What Causes Chronic Constipation in Adults and How to Relieve It

You’re all plugged up and can’t poop. You feel more backed up than a rush hour traffic jam.  

Maybe it feels like there’s something in there that refuses to budge.

Your stomach is so bloated it looks like you swallowed a bowling ball.

If you have chronic constipation, we’re sure you’ll agree when we say it’s a real pain in the butt.  

The good news? There are ways to get things moving again. But before we go into constipation relief, we’ll talk about what constipation actually is and what causes it. 


What Is Constipation?

From a conventional medicine perspective, constipation is defined as having less than three bowel movements per week. 

Functional medicine providers, on the other hand, usually want patients to have one to three bowel movements per day. That’s because they recognize the importance of bowel movements for removing toxins and other waste products.

Constipation can also refer to unhealthy stool. Doctors use what’s known as the Bristol Stool Chart to determine the health of a patient’s poop. This type of chart describes stool as being one of seven types. Type 1 (separate hard lumps) or type 2 (lumpy and sausage shaped) both indicate constipation.  


What Causes Constipation? 

Constipation can have a variety of causes, which is why it’s also a good idea to work with a functional medicine provider to find the root cause. 

In some cases, people can have structural and anatomical issues that cause constipation. Medications like opioid drugs can also lead to constipation. 

When those are not the issue, the most common causes of constipation are:

The Good Bugs vs. the Bad Bugs

The collection of microbes in your gut—both good and bad—are called the gut microbiome. When the microbes that make up the microbiome become imbalanced—either by the bad outnumbering the good or by too much of one type of microbe—it can lead to gastrointestinal problems, including constipation. 

Indeed, research shows that an imbalanced gut microbiome can affect how quickly food moves through your bowels and cause constipation. On the other hand, researchers have shown that a healthy gut microbiome prevents constipation. They accomplished this by performing what’s known as a fecal transplant, a procedure where fecal matter from patients who are healthy is transplanted into someone who has gastrointestinal problems. When scientists performed this procedure on patients with constipation, the patients’ gut microbiota and their constipation symptoms improved.   

Because constipation is linked to an imbalanced gut microbiota, it’s also linked to other health problems you would never think have anything to do with the gut. For example, people with constipation are at an increased risk of having hay fever


Candida or Yeast/Fungal Overgrowth

An infection with Candida or any other type of fungus can lead to an imbalance in the gut microbiome. This spells trouble for GI health and stool not moving as smoothly through the intestines. 


Sluggish Thyroid

The thyroid gland is important for many processes in our bodies. When it’s underactive—a condition known as hypothyroidism—it causes the body’s processes to slow down. Hypothyroidism slows down the speed at which food moves through the digestive tract. 



If you want to know how to relieve constipation in adults, drinking enough water is one of the best solutions. 

The large intestine isn’t supposed to be the Sahara desert. It needs fluids to function. When you haven’t had enough water, the colon will grab it from the food, turning stools hard, dry, and more painful to pass. Being well-hydrated also keeps food moving through the intestines. 


Parasite Infection 

Usually, a parasitic infection starts with acute diarrhea soon after the infection started, like right after returning from a trip. But in my clinical practice I regularly see parasite-caused diarrhea turn into either chronic constipation or constipation alternating with diarrhea. 

Patients who have parasite-caused constipation also have bowel movements that feel incomplete.


Pregnancy-Related Constipation

Constipation is a common complication of pregnancy. Nearly half of all pregnant women get constipated at some point during their pregnancy.

During pregnancy, constipation is caused by the dramatic increase in the hormone progesterone, which affects the intestinal muscle and causes food to move through the intestines more slowly.   


Small Intestinal Bacterial Overgrowth

Small intestinal bacterial overgrowth—SIBO for short—is another common cause of constipation. SIBO is an abnormal increase in the bacterial population of the small intestines, especially with species of bacteria not usually found in this area of the body.   

