"Natural Gastroenterologist" Female Irritable Bowel Syndrome and Hormones

February 27, 2024

"Natural Gastroenterologist" Female Irritable Bowel Syndrome and Hormones

Dr. Nicole Sundene, NMD

Women's Health Specialist

"What natural treatments can I use to help my IBS symptoms?"

~Kelly T Scottsdale, AZ

Finding a good Gastroenetologist to treat IBS symptoms with lasting results, can be very challenging. While I am not a Gastroenterologist, I have helped a lot of women in my seventeen years as a Naturopathic Doctor achieve remission or at least much better control with my "Naturopathic IBS Process" I will review today.

Natural IBS Relief for my patients is very troubling and challenging to achieve. That is why helping with this is one of my favorite things to do, especially when I was younger I was SO EMBARRASSED to even tell my doctor about this. Also, as a child growing up I thought it was totally normal to feel like someone was stabbing me in the stomach with knives. Many days I would sit hunched over my desk holding my stomach in severe pain as a child at school, scared the teacher would not give me a bathroom past fast enough or at all...

So of course my IBS symptoms became MUCH WORSE when I went off to college as a seventeen year old. The stress was triggering me and I was convinced the school put sawdust in my food because my belly would swell up like a balloon after each dorm cafeteria meal.

The good news about this though, is that severe stomach pain no doctor or gastroenterolostic could solve, is what brought me into the Naturopathic Doctor profession. As I tell in more detail in my story about "Why I Became a Naturopathic Doctor."

Up until that point I was on track to be an OBgyn and studying biochemistry and premed. My professional pivot point happened because nobody in MD land could fix my female bloating. Why would I want to go to school to learn how to be ineffective?

The relief I found from Naturopathic Medicine was truly astonishing and much better than any prescription drug I had tried from the variety of specialists I visited with. Up until that point I had been on a very stressful loop of doctor appointments and scary tests.

Furthermore, the Naturopathic Doctor talked to me for an hour about my sleep, stress, period, diet, schedule, and alcohol consumption. Things nodody ever asked me about before and I suddenly realized as I ate more junk food and had greater stress and less sleep my IBS symptoms were flaring badly.

As a teenager away from my family at college, I was going to all these appointments for my IBS by myself, and it was my first time without my mom there to answer the doctors questions.

First the college campus doctor sent me to an internal medicine doctor who had no answers. The Internist then sent me to a GI Doctor. That GI Doctor did some tests, then sent me to a different Gastrogenterology specialist. I saw multiple Gastroenterologists to no avail and nobody could seem to ever help me with the alternating Female Bloating, and severe IBS pain I suffered with.

HOW IS NATURAL GASTROENTEROLOGY DIFFERENT THAN AN MD DERMATOLOGIST?

Finding a good Gastroenterologist that provides long term lasting solutions for IBS is very difficult is basically what I learned from my own heartburn, stomach pain, and female hormonal bloating. The pills I were prescribed were basically useless and my depression and anxiety worsened as I felt more nervous at school, and hopeless there were decent long term solutions.

If you have IBS you begin to develop anxiety because most of my patients with these unpredictable symptoms eventually develop anxiety over not having control of their schedule, event, or work day.

HOW DO YOU HELP WOMEN WITH THEIR FEMALE HORMONAL IBS AND BLOATING?

So today I would like to talk about how I address chronic upset stomach symptoms much differently than the average GI Doctor, or Gastroenterologist. Don't get me wrong, I am not "poo pooing" going to the MD Gastroenterologist at all. Honestly, I highly recommend and prefer you go to an MD Gastroenterology Specialist first to determine there is nothing actually wrong with you like cancer. They can perform a variety of tests to rule out cancer such as blood work, ultrasound, x-rays, Colonoscopies and Endoscopies.

When I worked in regular Gastroenterology as the hospital I worked at for eight years we would constantly scope patients, and if we found nothing wrong, then the doctor would give me a handout on IBS Foods to Avoid (Listed Below), and ask me to call and update our post surgical patients the "good news" that they are healthy and "Just have IBS."

Well as nice as that is to know that you don't have cancer, it certainly does not fix the IBS symptoms and patients would often call back complaining to me that their stomach was still getting worse and the doctor would want them to come back in for more testing. One patient at the hospital I worked at called me every single day about her IBS for nearly eight years!

