Introduction and Summary

Ask your doctor about the cause of IBS and they will likely give you a blank stare.

The 3-minute assembly line churns and since you aren’t about to die, it’s on to the next case.

The NIH estimates that as many as 20% of Americans may experience signs of IBS. (R)

As you will see, IBS is a complex disease and there are many variables in the web of causes.

There are two main types of IBS – one that involves Diarrhea (IBS-D) and one that involves Constipation (IBS-C).

  • Contractions (flow) that is too fast cause diarrhea predominant (IBS-D)
  • Contractions that are too slow cause constipation-predominant IBS(IBS-C).

Food goes from your stomach to your small intestine, where it’s broken down into carbohydrates, fats, and proteins. Only simple sugars (glucose, fructose, galactose and mannose) can be absorbed into your bloodstream.

The carbohydrates that aren’t broken down or absorbed pass to your large intestine, where bacteria ferment them. Fermentation produces gas, which is normal. This fermentation is supposed to occur only in your large intestine.

So food goes from stomach-> small intestine->large intestine.

The large intestine is loaded with bacteria, but the rest of your gastrointestinal tract has relatively few bacteria. You are not supposed to have large amounts of bacteria in your small intestine.

When a person has bacteria in the small intestine, unabsorbed carbohydrates are fermented there, producing significant amounts of gas.

This causes cramping and burning because the gas stretches the small intestine. The gas can also push the intestinal contents rapidly toward your large intestine to cause diarrhea.

Bacteria generally ferment in your small intestines because your gut ‘flow'(motility/peristalsis) is slowed down in this area.

When people have diarrhea, it usually means the flow is quickened in the large intestine.

Gut pain comes from the neurons in your gut being ‘hypersensitive’, and this has many causes as you will see.

When your intestines expand, this is sensed by the neurons in your gut.  If your neurons are hypersensitive, this distension will feel uncomfortable or hurt.  Others will just feel bloated, but not pain.

One major cause of gut flow changes is because we have too little serotonin. Why?  Because the gut immune system is imbalanced.

This post is mainly about IBS, but other gut problems are often from the same causes.

1) Stress and IBS

gut_270210278

Chronic stress response activation (HPA) is believed to be a causal factor of anxiety disorders, bipolar, insomnia, PTSD, borderline personality, ADHD, major depression, burnout, chronic fatigue syndrome, fibromyalgia, IBS, alcoholism and other diseases. (R)

Chronic stress is probably the most common and significant cause of gut flow (motility) changes.

Indeed, increased activation of the stress pathway (HPA axis) is associated with IBS. (R)

CRH

The effects of stress on the gut mostly has to do with the effects of Corticotropin Releasing Hormone (CRH), which is released from the hypothalamus when stressed (R).   

Your gut is lined with these motors (neurons) that move things along at a steady pace.

CRH is a direct cause of IBS by increasing the flow or motor speed in the colon and decreasing it in the small intestine.  When the flow is decreased in the small intestine, bad bacteria overgrow by feeding on carbs. (R)  This results in gas from the ass.

This fermentation in the small intestine can increase methane-producing bacteria from carbs, which produces methane gas. (RR2)

When motility is increased in the colon, that could cause diarrhea.

People who get IBS are more susceptible to gut dysfunction when CRH is released (R).

In IBS, there are increased HPA axis responses to stressors such as meals, hormones and mental stress compared to controls. (R)

Therefore, stress is more harmful to people with IBS with regard to gut function.

CRH also causes your gut to be ‘hypersensitive’ and experience pain more. When given a drug that blocks CRH, the pain goes away. (R)

Probiotics (best one) such as B coagulans reduces this hypersensitivity. (R)  LDN also reduces hypersensitivity. (R)

CRH does many other bad things such as:

Stress will also cause the release of various neurotransmitters (catecholamines), which decreases intestinal flow. (R)

Chronic stress or frequent activation of the HPA axis can cause oxidative stress as well. (R)

You want to read my post on why stress is bad and all of the triggers of your stress response.

I recommend putting a device called ICES on your head to decrease CRH and inflammation.