Diarrhea is a more common symptom of SIBO. When constipation occurs with this condition, it’s usually due to the methane-dominant form of SIBO. In this type of bacterial dysbiosis, there is an overgrowth of bacteria that make methane which can be detected on SIBO breath tests. 


 How To Relieve Constipation in Adults 

It’s no fun being all backed up. Your body can’t get rid of waste and digestion is hampered. You may lose your appetite and when the poop finally comes out, it hurts. While you have probably tried the popular recommendations of drinking water and taking fiber, it may not have been enough. Here are my tried-and-true chronic constipation treatments to get my patients regular again.

Stay hydrated – Drink at least eight glasses of filtered water every day. Coffee and juice don’t count. Neither does tea unless it’s herbal tea. Helpful hint: put a pinch of sea salt in the water. This will help you absorb the fluid better. 

Also, sip on warm water with lemon first thing in the morning. Drink this slowly and it will stimulate the gastrocolic reflex, which controls the movement of food through the GI tract after a meal.    

Get a good night’s rest – Our bodies have their own internal clocks which control our circadian rhythms. When we ignore our natural circadian rhythms, it can lead to many problems, including constipation. That’s why between 48% and 81.9% of people working either rotating or night shifts have some form of GI problem including constipation. 

Researchers also have found that morning IBS symptoms were worse after a night of poor sleep. The IBS symptoms improved after the study subjects slept better.

One reason why lack of sleep causes constipation is because it can affect the gut microbiota.  

Get Moving – Walking and yoga are both helpful for constipation relief. Exercise is linked to what scientists call better gut motility—in other words it helps move food faster through your digestive tract. 

Use a Squatty Potty – As the name implies, this allows you to squat when you poop. It’s a better, more natural angle and decreases straining. 

Biofeedback –  Biofeedback is a way to control some of your body’s functions. You can use it to help train your colon muscles to become more coordinated. 


Foods to Help Constipation in Adults

I have found that a paleo diet can really get things moving again. This diet mimics a hunter-gatherer diet of meat, fish, eggs, seeds, nuts, fruits, veggies, and healthy fats and oils. In the paleo diet, there is no sugar, refined flour, gluten or dairy. 

A low FODMAP diet or specific carbohydrate diet (SCD) has also worked in many of my patients with constipation. FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. These are nondigestible carbohydrates which can trigger gut symptoms in some people. The SCD eliminates most carbohydrates including grains, starches, dairy, and sugars with only specific carbohydrates that require minimal digestion allowed. Fresh fruit, most vegetables, grass fed meat, and wild-caught fish are allowed while starches, grains, and processed or canned foods are prohibited. Usually, these types of diets are used for chronic diarrhea, but I’ve seen them kickstart bowel movements, especially when a patient has a chronic infection or an imbalanced gut microbiome.  

If you find that your constipation gets worse with starches and sugars, stop eating sweets, which is really a good idea for your health anyway. Avoid using flours. Eat only whole food carbs like root veggies and whole grains if tolerated. Examples of root vegetables are daikon radish, beets, carrots, and parsnips. Beets are the best option especially if you notice that insoluble fiber makes your constipation worse.

Increasing healthy fats from olive oil, ghee, coconut, organic butter, and eggs is also helpful. Make sure you’re getting 2 tablespoons or more per meal—6 tablespoons per day. Fats can increase the rate at which foods move through your digestive tract.   

If you tolerate dairy, try making 24-hour yogurt from full-fat cream. Yogurt is a good source of probiotics, which nourish the gut microbiome.

Unless you know or suspect that FODMAP veggies make your constipation worse, get more fiber in your diet by eating seven to 11 servings of vegetables per day.

It’s also a good idea to boost potassium intake. A great way to do this is by making homemade juice with cucumber, tomato, spinach, chard, and melon. Ripe bananas, avocados, and kiwi are also rich sources of potassium.  

Fermented foods like chia soaked in kombucha are another ideal choice. These can promote a diverse and balanced microbiome.  


Supplements for Constipation 

The most common method of constipation relief are laxatives and stool softeners. Warning: these are gut irritants and are not a friend to the gut lining. What’s worse, you can become dependent (otherwise known as habituated) on laxatives so that your gut “forgets” how to poop regularly on its own. 

