What’s Wrong With My Poop?

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Common factors that contribute to digestive system problems

Many people experience a change in stool from time-to-time – what one has eaten, medications and supplements, a shift in the normal morning schedule, and emotional events all may contribute to irregular “pooping” patterns. However, a considerable number of people have a tendency towards bowel trouble, and even the slightest shift, such as a bit of a food trigger or an upsetting conversation, can cause problems. When these changes happen far too easily, we often must question if there is an underlying flora imbalance, food sensitivities or intolerances, or any other number of factors that lead to the symptoms of what is often diagnosed as irritable bowel syndrome (IBS).

IBS: the irritable / infuriating / inconvenient bowel syndrome

IBS is one of the most common chronic gastrointestinal conditions, affecting approximately 10 to 15% of adults in the U.S. Symptoms include chronic gastrointestinal (GI) patterns of diarrhea and/or constipation, feelings of incomplete bowel evacuation, bloating, flatulence, abdominal pain and cramps, and mucus in the stool. Some individuals additionally may experience anxiety, fatigue, and diminished quality of life if symptoms are severe. If IBS symptoms are accompanied by unexplained sudden weight loss, difficulty swallowing or blood in the stools, further medical investigations must be sought.

IBS is diagnosed as a syndrome – a set of characteristic signs and symptoms, as opposed to a disease, which has an identifiable underlying pathophysiological basis.

IBS is diagnosed as a syndrome – a set of characteristic signs and symptoms, as opposed to a disease, which has an identifiable underlying pathophysiological basis. Diagnosis of IBS may involve ruling out other possible problems such as celiac disease, inflammatory bowel disease (Crohn’s, ulcerative colitis), or other conditions that present with similar symptoms. Unfortunately, conditions such as celiac disease are often underdiagnosed, as they are not assessed for if someone has general gastrointestinal symptoms and lacks a family history significant for celiac or autoimmunity. Food sensitivities, lactose intolerance, fructose malabsorption, and small intestinal bacterial overgrowth (SIBO) are possible underlying conditions which may lead to IBS and should be assessed for as one may have resolution of their IBS symptoms if these conditions are appropriately treated.

A state of dysbiosis or infection in the large intestine (as opposed to SIBO, which reflects the small intestine) also may contribute to gastrointestinal and systemic symptoms.[1] Large intestinal health, microbial balance, and digestive function are best assessed with a comprehensive digestive stool analysis with parasitology. Correction of large and small intestinal flora imbalances and appropriately addressing gut health with a restorative phase will often improve systemic symptoms such as low mood, chronic pain, and skin conditions in addition to digestive symptoms.

It may be that there are certain things that are primary triggers for IBS symptoms. Foods which trigger an immune response, infectious or dysbiotic microbes, or even stress may lead to altered health of the gut lining and a condition known as “leaky gut” (medically referred to as increased intestinal permeability). This may be accompanied by problems at the brush border of the intestines where many of the enzymes for digestion also exist and are activated. Collectively this creates an inflammatory state and digestion problems with a variety of foods such as individuals with IBS often experience.

Dietary solutions to IBS

Common foods which may cause problems (in addition to food sensitivities) include disaccharides (a common type of sugar, found in table sugar and other forms), fructose (the kind of sugar found in fruit, agave syrup, and high fructose corn syrup), lactose (the kind of sugar found in dairy products), cellulose (found in vegetables), and gluten (the protein found in wheat and several other grains). Foods that are high in histamine or histamine-releasing foods can also lead to problems in some individuals. Food sensitivity testing may help isolate if proteins in certain foods are contributing to problems, however it will not give indication of if many of these (disaccharides, fructose, lactose, cellulose, or histamine) are problems, hence the use of an elimination diet.

IBS symptoms often improve utilizing the guidelines of a Paleolithic (aka “Paleo”) diet, a low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) diet, the Specific Carbohydrate Diet (SCD), or a GAPS diet.

Elimination diets focus on the removal of potential problematic foods for a period of time (which can range from a couple weeks to months), with the gradual introduction of foods one at a time after this period to determine which foods (or substances in them) were contributing to symptoms. An elimination diet may be guided by food sensitivity and/or allergy testing to evaluate if there is an immune response to particular foods, especially in children where highly restrictive diets are often difficult and may lead to deficiencies of essential nutrients. An immune response can include an actual allergy, mediated by immunoglobulin E (IgE), or delayed hypersensitivity, mediated by IgG, in which case it is called a food sensitivity.

With SIBO there often are digestive problems with a wide range of foods. Symptoms often improve utilizing guidelines of a Paleolithic (aka “Paleo”) diet, a low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) diet, the Specific Carbohydrate Diet (SCD), or a GAPS diet. Foods and supplements that contain mucilaginous gels and gums (such as aloe vera or guar gum) also may promote symptoms of SIBO in a sensitive individual. Fermentation of different types of soluble fibers, including from FODMAP sources, produce short chain fatty acids (SCFAs), as well as gases (methane, hydrogen and carbon dioxide). Although the fermentation of these soluble fibers is important for gastrointestinal health,[2] in individuals who experience a high level of dysbiosis such as SIBO, FODMAPs can lead to greatly increased fermentation and related symptoms of bloating and gas.

Supplemental strategies for IBS

In addition to a diet with adequate water and fiber, there are natural substances that can help the body to eliminate with improved regularity. Supporting the body with digestive support such as digestive enzymes, pancreatic glandular substances, or supplemental bile may improve IBS symptoms for many people.[3] Inadequate biliary secretions are not uncommon and can contribute to constipation and dysbiosis, and because of this, supplemental bile can help eliminate constipation. Magnesium and vitamin C are two natural substances which can have an osmotic laxative effect after a certain dosage threshold (which varies individually) is reached. Perilla leaf extract has been shown to support normal motility and also functions as an antispasmodic.[4] Papain, a proteolytic enzyme from papaya, has anti-inflammatory effects, supports digestion, and can be helpful for constipation in children.

Supporting the body with digestive support such as digestive enzymes, pancreatic glandular substances, or supplemental bile may improve IBS symptoms for many people.

Intestinal secretory IgA (sIgA) is a critical and synergistic part of the gut’s immune system; essential for establishing and maintaining a healthy balance of gut bacteria and protecting the body from things like food proteins as well. Levels of sIgA can be affected by acute and chronic stress states as well as infections and routine consumption of food sensitivities. Saccharomyces boulardii is one probiotic that is supportive to improving mucosal function and sIgA levels.[5] Healthy levels of sIgA are necessary for normal mucosal health and immunity.[6],[7]

Don’t forget the gut / brain axis!

Finally, altered bowel habits commonly coexist in individuals with anxiety and depression. In a recent study, acute anxiety was shown to coexist in 84.1% of individuals with gastrointestinal disorders, most commonly related to food allergies, SIBO, Helicobacter pylori (Hp) infection, and ulcerative colitis in active phase.[8] An overall tendency toward anxiety was found to be related to similar issues as well, with the addition of IBS. These relationships do not directly imply causation but do shed light on a mental/emotional relationship with bowel issues that also should be addressed. Autoimmune diseases such as celiac and ulcerative colitis also have increased symptoms when under stress or with anxiety. Muscle contraction abnormalities of the digestive tract also exist in some patients with IBS.[9] These disturbances are often provoked with stress,[10],[11],[12] shedding light on the importance of addressing the stress response of the body as well.

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