Adrenaline

Adrenaline and noradrenaline, through ADRA2A receptors, inhibit gut flow (R).

In addition, they cause a short-lived increase in blood pressure, but a longer term decrease in blood pressure.  They also cause sedation and thicker blood (platelet aggregation) (R).

These are all symptoms that are more common in people I see who have IBS-C.

2) Inflammation

inflammation_233859859

In some sense, IBS may be considered IBD-lite, which means it’s like IBD (Crohn‘s, colitis), but with lower levels of inflammation.  Patients with IBD experience IBS-like symptoms when their IBD cools down.  (R)

A three-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period. (R)

The risk of developing IBS increases sixfold after acute gut infection.  (R)  After salmonella, risk increases by 8X (R). This is because infections cause inflammation (and oxidative stress).

Inflammation can affect the gut in many ways.  One way is by activating our stress response/HPA axis. (R)

Most of my clients with IBS also are more stressed than the general population – not because they are stressed out people, but because inflammation activates the stress pathway, which causes more physiological stress.

People with IBS likely have immune reactions to dietary proteins, as food elimination based on IgG antibodies has been found to result in a significant decrease in symptoms of IBS. (R)

Mast cells have been shown to be increased in intestinal mucosa in patients with IBS, especially by intestinal nerves. (R)

Mast cells directly influence gut flow and results in an increase in abdominal pain and discomfort  (R).

Various markers of inflammation have been found to be elevated in people with IBS.

There’s evidence that anti-inflammatory drugs such as Mesalazine help treat IBS. Mesalazine helps to normalize the gut flora and reduce gut permeability. (R) Anti-inflammatory supplements should work as well.

A wide variety of inflammation types can cause IBS.  There’s no one cytokine that’s dominant.

Even if the inflammation isn’t always systemic, it could still be localized.  However, most/all of the cited studies are measuring elevated systemic inflammation.

This is less reliable than if you were to actually measure the inflammation in your gut tissue.  Local inflammation would likely be much worse.

People with IBS are more like to have:

Taking a good Probiotic can counteract the inflammation, as well as anti-inflammatories recommended in the linked articles.

If you click on the linked articles, you’ll see I’ve done a lot of research into each parameter of inflammation and how to combat it.

3) Oxidative Stress

In people with IBS, markers of oxidative stress were significantly higher – specifically, blood levels of xanthine oxidase (XO), adenosine deaminase (AD), malondialdehyde (MDA) and nitric oxide (NO).

The enzymes that break down oxidants were significantly lower (Superoxide dismutase (SOD), Catalase (CAT), and Glutathione peroxidase (GPx). (R)

These changes are in part genetic, but they can be overcome with the right environment (and supplements if needed).

4) Serotonin

Most of the serotonin in the body (95%) is found in your gut. (R)

Serotonin quickens gut flow by speeding up motor neurons and it releases chloride.

Serotonin cells were significantly higher in IBS-D and lower in IBS-C than in controls. (R)

This makes sense.  If there’s less serotonin, constipation will occur and if there’s too much, diarrhea will occur.

In particular, there were small numbers of serotonin-containing in the small intestine, which means the flow is slowed. (R)  This is why bacteria can build up in the small intestines.

Serotonin transport is also reduced in patients with IBS, possibly because of interferon gamma (Th1). (R,R2)

5) Low cyclic AMP

cAMP is a molecule that is an important second messenger for cellular communication.

cAMP has so many roles in the body, one of which is increasing gut flow (R).

6) Low cyclic GMP

Like cAMP, cGMP is an important second messenger for cellular communication.

cGMP helps blood vessels, lungs, insulin secretion, and gut flow (R).

Not getting enough sun will cause lower nitric oxide, which will lead to lower insulin release.  People with slower gut flow generally don’t get enough full body sun.

