This is a harder question to answer than you might think. What exactly is Irritable Bowel Syndrome (aka IBS)? Thankfully, we are now better able to answer this question and, most importantly, take action against IBS.

Up until recently IBS was a “diagnosis of exclusion”. This means that everything else was ruled out, and if they still couldn’t figure you out they’d say it was this syndrome. This process of ruling out “everything else” differs from doctor to doctor and patient to patient, but the typical list includes Celiac disease, Crohn’s, and Ulcerative Colitis for IBS-D and things like hypothyroidism for IBS-C. Of course, because they didn’t know what was causing your IBS, you can bet they didn’t know how to properly treat it.

Luckily we now have a pretty good idea of what causes the majority of IBS. Below is a list of the top things that need to be ruled out if you have IBS.

1. Small Intestinal Bacterial Overgrowth (SIBO) is the number one cause of IBS (84% according to this older study, 60ish% according to the last SIBO Symposium) . I will write additional blog posts about SIBO in the coming weeks, but the short explanation of SIBO is “bugs in the wrong place”.

Normally, most of your gut bugs live in your colon (green) where we want them. They happily munch on the fiber and carbs (FODMAPs) we feed them, and in return they make stuff that keeps our colon cells happy. It’s a win-win!

In SIBO, however (right), these bugs get a chance to creep up into the small intestine where they don’t belong. The small intestine was never made to house bugs, and it doesn’t appreciate all that stuff (namely, gas) they make. This leads to the classic SIBO bloating and diarrhea or constipation.

2. Food Sensitivities and Food Intolerances can also cause diarrhea, bloating, and constipation. After SIBO (and often times in conjunction with SIBO), I think this is probably the next most common. For more on the difference between a sensitivity and an intolerance, click here.

3. Leaky Gut Syndrome (aka “intestinal permeability”) oftentimes goes along with the other two, but it is worth mentioning. Leaky gut is exactly what it sounds like- the lining of the gut doesn’t function as well as it should, which can allow large molecules (large proteins like gluten, bacterial toxins) into the body. This in turn leads to a lot of inflammation (both locally and body-wide) and malabsorption of nutrients. Taking intentional steps to heal a leaky gut can be a critical piece of the puzzle for many IBS sufferers.

4. Other stuff including hypothyroidism (constipation), stress (either), food poisoning (diarrhea), and hormonal imbalances like low testosterone (constipation) can cause the symptoms of IBS.

I see a lot of patients with Irritable Bowel Syndrome/IBS at my office in Chapel Hill. I am able to offer proper testing for all of the above conditions, as well as natural solutions (herbs, etc) to help you overcome each of these things and finally heal.

If you are interested in becoming a patient at my office please download my e-book “Why Conventional Medicine CAN’T Cure IBS“. In the last couple of pages of my e-book I discuss what you can expect coming to my office and what the application process is like.

Best of health,

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