13 Causes of IBS-D Most Doctors Never Test For (but should)

by Steven Wright

IBS-D-Chronic-Diarrhea

Over 60 Million Americans are affected with Irritability bowel syndrome (IBS).   IBS-D is when it’s diarrhea predominate in other words if you suffer from diarrhea or loose stools weekly this is the label you get.

If you’re anything like me you were probably told to supplement with fiber and prescription drugs.  If you’re lucky your doctor might have mentioned that food changes could help.  I wasn’t and the several doctors I saw said what I ate didn’t matter.  But after a few years of choking down Metamucil and spending way too much time in the bathroom I decided I didn’t want this “life sentence”.

The medical community is now learning that IBS is a diagnosis by exclusion, it puts people in a box but delivers nothing of value to the patient.  IBS-D is a syndrome… not an actual disease.  It’s a group of symptoms that are made easier to talk about because of a label but do a major disservice to patients.

Regardless of what a doctor has told you it’s not “all in your head”, “not normal”, and Food DOES Matter.  A doctor who’s interested in fixing you will be willing to spend the resources necessary to figure out the real cause of your reoccurring diarrhea.

IBS is Real and Can Lock You in Your Home

When you are having diarrhea, it’s pretty hard to do much of anything.  You’re confined to a small radius around a toilet.  Hopefully you have family or friends who can help out.  If you have IBS-D, it’s likely you spend several hours a day in the bathroom, are scared that every fart might give you more than you bargained for and you’ve probably skipped a social event because you were scared how your stomach would respond.

Once I learned that IBS wasn’t actually normal and that people had cured themselves, I got kind of mad.  Then I got resolute, I wanted to know how to make sure this stopped and never happened again.

How Would You Know If You Have IBS-D?

An IBS-D diagnosis is based on chronic diarrhea or altered bowel habits towards loose and watery stools.  It’s also very likely that you suffer from abdominal pain, bloating, gas, and other gut pain.  If you suffer slower motility and tend to be more constipated then it’s called IBS-C.

Common conventional medical practice is for a doctor to rule out other inflammatory bowel or organ conditions like Crohn’s disease or stomach ulcers.  The Merck Manual suggests that diet can bring relief (gasp…) and also antidiarrheal drugs and antidepressants (seriously!?) as ways to treat IBS-D.  Of course, any conventional treatment guide will mention fiber, laxatives and exercise as helpful but the reality is none of these actually solve the underlying problem.  And for most people these options don’t offer much relief from the symptoms.

When I was ready for a different opinion, I wish I would have found a resource like this.  Below are 13 common root causes of your chronic diarrhea and a few ideas on how you can rule them out.  The point is: you have the power to change your health.  But it starts with you first bringing these ideas to your doctor.  Then  if he/she are unwilling to help and find a better one here, here, or here.

13 Root Causes of IBS-D

The root causes of IBS-D are actual problems that until corrected, will continue to cause diarrhea and can lead to further health decline.  This list is in no particular order and if need be could be printed to take to your next doctor’s appointment.

1. Gut Dysbiosis:  simply is a condition in which the gut flora is disrupted.

Patient Translation: You have a bug problem in your gut.  Each of us has over 100 trillion bacteria in our intestines and they live in a very complex and unique community.  What we know at this point is if you upset that community you hurt your health.  And if bad bacteria, yeast or parasites take over it can result in diarrhea, constipation, gas, bloating etc.

What to do about it: The first step is to get a snap shot of what is actually happening down there.  A very broad and in-depth stool test will be the ticket you need to figure out what is happening.  Ask for a Metametrix GI Effects Complete stool test.

2.  Carbohydrate Malabsorption: the poly and di-saccahride carbohydrates you’re eating are not being broken down normally and are causing digestive problems.

Patient Translation: The complex carbohydrates (wheat, rice, quinoa etc) you’ve been told are good for your health are actuallycausing gas, diarrhea, bloating and other GI problems.  Over our life toxins, antibiotics, bad bugs, stress and many other problems damage the intestines ability to digest food.  When a damaged gut lining can’t split sugar molecules like it normally should, these molecules end up sitting around in the small intestine, not being absorbed by the body, and provide a great food source for bacteria and other organisms that shouldn’t eat them.