7) Excess IDO, Low Tryptophan

The enzyme IDO1 degrades tryptophan into kynurenine and is needed to create Tregs (Good).  (R)

However, IDO1 may sustain self-attacking antibody production by B cells (Bad), and cause cancer in the context of chronic inflammation. (R)

IBS is believed to be caused by too much IDO, and therefore too much conversion of tryptophan to kynurenine (instead of to serotonin).  (R)

The conversion of tryptophan to kynurenine causes too much oxidative stress in the gut and too little serotonin.  (R)

High Kynurenine and low tryptophan is a good marker for IBS, but this imbalance is found in other inflammatory conditions, so it’s not specific.  (R)

Inflammation from Interferon gamma (Th1 cytokine) or LPS from bacterial infections will increase IDO. (R)

Studies have found that interferon gamma increases in the small intestine after consuming gluten (by gluten-sensitive patients without coeliac disease). (R)

COX-2 inhibitors decrease IDO. (R)

IBS AND THE GUT IMMUNE SYSTEM:

AhR is a receptor in gut cells that helps the development of tolerance to proteins and also curbs the growth of bad bacteria (candida) by producing antimicrobial peptides. It regulates the number of Tregs, cytotoxic T cells, B cells and mast cells.  (R)

Too little activation of this gut immune system may result in autoimmunity and allergies. (R)

Good bacteria (LAB such as L Reuteri) eat tryptophan as a source of energy and produce molecules that activate AhR.  (R)  Kynurenine also activates AhR. (R)

This curbs the growth of Candida and boosts the growth of good bacteria (lactic acid bacteria). (R)

Without tryptophan in their ‘diet’, microbes do not produce molecules that activate AhR (IAld).  This results in less good bacteria (lactobacilli) and more bad bacteria (Candida), which is typical of IBS. (R)

Tryptophan supplementation may increase levels of serotonin and AhR activation (both good).  (R)

However, it’s a double-edged sword because tryptophan metabolism will cause oxidative stress.  (R)

Adding antioxidants with tryptophan is one approach to getting around this.

Cruciferous veggies contain indoles, which activate AhR. This contributes to a favorable microbial environment in the stomach. (R)

A variety of herbal extracts such as ginseng, licorice, gingko Biloba results in AhR activation. (R)

AhR activation is not always positive, as it can activate mast cells. (R)

8) Microbial Imbalance: Lack of Good Gut Bacteria, Excess Bad Bacteria

Individuals with IBS have been found to have decreased diversity and numbers of bacteroidetes microbiota.

Fecal microbiota transplant has a ‘cure’ rate of between 36 percent and 60 percent. (R)

The nonabsorbed antibiotic rifampin can provide sustained relief for some IBS patients.  This could be because it prevents the overgrowth of small intestinal flora. (R)

In all mammals (our animal relatives) tested, they were found to have L reuteri in their guts.

With humans, L Reuteri is found in only 10-20% of people.  It’s likely that we once had this in our guts, but with our shitty diets and lack of fermented veggie, most of us don’t now.

L reuteri switches consumption from sugar to tryptophan and produce the molecules for our gut protection (AhR ligands – 3-IAld).

L Reuteri increases gut motility and decreases pain perception. (R)

Clay has been found to be beneficial, likely because of its antimicrobial and laxative properties. (R)

9) Intestinal Permeability

If you’ve been reading the blogosphere, you’ll know by now that gut permeability has to do with every disease in existence – and even in diseases not in existence such as adrenal fatigue.

Well, the whole gut permeability spiel is overdone, but there’s some truth to it.

IBS and IBD are in part caused by gut permeability. (R)

Stress increases gut permeability. (R)

In animal models, both acute and chronic stress enhance the ability of bacteria to adhere, internalize and cross over your gut, which causes gut inflammation.  (R)

Hypersensitivity from stress results from an alteration of colon permeability.  (R)

Probiotics such as L Plantarum (R), L Rhamnosus, B infantis and S Boulardii counteract these changes in gut permeability. (R)

10) Bad Diet: Excess Sugar

When bacteria in our gut consume sugar, they stop producing molecules (AhR ligands) that are necessary for our gut protection against pathogens such as candida. (R)  These bad pathogens then overgrow.

When sugar is the energy source for our gut microbes, they stop consuming tryptophan and serotonin is reduced. Serotonin is necessary for proper gut function. (R)

So stay away from added sugars.

Also, added sugars, sugared drinks, and foods made from flour (bakery products and pasta) are the ones that are most easily fermented by bacteria to cause intestinal gas.

