Living with IBS can be exhausting - but understanding what’s driving your symptoms can change everything
Irritable bowel syndrome (IBS) has a way of quietly shrinking your life. You start avoiding certain foods, certain situations, certain plans – just in case.
You learn to manage around your gut rather than trusting it.
For many of the people we work with, that’s been going on for years before they find us. If that sounds familiar, you’re in the right place.
This article explains how a Coho functional medicine approach to IBS is different – and why, for so many people, it’s the first time they’ve finally started getting real answers.
Table of Contents
From a functional medicine perspective, IBS is often not a single condition itself, but a label used when digestive symptoms are present and the underlying causes have not yet been fully explored.
For many people, abdominal pain is on the most distressing aspects of IBS. Research suggests that around four out of five people with IBS report pain as a key factor contributing to the severity of their symptoms.
What is IBS?
IBS is classified as a ‘functional’ gastrointestinal disorder, meaning the digestive tract appears structurally normal, but isn’t functioning as it should.
It’s one of the most commonly diagnosed gut conditions, affecting an estimated 5-10% of people worldwide and is more frequently diagnosed in women than men.
Symptoms vary widely between people – and often from day to day – which is part of what makes it so difficult to live with.
What tends to be consistent is the impact: on confidence, on spontaneity, on the mental load of constantly managing around your gut.
From a functional medicine perspective, IBS is often not a standalone condition but a signal – one that conventional testing hasn’t yet fully investigated. That’s not a criticism of conventional medicine; it’s simply a recognition that the standard tools aren”t designed to look at gut function at the level of depth we work at.
The gut is far more complex than most people realise – and far more connected to the rest of the body. How well your digestive tract moves, how your gut microbiome if functioning and how your gut and nervous system are communicating with each other all play a role in how IBS symptoms develop and persist.
When any of these systems are out of balance – whether that’s due to a disrupted microbiome, a nervous system stuck in a stress response, or impaired gut motility – symptoms can follow. And because these systems are so interconnected, one imbalance often influences another.
This is why IBS rarely has a single cause. Research points to a combination of factors that can influence how the gut functions and how sensitively it responds:
- Genetics
- Diet
- Stress
- Infections
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Living with IBS can be incredibly frustrating. Many people spend years trying different diets, medications, or supplements without finding lasting relief.
There is no single ‘cure’ for IBS. However, a range of strategies can often help improve symptoms, including changes to diet and lifestyle, targeted supplements, and, in some cases, medications.
Conventional treatments often focus on managing symptoms. While this can be helpful for some people, it does not always address the underlying factors that may be contributing to the problem.
A root-cause approach looks deeper. By investigating and addressing the root causes that may be driving IBS symptoms, many people are able to achieve significant improvements in their digestive health and overall wellbeing.
For many of our clients, understanding why their symptoms are happening is the first step to finally regaining control of their gut health.
Sign & symptoms of IBS
Some people notice that their symptoms worsen after eating certain foods or after drinking caffeine or alcohol.
Others find that stress makes their symptoms worse – which, given the close connection between the brain and the digestive system, is perhaps not surprising.
One of the most common features of IBS is a change in bowel habits. This may present as constipation, diarrhoea, or in some cases a mixture of both, with diarrhoea alternating with constipation.
In addition to these core symptoms, people with IBS may also experience a range of other digestive and non-digestive symptoms.
Common symptoms of IBS include:
- Stomach pain or cramps that get worse when you eat, but you feel better after going to the toilet and passing a stool
- You may feel like you have more bloating – your stomach may feel very full and become uncomfortable
- Nausea
- Diarrhoea, where you may have a very watery stool, this may be accompanied by urgency where you have to go to the toilet immediately
- Constipation, where you may strain when you go to the toilet and you feel that you won't empty your bowels completely or at all
- There are some days when you feel better, and other days when you have flare ups. Flare ups may be triggered by specific foods or drinks, or stress
- Abnormal flatulence / wind
- Passing mucus
- Anxiety
- Depression
It is not uncommon for these symptoms to come and go.
The conventional medicine approach to IBS
Conventional treatment for IBS typically focuses on managing symptoms – medication for diarrhoea, antispasmodics for cramping, laxatives for constipation. These approaches can bring relief, and there’s absolutely a place for them.
But symptom management and root cause investigation are two different things. For many people with IBS, the underlying factors driving their symptoms have never been properly explored – not because their doctors haven’t cared, but because the standard toolkit isn’t designed for that level of investigation.
At Coho Health, we work differently. Rather than asking ‘how do we manage this?’ we start by asking ‘why is this happening?’ – and then we go looking for the answer.
The Functional Medicine approach to IBS
The investigation starts with something deceptively simple: a detailed look at your health history.