People also often use fiber supplements for constipation, but this can backfire. Fiber supplements can make some people worse. Acacia and partially hydrolyzed guar gum (PHGG) are often the fiber supplements that constipated people can handle the best.

Digestive enzymes and a hydrochloric acid (HCL) supplement are other good choices.  Bile support, especially in people who have trouble digesting fats, can help regulate gut motility and transit time (the amount of time food takes to get through your intestines). MegaGuard is a bile support supplement that works well for my constipated patients.

Magnesium oxide or citrate (500 – 2,000 mg at night) can get things moving. Work up to the higher dose slowly. Some people do better with magnesium hydroxide. Magnesium is osmotic, which is just a fancy way of saying it pulls water into the colon. Remember, the colon needs water and magnesium helps there. Natural Calm is a high-dose magnesium supplement you can try.

Another way to increase magnesium levels is to take an Epsom salt bath before bed. This will also soothe away stress.

Buffered vitamin C (2,000 mg) before breakfast and lunch will get your bowels moving. Colon Rx, which includes both Magnesium Oxide and the Ayurvedic herb triphala, has been used for millennia for bowel regulation. Both of these are non-habituating and very safe ways to reduce constipation.

If you have methane-dominant SIBO, Atrantil can treat constipation. It works for many people, but not everyone. It can take up to 21 days to see the full effect.

If you have a severe episode of constipation and nothing else is working, try glycerin suppositories or enemas using water, saline, or coffee. These can make a huge difference to get the gut moving in quick time.

Herbal formulas can work. But be cautious with ingredients like Senna, rhubarb, and aloe. You can become dependent (or habituated) on all of these stimulant laxatives if you use them too often and for too long. If you’ve been taking any of these ingredients, taper slowly while using other support. 

Some herbal formulas I like are:

Smooth Move tea is another herbal option to help with constipation relief. It also contains Senna, so only use it occasionally and work with your functional medicine provider to uncover and address the root causes of your constipation.


Probiotics for Constipation 

In choosing a probiotic supplement, avoid formulas that have too high a level of fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), inulin, chicory, or arabinogalactan. These ingredients at too high a level can cause a flare in imbalanced gut microbiota. If you have a gut infection, wait until it is cleared to take any supplements with those ingredients.

Some probiotics for constipation that I like: 

Test one species first. Start with about 40 billion and then ramp up as far as 300 billion by doubling your dosage every three days. Stop if your symptoms worsen.


Critical Tests If You Have Chronic Constipation

As you read earlier in this article, there are a lot of causes of constipation. Some of them could be damaging more than just your GI tract. That’s why it’s important to test for parasitic and other gut infections, Candida and fungal overgrowth, and an imbalance in the gut microbiota. Depending on the specifics of your case, we might choose to use the GI-MAP, the Parawellness Stool Pathogen panel, or the BiomeFX panel. We might also include Lactulose and Fructose Breath Testing for gasses that can indicate SIBO.

You really don’t want to tackle these types of gut imbalances on your own. Instead, book a free 15-minute troubleshooting call with me to find out the best course of action. If after the call you come on board as a patient, I’ll order the right tests, recommend a plan customized for you, and put you on the path to feeling like your regular self again.   

A Functional Medicine Approach to Healing IBS

So, your doctor says you have IBS - Irritable Bowel Syndrome.

This diagnosis can either feel like a relief or a nightmare.

On the one hand, an IBS diagnosis means some of the causes of digestive issues like Crohn’s, Ulcerative Colitis, and Celiac disease have been ruled out - that’s a good thing. 

But on the other hand… IBS is essentially a name for “something’s wrong but we don't know what.”

And in the functional medicine, holistic approach I use - that’s not a good enough answer. In fact, it's not an answer at all!

An IBS diagnosis leaves people to suffer through their symptoms alone - which is bad enough - but even worse, it ignores the root cause of the issue.