While I am certain she is probably not still alive at >115 years... she will always be alive and well in my mind! I guess you can call it somewhat of a hazing process that I went through at the hospital I first worked at in 1999, I was a new grad, and twenty-four year old newbie so all the older doctor's and nurses in charge of me passed her off to me and only me as an "educational opportunity." What I learned working in a big clinic that managed IBS symptoms, is that after a while every doctor and nurse begins to lose empathy for IBS patients because they don't know what else to do. So eventually you may see your doctor hit this brick wall with your IBS symptoms and they then dismiss you with.... "Deal with your gas. The average person has gas fourteen times per day. This is all normal and fine." But it is not fine, and IBS patients do not feel fine.

So I got assigned this elderly IBS woman's chart routinely to call and triage her chronic constipation and IBS symptoms. Some days when it was bad she would call me three times a day. On her good days she would call me once a day. Every day my nursing supervisor would know exactly when I was talking to her and actually review other patients she needed me to call as we both listened to her review the same frustrating IBS symptoms each and every day.

For many days in a row we constantly reviewed her doctor's IBS plan I was to enforce of prunes, a long with increasing her hydration, her fiber intake, her magnesium, and to no avail, she was not any better. Every day she would tell me exactly the same thing and I would tell her doctor exactly the same thing.

No doctor or nurse could handle the poor elderly woman's confusion over her female bloating and constipation, and because I was the youngest there... all the doctor's and nurses literally dumped this patient they all knew they could not help on me as my personal project to manage. While I knew I was being somewhat hazed as a newbie, I was also convinced to care and listen and try to help her solve the constipation by adding in more hydrating fruits and not so many dried fruits which finally seem to work and eventually we would hear from her several times a week instead of several times per day.

It literally got to the point that she would call the nursing triage line and start with, "Nicole....." and if I answers the phone I knew it was her immediately, as did any nurse, assistant, or receptionist in our clinic. My support staff would tell her to hold a moment and instantly transfer her to my desk. We do learn and memorize our patients sometimes just by the sound of their voice. So my very first "Dear IBS Patient" and I basically became BFF's. Her doctor would scream at me any time I mentioned her name, would basically tell me to deal with it unless she was hemorrhaging internally with blood or black stools he did not want to hear about it.

The pressure was on me, and I am a stubborn competitive Scandinavian doctor that likes to see results. So it was all on me to help this patient feel "heard" about her painful stomach aches, gas and bloating. I learned instead of falling victim to it at exactly the wrong time each day ie: the early morning and late afternoon are the worst time to try to talk to your busy doctor or nursing staff, I became proactive and would wait to return her call every late morning, once my call button was off, and I no had any other patients to triage stressing me out wondering if it was a heart attack, stitches or a fracture I needed to triage.

So every day around 10am, I would grab a cup of tea, from the break room and do some stretching and gear up somewhat like a professional athlete, for my daily marathon constipation nursing call about her constipation and bloating. Often I could complete a full fifteen minutes yoga stretching routine while listening to her through my headset. She generally spoke at a rate that nobody could interrupt, and it was the exact same description of her stools I would listen to each day.

Every day for many years, I would eventually do yoga or just kick my legs up and listen to her complain to me about her ongoing IBS symptoms for a good fifteen minutes before reiterating the same advice her doctor always told me to tell her when we reviewed her case.... the same advice that still continued to fail her, and despite me being able to provide her empathy for her IBS, I did not have a long term lasting solutions to help reduce her female IBS and bloating symptoms. We were both frustrated.

Working many years as a telephone triage nurse for the Gastroenterologist, I was the person triaging his post surgical patients for emergencies while managing chronic patients through our portal. I learned a lot from sending all the different GI Doctor's messages about their patient's concerning IBS symptoms, and often their solution would be for me to call to the pharmacy another drug that did not seem to provide lasting relief, caused side effects, or even worse did not fix the IBS symptoms at all. Many patients would get worse with the prescription medicines, fiber, psyllium, and stool softeners they would recommend for female constipation.

This was in 1999 before I started Naturopathic school, and I was using the hospital based IBS management system, and at the time I will admit, I was frustrated too, because I did not know what I know now as a Naturopathic Women's Health Doctor. Thus the reason, I share my most common IBS patient's story. A story I have since heard many times, with the same failed treatments.

Let me help you learn from my past mistakes and lack of proper education about IBS symptoms and why we need to address them properly like a screaming toddler and expect if we cover their mouth with our hand.... they will stop screaming.

Every parent knows that when they try to stop a kid from crying they may even get violent and kick or even bite you, so it is best to "listen to why they are upset" in the first place. In order to do that we need to implement my IBS symptoms process that helps to understand why my IBS patient's gut is screaming at them that it is not happy.

