Before reviewing this post, I highly recommend you read:
- What are Your Food Sensitivity Test Options
- What to do AFTER Food Sensitivity Testing
- Why I Don’t Recommend Elimination Diets
- What is Inflammation?
- What is the GI MAP, and Is It Worth It?
- What is Leaky Gut?
This post will build on the information I shared in those posts. It’s funny, for as much as I’ve written about food sensitivity testing, it recently came to my attention that I’ve written very little about who should consider getting tested. My goal is to share a different health condition every month and discuss whether or not food sensitivity testing is a good option. Heads up, not every condition benefits from it, and we have very little research. There are some conditions I recommend against it, even though many practitioners advocate for it. Feel free to leave comments on this series with your questions. If you are thinking it, someone else probably is too!
Irritable Bowel Syndrome (IBS)
What is IBS or Irritable Bowel syndrome? It is classified in three ways:
- Diarrhea Predominant (D- Type)
- Constipation-Predominant (C- Type)
- Cyclic (alternating diarrhea and constipation)
Sympt0ms can include:
- going to the bathroom more than three times per day or less than three times per week
- abnormal stool (loose/watery or lumpy/hard)
- straining, urgency, or feeling of incomplete elimination
- passage of mucus
- abdominal distention
Typically the Rome IV Diagnostic Criteria is used in diagnosing IBS. We know that those who suffer from IBS have every area of their life affected. Although it is often assumed their symptoms will normalize, I have worked with clients who have suffered from them for more than 20 years. It is common for patients to develop depression, anxiety, exaggerated stress reactions, and difficulties coping. Often this stress can further exacerbate the symptoms they are having.
What’s Going On?
As I already said, stress is a known trigger for IBS symptoms. Most IBS patients also know that certain foods trigger their symptoms, but they have a tough time determining the specific foods. They end up trying types of elimination diets that only kind of work and end up being even more stressful. At that point, is it the chicken or the egg? Is it the stress associated with trying to figure out the foods or an overactive immune response/inflammation? Likely it’s interaction with both.
Over 80% of the immune system is located in the GI tract. It’s the number one defense against pathogens. It’s almost like it’s outside of the body, considering how many outside components it’s exposed to on a daily basis. So we can’t discount the immune system’s role in IBS.
The current theory is that the body has lost “oral tolerance,” and the immune system is experiencing an exaggerated response to normally benign foods. Why this happens, we aren’t sure. Regardless the body produces inflammatory cell mediators such as histamines, prostaglandins, leukotrienes, cytokines, and others. They damage tissue causing a lack of intestinal permeability (Leaky Gut) and sometimes “global symptoms.” Global symptoms commonly associated with IBS include migraines or headaches and tiredness. If you can identify these triggers and remove them, then you can give the immune system time to stop being so overreactive and the chance to heal the gut. Similar to if you have a muscular injury, stop using it or aggravating it, so it’s more likely to recover, right? Same deal. Once it heals, you can often go back to eating many of the foods that were once a trigger (but sometimes, not all of them, particularly if you have an issue with gluten or dairy.)
What Does The Research Say?
We have a ton of research to now support the once-discarded theory of the Leaky Gut (this is a great article). We have even identified new markers that help us determine the degree of intestinal permeability. Beyond that, it gets a little murkier as far as sound evidence goes. A small study found that those patients with IBS-D have higher c-reactive protein (CRP), a marker for inflammation, than those with IBS-C. Another study found higher neutrophil counts in patients with IBS compared to healthy controls.
Food sensitivity testing helps identify foods that may be contributing to inflammation and help decrease it. But, because of the highly individual nature of food sensitivity testing, it’s hard to create double-blind controlled studies that are repeatable with the same results. The immune system is constantly reacting to its environment, including what you are and are not consuming. It’s hard to reproduce results when the immune system response is always changing. That being said, numerous NIH case studies and theory research has been published in support of food sensitivity testing.
IBS & Food Sensitivity Testing?
I find that food sensitivity testing is very helpful for identifying food and chemical triggers. Typically I recommend a patient with IBS get a food sensitivity test under the following conditions:
- They are IBS-D or cyclical. The research doesn’t support IBS-C as it hasn’t been shown to have an inflammatory component. These clients I’ll work with to see if there is something else going on. SIBO or thyroid concerns are at the top of my list. I’d be more likely to recommend a GI MAP instead if interventions such as increasing water, magnesium, increase fiber, etc., didn’t work.
