Irritable Bowel Syndrome

Metabolically Directed Approach to IBS

Irritable bowel syndrome is a name given to a group of symptoms pertaining to abnormal gastro-intestinal function. Some of the IBS symptoms include constipation, diarrhea, heartburn, gastro-esophageal reflux, abdominal pain and gas
Often times, irritable bowel syndrome will be associated with other chronic functional disorders like fibromyalgia, chronic fatigue syndrome (CFS), depression, anxiety and hormonal imbalances. The reason for this may be the presence of leaky gut syndrome, an abnormal condition in the small and/or large intestines where partially digested foods can set off severe immunological reactions. Some of the underlying causes of IBS are improper diet, poor glycemic control, autonomic dysfunction, dysbiosis, and other metabolic imbalances.
Additionally your bowel contains a large proportion of your immune system (approximately 70% of all immune cells). Therefore, a bowel problem will often affect your immune system. Since your immune system will affect your nervous system and your endocrine system, you can see how these seemingly disparate symptoms are usually interrelated.

Classifications of IBS

Conventional diagnosis and treatment for IBS focuses on naming the type of IBS you have and then tailoring treatment towards alleviating these symptoms
However, naming the type of IBS and treating the symptoms does not get to root cause
There are a few different classification systems for IBS

The Rome Classification

IBS – C – predominantly constipated
IBS – D – predominantly diarrhea
IBS – M – both constipation and diarrhea are frequent
IBS – U – Cannot fit into the above categories

IBS Subtypes

Type 1 – Seperate Hard Lumpy Stools like Rabbit Pellets (hard to pass)
Type 2- Lumpy but somewhat sausage shaped
Type 3 – Cracked sausage with lumps on surface
Type 4 – Like a suasage surface is smooth, stool is not too soft or hard (“the perfect poop”)
Type 5 – Soft stools with chunks but clear cut edges
Type 6 – Fluffy, mushy stool with unclear edges
Type 7 – Completely liquid

More Subtypes of IBS

functional constipation, functional diarrhea, functional abdominal bloating/distention, unspecified functional bowel disorder, opiod induced constipation, centrally mediated abdominal pain syndrome, narcotic bowel syndrome/opiod induced GI hyperalgesia,biliary pain, functional gallbladder disorder, functional sphincter of Oddi disorder, functional pancreatic sphincter of Oddi disorder, fecal incontinence, functional anorectal pain, functional defecation disorders, functional nausea and vomiting disorders, cyclic vomiting syndrome, functional abdominal pain disorder, postprandial distress syndrome, abdominal migraine……
There are countless subclassifications of these subclassifications

More Naming and Blaming

Unfortunately, since conventional medicine is so focused on “making the diagnosis” rather than treating the root cause, more and more symptoms based criteria are utilized to attempt to be more specific with pharmaceutical treatments
Decades ago, there was only one diagnosis of IBS, now there are dozens of types of IBS

Conventional Medicine Approach to IBS

Focused on “making the diagnosis”
Pharmaceutical or Surgical Intervention
Most diseases or symptoms are considered idiopathic and incurable

Conventional Medicine

Advantages – very powerful interventions
Disadvantages – root cause of disease is rarely addressed

What is a Metabolically Directed Approach to IBS?

Focused on looking at “The Big Picture”
Treat the patient’s underlying metabolic problems, not the symptoms
Identify and fix metabolic problems
Acid – Base Imbalances
Autonomic Nervous System Imbalances
Anabolic-Catabolic Imbalances
Water/Electrolyte Imbalances
Glucogenic/Ketogenic Imbalances
Sex Hormone Imbalances
Adrenal Hormone Imbalances
Thryoid Hormone Imbalances
Environmental Exposures
StealthOrganisms
Food Intolerances
Other toxins

Health is Achieved Toward the Middle of the Curve

The Goldilocks Principle – Balance is the Key – You Want your “Soup” to be Just Right

Autonomic Nervous System Imbalances

As a Root Cause of IBS

The Autonomic Nervous System ANS

First described by Dr Francis Pottenger in his book “Symptoms of Visceral Disease”, originally published in 1919

Every Organ System in Your Body is Under Autonomic Control – SNS

Sympathetic Nervous System (SNS) – Fight or Flight Response – prepare to run or fight for your life. Gastrointestinal system slows down – digestion of food, movement of food stuffs through your GI system, production of stomach acid and digestive enzymes all reduced
Frequent symptoms – constipation, thin, ribbon like stools, decreased urge to defecate, reflux
There may be other symptoms of elevated SNS activity – slow urine flow, urinary retention, anxiety, high blood pressure, tachycardia, dry mouth, dry nose, insomnia, cold hands and feet, excessive sweating, high blood sugar, dry eyes, blurry vision….

