Is your heartburn causing bloating and IBS?

Ever had a "Bridesmaid moment"? One of my patients the other day told me about hers. The thing is, she eats exceptionally healthy, exercises, meditates daily and has one of the sunniest outlooks on life I've ever seen. She did not have food poisoning. But her digestive system was a mess.

In fact, she had been diagnosed with Irritable Bowel Syndrome (IBS) and her doctor also suspected Gastroesophageal Reflux Disease (GERD) to be the cause of her vocal hoarseness. She was recommended to take fibre, an anti-diarrhea medication (Immodium) and an antacid. Unfortunately for her, these did nothing to make her feel better.

Irritable Bowel Syndrome is estimated to affect between 10-15% of Canadians (1). I would tend to say that these numbers are extremely conservative because  many people with digestive disorders may not seek care from their medical doctors, or it may take several years to receive a diagnosis. In fact, the vast majority of my clients have one or more digestive concerns.

If you have one digestive issue you are likely to have another. They are not unrelated. This is not a fluke. And you're not going to fix it unless you treat the whole system, or more practically, treat you as a person rather than a collection of mouths, stomachs, guts and colons.

The most common digestive issues that I see and treat are:

• constipation, diarrhea and a combination of both
• Irritable Bowel Syndrome 
• heartburn and H. pylori
• low appetite (in particular, nauseated and skipping breakfast)
• food sensitivities (trouble digesting wheat, meat, dairy, MSG, take out..)
• bloating (5 months pregnant with a food baby?)
• abdominal pain
• gas (painful, silent & deadly, or just plain noisy)
• rectal itching, cuts and bleeding
• Crohn's disease and Ulcerative Colitis (collectively called Inflammatory Bowel Disease)
• and the most frustrating, "My doctor says I'm fine but I can barely leave the house because I'm always running to the bathroom!!"). 

Treatment  for these concerns may not be particularly helpful and can often cause additional concerns. For example, Proton Pump Inhibitors (PPI) are commonly prescribed to treat heartburn. Side effects of Nexium (Esomeprazole) a common PPI, include constipation, watery diarrhea, abdominal cramps, stomach pain, and nausea (2). Other PPIs may decrease absorption of calcium, magnesium, zinc, iron and vitamin B12, increase risk of Community Acquired Pneumonia, C. difficile infection, Traveler's Diarrhea, and Small Intestinal Bacterial Overgrowth (3).

Moreover, these medications work by decreasing acid production within the stomach. While this may alleviate heartburn (read my thoughts on this here), this is like cutting off your nose to spite your face. 

The thing is, we need lots of stomach acid. The stomach's job is to burn off parasites, molds, bacteria and viruses to help protect our body from infections. Without a strong acid barrier, our body is not going to be able to protect against these nasty things. In particular, heartburn is associated with Small Intestinal Bowel Overgrowth (SIBO) - a condition of inappropriate types of bacteria hanging out in the small intestine where they shouldn't be. This is relevant because SIBO is conservatively estimated to be the direct cause of Irritable Bowel Syndrome in 40-85% of cases.

That's right, IBS is not idiopathic or in your head. To add more fuel to the fire, a 2009 study showed that people with GERD were 3.5 x more likely to develop IBS and that people with IBS were 2.8x more likely to develop GERD (4). 

So, what can we do about it?

Treat the Cause.
Here are the big priorities.

1. Rethink the medications. While acid blocking medications may have their place (think ulcers and Zollinger-Ellison Syndrome), and fibre can be helpful they are not the solution. GERD, SIBO and IBS are not caused by a medication deficiency, and to effectively treat the problem, we need to think bigger than chasing symptoms. 
2. Clean Up Your Diet. We all know that eating crap food isn't going to help the situation. While comfort food is tempting when you don't feel well, it can also make a bad situation worse. Focus on the basics: lots of water, fresh vegetables and fruit, healthy protein like grass fed meat, eggs, beans and plenty of nourishing fats like salmon, nuts, seeds, avocados and coconut oil. Ditch the pop, candy, chips, processed grains and sugars.
3. Identify Food Sensitivities. Food sensitivities can exacerbate GERD, SIBO and IBS because they add insult to injury. If your body is already struggling to protect itself, adding in reactive foods will increase the burden of stuff that your body has to deal with. Food Sensitivity testing is different than a food allergy and is not commonly tested by medical doctors and allergy specialists. Learn about the differences here.
4. Practice Good Food Hygiene. Over-eating, eating too quickly and eating on the run are a great way to over-tax your body. Slow down before you eat, take a few deep breaths, chew thoroughly and don't eat while distracted. You will also want to stop grazing and give your body a few hours rest between meals so that it can properly digest. Much like multi-tasking at work is a great way to get distracted and more stressed out, constantly eating and snacking doesn't give your body a break.
5. Create an individualized plan. To effectively get results you will need to work on the digestive system as a whole. This means supporting, not suppressing. In my practice, we do comprehensive testing to assess food sensitivities, bacterial overgrowth within the gut, stool testing as well as more traditional blood work to gain a complete picture of how your body is functioning. From there we create a customized plan that includes dietary recommendations, stress management techniques and targeting supplementation to strengthen the body to heal.

If you find this article helpful or surprising and would like to learn more, I would love to invite you to book a complimentary Health Discovery Session with me to discuss your options.

In happy digestive health,

---

Dr. Keila

References:

1. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome.Clinical Epidemiology. 2014;6:71-80. doi:10.2147/CLEP.S40245.
2. http://www.rxlist.com/nexium-side-effects-drug-center.htm
3. Johnson D, Oldfield E IV. Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use, Dissecting the Evidence. Clinical Gastroenterology and Hepatology. 2013;11(5):458-464. http://www.medscape.com/viewarticle/804146_1
4. Ruigómez A1, Wallander MA, Johansson S, Rodríguez LA. Irritable bowel syndrome and gastroesophageal reflux disease in primary care: is there a link? Dig Dis Sci. 2009 May;54(5):1079-86. doi: 10.1007/s10620-008-0462-0.