What to do about it: The Specific Carbohydrate Diet was designed to combat this problem.  You could try the diet first, or you can ask your doctor for lactose and or fructose breath tests.  A positive result tells if you do have some deficiency in the digestion of carbohydrates.

3.  Dairy Intolerance: inability to properly digest and assimilate cow, goat, or sheep products.

Patient Translation: You cannot properly digest either the carbohydrate and/or protein contained in milk products.  This causes symptoms like diarrhea, gas, or bloating.  The carbohydrate is lactose, and most people are familiar with Lactose Intolerance.  There is major marketing movement by corporations to create lactose free products… the problem is that just as many people cannot tolerate the protein in dairy called casein.

What to do about it: You can stop eating all dairy and see if you notice any changes.  You can also ask your doctor for two tests to rule this out (skip the skin allergy stuff, and regular blood testing it’s not reliable) the first test is to check lactose tolerance using a breath test.  The 2nd test is an Enterolabs test to check your ability to handle the casein protein.

4.  Gluten Sensitivity: New research shows that a group of people still have measurable inflammatory reactions to wheat even though they are negative for celiac disease.

Patient Translation: Wheat contains many problematic proteins and chemicals that can cause significant diarrhea, brain and skin issues. It’s not just celiac disease anymore.  Research is still emerging, but suffice to say this is a much bigger problem than most thought.

What to do about it: Get a saliva IgA test, Celiac blood tests, and if you really want to rule it out get this Cyrex Lab #3 to check to make sure all forms of wheat are okay for you.

5.  Celiac Disease: an autoimmune condition in which the villi of the small intestine get flattened/destroyed causing reoccurring diarrhea, loose stools and many other non GI health problems.

Patient Translation:  For a Celiac, their small intestine is damaged to a degree in which it makes it very hard to digest and absorb foods.  Wheat will continue to damage the gut wall if it is eaten and create further autoimmunity.  Actually, all grains contain a toxic component very close to wheat that is likely problematic to these people.

What to do about it: Ask your doctor to rule this out with an endoscopy taking a biopsy of the villi.  The truth is it’s not just about wheat, so while you’re waiting stop eating all grains.

6.  Crohn’s Disease: is an inflammatory bowel disease that can be found from the mouth to the anus and is charachterized by patchy spots of inflammation.

Patient Translation: Crohn’s disease can latterly affect any area of the digestive tract and comes in several forms.  What is shared among them are patches of high inflammation.  These areas can be deep into the tissue or just surface level. Most people have symptoms of reoccurring diarrhea that can be mild to violent.

What to do about it: If after reading about Crohn’s you want to rule it out ask your doctor for an endoscopy and colonoscopy.

7.  Ulcerative Colitis: the other major inflammatory bowel disease usually located in the large intestine.

Patient Translation: Ulcerative colitis is usually defined by wounds that do not heal (hence the name Ulcer-ative) in the large intestine.  Most patients with Ulcerative colitis have diarrhea and other abdominal pains.  The loose stools or diarrhea can be mild to violent.

What to do about it: Ask your doctor for a colonoscopy, which will be needed to rule it out.

8.  Small Intestinal Bacterial Overgrowth (SIBO): is an overgrowth of bacteria in the small intestine.

Patient Translation: Bacteria are normal to the intestines, but not in high numbers in the small intestine the majority is supposed to be in the large intestine.  Due to a number of reasons, sometimes they creep out and make a home in the small intestine.  Here they have free rein on the place and cause all kinds of trouble.

What to do about it: Ask your doctor for either a lactulose breath test (standard) or a Metametrix Organix urine test (newer).

9.  Antibiotic Use: extended or repeated antibiotic use for any reason can lower the total number of bacteria and lower the number of bacteria species that live in a normal healthy digestive tract.

Patient Translation: Antibiotics are not targeted missiles, instead they are like massive nuclear bombs for all bacteria in the body.  So if you get a sinus infection, yes the antibiotic helps treat the infection, however studies show that it also damages your gut flora, potentially long term on every single use.