The spoiler alert in my story of "Why I became a Women's Health Naturopathic Doctor," is that I had gone to a half dozen of them in college, had a battery of stressful tests conducted on me that seemed to just worsen my anxiety and fears I had cancer in college, and nothing they prescribed me ever seem to help my symptoms.

The real problem is that nobody was talking to me about my nutrition, and I had recently changed to the Vegan Diet my room mates in college were eating, and many of the new foods that were supposed "Healthy Foods for Women," were not a good choice for the "Nicole Diet."

This is where Naturopathic Medicine really shines, because we are tailoring the patient's nutrition, macronutrients, and micronutrients to what specifically worked for them. If one diet truly fit all, then we would not have IBS or Irritable Bowel Syndrome, and the food that is the right fuel for my body, is oftentimes not the right exact diet for my patients. While I give all my patients my Naturopathic Hormone Balancing Diet Program when they enroll which has the top fifteen allergens I most commonly see removed, nightshades are removed, and foods that specifically irritate the lining of the intestinal tract such as citrus and cashews are removed, I still have to work to adjust the meal plans and recipes to what works specifically for my patient.

HOW IS NATUROPATHIC GASTROENTEROLOGY DIFFERENT THAN MD GASTROENTEROLOGY?

  1. I am working to address the "Root Cause" HINT: It is different in each patient with IBS.
  2. Evaluate and eliminate food triggers specific to the patient
  3. Rule out microbiome imbalnce with comprehensive stool testing that evaluates multiple markers of bad bacteria, dysbiotic bacteria, bacterial overgrowth, yeast overgrowth, parasites, and important markers for inflammation, leaky gut, inability to absorb fat, and pH that help me understand what is specifically off for my patient.
  4. Understand the timing of your symptoms and how they are related to any history of prior travel (when did these symptoms start? Look in your phone for photos of you when you felt good and look at the trips you went on prior to the symptoms starting.)
  5. Evaluate, treat, or remove stressful triggers.
  6. Implement stress management tools like my favorite Anxiety Breathing Exercise.
  7. Help my patients reduce stress as cortisol stress hormones can trigger diarrhea AND constipation.
  8. Test and treat for hormone imbalance causing the symptoms. This is very important in women's health especially if the IBS symptoms are occurring cyclically each month (keep a period tracker app to make notes about your symptoms with your cycle to see if you need me to check your hormones thoroughly. Use the free app with the pink flower.) Women with IBS should especially track periods, if your IBS flares with a painful or painless period that is a strong sign I need to fix your hormones to fix your IBS. Or if you never had stomach problems until your forties or fifties I suspect hormonal changes are the underlying challenge triggering IBS symptoms.
  9. I need to evaluate for other signs of hormone imbalance worsening IBS I commonly see such as palpitations, swelling, weight gain, insomnia, anxiety, hormonal rage, depression or other signs of female hormone imbalance such as in perimenopause and menopause are ocuring.
  10. Implement supplements and herbal medicine to help control symptoms so we can use less medications, or eventually work to lower the amount of IBS medications my patients require to control their IBS symptoms.
  11. Take my stomach acid test on my "Heart Burn" blog as if you do not make stomach acid there is nothing that will fix your IBS symptoms until you do. You should burp in five minutes. If not you need HCL support with your meals and likely digestive enzymes. BEWARE: Some of my IBS patients have SUCH bad inflammation they cannot even tolerate HCL or enzymes at first which is why this blog is for information purposes, and I highly suggest you do the most important thing on my list:
  12. SCHEDULE a Naturopathic visit with me so I can help you through this process.

Helping women manage their IBS naturally with nutritional changes, microbiome testing and management, hormone testing, and food trigger elimination, is one of my favorite things to do as a Naturopathic Doctor!

I know first hand how scary it feels to not know where the next bathroom will be or if I will make it through a long bathroom wait line with IBS symptoms. I know stress is a terrible IBS trigger because my stressful biochemistry track I was on in college is what started flaring my stomach pains. The less reliable my stomach became the greater my anxiety. Which then suddenly became a vicious IBS loop.

WHAT IS IRRITIABLE BOWEL SYNDROME? (IBS)

Irritable Bowel Syndrome (IBS) also known as chronic digestive issues resulting in diarrhea, constipation or alternating diarrhea and constipation is best improved with Naturopathy.

WHY DO MORE WOMEN HAVE IBS SYMPTOMS THAN MEN?

When women are noticing IBS symptoms flare with PMS, Perimenopause or Menopause that can indicate a hormonal Root Cause. Hashimotos Thyroiditis and Hypothyroidism can also impact digestion and cause constipation or diarrhea. Most hypothyroid patients struggle with constipation. With menopausal changes, your body becomes more dry and inflamed.

