The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: IBS

Episode Date: April 6, 2021

My team and I are excited to introduce our revolutionary new platform, Dr. Hyman+, which offers premium content, perks, and information available exclusively for Dr. Hyman+ members.  In this teaser episode, you’ll hear a preview of our second Dr. Hyman+ Functional Medicine Deep Dive on IBS, or irritable bowel syndrome with Dr. Mary Pardee. To gain access to the full episode, head over to https://drhyman.com/plus/. With your yearly membership to Dr. Hyman+, you’ll gain access to: Ad-Free Doctor’s Farmacy Podcast episodes Access to all my docu-series, including Broken Brain 1, Broken Brain 2, Longevity Roadmap + bonus material Exclusive monthly Functional Medicine Deep Dives Monthly Ask Mark Anything by you and only for you

Hey everyone, it's Dr. Mark Hyman here. Now my team and I have been working hard on something that I'm so excited to share a little bit about today. It's a revolutionary new platform called Dr. Hyman Plus, which is a premium membership exclusive for my community. With Dr. Hyman Plus, you get a ton of private content and special access that no one else gets. This yearly membership gives you exclusive access to ad-free Doctors Pharmacy podcast episodes, access to all of my docuseries, including the Longevity Roadmap and Broken Brain 1 and 2, plus all the bonus content. You get monthly functional medicine deep dives where one of our doctors goes deep into a health topic to tell you everything you need to know to heal.

You'll also get access to a monthly Ask Mark Anything Q&A where I answer the Dr. Hyman Plus community's biggest health and wellness questions. This Q&A is only accessible with a membership. Now, because I'm so excited to share this premium membership content with you, I'm releasing a teaser of the brand new Functional Medicine Deep Dive episode diving into one of the most important topics in health. I hope you enjoy it and head over to drhyman.com forward slash plush. That's drhyman.com slash PLUS for more information. Okay, here we go. Hello, everybody. Welcome to the March 2021 Dr. Hyman Plus exclusive functional medicine deep dive. I'm Dr. Mary, and we're going to be talking about irritable bowel syndrome, more specifically SIBO, small intestinal bacterial overgrowth, one of the most common things that I see in practice.

Again, I'm Dr. Mary Pardee. I'm a naturopathic medical doctor and a certified functional medicine doctor through the Institute of Functional Medicine. I have a bachelor's in human nutrition and I'm the founder of ModernMed, which is a virtual telehealth company. My Instagram is at dr.maryparty and also at ModernMed. My specialties, integrative gastroenterology is my specialty. I'm also now entering the world of mental health and have done a lot of cognitive performance work and have a special interest in metabolism and weight loss as well. So IBS, irritable bowel syndrome, it affects 40 million people in the United States, 1 billion worldwide, approximately 10 to 15, up to 20% of adults and teens have symptoms consistent

with IBS. Furthermore, it's not just a health issue, it's an economic issue. So the global irritable bowel syndrome treatment market size was valued at 1.5 billion U.S. dollars in 2018, and you can see it's trending upward continuously. So what is IBS first of all? Well, it's changes in bowel habits. So that could mean diarrhea, constipation. We're talking about frequency there, but also appearance of the stool isn't much harder or much looser than it should be. And we'll talk about what normal is in a little bit as well. Also frequently accompanied by gas and bloating. So a lot of people with IBS will also mention that they have a lot of gas and distension of the abdomen kind of feeling like they're pregnant

can be really uncomfortable. Um, so abdominal discomfort is also very common and this feeling of fullness, you know, after eating a small meal, you might feel that you're really full easily because of this gas, distension, bloating, things moving slower. And we'll talk about other reasons behind that as well. And then the big thing here, which is something that may be changing in the future, but no organic disease identifiable. What this means is that your doctor, if you go to see a gastroenterologist, is going to run a bunch of lab work. And if something comes back, like you are hypothyroid,

you have low thyroid function, then that is an organic identifiable disease that could be causing constipation. So then we'd want to treat for that. And then if it's still an issue, possibly the diagnosis of IBS. But IBS means that we've ruled out all things that could be contributing to altered bowel habits, change in the appearance of stool, gas, and bloating. And there isn't anything in the lab where a colonoscopy is going to be normal and endoscopy is also going to be normal in people with IBS. There's different types of IBS. And the different types are really crucial to understand because

we treat them differently and the testing looks different too. So IBS can be somebody who's primarily constipated, IBS-C. IBS-D is mostly diarrhea, looser stools, or there can be mixed IBS where people are fluctuating between diarrhea and constipation back and forth. And then you can have people that meet the requirements of IBS, but they don't fall into one of these three categories. And this is IBS unclassified. Okay. So let's go into what normal bowel habits should look like. And this will really start to make sense as to if something is abnormal or not. So let's start

