You may have been told that IBS and fatigue aren’t related, but the truth is, they often go hand in hand. On their own, each one comes with its own challenges, but when you’re hit with both, they can take a heavy toll on your everyday life.
IBS can be tough to diagnose, leading some patients to feel unheard. It may not be obvious with normal blood work or a typical physical examination. While there can be physical abnormalities, they’re usually not obvious unless you know what you’re looking for.
Getting to the root cause of IBS and fatigue requires self-awareness and working with a doctor who’s willing to dig into the subtle signs and nuances of “dis-ease” that are causing your symptoms.
Here’s how functional medicine looks at IBS and fatigue, why they’re connected, and what we can do to help you manage or even reverse the symptoms of both conditions.
What is irritable bowel syndrome?
Irritable Bowel Syndrome, or IBS, is a disorder of the digestive system that occurs when there’s a disruption in communication between the gut and brain.
IBS appears to be more common in people who are less than 50 years old, and women are more than twice as likely to develop the condition than men. Overall, IBS affects about 10-15% of the world’s population.
You should also know that IBS and Irritable Bowel Disease (IBD) are not the same thing. IBD is destruction and severe inflammation of the bowel, which can cause sores and a narrowing of the intestines.
It is possible to have both conditions at the same time, especially if the cause of your IBS symptoms goes untreated.
The Connection Between Your Microbiome and IBS
In functional medicine, we recognize that patients with IBS have an imbalance in the microbiome. But what is the microbiome and how does it become imbalanced?
The human microbiome is a community of trillions of bacteria, fungi, viruses, and other microorganisms that live primarily in the gut. Many of these microorganisms are beneficial and have important jobs to do. But some can actually be quite harmful if they’re not kept under control.
Imbalances in the microbiome can be caused by poor intestinal motility, repeated use of antibiotics, poor diet, stress, and other factors. This imbalance can lead to conditions like small intestinal bacteria overgrowth (SIBO) and leaky gut. These imbalances are also responsible for triggering classic IBS symptoms like diarrhea, cramping, gas, abdominal pain, and constipation.
The Vagus Nerve Plays a Key Role in IBS
We also know that there’s a disconnection in communication between the gut and the brain with IBS. And that’s where the vagus nerve comes in. It’s the longest cranial nerve in your body, beginning in your neck and passing through your thorax all the way to your abdomen.
The vagus nerve connects your brain to the heart, lungs, liver, and pancreas. Its job is to regulate the function of the autonomic nervous system… or the part of your nervous system that functions automatically. Things like your heartbeat, breathing, blinking, liver and kidney function, urination, and more.
The vagus nerve also stimulates certain key digestive functions, including the churning of food in the stomach, producing stomach acid, and producing bile in the liver and gallbladder.
But the vagus nerve can only function properly when your body is in a parasympathetic state, known as a state of rest and digest. When the vagus nerve isn’t functioning optimally, often due to high stress levels, we see low levels of stomach acid and low enzyme production.
This leads to poor digestion, heartburn, SIBO, and IBS symptoms like constipation and diarrhea. If left unaddressed, dysfunction in the vagus nerve can lead to conditions like poor intestinal motility, Inflammatory Bowel Disease (IBD), ulcerative colitis, acid reflux, and GERD.
Does IBS Cause Fatigue?
According to a systematic study published by The World Journal of Gastroenterology, fatigue is a common symptom of IBS. We also see the connection between IBS and fatigue in our patients every day. One reason is that IBS is often accompanied by nutrient deficiencies that can leave you feeling wrung out and just generally unwell.
For example, the bad bacteria in your gut love vitamin B12, which is an essential nutrient for energy and metabolism. When the microbiome is out of balance, as it often is with IBS, the bad bacteria in your gut are consuming your vitamin B12 before your body has a chance to use it, leaving you feeling chronically tired.
Another example is vitamin D, a fat-soluble vitamin connected to energy and immunity. Bile is an enzyme produced by your liver and stored in your gallbladder and used to absorb fats. Unfortunately, bad bacteria also like to eat bile, which leaves you unable to absorb fats and fat-soluble vitamins, including vitamin D, E, and A.
And let’s not forget that stress is a major contributing factor in IBS. Chronic stress can also leave you feeling exhausted and overwhelmed, so there’s a connection there as well.
Other Signs and Symptoms of IBS
Other common signs and frequent symptoms of IBS are:
- Lower abdominal pain and cramping due to excessive gut muscle contractions to produce a bowel movement.
- Weight loss and nutrient deficiencies are common in patients suffering from extreme diarrhea.
- Excessive gas, bloating, nausea, and other gastrointestinal symptoms are caused by an overload of bad bacteria in the gut.
- Diarrhea and constipation are caused by abnormal gut contractions due to disrupted communication between the gut and brain.
- Sensitivity to FODMAP foods, a type of carbohydrate that causes gut inflammation and irritation. High FODMAP foods include nuts, legumes, avocados, onions, and garlic.
- Joint pain due to excessive inflammation throughout the body.
- Psychological distress caused by the physical symptoms of IBS. Incidentally, feeling stressed also worsens the symptoms.
- Brain fog, confusion, poor judgment, and difficulty concentrating are most likely related to stress, fatigue, and other physical symptoms.
What is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome, or CFS, is characterized by unexplained, persistent fatigue that doesn’t go away with rest. People with CFS aren’t just tired all the time, they generally feel unwell after even mild physical activity. They often experience muscle and joint pain, along with headaches, sore throat, and tenderness in the lymph nodes. Insomnia and poor memory are also common symptoms of CFS.