What to do about it: The first step is to stop using them unless it is a life threatening situation.  The second step is getting a good idea about how healthy your gut really is.  Get the Metametrix GI Effects complete stool test.

10.  Probiotics: some people are intolerant to the probiotic bacteria they are supplementing. causing repeated loose stools or diarrhea.

Patient Translation: Probiotics are extremely helpful for almost everyone, unless the kind you’re taking is causing you GI problems.  How could this be?  Well the strain in the supplement could be your enemy, the fillers, the capsule or supplementing bacteria to a gut that isn’t ready.

What to do about it: If you’re still having diarrhea and you’ve tried several other tweaks to stop the diarrhea, think about stopping your probiotics for 7 days and see what happens.  Try eating fermented foods instead.

11.  Egg Intolerance: due to a leaky gut, the body can mount an immune response to egg, causing digestion distress and inflammation.

Patient Translation: Eggs have the potential to cause problems for people who are susceptible to them.  They contain a protein albumin that the body will sometimes in a state of sickness mount a reaction too.  When this happens you get sicker and feel bad.  Many times these people will get diarrhea several hours after eating eggs. But it could take up to several days.

What to do about it: You can get tested to see if you are mounting a response to egg, but that test doesn’t tell you much more than if you stop eating egg and feel better.  Try removing egg from your diet for 4-days and see how you feel.

12.  Low Stomach Acid: hypochlorhydria or achlorhydriaare cases in which the stomach doesn’t produce enough acid in response to the food eaten.  This disrupts digestion right from the beginning and can cause GI distress.

Patient Translation: If your stomach doesn’t’ make enough acid to digest the food you eat then you won’t digest it.  When you don’t digest it, it can ferment and the wrong bugs can feed on it or it can get flushed out of the system because the body thinks something is wrong.

What to do about it:  The first step is to test for low stomach acid.  If possible, get a Heidelberg test done for the best accuracy and find out exactly what is going on.

13.  Chronic Stress: the body’s stress response happens whether the stressor is an emotion, a thought, an email or a tiger.  The response is a chemical process that can cause an increase in inflammation over a long period of time.

Patient Translation: Stress is normal, but it’s not supposed to happen all day long.  In today’s environment the human body is usually outmatched and thinks we are always fighting life and death scenarios.  This causes the stress chemicals to always be high and deplete our body’s ability to heal and reduce inflammation.  Chronic stress or even single high stress events have significant stomach impact and can cause loose stools, diarrhea or pain.

What to do about it: This should be checked for almost everyone.  Unless your actively managing your stress in today’s world you’re almost guaranteed to be chronically stressed.  Ask your doctor for a 24hr adrenal stress index test.

The One Step That Helps Everyone Suffering From Diarrhea

There is one common change that will help stop IBS-D regardless of the root cause.

Changing the foods you eat.

The Specific Carbohydrate Diet gave me results in less than a week and I haven’t looked back since.  You still should invest the time and effort to get the testing done that I’ve listed above.  But while you’re waiting, if you’re sick of the pain then change the number one thing you have control over – what you eat.

You can download a free quick start guide here.

-Steve

About the author

Steven Wright Steve Wright is a health engineer and author. In 2009, he reached a breaking point when IBS took over his life and the doctors didn't know how to help. Since then, he has transformed his health and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

The Specific Carbohydrate Diet Works

{ 23 comments… read them below or add one }

Caralyn @ glutenfreehappytummy August 30, 2012 at 5:53 pm

this is such a helpful post. thank you!

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Charlie August 30, 2012 at 7:21 pm

This is a great overview that I wish I had been around 10 years ago. It would have saved me many months of googling! I’ve got to get the Metametrix tests sometime…

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Steven Wright October 9, 2012 at 2:02 pm

@Charlie – Thanks I wrote it hoping that people will pass it on to those in their lives who may be struggling with loose stools or diarrhea. let us know what you find out.

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Scott October 30, 2012 at 5:47 am

Will you do a similar article about IBS-C?