A lack of plants or natural antimicrobials contributes to the bacteria in your gut.

11) FODMAPs

FODMAPs are fibers that result in fermentation and associated gas production, which causes gut distension and bloating.

One the most evidenced-based treatments for IBS is to restrict FODMAPs. (R)

Studies show a good improvement when people go on a low FODMAP diet and it’s suggested that low FODMAP diets be used as a first-line approach in treating IBS. (R)

Leafy greens and cucumbers are low FODMAP veggies that I enjoy.

Bottom Line: FODMAPS+CRH=Gut pain.

12) TGR5 and Bile

TGR5 is a receptor that lines our gut and is activated by bile acids and some herbs.  (R)

It enhances energy expenditure, increases oxygen consumption, prevents obesity, and decreases insulin resistance in a mice model of obesity.  In humans, it converts T4 into T3. (R)

TGR5 and its activation by bile acids speed up the gut flow. (R)

Mice without TGR5 have leaky gut. (R)

Therefore, a deficiency of bile could lead to IBS-C and too much bile could lead to IBS-D. (See below for variations in the TGR5 receptor). (R)

Indeed, up to 30% of people with IBS-D have bile acid malabsorption (which is a different condition, but the results are similar: diarrhea).  These people do well with bile acid sequestrants.  (R)

If you have IBS-C then you should consider taking Ox Bile to activate TGR5.

13) Undiscovered Infection

Research supports IBS being caused by an as-yet undiscovered active infection.

The nonabsorbed antibiotic rifampin can provide sustained relief for some IBS patients.  This could be because it kills an undiscovered microbe (or because it reduces overgrowth of intestinal flora). (R)

Other researchers have focused on a possible unrecognized protozoal infection such as blastocystosis as a cause of IBS, as certain protozoal infections occur more frequently in IBS patients. (R)

14) Antibiotic Usage

Antibiotics can contribute to intestinal overgrowth by killing your good bacteria.

Antibiotic usage increases the risk of developing IBS. (R)

However, some antibiotics like rifaxamin can be beneficial, probably because it’s selective against only certain bacteria.

15) Low Stomach Acidity

Stomach acidity prevents the growth of bacteria.  Although neutralized when it goes to the small intestine, if your gut isn’t acidic, more bacteria will grow in your intestines.

a meta analyses found that proton pump inhibitors (decreases stomach acid release) caused an increase in small intestinal overgrowth (SIBO). (R)

IBS and Hormones

16) Low T3

Adequate T3 (the active thyroid hormone)  allows for the absorption of carbs in the intestines and also controls your gut flow.

If you have low T3, fewer carbs will be absorbed and your gut flow will decrease.  Both of these result in increased fermentation of bacteria in your small intestines.

17) Excess CCK

People with IBS are more likely to release too much CCK (a gut hormone) in response to a fat-rich meal.  (R)

CCK is the culprit that causes gas soon after eating. (R)  This might be because of activation of the vagus nerve or because CCK directly interacts with the hypothalamus to stimulate the flow of your colon, which will cause gas. (R)

See my post on CCK.

18) Excess Cortisol

I already spoke about CRH being a cause of IBS.  But cortisol may also be involved.

Cortisol is unusually high in women with IBS.  (R)

This is probably because we know that CRH causes significantly more ACTH to be released in people with IBS when compared to people without IBS. (R)

Cortisol was generally higher in the morning and lower in the evening than healthy controls. (R)

When researchers evaluated the psychological stress of the subjects, they found that the higher Cortisol levels in IBS could not be explained by differences in psychological stress.  (R)

19) Sex Hormones: Testosterone, Estrogen, Progesterone

Low estrogen and progesterone play an important role in IBS. (R)

Estrogen and progesterone receptors are in your gut.  (R)

Both women with and without IBS are more likely to experience
symptoms such as stomach pain, diarrhea, nausea, and bloating when estrogen and progesterone drop down to the lowest levels in the body (during the menses). (R)

During the low estrogen and progesterone phase (menses),  women with IBS are more sensitive to gut pain. (R)

Bloating also seems to be worse during the phase associated with higher progesterone (the luteal phase). (R)

Women tend to experience a decrease in IBS during menopause, where estrogen and progesterone decline. (R)  This indicates that the hormones may not have as much to do with IBS as does their fluctuation.