And because the gut is so integral to overall health, issues in your gut inevitably lead to more health issues - hormones, mental health, weight concerns, thyroid issues, and more.

So why do we accept this? Why do doctors tell you that you “just” have IBS and send you out the door?

Because treating IBS isn’t easy! There’s no one pill that can fix it, because no two people have the same causes. It requires a multi-step, hands-on treatment approach that usually needs to be tweaked in real time. That’s not the kind of care most standard MDs are able to provide.

Don’t worry - I got you! Today I’m going to share my approach to treating IBS.

But buckle up, because this isn’t a quick 3-step process (sorry!). Today, we’re diving deep into the nitty gritty of treating one of the trickiest conditions out there. 


You’re Entitled To More Than One Problem

In Chinese medicine school, I often heard the saying “You’re entitled to more than one problem at the same time.” This was the tongue-in-cheek way of saying it’s the norm, not the exception, for a patient to have multiple contributing factors to any health challenge they faced. 

And this is especially true in the case of IBS because the gut is so intricately connected to every part of the body, but also because one gut issue - like inadequate digestive secretions (due to stress, medications, etc.) - can create the environment for another problem to arise. 

That’s why the treatment plan I use for IBS has a lot of steps. Because you may have low stomach acid, or bacterial overgrowth, or a parasite… but that’s more than likely not going to be the only issue you’re dealing with. Instead of obsessing over discovering the one root cause of your IBS, my approach works systematically through the most common issues, creating a powerful foundation for lasting health.

So let’s peel back the layers, step-by-step, and tackle this together. 


Start From The Top and Work Down

Most people don’t think of it this way, but the mouth is actually the start of the gut. The mouth has its own microbiome that directly influences the composition of the large intestine microbiome. In fact, research has shown that simply brushing your teeth 3x daily can measurably lower levels of candida in the stool. 

94% of Americans have some degree of gingivitis and the mouth and sinus are home to fungal strains including Candida species (present in 75% of participants), followed by Cladosporium (65%), Saccharomycetales (50% for both), Aspergillus (35%), Fusarium (30%), and Cryptococcus (20%). In addition, gram negative bacteria such as Enterococcus faecium, E faecalis, Escherichia coli,  Klebsiella pneumoniae, and Proteus mirabilis are also common in the mouth. These are the same bacteria most commonly overgrown in cases of Small Intestine Bacterial Overgrowth (SIBO). 

The best defense is controlling bacteria levels in the mouth with your oral hygiene routine. I recommend Dentalcidin toothpaste and Biocidin Dental Rinse as an important first step for anyone with dysbiosis or candida, SIBO, IBD, IBS, gas that clears the room, or a history of poor dental health. 


Optimize Your Gut Terrain

Once you’ve got your new oral hygiene routine in place, the next step is to optimize your gut terrain and environment.

Before we ever run a stool panel, clear a pathogen or take those precious leaky gut supplements, and especially before we start going down side rabbit holes like mold, we need to replace any missing digestive secretions and work on meal hygiene and transit time. This literally sets the stage for a healthy gut.

Digestive secretions include stomach acid (HCL), bile, and pancreatic enzymes. HCL is secreted by parietal cells in the stomach in response to the smell and taste of food, as well as distension in the stomach and small intestine (distention occurs when food enters the stomach). 

HCL is particularly important for the breakdown of protein. Most importantly, however, HCL acts as the first domino for all the other digestive secretions. Without adequate HCL, all other secretions will suffer!

The #1 reason for inadequate HCL? Stress. HCL release is triggered via the vagus nerve which connects the brain and the gut. Vagus nerve activation requires a parasympathetic state of the nervous system. You might know this as the “rest and digest” mode. Eating while stressed, busy, or otherwise unfocused is therefore a major cause of low HCL. Other causes include the use of PPIs and other acid-blocking meds, as well as the presence of certain bacteria in the gut like H. pylori, which can denature HCL. 

