Functional Medicine for Digestive Disorders: IBS, GERD, and SIBO
By P. Lovegrove Medically Reviewed by Lindsay Langley, BSN, RN, CHT
Posted Tuesday, September 24th, 2024
Digestive disorders can disrupt daily life in significant ways, causing discomfort, pain, and confusion. Traditional medicine often addresses these issues with medications that treat symptoms but don’t get to the root cause. This is where functional medicine comes into play. Functional medicine looks at the body as an interconnected system and aims to address the underlying causes of digestive disorders, rather than simply suppressing symptoms.
In this article, we’ll dive deep into how functional medicine approaches three common digestive issues: Irritable Bowel Syndrome (IBS), Gastroesophageal Reflux Disease (GERD), and Small Intestinal Bacterial Overgrowth (SIBO). We’ll explore the symptoms, underlying causes, and how functional medicine works to provide long-term relief.
What Is Functional Medicine?
Before we jump into each digestive disorder, let’s define functional medicine a bit more clearly. Functional medicine is a personalized, systems-based approach to healthcare that focuses on identifying and addressing the root causes of disease. Instead of looking at the body as separate systems (like digestive, cardiovascular, or immune), functional medicine treats the body as a whole and recognizes that imbalances in one area can affect others.
This approach uses detailed health histories, advanced lab testing, and natural interventions (such as nutrition, lifestyle changes, and supplements) to restore optimal function. It’s highly personalized, meaning that even if two people have the same diagnosis, their treatment plans might look entirely different based on their individual health status, genetics, and lifestyle factors.
Irritable Bowel Syndrome (IBS)
What is IBS?
Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder that affects how your bowels work. IBS doesn’t cause structural damage to the digestive system, but it can cause intense discomfort, including:
- Abdominal pain
- Bloating
- Gas
- Diarrhea or constipation (or a mix of both)
The symptoms can range from mild to severe and tend to flare up and subside over time. Stress, diet, and hormonal changes can all influence the severity of symptoms.
Traditional vs. Functional Medicine Approach to IBS
In traditional medicine, IBS is often treated with medications like antispasmodics, laxatives, or even antidepressants. These drugs help manage symptoms but don’t address what’s actually causing the digestive issues.
Functional medicine, on the other hand, takes a more holistic approach to understanding IBS. Practitioners believe that IBS is often a symptom of underlying issues like gut dysbiosis (an imbalance of gut bacteria), food sensitivities, or even chronic stress.
Key Causes of IBS in Functional Medicine
- Gut Dysbiosis: Many people with IBS have an imbalance in their gut microbiome—meaning they may have too many bad bacteria and not enough good bacteria. This can lead to fermentation in the intestines, causing gas, bloating, and irregular bowel movements.
- Leaky Gut Syndrome: Another potential factor is increased intestinal permeability, also known as leaky gut syndrome. This happens when the lining of the small intestine becomes damaged, allowing undigested food particles and toxins to enter the bloodstream, triggering inflammation and IBS symptoms.
- Food Sensitivities: Foods like dairy, gluten, and processed sugars can trigger or worsen IBS symptoms. In functional medicine, it’s common to use elimination diets to identify these triggers.
- Chronic Stress: Stress affects gut function. The gut and brain are closely linked through the gut-brain axis, meaning stress and emotional health can directly impact gut motility and sensitivity. This is why stress management is often a cornerstone of IBS treatment in functional medicine.
Functional Medicine Treatments for IBS
- Gut Healing Protocol: This may include supplements such as L-glutamine, aloe vera, or zinc carnosine to heal the gut lining.
- Probiotics: Supplementation with high-quality probiotics helps restore the balance of good bacteria in the gut.
- Food Sensitivity Testing: To identify trigger foods that may be causing inflammation and exacerbating IBS symptoms.
- Stress Management: Techniques like mindfulness, meditation, and yoga help manage stress levels, which in turn helps ease IBS symptoms.
Gastroesophageal Reflux Disease (GERD)
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a condition in which stomach acid frequently flows back into the esophagus, causing symptoms like:
- Heartburn
- Chest pain
- Regurgitation of food or sour liquid
- Chronic cough
- Difficulty swallowing
GERD is more than just occasional acid reflux; it’s a chronic condition that, if left untreated, can lead to complications like esophageal inflammation or damage.
Traditional vs. Functional Medicine Approach to GERD
In traditional medicine, GERD is typically treated with proton pump inhibitors (PPIs) or H2 blockers, which reduce the production of stomach acid. While these can provide relief, they don’t address the root cause of GERD and can even lead to nutrient deficiencies when used long-term (like deficiencies in magnesium or vitamin B12).
Functional medicine, however, views GERD as a symptom of a deeper imbalance. Instead of automatically assuming excess stomach acid is the problem, functional medicine practitioners often find that low stomach acid is the real issue behind GERD.