Testosterone is capable of increasing pain hypersensitivity. (R)

20) Decreased Motilin

Motilin is a hormone that stimulates the gut flow and is normally decreased after meals but increased in between meals or fasting.  Insulin inhibits motilin. (R)  Motilin stimulates the gut flow.

People with IBS have decreased motilin response to both a meal and water. (R)

However, they show an increase in motilin in response to mental stress and this causes abnormally increased gut activity. (R)

Studies suggest that pH in the beginning of the small intestine (duodenum) affects motilin release. (R)

Low pH (acidic) inhibits motilin and gastric motor activity, whereas a high pH (alkaline) it has a stimulatory effect. (R)

This is one culprit that causes gas soon after eating. (R)

21) Excess VIP

VIP stimulates the intestines. (R)

VIP stimulates the secretion of water and electrolytes, bicarbonate and pepsin (an enzyme).  It inhibits gastric acid secretion. (R)

VIP stimulates the bowels and can cause crampy and watery diarrhea when highly concentrated in the gut.  (R)

In two studies, VIP was twice as concentrated in IBS patients compared to control subjects. (R)

In another study, VIP was only high in women with IBS-D. (R)

22) Low PYY

PYY stimulates absorption of water and electrolytes and inhibits PGE2 and VIP, which stimulates intestinal fluid secretion.  (R)

It acts to slow down the small intestines.

PYY cells are reduced in both IBS-D and IBS-C.  (R)

23) Ghrelin

Ghrelin cell density was significantly higher in IBS-D and lower in IBS-C than in the controls. (R)

In people with IBS, Ghrelin and motilin are more in sync and vary with each other. (R)

The Obestatin/Ghrelin ratio also has some significance. (R)

24) Secretin, GIP

In IBS-diarrhea patients, there are fewer cells that release CCK, secretin, GIP, and somatostatin. (R)

These hormones stimulate bicarbonate, enzyme secretion, and gall bladder contraction (CCK). (R)

Secretin, GIP, and somatostatin inhibit stomach acid secretion, so having too little of them could result in excess stomach acid release. (R)

25) Low Oxyntomodulin

Oxyntomodulin cells were significantly lower in both IBS-D and IBS-C than controls. (R)

26) Somatostatin

Somatostatin cells were significantly lower in the IBS-D groups, but higher in IBS-C patients than in the controls.  (R)

27) Excess Substance P

Substance P was also elevated in people with IBS (0.11 vs. 0.03). (R)

28) TRH

TRH is the precursor to TSH and acts to stimulate gut flow and this is dependent on stimulation of the vagus nerve. (R)  This can worsen IBS-D.

Other

29) Defective Mucus Layer

The mucus layer in your gut is an important barrier to keep out the microbes in your gut. If it’s not functioning properly (not enough mucin (R)), bacteria will cross over, cause inflammation and this will also change your gut microbiota for the worse.  It can also alter the intestinal structure.  These changes are common in IBS. (R)

30) Guanylate cyclase 2C

Guanylate cyclase 2C is a receptor in your gut cells that influences gut flow.  When it’s activated, it speeds it up.  A drug called Linaclotide does just that (FDA approved in 2012 for IBS-C). (R)

Linaclotide reduces activation sensory neurons in the colon, reducing pain.  50% of those receiving linaclotide saw a significant reduction in pain, versus 37% with the placebo. (R)

Linaclotide activates colonic motor neurons, which increases gut flow and thus promotes bowel movements. (R)

31) Nutrient Deficiencies

Vitamin D deficiency may contribute to IBS and some case reports show improvement in symptoms. (R)

A low intake of vitamin B6 is correlated with worse symptoms of IBS. (R)

32) Lack of Soluble Fiber

Some evidence suggests soluble fiber supplementation (e.g., psyllium husk) is effective for IBS.  (R)

For IBS-D, it allows for a more consistent stool. For IBS-C patients, it seems to allow for a softer, moister, more easily passable stool. (R)