Adequate HCL then triggers the release of bile from the gallbladder. Bile is necessary for the digestion of fats, but bile also acts as an antimicrobial in the small intestine, helping to prevent bacterial overgrowth. Bile also collects toxins for the liver to secrete. Bile levels can be impacted by inadequate HCL, dehydration, gallbladder issues or removal, and exposure to high levels of toxins. If bile is inadequate it can lead to dysbiosis of the microbiome and deficiencies in fat soluble vitamins like A, D, E, and K and nutrients. 

Pancreatic enzymes are secreted by the pancreas and play key roles in breaking down carbs like sugar and starches as well as fats. Pancreatic enzymes allow starches to be broken down in the small intestine, rather than fermented, preventing bacterial and fungal overgrowth. Pancreatic enzymes act as a bactericidal against Escherichia coli, Shigella species, Salmonella species, and Klebsiella pneumoniae, and have fungistatic activity against Candida albicans. The release of pancreatic enzymes is dependent on adequate HCL. 

HCL, bile, and enzymes can all be supplemented if needed, but there are other things you can do as well. First up, make sure you’re hydrated. Proper hydration is necessary for the production of digestive secretions - think of water as the key ingredient. Secondly, slow down and really chew your food. Thorough chewing allows time for the brain to signal the gut that food is coming, and the gut to secret HCL and bile in response. 

With my one-on-one clients I utilize gut testing to check enzyme levels, and often supplement HCL, bile, and enzymes as needed.


What About Probiotics?

I tell my clients to introduce fermented foods as tolerated - even if that’s only a single strand of sauerkraut to start. 

Beyond that, certain probiotics can be really helpful. Some strains support secretory IgA, which protects the mucosal barrier of the gut. Those include spore based probiotics, S. boulardii, L. plantarum, L. Reuteri, and B. lactis.

Generally well-tolerated probiotics include OrthoSporeIG, or MegasporeBiotic. For those who are highly sensitive, you may want to start with HU58 instead, which is a single spore organism.

Probiotics can also support specific symptoms of IBS. For diarrhea, S. boulardii works well. I like Floramyces. For constipation, Optibac  (1-4 doses per day) or HN019 strain of Bifidobacterium lactis (Xymogen’s Probiomax) are my favorites. BioGaia Protectis drops, which contain Lactobacillus reuteri DSM17938, are my favorite for bloating. And in general, many IBS patients benefit from Ideal Bowel Support which contains L.plantarum 299V. 


Address Motility & Transit Time

Addressing motility and transit time goes hand-in-hand with optimizing the terrain of the gut. Bacteria in the gut bloom like a coral reef after meals. If food and bacteria are moving through the gut and into the large intestine, that’s a great thing. But if food isn’t moving as it should, bacteria can bloom in the small intestine, and that’s a problem.

Bacterial overgrowth in the small intestine (SIBO) is a factor in as many as 80% of all IBS cases. (That being said, it’s not the only cause of IBS. I see it more often as a contributing cause - more the “branch” than the “root” of IBS!)

Motility is controlled by the migrating motor complex (MMC), an electrical wave that originates in the brain via the vagus nerve. The MMC acts like a broom, sweeping food and bacteria through the small intestine and into the large. Many factors can contribute to a deficient MMC, including bacterial overgrowth itself, which can secrete toxins that disrupt the vagus nerve. 

To improve motility, I use prokinetics (not to be confused with laxatives), which help trigger normal MMC function, as well as other approaches to keep bowels moving regularly. But if motility issues are chronic, it’s a sign of an impaired gut-brain axis. Modalities that can heal the gut-brain axis include:

  • Neuroplasticity
  • Biofeedback
  • Frequency Specific Microcurrent 
  • Vagal nerve stimulation
  • Acupuncture
  • Therapy like EMDR, or somatics for trauma


Nutrition Based On Symptoms

Once the gut terrain and motility have been addressed, it’s time to look at your diet. For all my clients dealing with IBS or other gut issues, I have some basic diet recommendations:

  • Paleo or Autoimmune Paleo as a foundation
  • Focus on nutrient dense foods, including gut-healing foods like bone broth, 24-hour yogurt, and sauerkraut (just start small)
  • Gluten, dairy, and added sugar-free
  • Avoid eating the same foods day after day - variety is key
  • Stay well hydrated
  • Practice good meal hygiene (sitting down to eat, avoiding screens while eating, slowing down, chewing thoroughly)
  • Incorporate fermented foods as tolerated (start really small)
  • Incorporate fiber-containing plants as much as tolerated

While many people want to skip these simple diet changes, they matter. It’s a foundation, not an aside. You will not get better if you’re only eating gluten free toasted waffles, even if you tolerate them well! By the same token, if you’ve found you can stay symptom-free by eating a very limited diet, we eventually need to expand your phytonutrients and nutrients in general if you want to actually get better (and enjoy eating again!). 

For those patients with more specific concerns, I do often trial special therapeutic diets like the Specific Carbohydrate diet (SCD), low-FODMAP, or low histamine. Having diarrhea 15 times per day? Try the SCD Diet. (Just make sure you don’t skip the essential Intro phase!) Tons of bloating, belching, and some loose stool or constipation? I’d suggest a low-FODMAP trial. And for those with lots of rashes, headaches/migraines, hives, itching, anxiety, insomnia, brain fog, sudden episodic diarrhea after meals, and allergies with foods, I will try a low histamine diet. (And some may need to take it a step further and follow low nickel - especially if rashes or eczema are present - or have salicylate or oxalate intolerances as well.)


And Now We Test

You might be surprised to see that only now am I considering testing  - stool testing, breath tests, or even hormone panels. The truth is that there is so much to work on long before any labs need to be ordered. And for some people, simply improving the health of the oral microbiome, optimizing the gut environment, and making some nutrition changes are all that is needed to completely resolve symptoms! I too often see people on fancy gut protocols, who aren’t getting results, simply because they have addressed the foundation first! Bottom line: don’t skip ahead!

But once we’ve covered the basics, testing can provide invaluable information that leads us forward in the right direction and saves you a ton of wasted time, energy, and money. 

My two essential tests are multiple stool panels and hormone testing. In addition, I often find breath testing for SIBO, organic acids tests, and food sensitivity testing to be valuable tools, as well. 


Why You Need Hormone Testing for A Gut Problem

It might seem odd if your symptoms are all in your gut, but hormone testing is a must-have tool for treating IBS. Why? Because your struggle with inflammation in the gut, and your ability to resolve it, is to some extent limited or empowered by how harmonious and optimized your hypothalamic–pituitary–adrenal (HPA) axis is. Cortisol, the primary “stress hormone” whose production and release is controlled by the HPA axis, is like your own endogenous prednisone. If cortisol levels are sky high, or have tanked and are too low, the body can’t repair tissues (like leaky gut) or resolve inflammation. Trophic hormones like DHEA are also essential for tissue repair. Stress and cortisol also inhibit secretory IgA, the most important immunoglobulin for repairing the mucosal barrier of the gut. I think of secretory IgA like the immune system of the gut. 

Most of my clients have some level of hormone dysfunction - but once we know what it is, we can take active steps to mitigate it. I recommended actively addressing stress and trauma with tools like therapy, EMDR, vagal nerve stimulation, and tools like the Gupta Program or the Inaura platform. 


Order These 2 Stool Tests

I always use two stool tests to detect pathogens like H. pylori, fungal overgrowth, and parasitic infections. Right now my favorites are GI Map and Parawellness. To get started, I prefer to use tests that focus on identifying pathogens vs. microbiome tests like BiomeFx or the Genova Panel. While general microbiome wellbeing is incredibly important, if pathogens aren’t first tested and cleared, they will usually impede any improvements to the health of the microbiome. (That said, I do love the BiomeFX for really targeted rebuilding of the beneficial microbiome after we’ve “weeded” the garden!) 

That being said, the microbiome is essential in understanding why pathogens are a problem for some people but not others. It’s not just about what pathogens are present, but how your body responds to the pathogen. This is akin to the concept in Chinese medicine of Wei Qi. Wei Qi has its roots in the Kidney Qi (your core energy, or how strong you were when you came in, based on genetics, and how well you’ve nurtured that with nutrition, lifestyle, and exposure). 