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Steven Wright October 30, 2012 at 10:49 am
Kimberly January 29, 2013 at 4:56 am

Hi! I had a question & I’m having trouble finding an answer online that I trust, so I thought I might see if you guys know…
I am prepping for a colonoscopy tomorrow, and I’m just wondering if this is going to wipe out all the hard work I’ve done to build up the good bacteria in my gut (by consuming fermented foods)? Thanks for your help…
~ Kimberly

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Jordan Reasoner January 31, 2013 at 3:27 am

Take lots of probiotics after and do a 2-3 intro diet to reboot after.

Jordan

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BH May 2, 2013 at 7:26 pm

You left out another major cause of GI distress, hormonal fluctuations. These fluctuations not only cause digestive issues, but can also be responsible for migraines.

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dana May 17, 2013 at 8:51 am

I think I have ibs-d which is contributed from anxiety..i have always had a “nervous-fluttery” stomach…which is now 24/7. i can honestly say my day is not centered around a toilet (thank goodness)…but i do have to stay around one in the mornings. my health care provider is treating me with a slow introduction to Prozac…will have to see how that works.

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Liz April 20, 2014 at 12:14 am

Did the Prozac help? I am having similar problems. Mostly when I wake in the morning and have intense anxiety that wears off by about noon. They have run a million tests with all negative results. I am on Lexapro and Xanax with no results.

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John May 27, 2013 at 7:05 pm

Steve, this is the best article I’ve found on IBS and what to do about it. Thank you for sharing your knowledge with us!

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Steven Wright May 30, 2013 at 9:48 am

Your Welcome!

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Mr Ley June 26, 2013 at 1:27 pm

You should add 1 more cause of IBS-D that never gets looked at.
Bacteria in your drinking water- many people who are on well water or that have poor habits in handling their drinking water such as not running the faucet for 20 seconds before filling their glass are getting high amounts of bacteria every time they fill their drinking glass.

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Sara July 6, 2013 at 3:30 pm

I was agreeing with what you wrote, until I found the spot about celiac disease…CHANGE YOUR INFORMATION!!! If a person is going to get a biopsy to confirm the diagnosis, they CAN NOT stop eating gluten. This will give a false negative, as the body has started healing the damage already. If they already stopped eating gluten and don’t want to start again, there is no point in having the biopsy done; it will just be a waste of money. This also applies to many food intolerances or allergies. Without the offending food in your body, there is no reaction. You have some really good information, but you have to be careful with what you tell people about serious diseases. There’s people out there that have CD, but got a false negative due to incorrect information about how to handle tests.

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Daniel Butler December 1, 2013 at 11:51 pm

My background starts from a few years ago when one day out of nowhere I started
getting heart palpitations and constant burning in my stomach.
It was finally discovered I had a hiatal hernia and I got a Nissen Fundoplication.
About a year after the Nissen I started feeling quite a bit better.
(Im not sure if any of the above is super relevant to my problem now)

I still have some burning in my stomach occasionally, but I seemed to have developed ibs, (mostly in the morning)
I also get nauseated pretty frequently after eating, and my stomach really doesnt like it when i lay down flat.
Im only 24 and I am always scared of what I eat…
The worst offenders seem to be…
Chocolate
Tomato based foods
Spicy foods

Im sick of feeling crappy all the time and not being able to eat almost anything without my stomach disagreeing.
Any help would be appreciated…
Where do you think I should start?
Thanks
-Daniel

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Lisa January 8, 2014 at 11:58 am

Hey.. Thanks for the advice.

I have what doctors have labelled me as having IBS. I do not fit into the usual criteria of IBS sufferers though. My main problem is the constant nausea that can happen very suddenly and at any time of the day but usually it is evening times. I have an extremely limited diet now where I have cut out food that I know will make me feel poorly and I basically live off toast beside other basic food. I still get bad times and still get nauseous a lot.

I am currently being treated as I have a bad lung infection and it looks like I will have to have part of my lung removed as the 10 week course of penicillin didn’t kill off all the infection or the fungal growth in the lung. I cough up a small amount of crap in the mornings so I know the infection is still there even if it’s just a little bit now.

I too, like Daniel, are so very tired of feel ill all the time and having no quality of life at all. Everyone enjoys food, it’s part of the pleasures of living, but not me… Food is my enemy and I want to know why this is and to put a stop to it.