first with consistency. So consistency of the stool is what we're going to be looking at here in the Bristol stool chart. Is it hard? So type one are these hard rabbit pellets can be really uncomfortable. People usually have to bear down to get these out. Also type two is going to be continuation where these pellets are just stuck together here. Type three is getting a little bit less hard, so a little softer. And then type four is going to be really the ideal stool here. Soft, but well-formed. It doesn't fall apart, but easy to pass. Type five, we're looking at well-formed, but blobs. So a little bit on the softer side. I know I'm getting visual. I talk about this all the time, so it feels natural to

me. Type six is looking like oatmeal consistency. It still has some form to it, but it's getting very loose. And type seven, we're almost looking at water here. So again, type four is considered normal, but what is also normal is to fluctuate. Sometimes maybe you'll have a type three, then you go to type four, and maybe one day you have a type five, but most of the time you want to be looking for stools around the type four consistency. Does that mean you need to have 100% all the time type four? Absolutely not. Color. So color is an interesting one to talk about. And most people don't know why, but your stool should obviously be brown. The reason for that is because it comes from the bile that's released from your gallbladder.

Gallbladder is an integral part of the gastrointestinal tract and your red blood cells die every 90 days. And when they die, your body breaks them down. They produce something called bilirubin. And that bilirubin is excreted through the gallbladder into the poop, making it brown. So that's why you have brown poop. Brown is not the only normal color, though, which people are surprised by. But the foods that you eat can also change your stool color, and it's totally normal.

So if you eat a lot of beets, then there's a pigment called betaline in the beets that can make your stools red or purple. And that's totally normal if you ate a bunch of beets the night make your stools red or purple. Um, and that's totally normal. If you ate a bunch of beets the night before what's not normal, you didn't eat beets and you have red stool, you know, red stool is something that you need to see your doctor about because it can indicate blood obviously in the stool, which is never normal. Um, also if you eat a lot of sweet potatoes, there's beta carotene, which is very good for you. And especially in babies, we'll see this a lot.

But if you eat a lot of sweet potatoes, a lot of carrots, sometimes it can stain your poop like an orangey color. Also normal if you can explain it by the food there. What colors are not normal for stool? Again, we said red. Blood is never normal in the stool. Something you always want to talk to your doctor about to get testing for. Black stool is also not normal. With the stool, something you always want to talk to your doctor about to get testing for. Black stools, also not normal. With the exception, biohackers out there, if you're taking activated charcoal or bismuth is another thing. Some things can cause the black stools to be there, but if there's no explanation, black stools need to be looked at by a doctor as well because it can indicate an upper GI, so a bleed up in the intestines, higher up in the stomach. So again, something you want to talk to your doctor about. White stools can also be something that happens and white stools are going to be formed when you don't have this bilirubin

present. So it can indicate an issue with the gallbladder. Need to look at that as well. Yellow stools can come about when you don't have the absorption or digestion of fat gets this yellowish tinge. Usually with those, you'll also get like a film. So almost like a greasy film that you can see in the stool. Um, and that can indicate pancreatic issues, lack of absorption or digestion of fats, fat malabsorption. You want to look at that as well. Smell, um, smell of the stool. Your stool should not smell like roses, unfortunately. They should smell like a stool. What you don't want though is rancid stools. So sometimes an infection in the GI tract can actually make your stool smell worse than it should. So that's an

indicator, something you want to discuss with your doctor. Frequency. How often should you be going to the bathroom? Ideally, you want to be having one full formed bowel movement every single day. Some people will have up to three or four. Some people will alternate days. I usually want to work on that. So you're having a formed bowel movement every day. You want to feel like you fully voided. And that feeling of lightness can also affect your energy levels, fatigue. So that's our ideal there. And again, blood is never normal in the stool. Gas and bloating, are they normal? Yes, they are to a degree. And so a gastroenterologist will consider 10 to 20 episodes of passing gas per day normal. I think 20 is a little bit high. I'm more edging on the side of 10 being normal, but do know that sometimes passing

gas is normal. So we want to consider that. What's abnormal is when you wake up with a flat tummy, flat stomach, and throughout the day, it gets more distended, more distended, more distended until the nighttime where you have this pressure in your stomach can be really uncomfortable, affects your quality of life. Maybe you don't want to go out and see friends because of it. This is where we start to say, not normal, probably something we can do about this as well. Causes of IBS. So what actually causes IBS?

