IBS or Yoyo Diarrhea and Constipation
Dr. Heather Boyd-Roberts

IBS or Irritable Bowel Syndrome can be debilitating, having your trips to the store dictated by the proximity of the bathroom, not being able to have a bowel movement for days, or suddenly suffering with random cramping abdominal pain. And, yet after colonoscopies and endoscopies and ultrasounds, nothing is found.

IBS is a syndrome, meaning there are enough people to create a diagnosis, but nobody knows where it is coming from. It causes symptoms of cramping or abdominal pain, diarrhea, constipation, bloating, gas, indigestion and a tendency to development a growing number of food intolerance. But there is hope for IBS. You can take back control of your bowels. Read below to see the potential root cause of IBS, some functional testing and ways to receive access to treatment protocols.

IBS or Irritable Bowel Syndrome Types
There are different forms of IBS depending on the symptoms that predominate:

1) IBS with constipation, or IBS-C means that you have hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time.
2) IBS with diarrhea, or IBS-D is means you have loose or watery stools at least 25%of the time and hard or lumpy stools less than 25% of the time.
3) Mixed IBS, or IBS-M means you have hard or lumpy stools at least 25% of the time and loose or watery stools at least 25% of the time.
4) Unsubtyped IBS, or IBS-U means you have hard or lumpy stools less than 25%of the time and loose or watery stools less than 25% of the time. This type isn't discuss much.

IBS Causes

Food Intolerances

One of the first steps to identify with IBS is what role food is playing the development of your symptoms. Food reactions can come in the form of food intolerances, poor tolerance to particular constituents of foods such as lectins or FODMAPS or poor tolerance of certain food groups such as meat or grains. Once the source is determined steps are taken to eliminate it.

Deficient Stomach Acid

Sufficient stomach acid, known as HCL, is needed to initiate the digestive process. Stomach acid is required to stimulate the release of bile from the gallbladder and enzymes from the pancreas. If you are hypochlorhydric or low on stomach acid your digestion will be compromised at the start. Low stomach acid can cause bloating, a heavy feeling in the stomach shortly after eating, constipation, gastric reflux similar to excess stomach acid and it can contribute to slowed gastric emptying.

Gallbladder Problems with Poor Bile Output

Your liver produces your bile from cholesterol and it is then stored in your gallbladder in preparation for release after consumption of fat. Biles purpose is to emulsify fat, or break down into tiny globules, so that it is more easily digested by your pancreatic enzymes. Without proper digestion of the fat you will more likely become deficient in fat soluble vitamins such as Vitamin A, E and D. Bile also has the purpose of sterilizing your small intestine, preventing bacterial overgrowth as food is passing through the small intestine. Without proper bile output and sufficient hydrochloric acid you are predisposed to the development of small intestinal bacterial overgrowth.

Symptoms of problems with the gallbladder include abdominal tightness, bloating, nausea, referred pain to your right mid back, diarrhea, sticky floating stool and trouble digesting fats. Inadequate levels of bile can cause a build-up of toxins in the liver because of the fact that bile conjugates and carries out the bodyís burden of toxins. Liver congestion can result in gall bladder stones and stagnation. If a personís cholesterol production is low, bile production is also likely to be low.

Deficient Pancreatic Enzymes

If your pancreatic enzymes become low it means you lack the digestive enzymes needed to properly digest food. As a result, your body canít absorb the nutrients from your food and you have left over undigested food readily available for unwanted bacteria to flourish.

This can cause symptoms such as diarrhea, loss of appetite, and weight loss. Supplying pancreatic digestive enzymes when deficient and at times small intestinal brush border enzymes to optimize digestion is often needed to alleviate stress on an already depleted digestive process.

Small Intestinal Bacterial Overgrowth

Your small intestine should be relatively sterile with maybe 100,000 bacterial colony forming units. The large intestine should contain billions of organisms. If the digestive process we discussed earlier doesnít function properly then bacteria can overgrow in the small intestine. This leads to symptoms of bloating, constipation, diarrhea, GERD, heartburn, cramping, food allergies, brain fog, fatigue, inflamed joints, risk factors for the development of autoimmune diseases, and many other symptoms. Some research has suggested up to 78% of people with IBS have small intestinal bacterial overgrowth.

Imbalanced Colon Microbiome

While your small intestine should be sterile, your large intestine is home to billions of bacterial organisms that help you make B vitamins, that digest fibers and produce butyrate which keeps your colon cells healthy, that defend against invading organisms, that aid with reducing inflammation and providing a first line of defense against colds and flus. An improper microbiome with the wrong kinds of bacteria, yeast or parasites has contributed to autoimmune disease, joint pain, inflammation, heart disease, diabetes and psychological and cognitive disorders and IBS.


What diagnostic tools we use depends on the individual. Here is a list of possible options.

Stool Tests

Stool tests can be used to measure the types of bacteria, both beneficial and detrimental, and the presence of other infections such as parasites or yeast. They can show the level of inflammation and if enzyme production and fat digestion is sufficient.

Food Intolerance Testing

This is tricky. A number of companies run reasonably priced immunolgolbuin or antibody testing, but I have found this to be notoriously incorrect. One company measures antibody response to partial proteins within a food group and it is significantly more accurate. The challenge is the cost to do a more complete panel ranges from $200 to $800 depending on which items are chosen. In some individuals the tests should be run, but for others a food avoidance trial saves a lot of money and allows you to invest in other treatment forms while you work on your diet. I do often recommend one part of the food intolerance test called the Wheat Zoomer. It is $200. It measures antibody reactions to numerous gluten components and non-gluten fractions of wheat. The test also measures markers for the presence of increased intestinal permeability, what is commonly know as Leaky Gut Syndrome.

Lactulose Breath Testing

The stool test is used to measure what is happening in the large intestine. To measure the bacterial growth in the small intestine we use a breath test. About 84% of patients with IBS have a positive lactulose breath test. The breath test is done by following a simple diet for 12-24 hours, then a solution of lactulose is consumed and your breath is measured every 20 minutes for 3 hours. The level of hydrogen and methane gas is measured to identify the type and quantity of bacteria in your small intestine.

Other Testing

The stool, breath and food testing are usually the most valuable for IBS, but if we find resistance to treatment then traditional testing such as a gallbladder ultrasound, endoscopy or colonoscopy may be necessary to rule out more significant dysfunctions, if they have not already been done.


Addressing IBS is a multi step process. It requires work on your part to change your eating habits and lifestyle choices. It requires supplements to help with symptomatic control while we are addressing the underlying dysfunction causing your IBS.

I have created some simple protocols to address IBS. To have access to those you can REGISTER AT Wellevate and then email us at and Shana, the friendly voice at the front desk, will connect the protocol to your registered account. Please set up your Wellevate account first by clicking on the link. If you don't use that link we won't be able to connect the protocol to your account.

Remember, this is not in place of medial advise. If your symptoms do not resolve then you need to schedule an appointment.