Every Organ System in Your Body is Under Autonomic Control – PNS

Parasympathetic Nervous System (PNS) – Rest and Digest Response – recover from activity, digest and assimilate ingested food. Gastrointestinal system speeds up – digestion of food, movement of food stuffs through your GI system, production of stomach acid and digestive enzymes all increased
Frequent symptoms – frequent and urgent defecation, increased mucus production, wet stools, increased urge to defecate, excessive gas and bloating, eating stimulates urgent need to defecate
There may be other symptoms of elevated PNS activity – frequent and urgent urination and urinary incontinence, depression, low blood pressure, bradycardia, drooling of saliva, watery eyes, post nasal drip, hypoglycemia, asthma, difficulty seeing in the dark….

Many People Diagnosed With IBS are Suffering From Autonomic Dysfunction

What causes autonomic dysfunction in the first place?
Chronic Stress – many factors – overwork, lack of rest, too much exercise, lack of, or poor quality sleep, EMF exposures, “Stealth Organisms”, environmental exposures…
Poor diet – fluctuating blood sugar levels

Anabolic – Catabolic Imbalance Contributing to IBS

The Work of Emanuel Revici MD

Dr Revici published his book “Research in Physiopathology as the Basis of Guided Chemotherapy with Special Application to Cancer” in 1961
Revici spend over 3 decades doing basic and advanced research to describe the balance between anabolic and catabolic forces in living organisms. Unfortunately, 60 plus years later his discoveries are mostly unknown and unrecognized
Anabolic – to build up
Catabolic – to break down

Revici’s Paradigm

Revici discovered that the balance between fatty acid and sterol activity within the lipid bilayer of the cell membrane was vital to one’s health
A normal, healthy person will oscillate between Anabolic and Catabolic phases in conjuction with normal circadian rhythms
Some people can get “stuck” in the anabolic phase of their metabolism and some people “stuck” in the catabolic phase

A Balance Between Fatty Acids and Sterols

Revici’s Paradigm – Anabolic

Anabolic metabolism – also referred to as “anaerobic” metabolism is a result of excess sterol activity within their lipid bilayer. Excess sterols, excessively bind fatty acids leading to low oxygen (anaerobic), acid (resulting from production of lactic acid) and dehyrated environment
This dehydrated tissue environment can lead to constipation
Water leaves your bowels and ends up in your bladder, leading to excessive urination and infrequent stools
Other symptoms of anaerobic (anabolic) imbalance – depression, sleepy fatigue, burning joint and muscle pain, brain fog, low serum cholesterol, vertigo, tinnitus, low serum potassium levels, hypertrophic disease states

Too Many Sterols

Revici’s Paradigm – Catabolic

Catabolic metabolism – also referred to as “dysaerobic” metabolism is a result of excess fatty acid activity within their lipid bilayer. Excess fatty acids are prone to oxidative stress (a dysfunctional use of oxygen), these excess fatty acids, sequester chloride into tissues, leaving behind carbonates resulting in an alkaline and overhydrated bowel environment
This overdehydrated tissue environment can lead to diarrhea
Water leaves your bladder and ends up in your stools, leading to reduced urination and frequent, watery stools
Other symptoms of catabolic (dysaerobic) imbalance – anxiety, burnt out fatigue, stabbing joint and muscle pain, brain fog, high serum cholesterol, vertigo, tinnitus, high serum potassium levels, degenerative disease states

Too Many Fatty Acids, Not Enough Sterols

Acid - Base Imbalances Contributing to IBS Symptoms

Many people are under the misguided impression that excess acid is the root cause of all diseases
This is not true. Both excess acidity and excess alkalinity can cause symptoms, and in fact, excess systemic alkalinity is much more common in clinical practice than excess acidity

Excess Alkalinity can Contribute to IBS

Excessive systemic alkalinity can contribute to low levels of stomach acid
Adequate amounts of stomach acid are vital to healthy gastrointestinal function
Low stomach acid leads to poor digestion of your food leaving undigested materials in your GI tract that feed unhealthy bacteria leading to gas, bloating, reflux (GERD), increased risk of H.Pylori (and therefore peptic ulcers), dysbiosis
Also excess systemic alkalinity can stimulate your parasympathetic nervous system (PNS) leading to excess PNS symptoms
Excess systemic alkalinity impairs release of oxygen from your red blood cells contributing to anaerobic metabolism

Excess Acidity can Contribute to IBS

Excessive systemic acidity can contribute to excess levels of stomach acid
Excess amounts of stomach acid can injure the cells of your gastrointestinal lining
Also excess systemic acidity can stimulate your sympathetic nervous system (SNS) leading to excess SNS symptoms
Excess SNS activity increases release of free fatty acids contributing to dysaerobic metabolism

What Causes Acid-Base Imbalances?

