Conditions
IBS and digestive health
IBS is a diagnosis of exclusion. It tells you what you do not have. It says very little about what is actually happening in your gut, which is why so many people hold the label for years without improving.
Past the label
Two people with the same IBS diagnosis can have entirely different mechanisms: bacterial overgrowth, bile acid malabsorption, enzyme insufficiency, disordered gut motility, food reactions, or a gut-brain axis wound tight by years of stress and vigilance.
They need different treatment. That is the whole argument for investigating rather than cycling through symptomatic remedies.
What gets investigated
The history does most of the work: timing, triggers, stool pattern, what preceded onset, antibiotic and infection history, and what has already been tried.
From there, testing is targeted. Breath testing where overgrowth is likely, stool analysis where infection or inflammation needs excluding, coeliac serology where it has not already been done properly, and targeted food investigation where the pattern suggests it.
Diet is usually part of the plan but rarely the whole of it. Low FODMAP is a useful diagnostic tool and a poor long-term diet; the aim is to widen what you can eat, not narrow it permanently.
The gut-brain part, taken seriously
The connection between gut symptoms and the nervous system is real, well evidenced, and often raised in a way that makes people feel dismissed. Saying that stress affects your gut is not the same as saying your symptoms are imaginary.
Where the gut-brain axis is a significant contributor, treating it directly tends to work better than treating the bowel alone.
Common questions
I have had a colonoscopy and it was normal. Is there any point?
Yes, and that is a good starting position. A normal colonoscopy excludes structural disease, which is important and reassuring. It does not investigate function, and function is where most IBS actually lives.
Is SIBO real?
Small intestinal bacterial overgrowth is a real entity, though it is over-diagnosed in some quarters and the testing is imperfect. I use breath testing where the history supports it and interpret the result alongside everything else rather than as a verdict.
Will I have to give up gluten and dairy?
Not automatically. Some people clearly react to one or both; many do not and have removed them unnecessarily. I would rather establish it properly than have you avoid foods for years on a guess.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.