Key Causes of GERD in Functional Medicine
- Low Stomach Acid (Hypochlorhydria): Believe it or not, low stomach acid is a common root cause of GERD. Without enough acid, food isn’t properly broken down in the stomach, leading to fermentation, bloating, and pressure that forces stomach contents (including acid) back up into the esophagus.
- Food Sensitivities: Just like with IBS, certain foods may be triggering GERD. Common culprits include spicy foods, alcohol, caffeine, and processed foods.
- Imbalance of Digestive Enzymes: A lack of proper digestive enzymes can contribute to poor digestion and exacerbate reflux symptoms.
- Lifestyle Factors: Functional medicine also recognizes that lifestyle factors, like eating late at night, lying down after meals, or consuming large, heavy meals, can trigger GERD.
Functional Medicine Treatments for GERD
- Betaine HCl: In cases where low stomach acid is the root cause, practitioners may recommend Betaine HCl supplements to boost acid levels and improve digestion.
- Digestive Enzymes: To help break down food properly and reduce fermentation that can lead to reflux.
- Dietary Changes: Elimination of trigger foods (such as caffeine, alcohol, or processed foods) and an emphasis on whole, nutrient-dense foods.
- Meal Timing: Eating smaller meals and avoiding lying down after eating to prevent reflux.
- Herbal Support: Herbs like slippery elm, marshmallow root, and DGL (deglycyrrhizinated licorice) can soothe the esophagus and reduce inflammation caused by acid reflux.
Small Intestinal Bacterial Overgrowth (SIBO)
What is SIBO?
Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is an abnormal increase in bacteria in the small intestine. These bacteria can interfere with nutrient absorption and cause symptoms like:
- Bloating
- Diarrhea
- Constipation
- Abdominal pain
- Malabsorption of nutrients (leading to conditions like anemia)
SIBO is often misdiagnosed or overlooked, but it’s a significant factor in many digestive disorders, including IBS.
Traditional vs. Functional Medicine Approach to SIBO
Traditional medicine treats SIBO primarily with antibiotics, like rifaximin, which target bacterial overgrowth. While this can be effective, it’s often a short-term solution, as SIBO has a high relapse rate without addressing the underlying causes.
Functional medicine takes a broader approach, focusing on why SIBO developed in the first place. There are many reasons why bacteria might overgrow in the small intestine, and functional medicine practitioners work to restore balance and prevent recurrence.
Key Causes of SIBO in Functional Medicine
- Motility Issues: One of the main causes of SIBO is impaired motility, meaning food and bacteria aren’t moving through the digestive system as they should. This can be due to nerve damage, surgery, or certain conditions like hypothyroidism.
- Low Stomach Acid: Stomach acid is a key defense against bacterial overgrowth. Without enough acid, bacteria that would normally be killed can survive and overpopulate the small intestine.
- Immune System Dysfunction: The immune system plays a role in controlling bacterial populations in the gut. Dysfunction in this system can lead to overgrowth.
- Structural Abnormalities: Scar tissue, surgeries, or strictures in the digestive tract can cause food and bacteria to become trapped, leading to overgrowth.
Functional Medicine Treatments for SIBO
- Antimicrobial Herbs: Instead of relying solely on antibiotics, functional medicine often uses antimicrobial herbs like oregano oil, berberine, and neem to target bacterial overgrowth.
- Prokinetics: These help improve motility and ensure that food and bacteria move efficiently through the digestive tract, preventing future overgrowth.
- Low-FODMAP Diet: Since certain types of carbohydrates can feed the bacteria in the small intestine, a Low-FODMAP diet is often recommended to starve the bacteria and reduce symptoms.
Functional Medicine Treatments for SIBO (continued)
- Low-FODMAP Diet (continued): This diet reduces certain fermentable carbohydrates like fructose, lactose, fructans, and polyols that feed bacteria in the gut. By temporarily cutting out these foods, you help starve off the bacterial overgrowth and ease symptoms like bloating and gas. After a period of healing, these foods are gradually reintroduced to determine tolerance.
- Gut Healing Support: Addressing damage caused by SIBO is crucial. Supplements such as L-glutamine, aloe vera, and zinc carnosine are used to heal the gut lining and support recovery. Inflammation caused by bacterial overgrowth can lead to leaky gut syndrome, so healing the gut lining helps prevent further complications.
- Probiotics: While probiotics are typically beneficial for gut health, treating SIBO requires a careful approach. Not all probiotics are recommended during the initial phase of SIBO treatment, as certain strains may worsen symptoms. Functional medicine practitioners may recommend specific strains like Saccharomyces boulardii, which has been shown to improve gut function without exacerbating bacterial overgrowth.
- Addressing Underlying Conditions: Since SIBO is often a result of other issues like hypothyroidism, gut motility disorders, or immune dysfunction, treating the root cause is a key part of preventing relapse. This might involve hormonal balance, nerve support, or thyroid optimization.