- They have a relatively clean diet. If you are eating fast food for every meal, we need to work on that first. Your symptoms may resolve by cleaning up your diet.
- You’ve had symptoms for greater than six months.
- You’ve had a colonoscopy, and the results came back negative or only showed inflammation.
- You’ve tried other methods with little to no relief, such as probiotics and prebiotics.
- You wish to get off the medication that you are currently using to control symptoms.
- You have other common symptoms, including a headache and fatigue.
- You also have an autoimmune condition or are pre-autoimmune (positive ANA), or have a family history of any autoimmunity.
- You felt some relief trying specific diets but were unable to get full relief or stick to the plan because it was too restrictive. (This signals to me that you have food sensitivities, we just didn’t identify them all clearly in that diet.)
- Note – if you find a lot of relief from low FODMAP diets, I’d likely recommend the GI MAP or a combo of GI MAP in place of or with food sensitivity testing. We know that people who respond well to a low FODMAP diet often have a SIBO or high level of methane-producing bacteria. We can use the GI MAP to see if that’s what is going on and potentially work to decrease those bacteria levels so that you don’t have to do low FODMAP forever.
- You’ve tried other ways to fight inflammation without full relief.
I never run food sensitivity tests without also monitoring for leaky gut simultaneously. See What to Do After Food Sensitivity Testing.
When You Should See A Doctor for IBS
Honestly, I always like my clients to see a GI doctor before they come to me. Why? I’m not a doctor, I have a very specialized set of things I can do to help my clients. What I would hate the most is for my clients to spend a bunch of money seeing me (most insurance doesn’t cover functional testing or nutrition counseling or has limited coverage at best) only to find out they have a condition that can ONLY be treated by conventional medicine.
On the scary end would be something like GI-related cancer. But I’ve also had several situations over the years where I encouraged the client to see a GI Doc. They refused and asked me to move forward with testing, but then as I feared, got no benefit from the testing. One ended up having intestinal malrotation. Another had a brain tumor (she was not an IBS client, but was seeing me for symptoms that her neurologist had long suspected were possibly the beginnings of multiple schelorsis. It Turned out not.) These are very rare circumstances, but because of them, I always recommend we get as much info from the conventional GI doctor setting first before moving forward.
For instance, if your IBS ends up actually being IBD (Crohn’s or UC), we will proceed differently. So any information they give us is still important and pertinent in the functional and integrative setting.
Some red flags where I would refuse to run tests for a client until checked out by a GI doc would be:
- Signs or symptoms of gastrointestinal bleeding.
- Unexplained iron deficiency anemia.
- Unintentional weight loss.
- Family history of colon cancer and have not had age-appropriate colon cancer screening.
- The onset of symptoms age ≥50 years, and they have not had age-appropriate colon cancer screening.
- Sudden or acute onset of a new change in bowel habit.
Best Functional Approach for IBS
Over the last couple of years, I’ve switched to a test to don’t guess the model of care. I never assume anything, such as the presence of gluten issues, microbiome imbalances, or leaky gut, without evidence. Instead, I test and then use the 5R protocol from IFM (Institute of Functional Medicine) R is Remove, then Replace, Reinoculate, Repair, and Rebalance.
For clients with IBS-D or cyclic, the tests I recommend largely depend on the severity of their symptoms and the information above. If I have a client with severe symptoms that want to get to the bottom of their symptoms fast, I’d likely run the following combination of functional tests:
- Cyrex Array 2 Leaky Gut Test
- Cyrex Array 3X and an Array 4 or Array 10 food sensitivity panel
- GI MAP
We can also take those tests in stages as needed for budget constraints or just if the client feels overwhelmed by a lot of info (and it is a LOT of info!)
For clients with IBS-C, I would implement an approach to increase fiber, water, magnesium, etc. If that is unsuccessful AND their thyroid values look okay, I would run a GI MAP. I may also run a smaller food sensitivity panel if the client requests it. But that would be case by case!
As an RD, I understand the limitations of these often out-of-pocket functional and integrative tests, but I use them as a tool to give us a better-starting ground so you can feel better faster. We then work from there to bring down your symptoms, promote healing, and get a better understanding of your triggers. I don’t claim 100% remission, but you can get close and regain a great deal of quality of life.
I take all my clients through the consultation process to make sure they are 100% good candidates for the test. You can schedule your consultation here. The fee will be applied to the test package should we decide you are a good candidate and will benefit from it.