Wei Qi is the concept that the hand of cards you were dealt (genetics), under the influence of the exposures you’ve had or lifestyle you’ve chosen or been able to afford = your resilience. You might have also heard of this concept as “epigenetics.” Chinese medicine practitioners have been talking about it for 5,000 years! 

Pathogens can shift or suppress the immune system, increasing susceptibility to SIBO and other opportunistic dysbiosis. Parasites and gut infections degrade the protective lining of the gut, called the mucin lining, to decrease secretory IgA levels. They do this to stay alive: they need to degrade the immune system in the gut to prevent being destroyed.

In addition, many parasites can mimic or directly trigger IBS or Inflammatory bowel disorders including Giardia lamblia, Entamoeba histolytica, Cyclospora, and Cryptosporidium. In one study, blastocystis infection was found in 67% of IBS patients, and other research found that the prevalence of blastocystis, cryptosporidium and giardia is higher in IBS patients than in controls, and likely play a role in the development of IBS. 

If you’re thinking, “There’s no way I have a parasite,” think again! Risk factors include simple things like travel outside the U.S. and swimming in lakes/oceans/rivers. Lots of food intolerances - or food intolerances that change frequently - are also a warning sign for parasites, as parasites are able to “switch” the immune system from innate immune response (the TH1 immune system) to the “food allergy” response (TH2 immune system). Many people report no obvious symptoms. That’s why I test everyone, across the board.


Creating Your Custom Treatment Plan

One we have test results in hand, it’s time to create your customized healing strategy. While no two cases of IBS are the same, there are some general rules I follow:


#1 Start With H. Pylori (If Present)

Because H. pylori breaks down stomach acid, as well as “partners” with and encourages other pathogens, if it is present, it’s where I start. (H. pylori also promotes histamine synthesis and can contribute to histamine induced symptoms).


#2 Clear Other Pathogens

Once H. pylori has been addressed I move down the list of parasites such as Endolimax nana, Giardia, Entamoeba coli, Entamoeba histolytica, etc.


#3 Candida & SIBO

Next, I like to tackle candida overgrowth and SIBO. I often clear candida first, especially in the case of methane-dominant SIBO, because there is a strong association between candida and methane SIBO, and the SIBO often won’t respond to treatment unless the candida is cleared first. 


#4 Find & Treat Other Factors (If Needed)

If candida is not clearing after appropriate clinical steps, or, if SIBO won’t resolve after appropriate treatment, I look “further down the rabbit hole” for other things that could serve as impediment to those resolving like:

  • Heavy metals burden
  • Mycotoxins (Mold exposure)
  • Other biotoxin issues like Lyme and tick-borne diseases, chronic viral infections

(And if a patient has a known history with these  - like a mouthful of mercury amalgam fillings, or once lived in a moldy apartment, or known tick bites - I skip ahead and test for these issues earlier.)


Let’s Talk About SIBO

Like I mentioned earlier, SIBO is an underlying cause of IBS in as much as 80% of cases. But that doesn’t mean SIBO is the only cause of your IBS. SIBO is often just one aspect of a bigger set of issues. In fact, I often see patients who have had four or more rounds of SIBO treatment and still have symptoms. Why?

Often it’s because they have other parasites or pathogens that haven't been treated. Another common reason is that they actually have SIFO - small intestine fungal overgrowth. A 2015 study showed 25% of patients with unexplained GI issues actually had SIFO. SIFO symptoms are the same as SIBO symptoms, but common SIBO treatments like rifaximin and neomycin are just fuel on the SIFO fire. SIFO can be treated, too - it just requires a different treatment. 


Exceptions to the Rule

Now you know my basic treatment approach for IBS - but there are some exceptions. If someone is too overburdened, run down, or “weakened”, by what they’ve endured in body burden, often combined with a lifetime or period of high stress, sleep deficit, limited nutrition (because of what they can’t tolerate, or what is available), and poor assimilation, and are running on a deficit - they may need a different approach.