Many diseases and conditions, such as fibromyalgia, colon cancer, Crohn’s disease, ulcerative colitis, and IBD can have similar symptoms to CFS. While there’s no specific medical test or procedure to confirm a diagnosis of CFS, our team uses your symptoms and specialized diagnostic testing to confirm the underlying cause and recommend treatment options.
How are IBS and Chronic Fatigue Syndrome Connected?
Irritable Bowel Syndrome and Chronic Fatigue Syndrome often coexist. A study published by the journal Microbiome supports our belief that the root cause of both conditions is an imbalance in the microbiome.
These conditions also commonly occur in people who have recently had a bacterial, viral, or parasitic infection. This suggests that both conditions are also related to an overactive immune system response, which leads to gut inflammation and fatigue.
We’ve also noticed that patients with IBS and fatigue have often undergone recent trauma, such as the death of a loved one or divorce. Clearly, stress and anxiety are a common connection.
And finally, both conditions often involve hormonal imbalances as well, particularly an imbalance in serotonin levels. This is often related to poor gut health since many hormones are produced in the gut.
In many patients with IBS and chronic fatigue, stress, poor gut health, and hormonal imbalances are all intertwined.
How We Diagnose IBS in Functional Medicine
The first thing we’re going to do when you come into our office is spend some time getting to know you. What are your stress levels like? How’s your diet? How do you feel after you eat? Are you getting enough sleep and exercise? These things can all play a role in helping us diagnose the underlying cause of your symptoms.
We’ll look for the less obvious signs of nutrient deficiencies, like dry, scaly skin which could indicate low levels of B12 and iron. We also perform specialized diagnostic testing on the spot so we can get you feeling better right away. This may include blood tests to check nutrient levels and organ function, as well as stool tests to assess the health of your microbiome. A breath test can tell us if the levels of methane or hydrogen in your breath are high, which can also indicate a high level of bacteria in the gut.
We’re looking for those subtle patterns that can tell us the underlying cause of your symptoms.
Treating IBS and Fatigue with Functional Medicine
Conventional doctors will typically treat IBS and fatigue with drugs to control the symptoms of irritable bowel syndrome, such as antibiotics, pain relievers, anti-inflammatories, and anti-diarrheal medications.
While we may include some of these medications in a functional medicine treatment plan to address each patient’s specific condition, we will also seek to address the underlying cause of these conditions to minimize or even reverse the symptoms and provide long-term relief.
Our treatment plan may include supplementing with hydrochloric acid, a digestive enzyme used to break down protein. We may also recommend antimicrobial herbs or specialized antibiotics to correct imbalances in the gut. Strategies for repopulating your microbiome with healthy bacteria via supplementation with probiotics and butyrate and/or the use of probiotic foods as tolerated may also be recommended.
Other treatment options may include:
- Colon Hydrotherapy: Colon hydrotherapy removes toxins from the gut, strengthens the immune system, regulates hormones, and brings the microbiome back into balance. This therapy can also help to relieve diarrhea, constipation, headaches, chronic pain, and many of the other symptoms associated with IBS and fatigue.
- Neural Therapy: Neural therapy can help to improve overall gut health, reduce abdominal pain and cramping, relieve diarrhea, reduce muscle and joint pain, and relieve lymph congestion. Neural therapy is also beneficial for patients suffering from brain fog and depression, which often go hand in hand with IBS and fatigue.
- IV Nutrition Therapy: IV nutrition therapy is also a viable option for managing IBS symptoms and fatigue. Not only does IV therapy provide a boost of much-needed nutrition and fluids for energy, but it also helps to detoxify the body, reduce pain and inflammation, and overcome nutrient deficiencies that may be related to IBS.
What You Can Do To Manage IBS and Fatigue At Home
There are also some things that you can do at home to manage IBS and fatigue.
- Try a Low FODMAP Diet: Following a low-FODMAP diet is incredibly helpful for reducing IBS symptoms. Basically, it’s an elimination diet that involves removing high FODMAP foods from the diet and then reintroducing them slowly to determine which ones are contributing to your symptoms.
High FODMAP foods are foods that contain certain short-chain fatty acids that are difficult to digest, leading to diarrhea, gas, cramping, and bloating. These include things like wheat, dairy, beans, and certain fruits and vegetables.
Our team can walk you through the entire process of getting started with a Low-FODMAP diet.
- Reduce Stress and Support Vagus Nerve Function: Dysfunctions in the vagus nerve are often caused by stress, fatigue, anxiety, and overwhelm. Of course, you can’t always avoid the things that cause you stress, but you can try to find healthy ways to manage it.
Deep breathing, cold showers, meditation, and yoga are effective ways to manage stress and stimulate the vagus nerve. Exercise is also important for stimulating digestion and reducing stress, which also supports vagus nerve function.
Taking time for rest and self-care and the activities you enjoy can also make a huge difference. Your eating habits can also play a role in activating the vagus nerve. Try to eat slowly and mindfully and chew your food carefully without rushing.
Wrapping Things Up
The right dietary changes and supplements can have a major impact on fatigue, IBS, and SIBO, but every patient is different. Determining the underlying cause of your symptoms with specialized diagnostic testing and treatment with a combination of nutrition and stress management is often the best approach. Schedule an appointment with our team to find the best treatment options for you.