app actually that the FODMAP

group in Monash University in Melbourne, Australia put together and it's for the public and it provides a searchable database of foods low and high in FODMAPs. It has recipes, recommended food products and lots more. And there'll be a link in the show notes and on their website for more information. You go to monashfodmap.com. It's M-O-N-A-S-H-F-O-D-M-A-P.com. Now,

Now, research shows that tryptophan, which is the precursor to serotonin, which is a neurotransmitter that helps gut motility, can improve constipation in IBSC because it helps increase intestinal transit time, intestinal motility, which means moving things through, and gastric emptying similar to fiber. So that's good. If you have high levels of tryptophan, though, it could make

IBSD worse, meaning your diarrhea predominant. You want to be careful. If you're doing this, I encourage you to work with a practitioner. It's pretty restrictive. I don't think everybody needs to be on this, actually. I think there's ways of resetting the gut use of the FIBOR program and helping people eat more normally. But you want to work with an experienced nutritionist or functional medicine practitioner who can help you identify what's going on, what you should be doing. And the goal here is to improve digestion, not have a long-term restrictive diet.

The good news is we now understand a lot more about irritable bowel than we did. We understand what is driving this food baby. It's called SIBO or SIFO. We understand how to treat it in the right way with diet changes, lifestyle changes, the right medication sometimes, the gut repair program. And often traditional doctors might give you the antibiotic, but they won't treat your

yeast or fungal issues. They won't put you on a full 5-R program to reset you. They won't make a lot of dietary suggestions. So you'll get recurrence. So it can be a problem. You can get recurrence if you don't do it properly. As we wrap up things today, I hope you have a better understanding of the complex world of digestive issues that unfortunately disproportionately affect women. And I really hope to underscore the importance of examining the intersection of diet, stress, and hormonal fluctuations in digestive health, particularly in

in women. And hopefully our discussion on the role of the menstrual cycle and neuro bowel syndrome symptoms, the impact of stress on gut function, the dietary habits that contribute to conditions like SIBO and dysbiosis helps provide an

a foundation for really understanding and addressing these issues. Research highlights how hormonal changes affect GI motility and sensitivity, emphasizing the need for a tailored approach to treatment. By integrating this knowledge with functional medicine principles, we can really develop a more effective set of strategies to alleviate the symptoms and improve gut health overall.

It's crucial moving beyond just acknowledging these issues as common complaints that have to be tolerated toward really understanding their biological foundations so we can manage them better and treat them better. And if you're struggling with these symptoms, I would consider working with a functional medicine doctor or using some of these strategies we discussed and get better. You don't have to suffer from this. So thanks again for joining me today and see you next Friday for another juicy episode of Health Bites.

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