Your systemic acid-base balance is dependent on several factors:
• Genetic predispositions (SNPs)
• Diet
• How your body metabolizes food
• Some people have trouble metabolizing fat, while others trouble metabolizing carbohydrates

Energy Production as a Cause of acid-base problems and IBS

The Work of George Watson PHD

Glucogenic - Ketogenic Imbalances

Glucogenic Imbalance – trouble burning fat = overly dependent on carbohydrate metabolism. Carbohydrate metabolism (Krebs Cycle) generates a large amount of carbon dioxide (CO2). CO2 becomes carbonic acid in your body, pushing you in the acid direction
Ketogenic Imbalance – trouble burning carbohydrates = overly dependent on fat metabolism. Fat metabolism (beta oxidation) does not generate carbon dioxide (CO2). Low CO2 reduces carbonic acid in your body, pushing you in the alkaline direction

Hypothyroidism Contributing to IBS

Untreated or poorly treated hypothyroidism is a very common underlying cause of IBS
Hypothyroidism causes constipation
Hypothyroidism leads to excess systemic alkalinity
Hypothyroidism contributes to excess parasympathetic activity (urgent, frequent, loose stools with mucus)
Therefore, hypothryoidism can cause BOTH constipation and diarrhea and gas and bloating and reflux

Simplified Hierarchy of Thyroid Metabolism

Undiagnosed, Poorly Treated Hypothyroidism is Extremely Common

Most medical practitioners do not understand the nuances of thyroid metabolism
Overly rely on only TSH and Free T4 levels, ingoring T3 and reverse T3
Overly rely on “normal” range of thyroid hormones – which unfortunately are too broad to be accurate, hence missing many hypothyroid patients
Overly rely on using T4 only hormone replacement and not prescribing T3 contributing to reverse T3 syndrome
Reverse T3 syndrome causes a functional hypothyroid state, anaerobic imbalance, excess alkalinity and dysbiosis

Many Menstruating Women Suffer from Increased IBS Symptoms During Parts of Their Menstrual Cycle

Increased diarrhea early in cycle can indicate dyaerobic imbalance and sex hormonal deficiency
Increased diarrhea mid-cycle (ovulation) can indicate parasympathetic and excess estrogen
Increased constipation in mid-luteal phase can indicate anaerobic imbalance and sex hormone excess

A Few Examples of Types of IBS as Explained by Metabolic Imbalances

Anaerobic and parasympathetic – Mixed IBS – anaerobic imbalance contributing to constipation, parasympathetic imbalance contributing to urgent, loose stools. May also be depressed, have frequent and urgent urination, may have many other symptoms
Dysaerobic and parasympathetic – Severe diarrhea- both dysaerobic imbalance contributing to diarrhea and parasympathetic imbalance contributing to urgent, loose stools. May also be anxious, prone to low blood pressure, slow heart rate and dizziness when standing, prone
to headaches may have many other symptoms
Anaerobic and sympathetic – Severe constipation – anaerobic imbalance contributing to constipation, sympathetic imbalance contributing to constipation. May also have minimal urge to defecate even if large intestine is full of stool. Tends to have high blood pressure, tends to have
fast heart rate. May have many other symptoms
Dysaerobic and sympathetic – Mixed IBS – sympathetic imbalance contributing to constipation, dysaerobic imbalance contributing to loose stools. May also be anxious, have small amounts of concentrated urine, may have insomnia and may have many other symptoms
High Estrogen – Mixed IBS – high estrogen can contribute to parasympathetic imbalance causing frequent, urgent stools. However, high estrogen contributes to anaerobic imbalance causing constipation. High estrogen also contributes to reverse T3 syndrome leading to a functional hypothyroidism and constipation. Symptoms may peak during ovulation and mid luteal phase of cycle. May have mood disorders, ovarian cysts, uterine fibroids, weight gain, PCOS, heavy and painful cycles and many other symptoms
There are many, many other combinations when you consider acid-base imbalances and thyroid problems
These various expressions of metabolic imbalances are then named as IBS -D, IBS – C, IBS – M, IBS – U and stool classifications assigned Types 1-7