However, insoluble fiber (e.g., bran) has not been found to be effective for IBS and may aggravate symptoms in some. (R)

Fiber is especially beneficial in those with IBS-C.  Soluble fiber can reduce overall symptoms, but will not reduce pain. (R)

A meta-analysis found only soluble fiber improved global symptoms of irritable bowel, but neither type of fiber reduced pain. (R)

Studies have used 10–30 grams per day of psyllium. (R)

33) Fat Malabsorption

About 30% of IBS patients have fat malabsorption. (R)

Genetics

SelfDecode has a page on the genetics of IBS.  It’s the best genetic program to analyze your genes, so buy your 23andme ($99) and sign up.

There are many genes that can contribute to IBS.  These are just a few examples to give you an idea.

INFLAMMATION:

IBS/IBD individuals are less often HLA-DQ 2/8 positive than in  healthy populations.(R)

People with a genetic predisposition to produce higher TNF are more likely to have IBS and IBD.

The (A) allele of TNF-308 (rs1800629) is associated with higher levels of TNF.  41% of people with one An allele had IBS vs 26% of the people that didn’t. (R)

TRANSIT:

A mutation in the FGF4 gene (rs351855 – TT) results in slower gut transit. (R)

BILE:

A gene variation of TGR5 (rs11554825), a bile acid receptor, was associated with a quicker gut flow. The TC/CC group had an average 50% faster gut flow compared with the TT subgroup. (R)

OXIDATIVE STRESS:

The Glycine transporter (GLYT1) is essential for the protection of gut cells against oxidative damage.  This is controlled by the SLC6A9 gene (rs3791124 -AG is bad and AA is terrible).  The majority of clients with gut problems have a mutation in this gene.

Excluding Other Conditions

Conditions with IBS-like symptoms include parasitic infections, lactose intolerance, SIBO and celiac disease.  (R) However, SIBO goes hand and hand with most cases of IBS, so I wouldn’t necessarily consider them separate diseases.

The following investigations should be performed to exclude other conditions (R):

  • Stool microscopy and culture (to exclude infectious conditions)
  • Blood tests: Full blood examination, liver function tests, erythrocyte sedimentation rate, and serological testing for coeliac disease
  • Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)
  • Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and malignancies)
  • Hydrogen breath testing (to exclude fructose and lactose malabsorption)

IBS is Commonly Found With:

Several medical conditions appear with greater frequency in patients diagnosed with IBS.

  • 94% of IBS patients have psychiatric disorders -most commonly anxiety and depressive disorders. (R)
  • IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients. (R)
  • IBS occurs commonly with migraines and headaches. (R)

Disclaimer

The opinions on this blog and the references cited are for information purposes only and are not intended to treat, diagnose or prescribe for any illness or condition. For your specific diagnosis and treatment, consult with your doctor or health care provider.

FDA Compliance

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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24 COMMENTS

  • K S B

    I believe it is neurological, which is activated in and by a certain part of the brain, sending transmission to the vagus nerve into the digestive system, causing spasms and eliminating it’s normal rythum. How or why it comes into play at a certain age, etc.. is a mystery. But it has been shown with a different brain map , of IBS suffers. Once you have it, certain foods, drink, and lifestyle can lessen it. Is the spinal cord involved, deviated septum, genetics, once a root cause is found, it will be very interesting because I think to cure it you have to think outside the intestines. Somewhere on the body hold the message, gene/s, enzyme, hormones, so many avenues to explore. But, with so many suffers, let’s get more underlying stidies.

  • Gail J Young

    Thankyou for this masterpiece of information on ibs. It’s outstanding. It has taught me more about ibs than any material I’ve ever read and has given me more hope than I ever thought possible. My gratitude is beyond measure.

  • Paul

    I used to have terrible IBS. But it cleared up completely and hasn’t returned since going over to a whole or lightly processed plant food diet (vegetables, fruits, whole grains, legumes and a few nuts and seeds) supplemented with Vitamin B-12.

  • steinsmattis

    Prior to going on TRT and running my first cyle I suffered from IBS ( irritable bowel syndrome) pretty bad. A few days after my first shot 4 months ago I have not had a single issue with it.. Just out of curious , how does test help the IBS symptoms stay away ? Is it the increased protein synthesis ?