The Gut-Brain Connection: A Key Element in Functional Medicine
One of the key principles in functional medicine is understanding the gut-brain axis—the communication network between the digestive system and the brain. This connection plays a critical role in how conditions like IBS, GERD, and SIBO develop and how they are treated.
The brain and gut are in constant communication via the vagus nerve, hormones, and neurotransmitters. For instance, stress and anxiety can significantly affect gut motility and sensitivity, leading to conditions like IBS. Likewise, imbalances in the gut microbiome can influence mood, stress levels, and even cognitive function, creating a two-way relationship between mental health and digestive health.
Functional medicine addresses this by incorporating stress management, mind-body therapies, and cognitive behavioral therapy (CBT) as part of treatment plans. It’s not uncommon for practitioners to suggest activities like meditation, yoga, or even acupuncture to help restore balance to the gut-brain axis.
Testing in Functional Medicine for Digestive Disorders
One of the reasons functional medicine is so effective in treating digestive disorders is the use of advanced and comprehensive testing. Instead of relying solely on symptom-based diagnoses, functional medicine practitioners use tests to get to the root of what’s going on in your body.
Common Tests for IBS, GERD, and SIBO
- Comprehensive Stool Analysis: This test evaluates gut bacteria balance, checks for parasites, measures digestive function, and looks at markers of inflammation. It’s especially helpful for identifying dysbiosis, which can contribute to IBS symptoms.
- SIBO Breath Test: This test measures levels of hydrogen and methane gas produced by bacteria in the small intestine after consuming a sugar solution. High levels indicate bacterial overgrowth in the small intestine, a common cause of IBS-like symptoms.
- Food Sensitivity Testing: Blood or saliva tests can help identify foods that may be triggering immune responses or causing inflammation in the gut. Common triggers like gluten, dairy, and soy can aggravate IBS or GERD symptoms.
- Organic Acids Test: This test can give insight into bacterial and fungal overgrowth, energy production issues, and neurotransmitter imbalances, all of which can affect digestive health.
- Gastric pH Testing: To determine if GERD is being caused by low stomach acid rather than excess acid, practitioners may use pH testing to measure stomach acidity.
- Leaky Gut Testing: Tests that measure markers of intestinal permeability, such as zonulin, can help determine if leaky gut is contributing to digestive symptoms and systemic inflammation.
Long-Term Success in Managing Digestive Disorders
The goal of functional medicine isn’t just to provide temporary relief—it’s to restore balance and optimal function in the body so that symptoms don’t come back. Long-term success in managing digestive disorders like IBS, GERD, and SIBO requires more than a few months of treatment. It’s a comprehensive lifestyle change that involves addressing not only diet and digestion but also stress management, sleep quality, and emotional well-being.
Key Elements of Long-Term Success
- Personalized Nutrition: One size doesn’t fit all. Functional medicine practitioners tailor diets based on your unique needs, whether that’s continuing a low-FODMAP diet, reintroducing foods after an elimination diet, or focusing on anti-inflammatory foods to promote gut healing.
- Regular Gut Health Maintenance: Incorporating probiotic-rich foods (like fermented vegetables, yogurt, and kombucha) and fiber-rich foods helps maintain a healthy gut microbiome. Ongoing support with digestive enzymes or supplements may be needed depending on the individual’s digestive health.
- Ongoing Stress Management: Since stress is such a significant factor in many digestive disorders, creating long-term habits that reduce stress—such as daily meditation, exercise, and mindfulness practices—is crucial. Even after digestive symptoms are under control, keeping stress levels in check can help prevent flare-ups.
- Lifestyle Adjustments: Making changes like eating smaller meals, avoiding late-night eating, and staying active throughout the day can significantly prevent GERD and IBS symptoms. A balanced lifestyle supporting overall gut health is key to long-term management.
- Monitoring and Adjustment: Functional medicine treatment plans are dynamic. As your health changes, your treatment plan might need adjustments. Regular check-ins with your healthcare provider, retesting as necessary, and making tweaks to your diet, supplements, or lifestyle are all part of the process.
Conclusion
Digestive disorders like IBS, GERD, and SIBO can be frustrating, uncomfortable, and difficult to manage. Traditional medicine often treats the symptoms but doesn’t address the underlying causes. Functional medicine takes a more comprehensive, personalized approach, seeking to restore balance in the body and target the root of the problem.
By addressing factors such as gut dysbiosis, food sensitivities, low stomach acid, and stress, functional medicine offers long-term solutions to digestive issues. Whether through dietary changes, supplements, stress management, or gut-healing protocols, functional medicine empowers patients with the tools they need to feel better and stay healthy.
If you’re dealing with a digestive disorder, exploring functional medicine might be the path to finding real, lasting relief. By working with a practitioner who understands the complex interplay of factors that influence your digestive health, you can begin to take control of your gut health and, ultimately, your overall well-being.
About the author
P. Lovegrove