I hope any patients suffering with IBS symptoms feel comfortable talking to me about their embarrassing symptoms because back in the 90's I was terrified with anxiety to talk to my doctor about these very common Women's Health symptoms and that also was part of what delayed my ability to receive help for the IBS.

I was having massive stomach pain and problems and no MD I went to could ever help me. Each day in college I felt like a victim of IBS and never knew when it would strike. Would I have an episode during a test or a presentation? I felt terrified of the random pattern of the IBS and was never sure what to do, what to eat, or what medicine to take for my IBS.

Eventually, a friend recommended I see her Naturopathic Doctor who promptly tested me for Food Sensitivities and prescribed an IBS diet and Herbal Medicine supplements to help me finally get control of the IBS symptoms. The Naturopathic Doctor also talked to me about my stress levels as I was a college student that had just moved an hour from her parents for the first time and stressful life changes also seemed to be an underlying cause of my IBS. I had such a great experience with that Naturopathic Doctor that I decided to stop my pre-med plan to become an OBgyn and go to school instead to be a Women's Health Naturopathic Doctor.

WHAT CAUSES IBS SYMPTOMS?

The causes for IBS are not completely clear; physical and emotional issues, as well as dietary factors or irritants, have all been linked to this condition. Possible treatment considerations for IBS include increasing dietary fiber, eliminating allergic/intolerant foods, addressing the possible contribution of emotional components, and incorporating nutritional therapies. In many cases, IBS can be controlled by managing diet, lifestyle, and stress. From my experience as a Naturopathic Doctor treating a lot of digestive issues, I most commonly find there is a Food Sensitivity we can easily test for via a simple finger poke. Knowing which foods upset my stomach was a huge game-changer for me and explained why some meals I was fine when I was eating a small number of foods I was sensitive to, but it was the meals where I had unwittingly mixed ALL of my food sensitivities together that I would have a severe uncontrollable IBS flare! Mystery solved! Herbal medicine is then needed to heal the inflamed gut while we eliminate the triggers as in "Leaky Gut Syndrome." Eventually, the reactions to most of the foods on the Food Sensitivity test diminish and the patient can return to a normal diet rotating their allergens and continuing to watch for flares.

Nutrition Guidelines

  • Eat at regular times. Try not to skip meals or go long periods of time without food. The emptier your stomach, the more sensitive it may be.
  • Try to limit “stand-up, eat-on-the-run” type meals.
  • Chew thoroughly and eat at a leisurely pace – if you must eat in a hurry, only eat a small amount at a time.
  • Eat a balanced and varied diet.
  • Gradually increase your intake of fiber. Too much fiber can upset your stomach just like not enough. If increasing your fiber causes diarrhea or constipation you likely have SIBO or Small Intestinal Bowel Overgrowth that your GI doctor can do a simply breath test to diagnose. I don't recommend treating SIBO with antibiotics but instead I use herbs and nutritional changes.
  • When your stomach is empty, eat soluble fiber foods first. Make soluble fiber foods a large component of each meal (see fiber sources below).
  • Drink plenty of fluids, especially water (at least 6 – 8 glasses a day). If you are dehydrated that will make you more constipated. If you have diarrhea you are losing fluids and may need more water daily with electrolytes to prevent dehydration.
  • Eliminate all red meat, dairy, fried foods, egg yolks, coffee, soda, and alcohol from the diet. These are the most common triggers of IBS.
  • Limit foods that you are sensitive to or do not tolerate well. Posibilites include dairy products, chocolate, eggs, and wheat products.
  • Limit foods high in fat. If you know you will be having high-fat foods, eat a source of soluble fiber first – never eat high fat foods on an empty stomach.
  • Eat green salads at the end of the meal (small portions with non-fat dressing) as bitter greens help stimulate HCL and enzymes needed to digest your food.
  • Fibers are substances in plant foods that we do not digest and are useful in normalizing bowel function. The two main types of fiber are soluble and insoluble fiber.
  • Soluble fibers are commonly found in fruits (especially pears, apples, and citrus), oats, barley and legumes. These water-soluble fibers form gels that provide beneficial effects.
  • Insoluble fibers are commonly found in wheat bran, corn bran, whole grain breads and cereals, as well as vegetables. Insoluble fiber has the effect of preventing constipation.

Fiber acts like a sponge by attracting water into the digestive tract, softening stools and preventing constipation. On the flip side, fiber is also useful for adding bulk to the stool which is helpful when diarrhea is present.