For many people, IBS symptoms don’t appear out of nowhere. When we sit down and carefully map someone’s history, a pattern often emerges – a moment, or a period, where things shifted.
Symptoms frequently begin after:
- A bout of food poisoning
- A course of antibiotics
- Travelling abroad
- A prolonged period of high stress
- Or another specific event in someone's health timeline
For many of our clients, having someone finally join those dots is itself a turning point. Because once we understand what may have triggered the symptoms, we can start to investigate what’s been keeping them going – and that’s where the real work begins.
This is where the Coho you=1 functional medicine framework becomes invaluable. Rather than confirming the absence of serious disease – which standard tests do well – our approach looks at how the gut is actually functioning: the microbiome, digestive capacity, inflammation markers, infections, intestinal permeability, and more.
When we can see clearly what’s happening inside the gut environment, we can build a targeted, personalised plan. Not a generic protocol, but something designed around your results, your history, and your symptoms.
And unlike a fixed plan handed to you to follow regardless of how you feel, we adapt as we go. If something isn’t sitting right – a supplements, a dietary change, a pace that’s too fast – we listen and we adjust. That’s not a small thing. For many of our clients, it’s the thing that made the difference.
What are the possible root causes of IBS?
So what are we actually looking for?
Some of the potential causes of IBS – or conditions that may produce symptoms similar to IBS – include:
- SIBO (small intestinal bacterial overgrowth)
- SIFO (small intestinal fungal overgrowth)
- Coeliac disease
- Non-coeliac gluten sensitivity (NCGS)
- Food sensitivities
- Increased intestinal permeability (leaky gut)
- Low stomach acid or digestive enzymes
- Protozoal, bacterial, and viral infections
- Dysbiosis
- Anxiety
- Stress
- Increased inflammation
- Bile acid malabsorption
- Gallbladder disease
- Fat malabsorption e.g. further to removal of gallbladder
Functional testing in IBS
When someone comes to use with IBS symptoms, one of the first priorities is to understand what may be happening within the gut environment,
In many cases, this may involve using a comprehensive gastrointestinal function test to gain a clearer picture of digestive function, the gut microbiome, and other factors that may be contributing to symptoms.
There are several well-established stool tests available, and we recommend the most appropriate option based on the individual’s symptoms, health history, and clinical presentation.
These tests can provide valuable insights into areas such as:
- Digestion
- Inflammation
- Bacterial strains and levels
- Parasitic infections
- Yeast overgrowth
- Increased intestinal permeability ('leaky gut')
- Short chain fatty acids
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Imbalances in any of these areas can influence how the digestive system functions and contribute to IBS symptoms.
Stool tests performed by conventional doctors do not provide nearly as much detail as these comprehensive stool tests (but conventional medicine testing can be helpful in some cases, e.g. if you just want to rule out inflammatory bowel disease by checking calprotectin levels).
When we can see more clearly what may be happening within the gut environment, it becomes much easier to identify where support may be needed and develop a targeted plan to improve digestive health.
Below are examples of functional gut testing reports that highlight these kinds of imbalances:
Test result example: low pancreatic elastase
In these results we see a very low level of pancreatic elastase – a marker for the digestive enzymes produced by the pancreas. This person is likely to have maldigestion that can result in IBS symptoms.
Test result example: multiple IBS factors
This test result summary page shows a need to support digestion (low levels of pancreatic elastase), reduce inflammation (secretory IgA – the ‘first line of defence’ of gut immunity is slightly raised), and support metabolic balance by reducing the high levels of beta-glucuronidase, an enzyme produced by some bacteria that interferes with normal detoxification processes.
Test result example: dysbiosis & digestion
This summary page shows a high need to support digestion and dysbiosis. Dysbiosis is a bacterial imbalance, that in this case means there is a higher level of methane producing bacteria that can cause constipation, and an overgrowth of commensal ‘friendly’ bacteria that may be causing symptoms of abdominal bloating. These markers also indicate that this person may have a bacterial overgrowth in the small intestine (SIBO).
Test result example: parasites
In this result, we see an infection with the parasite, Blastocystis hominis. Common symptoms of infection with Blastocystis include watery or loose stools, diarrhoea, abdominal pain, anal itching and excess gas.
Test result example: additional bacteria
These results show a presence of five ‘additional’ bacteria at higher levels, that have the potential to correlate with symptoms. Many of these bacteria are commonly found at high levels in individuals with reduced digestion, constipation or small intestinal bacterial overgrowth (SIBO).
Test result example: low pancreatic elastase & low SIgA
In this test result we see a low level of elastase, a marker that reflects the digestive enzymes produced by the pancreas. When elastase levels are low, it can suggest that digestion may not be working as well as it should.
We also see low secretory IgA, which is an important part of the gut’s immune defence system. Secretory IgA acts as a first line of defence in the intestinal lining, helping the body respond to harmful microbes and potential food triggers.
