Irritable Bowel Syndrome (IBS): The Ultimate Functional Disorder

The term “functional” has been a buzzword in the medical world for years. But what does it actually mean, and why is IBS the quintessential functional disorder (at least in my eyes)?

When studying anatomy and physiology, we learn both the structure and function of different body parts and organ systems. For example, we learn that the heart has four chambers and four valves, and that its function is to use an electrical system to pump blood for oxygenation and circulation. On a broader scale, an organ’s function often involves its interactions with the surrounding environment and other systems in the body.

Yes, conventional doctors are trained in both structure and function from an anatomy and physiology perspective, but how does this translate to prevention and treatment? In many cases, conventional medicine approaches each organ in isolation, often hyper-focusing on structural abnormalities and how to fix them. In contrast, functional medicine takes a step back to examine how different organ systems interact and impact one another.

So, What Does This Have to Do with IBS?

Traditional primary care doctors and gastroenterologists often fall short when diagnosing and treating abdominal concerns because they rely heavily on what they see during a scope or biopsy. They check for conditions like Celiac disease, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), colonic polyps, and diverticula. If they don’t find any structural abnormalities or overt inflammation, they often conclude that your symptoms—pain, gas, bloating, constipation, diarrhea—must be IBS. You walk away with a diagnosis and a prescription that may or may not help.

IBS is actually the most commonly diagnosed gastrointestinal disorder in the United States, affecting 10-15% of the population. It is more prevalent in females but can occur in any gender. Surprisingly, it is also the second leading cause of missed workdays—right after the common cold.

For these reasons, IBS is the ultimate functional disorder—there’s nothing structurally wrong, yet something is clearly dysfunctional. Unfortunately, many people are told, “It’s just from stress.” While stress certainly plays a role, reducing stress alone often isn’t enough to resolve symptoms.

Where Do You Go from Here?

If you’ve been dismissed because your colonoscopy was normal, it’s time to seek out a practitioner who looks deeper—someone who won’t ignore your symptoms just because they aren’t visible on a scope.

A deeper investigation often reveals that IBS is not just a gut issue—it can stem from dysfunction in the gut microbiome, nervous system, and/or hormonal stress response system. It may be triggered by food sensitivities, leaky gut, thyroid or adrenal imbalances, or a history of antibiotic or steroid use that has altered gut health over time.

When nothing appears abnormal on a colonoscopy, I start with:
✔️ An in-depth look at daily nutrition (what you eat, when, and how it correlates with symptoms)
✔️ Comprehensive stool analysis to assess microbiome imbalances and leaky gut
✔️ SIBO (Small Intestine Bacterial Overgrowth) testing, which is strongly correlated with IBS but often underdiagnosed

Practical Tips for Managing IBS

While IBS treatment is highly individualized, here are some simple, yet effective strategies to start alleviating symptoms:

1. Mindful Eating

The gut is part of the “rest and digest” nervous system (parasympathetic system). In order to digest food optimally, you need to be in a relaxed state.

✔️ Before eating, take a few deep breaths to signal your brain to activate digestion
✔️ Put away screens (phone, computer, TV) and engage with your meal—notice the smells, colors, and textures
✔️ Chew thoroughly and eat slowly to support better digestion
✔️ Eat with others when possible, using meals as an opportunity to reduce stress and connect

Why is this important?
When we eat in a rushed, distracted, or stressed state, digestion is compromised. The rest and digest nervous system controls important functions like saliva production, stomach acid secretion, enzyme release, and gut motility—all necessary for breaking down food properly. If your body isn’t relaxed when you eat, digestion becomes sluggish, leading to bloating, discomfort, and irregular bowel movements.

Even if you can’t have a perfectly mindful meal every time, start with just a few deep breaths before eating. This small habit can significantly improve digestion over time.

2. Simple Nutritional Tweaks

✅ Start your day with warm lemon water – The acidity signals your digestive system to wake up
✅ Avoid drinking large amounts of water with meals – Excess water can dilute stomach acid, impairing digestion
✅ Incorporate bitter foods and herbs – Arugula, mustard greens, and dandelion leaf help stimulate digestion; bitter herbs like milk thistle, dandelion, and burdock root can be taken as teas or liquid extracts before meals

Why bitter foods?
Bitters have been used in traditional medicine for centuries to support digestion. They stimulate the production of digestive enzymes and bile, which help break down fats and proteins more efficiently and help reduce symptoms.

3. Consider a Short Trial of the Low FODMAP Diet

I know—your gastroenterologist may have suggested this without much guidance, and it can seem overwhelming. But I recommend it not as a long-term solution, but as a diagnostic tool. How your body responds to a low FODMAP diet can indicate whether you should be tested for SIBO.

FODMAPs are fermentable carbohydrates that can trigger IBS symptoms in some individuals, especially when SIBO is at play. While the diet is restrictive, it can provide important clues about what’s causing your symptoms. The goal isn’t to stay on a low FODMAP diet forever—it’s to identify specific triggers and create a long-term, sustainable plan.

Final Thoughts

IBS is more complex than many people realize, and the root cause varies from person to person. Finding a doctor who takes the time to assess your symptoms, nutrition, and environment is crucial. The right approach should be multifactorial and integrative, treating the root cause, not just masking symptoms.

That said, treatment doesn’t have to be complicated. Small, simple changes—implemented gradually—can make a huge difference. So don’t feel discouraged. Start with one change at a time, and know that relief is possible. We’re rooting for you!