    Matiss

  • Lorraine

    I was diagnosed with IBS while in college 25 years ago. I wonder whether I was wrongly diagnosed. My symptoms result in neither C nor D. For years, I thought coffee was the culprit. Now I know it may be *a* culprit, but not the only one. After I eat (foods that sometimes trigger symptoms and sometimes don’t), my intestines cramp with gas — it could be an hour or two later — I am overcome with exhaustion, and the symptoms are relieved by lying down to relax my gut muscles, and even sleeping. I’ve tried many diets over the years. Unprocessed, grain-free foods are definitely better. But sometimes carrots, an apple, or a potato can send me to the couch.

    1. Joseph M. Cohen
  • MR

    Can I get a clarification? My husband has the rs351855 TT that you said will result in a SLOWER gut transit. But, you link to an abstract for IBS-D which I thought meant a FASTER gut transit. I’d like to let my husband know about the medication that this abstract discusses but I want to make sure that I have the right information first. Thank you for all that you do.

    1. Joseph M. Cohen

      “FGFR4 rs351855 and KLB rs497501 were associated with differential colesevelam effects on ascending colon (AC) half-emptying time (t(1/2), P = 0.046 and P = 0.085 respectively) and on overall CT at 24 h (geometric center, GC24: P = 0.073 and P = 0.042, respectively), with slower transit for rs351855 GA/AA (but not for GG)”

      http://www.ncbi.nlm.nih.gov/pubmed/22271411?dopt=Abstract

  • Lissa

    This is an EXCELLENT article! THANK YOU!!

  • bb

    Great article!

    I really like that you started with stress. I think that how stress and our lifestyle in general affects our health is undermined. Anyway I was wondering if you have looked into plantarum v299?
    It looks like it is really promising for IBS.

    http://www.ncbi.nlm.nih.gov/pubmed/22912552
    http://www.ncbi.nlm.nih.gov/pubmed/22400184

    http://www.businesswire.com/news/home/20160426005748/en/Probi-Ipsen-Sign-Extensive-Primary-Care-Distribution

  • Beau

    Interesting list. According to my doctor (a naturopath) IBS-C, Celiac, Crohn’s etc. are all different manifestations of gluten intolerance. He regularly cures people of all this with a gluten-free diet and vitamin/EFA/mineral supplementation.

  • Kat

    Lots of great information here. Some info I had not even seen in some well know Sibo sites, thanks !

  • Prema badiga

    Ure a life saver!
    God bless you

    1. Joseph M. Cohen

      🙂

  • christinaier

    Great post, but I think the title is a bit misleading. I’m in my master of clinical and health psychology and things like CRH causing gut problems is actually well known. If we study those concepts, than I’m sure doctors-to-be are too. Unfortunately lots of them fall in the Cartesian way of split thinking later on.

    1. Joseph M. Cohen

      Thanks. Yes, some of these are well known in the science – especially CRH. But I believe that if you ask 95% of doctors why stress is bad for your gut, they won’t mention CRH. I could be wrong 🙂

  • Sonnyjimster

    Very interesting that Schisandra counteracts the stress response. That used to be my most effective supplement at reducing my wired feeling when my stress response would go off. Now it sets off the stress response… Yay! 🙂

  • bawsh

    This is legitimately the best resource for health anywhere on the web. Such a phenomenal achievement. Keep it up Joe!

    1. Joseph M. Cohen

      Thx 🙂

  • Dylan

    Good job, bro. I have some across some of the information before, but not succinctly distilled like like. I suspect IBS is my issue, causing my HPA-axis dysfunction.

    What do you think of VSL3 (probiotic)? Also there is something called mutaflor which is prescription only in Germany (not even sure if it’s in the US), but supposedly people have reversed IBS and fatigue issues with it.

    1. Joseph M. Cohen

      VSL3 is good

  • Joanna

    Great post Joe!

    1. Joseph M. Cohen

      I’m glad you like 🙂

      1. Jackie

        You’re the best!!
        Brilliant!

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