Bitter foods can improve the whole upper digestive system’s function and enhance the absorption of nutrients. Try adding some bitters to meals, which include chicory, endive, radicchio, and dandelion greens.

WHAT IS THE "MAGICAL HERB" THAT WILL CURE MY IBS SYMPTOMS?

If there was a magical exotic herb from the rainforest that I could take to cure my IBS permanently, trust me I would be taking that IBS herb, and blogging about it. Many of my IBS patients expect I have some magical herb to cure their IBS. That is not a realistic expectation, and instead I am working the above IBS steps with my patients to understand what makes their specific IBS symptoms better or worse. Herbal medicine is best used to help manage symptoms and heal the lining of the digestive tract so it can make HCL and enzymes again.

Herbal and Nutritional Supplements have been shown in research studies to be helpful in the treatment of IBS.

  • Enteric coated peppermint oil capsules are used to inhibit intestinal contractions and relieve abdominal pain and gas.
  • Chamomile and valerian aid in decreasing gas.
  • Slippery elm soothes the intestinal lining and decreases inflammation.
  • Licorice also soothes the lining especially with heartburn (do not take with High Blood Pressure.)
  • Lemon balm decreases intestinal cramping and spasms.
  • Nutritional supplements such as glutamine, beta-carotene, and zinc aid in the healing of the intestinal lining.
  • Magnesium is an excellent stool softener for those with constipation or IBS-C, and should be avoided by those with diarrhea or IBS-D.
  • Quercetin can be used to help calm histamine levels for those with IBS Allergic Reactions and IBS Food Sensitivities or Triggers.
  • Reduce overall IgE, IgA, and IgG: Conduct IgE seasonal allergy testing for the where the patient lives or specific to the Arizona Desert or Arizona Mountains, or for some of my patients with asthma that struggle with the "Arizona Air Quality Calendar" that rotate swing between allergy season, fire season, valley fever season, West Nile virus season and include a second peak of pollen in the fall. Arizona patients can follow pollen.com app to discover the level of pollen circulating, what pollen is blooming, and should stay inside when it is windy.

HOW DO I KNOW WHAT MY IBS FOOD TRIGGERS ARE?

Food Allergies and Sensitivities have often been linked to the symptoms of IBS. Roughly two-thirds of patients have some type of food intolerance or allergy. I have never seen a patient in my practice that did not have some form of food sensitivity triggering their IBS. Therefore, it is imperative that patients address these causes and eliminate the offending agents. Talk to your Naturopathic Doctor about identifying potential food allergens through Food Sensitivity Testing.

Lifestyle Guidelines

  • Exercise regularly – 30 to 60 minutes of moderate exercise every day. Contraction of skeletal muscles helps aid contraction of the smooth muscles lining the intestines and is vital for patients with IBS-C or the constipation variety.
  • Daily practice of yoga, Tai Chi, or meditation can significantly reduce stress-related symptoms.
  • Pay attention to your body’s signals. When you feel the urge to move your bowels, take the time to do so, don't hold it in. Ideally you shoul have a normal bowel movement each time after you eat.
  • Make sleep a priority – inadequate sleep reduces the body’s ability to manage stress effectively.

Emotional Components such as depression, insomnia, fatigue, and anxiety are often associated with IBS sufferers. Increased contractions of the colon have been shown to occur in patients with IBS in response to stressful situations, which can lead to uncomfortable symptoms.

Various methods of treatment that may be helpful to reduce stress, anxiety, depression, and fatigue include biofeedback, individual counseling, guided imagery, and physical activity. If necessary, seek the help of a professional to manage stress or other emotional factors.

It is important to determine the cause of any intestinal complaint; therefore infectious or other causes of bowel symptoms must be ruled out prior to diagnosis of IBS. Once a diagnosis of IBS has been made, know that stress and emotional factors weigh heavily in the equation and should be addressed as part of treatment. Food Sensitivity Testing from a reputable lab company is mandatory for me to properly help IBS patients. Please make sure it is affordable to work with me as well as afford a Food Sensitivity Test as we will need a few visits together and the specialty test is not covered per insurance as the majority of the labs I order usually are such as Hormone Testing is covered per your insurance plan.

Thank you for your great Naturopathic questions! Please send them to me on a postcard to my address below as I love to get something in the mail that is not a bill. If your question cannot fit on a postcard that means you need to treat yourself to a Naturopathic visit with me. Pop over to my SCHEDULE page to get that set up!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartum DepressionChronic Fatigue, Holistic Psychiatry,  Depression, Anxiety, Chronic Pain, Autoimmunity, Food Sensitivities, DigestionDermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

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