I have had all the usual camera down into the stomach, xrays, ct scans, pelvic scans, blood tests, trip something test etc but I have never heard of some of these tests mentioned here.

I have been going downhill slowly for a good 12+ years now and I am at rock bottom. 6 stone – skin and bones :(

If anyone can help me, please get in touch. Thank you.

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MiMi February 16, 2014 at 9:41 pm

I suffered from constant nausea for three months, regurgitating everything I ate. Lots of doctors and tests. Thought gall bladder, but my hida-scan showed bile ejection at over 40%, so this was dismissed. Finally found a great GI man who reviewed the tests and discovered that mine was hyperactive, at over 95%. Removed it a week later, and enjoyed my Mom’s meatloaf that same night.

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Randy February 18, 2014 at 10:13 am

Mr. Wright,

This was a great article and I appreciate the efforts and information. I feel bad trying to harvest more guidance from you sir. I am a soldier in the United States Army and have been for almost ten years. Over the last year I have seen my bowel issues growing more and more unpredictable. Often painful, watery, movements accompanied by the very pains your routinely mentioned.

Now, I have changed my diet as much as possible but there is only so much I can do while deployed to Afghanistan. I was wondering if there was anything you could offer to maybe help supplement while taking in consideration that I do not always have access the the freshest most beneficial leafy greens.

Additionally, trying to get a military Physician’s Assistant to approve an in-depth test, or assume it is anything other than an “upset stomach” is rather difficult. Mostly the treatment is Pepto, “drink water” and drive on.

Thank you for your time, and sharing this powerful stuff,

Randy

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ms mc rory May 6, 2014 at 9:27 pm

Hi … I think I have ibs a lot of bloating and gas. Over the past week I have started to feel nausea though out the day, and feeling full even when I should eat , it feels like my food is in my throat , I eat a healthy diet and exercise every morning I drink weatgrass first thing each morning and almost every morning I have a normal bowel motion ,but sometimes feel incomplete

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Amelia May 13, 2014 at 5:40 am

Hi, I’ve recently been diagnosed with post infection IBS, i wonder if any of you have this problem also? It doesn’t seem too bad most of the time (touch wood) most days I wake up and have a single bowel movement that is mostly normal, maybe slightly soft. But then occasionally i will wake up, have a BM then need another which will turn out to be diarrhea or very loose stool, i usually do not risk having another and take immodium after this which stops the urge to go but i still feel discomfort and i’m fine by the afternoon. I have exams coming up a few of which are 9am exams – most mornings i would most likely be fine but i don’t want to risk having a bad morning before an exam – would taking immodium the night before help? Whenever i take immodium it seems to stop BM’s the next day also so I think that is what i’m going to try for morning exams.

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Kathy June 8, 2014 at 8:23 pm

Amelia, you have the exact same symptoms as I do. I have never been diagnosed, but I am pretty sure I suffer from post infectious IBS as well. I too am mostly normal with the odd day with diarrhea. Some weeks it gets a lot worse, usually when I am stressed. I also use Imodium to control the symptoms and I totally agree about the effects taking the full effect the next day. For morning exams I take the Imodium the night before and I find it’s a lot better to do that than try to take it the morning of.

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Linda June 12, 2014 at 2:01 pm

There is not enough space or time to list how i have lived my life. IBS with constipation was the diagnosis. Days and days of constipation followed by laxatives. IN my 30′s, my gall bladder was removed. For years the suffering was worse, now it was more and more diarrhea,often combined with vomiting! On a whim, dr prescribed CHolestramine. Thank God! Usually given for high cholesterol it is sometimes given for chrones disease. After taking meds.laxatives,anti diarrheals, and being a prisoner in my own home,always mapping where the restrooms were,and yes, at times not making it and having embarrassing accidents, i now have a normal life!! If you have had gall bladder removed,please talk to your doctor.There is help for you.

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Kalidasan June 15, 2014 at 9:20 am

I am from the southern part of India. I am having pain in different areas around the abdomen. The pain just increases when I fart or burp. The pain increases significantly after some days. I pass loose stools 4-6 times everyday. What do you suggest me to eat and what medicine should I take? What habits should I undergo? Pleaseeee help me….

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