When secretory IgA is low, it can sometimes suggest that the gut immune system is under strain – which may occur in situations such as chronic infections, prolonged stress, or other factors that affect immune resilience.
In situations like this, it’s quite common for people to describe their digestion as ‘sensitive‘ or to feel that they react to a wide range of foods.
Test result example: high H. pylori
Whilst Helicobacter pylori is common and the bacteria is present in around 50% of humans, for some of us, at high levels, the bacteria can cause issues. H.pylori in the below results is high and two of the virulence factors are positive, suggesting that h.pylori may be more of a problem in this individual and could be associated with inflammation, increased duodenal ulcers, and increased gastric cancer risk. H.pylori can result in low levels of hydrochloric acid (HCl) which is necessary for digestion.
Test result example: high calprotectin & bile acids, low pancreatic elastase
The stool test results below show a high calprotectin level – a protein that, when raised, is associated with inflammation in the bowel and may indicate a higher risk of Inflammatory Bowel Disease (IBD).
The test also shows high bile acids. Bile acids are produced in the liver and play an important role in the digestion and absorption of dietary fats.
when levels are elevated in stool, it can suggest that fat digestion and absorption may not be functionally optimally.
This type of imbalance can sometimes be associated with symptoms such as increased bowel frequency or urgency, night-time bowel movements, excessive gas, abdominal pain or difficulty controlling bowel movements.
Test result example: SIBO in IBS
Small intestinal bacterial overgrowth (SIBO) has been found to occur frequently in people with IBS. In one study published in the American Journal of Gastroenterology, SIBO was identified in 78% of patients with IBS.
When the SIBO was treated, IBS symptoms resolved in 48% of those patients.
There are a number of signs and symptoms that may prompt your practitioner to consider whether SIBO could be contributing to your IBS symptoms.
The breath test reports below show examples of hydrogen-dominant and methane-dominant SIBO.
Test result example: hydrogen dominant SIBO
The below SIBO results are suggestive of hydrogen-dominant SIBO (a rise of more than 20 ppm (parts per million) of hydrogen gas from baseline, within 120 minutes).
Test result example: hydrogen and methane SIBO
The below results are suggestive of hydrogen and methane SIBO.
Diet & nutritional strategies for IBS
Nutritional strategies for IBS often depend on the type of symptoms someone is experiencing. One way IBS is commonly classified is by the dominant stool pattern, which can influence the dietary approaches that may be most helpful.
Depending on someone’s symptoms and underlying triggers, different nutritional approaches may be considered. These might include strategies such as a low FODMAP diet (for a short period of time only while the root causes are addressed), exploring potential food sensitivities, or in some cases looking at factors such as histamine sensitivity or mast cell activation.
Understanding these subtypes can help guide more personalised nutritional strategies.
The main IBS sub-types include:
- IBS-C, this is constipation dominant IBS
- IBS-D, this is diarrhoea dominant IBS
- IBS-M, this is diarrhoea and constipation IBS (mixed type)
Comprehensive gastrointestinal testing can help us gain a clearer understanding of the factors that may be contributing to someone’s symptoms.
Once these patterns are identified, support can be tailored through a combination of nutrition, targeted supplementation, and lifestyle strategies aimed at improving digestive function.
In clinic, our team of Coho practitioners work closely with clients to identify which foods may be aggravating symptoms, and which foods may help support better gut health.
While there is no ‘one diet’ that works for everyone with IBS, principles from a number of well-known dietary approaches can sometimes be helpful when carefully adapted to the individual.
Examples of these dietary approaches include:
- A Low FODMAP diet
- The SIBO Specific Food Guide (SSFG)
- A Low Histamine Diet
- A trial gluten-free diet
- A trial dairy-free diet
- Or a trial Elimination Diet
that would temporarily exclude certain foods and after a period of time, are re-introduced one at a time to assess for reactions.
If you’ve already tried a lot of things without lasting results, that’s not a reflection of you – it’s a reflection of whether the underlying causes have ever been properly investigated. That’s what we do differently.
Apply for your free 15 minute Discovery Call with Dee Brereton-Patel now
The wrap
For some people living with IBS, symptoms can be relatively mild.
For others, they can be much more disruptive – affecting work, social life, travel, and everyday routines.
Living with ongoing digestive symptoms can be exhausting, especially when it feels like your gut is unpredictable or difficult to manage.
The good news is that, with the right investigation, it is often possible to uncover the factors that may be contributing to IBS symptoms and begin addressing them in a more targeted way.
With a clearer understanding of what may be happening in the gut, we can work together with our clients to develop a personalised plan designed to support better digestive health and help restore confidence in how the body functions.
For many people, that process is the first step toward feeling more in control of their health again.
To your optimised, healthy future,
Dee & the Coho Health team
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