In these cases, a person may be too vulnerable to tolerate pathogen removal, either because it would leave them more vulnerable to another pathogen, or damage the microbiome itself. (Even natural agents can cause damage - looking at you, Oregano oil!)

A few weeks of support for healing gastritis, esophagitis, or leaky gut prior to digging in to increasing enzymes or HCL levels or endeavoring to clear a pathogen can make all the difference. They may also need several weeks of gentle detox support. I might use Chinese herbs, immunoglobulins and/or probiotics for  secretory iGA support, or treatments aimed at supporting HPA Axis normalization.  I think of this as strengthening Spleen (digestive) Qi and Wei Qi. 


Retest, Rebuild, Revitalize

We’ve already covered a lot, but we’re not done yet. In fact, these three final steps might be the most important. Please don’t skip them!

#1 Retest

Once we’ve completed our first round of treatment, it’s time to retest. Failure to retest is the most common reason people relapse after treatment. Yes, it really is worth the time and money! Retesting gives us insight into how you responded to treatment, if further treatment is needed, or if problems have been resolved. The only exception to this is SIBO testing: if your SIBO symptoms are 90% or more resolved, we often don’t need to retest, because SIBO doesn’t always look perfect on paper.

#2 Repair & Rebuild

We have already started the process of improving the gut terrain and environment. Now is the time to kick it into high gear and increase both probiotic and prebiotic foods. These help “bulletproof” the microbiome, preventing future infections and problems. Now is also the time to add supplements for anti-inflammation and leaky gut repair (butyrates, glutamines, curcumins, immunoglobulins, prebiotics, probiotics, nutrients like vitamins A, D etc). 

This is also the right time to utilize advanced microbiome testing like BiomeFX. We can use that information to focus on further diversifying the microbiome, because diversity is strength.

#3 Revitalize

Finally, I focus on detox support, nutrient replacement, and optimization of other systems that may have been impacted as innocent bystanders of the gut issues. Using an organic acids panel like ION, I take a look at liver detox, antioxidant status, amino acid status, neurotransmitter status, leaky brain, skin, and lungs, mitochondria and metabolism, and inflammation throughout the body. 

Even if you do every other step in the process, missing this one is like missing the icing on the cupcake. (I know, bad analogy for someone practicing nutritional medicine, even if it’s a gluten free, sugar free cupcake!). 

This step is WHY we bother doing the rest. You set out to clear your IBS because you don’t want to run to the bathroom 10 times per day. You don’t want to struggle to get to sleep, stay asleep, think clearly, or deal with rashes or autoimmunity.  You don’t want an overburdened detox system and excess oxidative stress to cause you to age prematurely. But clearing the gut and supporting the microbiome will only get you part way to relief (very far, but not entirely). 

For long term resilience and vitality, here’s what else I’m looking at:

  • Replacing missing nutrients
  • Supporting detox pathways
  • Glutathione status
  • Ability to optimally metabolize (aka use for energy) carbs, fats, and proteins, 
  • Omega fatty acid balance
  • Mitigating inflammation
  • Supporting mitochondrial function
  • Lowering oxidative stress
  • Optimizing brain function

Healing IBS Is A Journey

In case you haven’t picked up on it yet… healing IBS isn’t a “quick and easy” process. But most things that are really worth it in life take time and effort. You likely are not going to see impressive results by just taking a few supplements or cutting gluten from your diet.

But that’s not a reason to get discouraged. Trained practitioners like myself have years of experience, working with thousands of clients.There’s nothing more gratifying than helping a patient  - especially if that patient feels they have tried “everything” - peel back the layers of their IBS one by one and finally find relief!

If you need support healing IBS, I want to invite you to book a complimentary, no-obligation chat with my team. We’ll hear your story and let you know how we think we can help. 

>>> Schedule your free consultation here

Living with IBS is hard. You don’t just have to accept this as your normal. We would love to help.