Digging Deeper

Chronic stressors can contribute to various metabolic and hormonal imbalances
These stressors need to be identified and rectified for true healing to occur

Over Time These Chronic Stressors Lead to a Depletion in Vital Metabolic and Hormonal Reserves

Cortisol levels can be high or low or desychronized with your circadian rhythm
Autonomic dysfunction can result from chronic stressors
Estrogen is a stress hormone and can rise excessively with chronic stress
Chronic stress can cause chronic inflammation
Reverse T3 syndrome results from various chronic stressors
There are numerous metabolic imbalances resulting from chronic stressors

Biotoxin Illness

Chronic Inflammatory Response Syndrome (CIRS)

Extremely Common, often Overlooked Cause of Chronic Stress, and IBS

Environmental Illness Contributing to Chronic Stress and IBS

About 24% of the general population react to biotoxin exposure with production of inflammatory cytokines
The gene known as HLA –DR is carried on your sixth chromosome and helps your immune system differentiate “friend from foe”
These cytokines create a huge burden on your body and can contribute to chronic stress and IBS

HLA DR Susceptible Genetic Patterns

4-3-53
11-3-52B
12-3-52B
14-5-52B
7-2-53
7-3-53
13-6-52A,52B,52C
17-2-52A
15-6-51
16-5-51

Stealth Organisms

Hidden or “stealth organisms” – viruses, bacteria, parasites can contribute to chronic stress and IBS.
Stealth organisms can directly cause inflammation to bowel lining (“leaky gut”), dysbiosis, SIBO, SIFO

Test and Treat for Tick Borne Diseases

Lyme Disease
Erlichiosis
Babesiosis
Bartonella
Rocky Mountain Spotted
Fever (RMSF)
Anaplasmosis
Tickborne Relapsing Fever (TBRF)
Rickettsia
Tularemia
Powassan Disease
Borrelia mayonii
Borellia miyamotol

Consider other Sources of Toxicity

Chronic Mold Exposure leads to immune dysfunction which can contribute to downstream distortions in your microbiome, paving the
way for:
• Fungal overgrowth – Candida, yeast, small intestinal fungal overgrowth (SIFO)
• Dysbiosis – small intestinal bowel overgrowth (SIBO), imbalance in bowel flora, H Pylori
• Parasites
• Heavy Metals

Metabolically Directed Approach to Treating IBS

Identify and fix the underlying causes
Do not get distracted by named classifications (IBS -C, IBS -D…..)
Fix the anaerobic/dysaerobic imbalance through metabolically directed diet and nutritional supplementation
Fix the autonomic dysfunction through metabolically directed diet and nutrition
Fix the acid-base through metabolically directed diet and nutrition
Fix the thyroid dysfunction through metabolically directed diet and nutrition and appropriate hormonal treatment
Fix the sex hormone imbalance through metabolically directed diet and nutrition and appropriate hormonal treatment
Identify and treat “stealth organisms”, SIBO, SIFO
Identify and treat other toxicities

To learn more about Michael Rothman MD contact us today by giving us a call at (732) 268-7663, emailing us at [email protected] or by requesting an appointment online.

PATIENT PORTAL

Irritable Bowel Syndrome

Metabolically Directed Approach to IBS

As a Root Cause of IBS

A Balance Between Fatty Acids and Sterols

Too Many Sterols

Too Many Fatty Acids, Not Enough Sterols

Acid - Base Imbalances Contributing to IBS Symptoms

Excess Alkalinity can Contribute to IBS

Excess Acidity can Contribute to IBS

What Causes Acid-Base Imbalances?

Energy Production as a Cause of acid-base problems and IBS

Glucogenic - Ketogenic Imbalances

Hypothyroidism Contributing to IBS

Simplified Hierarchy of Thyroid Metabolism

Undiagnosed, Poorly Treated Hypothyroidism is Extremely Common

Many Menstruating Women Suffer from Increased IBS Symptoms During Parts of Their Menstrual Cycle

A Few Examples of Types of IBS as Explained by Metabolic Imbalances

Digging Deeper

Test and Treat for Tick Borne Diseases

Consider other Sources of Toxicity

Metabolically Directed Approach to Treating IBS

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