Now, previously it was believed that IBS was really a syndrome that was in somebody's head, strongly linked to mental health and anxiety alone. And I say alone because mental health is associated with virtually every chronic disease. And so I still think that there is a link there. However, now we know that there's two other possible causes that can be at play with IBS as well. One of them is post-infectious IBS. Post-infectious means you develop IBS after an infection in the intestinal tract. So one in nine people who experience food poisoning will go on to develop irritable

bowel syndrome. And this is an important fact to know. And there's testing that we can do to see if this is possibly the cause for your irritable bowel syndrome. And this is an important fact to know, and there's testing that we can do to see if this is possibly the cause for your irritable bowel syndrome. Another thing is an overgrowth of bacteria or archaea in the small intestines, which can change motility, leading to constipation, diarrhea, or alternating. This is where we see small intestinal bacterial overgrowth come in, and the new definition of intestinal methanogen overgrowth, IMO. About 60 up to 76% of people with IBS, it's now believed to be caused by this intestinal bacterial overgrowth.

All right, so let's go into this post-infectious IBS a little bit. And this is one that we don't really talk about a lot, especially even in functional medicine. So I'm excited to bring it to you guys today. We've been doing some studies, not me personally, but the research world has been doing studies in animal models, looking at rats. And what they've shown is that if you give a rat something called Campylobacter, an infection that's really common cause of foodborne illness.

What you see is that when you infect the rat with Campylobacter, there's high rates of IBS that develop after the infection has cleared. So of course, what we expect with food poisoning is that you can get a bout of diarrhea. That's your body's way of ridding you of the toxin that is produced by this bacteria that can make you sick. So the flushing is actually a good thing you want to get rid of it. However, once the infection has cleared, we want you to go back to normal. And sometimes we're seeing is that an infection can create higher rates of IBS that develop afterwards. So it's believed about 60% of people with IBS-D and IBS-M, so mixed in diarrhea, predominant IBS, are thought to have antibodies that indicate

post-infectious IBS. So let's look at kind of what happens here, how this actually develops. You have an infection. So you have a foodborne illness, maybe you have traveler's diarrhea, if you went to Mexico, or even in the United States, you get Giardia, a common cause of post-infectious IBS. What happens is the bacteria can release a toxin. This toxin is called CDTB. Now, the proper immune response that your body has is going to be to create an antibody against this toxin. So your body creates anti-CDTB and this fights against the toxin to help you heal. However, something that can go wrong in the body, which isn't just with post-infectious IBS, but other things as well, is that your body can get confused and it can see a normal protein in the gut called vinculin. Vinculin is a normal protein in the gut. What vinculin does is actually helps nerves in the

gut connect. And so it's a really integral part of the enteric nervous system. Now what can happen though, is your body can see that protein and it looks similar to CDTB. And so your body then creates, not all the time, but some of the time, an antibody against vinculin, against your own protein. Whenever we create an antibody against our own protein, this is an autoimmune state. And so this is something that can develop with a foodborne illness. So what we have here then is the development of anti-vinculin antibodies, and that can actually damage the gut. It can also create issues with motility. And we will talk about motility time and time again in this presentation.

Motility is really at the root of small intestinal bacterial overgrowth issues and IBS in general. So once you have anti-inculin antibodies, again, this is an autoimmune state, can create issues with motility and disrupt gut function. This is what we think is kind of developing into this IBSD, diarrhea predominant, or IBSM, resulting in abdominal discomfort, bloating, diarrhea, loose stools. There's a few risk factors that increase the risks for this post-infectious IBS. One of them is severity of food poisoning. So a really severe case of food poisoning may increase the likelihood of developing these antibodies. Being female predisposes you to a greater risk of post-infectious IBS. Having blood in the stool

during these infections also increases the risk. Needing antibiotics goes hand in hand with the severity of the food poisoning. And being sick for more than seven days also coincides with the severity of the illness. And then psychological factors have been linked to this as well, which is why we're going to talk about the gut-brain connection. SIBO, so small intestinal bacterial overgrowth. This is one of the other causes that we were talking about for IBS. So in the small intestines, which we see right here, in the small intestines, it should contain less than 10 to the third bacteria per ml milliliter. And so it shouldn't exceed that amount. The majority of your microbiome, microbiota,

the bugs in your gut should reside instead in the colon, the large intestine, which is right here. Large intestine has less than 10 to the 12 bacteria per ml, so significantly more. SIBO is when you have greater than 10 to the third bacteria per ml. And so you can see here, this is not an infection. That's a really common misconception. Instead, it's increased amounts of normal commensal bacteria. And so really, it's a quantity issue, not a who's who issue. And so we will talk about how and why this produces increased levels of these bacteria.

Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus all the content from my docuseries, and of course, any future ones we're going to release, plus monthly Ask Mark Anything episodes, plus monthly Functional Medicine Deep Dive episodes, I guess, right? That's why we call it Dr. Hyman Plus.

Head over to drhyman.com forward slash plus. That's drhyman.com slash PLUS to learn more. I'll see you there. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional.

This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.