5 min|Dr. Maya Kuczma

Common or Concerning? Understanding Digestive Symptoms

Wellness, Health, Education, Gut Health

Common Symptoms vs. Normal Symptoms

During a review of their medical history, many patients tell me that they’ve heard that what they’re experiencing is ‘normal’. Often, this verbiage has been used in regards to syndromes such as premenstrual syndrome (PMS) and irritable bowel syndrome (IBS). However, there’s an important distinction to make when it comes to symptoms - whether they are normal, or whether they are common. Many of the symptoms associated with these syndromes are common, but cannot be considered normal, particularly if they are creating interruptions in your daily life, pain, or embarrassment. 

While we each have a unique system, and have varied experiences when it comes to digestive, mood, or energy patterns, a distinction must be made to enable us to recognize when our experience may be common, but not necessarily normal, or more importantly, ideal.

Pre-menstrual Syndrome (PMS)

Many women suffer in silence with premenstrual symptoms because they’ve been told that these symptoms are normal, or part of the female experience. However, PMS is a syndrome. The word syndrome refers to a set of symptoms that consistently occur together; symptoms are considered subjective indications of disease.

PMS, by definition, is dysfunctional, and indicative of a deeper imbalance. Women experience hormonal fluctuations throughout a month; these hormonal fluctuations are normal, and may lead to subtle changes in cravings, libido, energy levels, and response to various type of exercise. However, when these subtle changes transform into monthly symptoms, such as depression, anxiety, irritability, bloating, cramping, breast tenderness, headaches, and acne, they are considered part of premenstrual syndrome, or PMS. While these symptoms are quite common, they are not normal.

If you are experiencing symptoms of PMS, evaluation of your hormones, including progesterone, estrogen, testosterone, melatonin, cortisol, insulin, and thyroid hormones, may provide insight as to the cause of your symptoms. Additionally, your doctor may evaluate levels of certain nutrients, such as iron and vitamin D, or neurotransmitters, such as serotonin.

Lifestyle choices are also thought to play a large role in PMS. For example, alcohol intake (1), stress (2), and smoking (3) have been linked to increased PMS symptoms. Alternatively, physical exercise (4), cognitive behavioral therapy (5), and vitamin D supplementation (6) have been shown to improve the symptoms associated with PMS. Talk to your doctor to identify the root cause of the PMS symptoms you are experiencing, and develop a treatment plan.

Bloating, constipation, abdominal pain, and diarrhea

Perhaps because digestive symptoms are so common, or due to the wide usage of the term Irritable Bowel Syndrome (IBS), many people have accepted a certain level of digestive discomfort daily. We grow up hearing that our family tends to have ’sensitive stomachs’, or that we have a ’nervous gut’; we may visit a doctor to inquire, only to be told we have IBS. But just like PMS, IBS is a syndrome, with symptoms that are trying to communicate a deeper imbalance.

IBS is characterized by recurrent abdominal discomfort, alongside a change in frequency or consistency of bowel movements. The diagnosis is based on symptoms; there is no test for IBS.(7) Treatment aims to decrease symptoms, but without a clear understanding of etiology, standard methods of treatment such as anticholinergics, selective serotonin reuptake inhibitors (SSRIs), or fiber powder, may or may not be helpful. Since there is no test for IBS, it is vital that other gastrointestinal conditions be ruled out prior to the diagnosis of IBS. If you are experiencing bloating, constipation, abdominal pain, and/or diarrhea, there are many considerations for your doctor to rule out.

Depending on the onset and severity, imaging such as a CT scan, gastroscopy, endoscopy, or colonoscopy may be utilized to rule out red flag diagnosis, such as appendicitis, Crohn’s disease, Ulcerative Colitis, ulcers, or digestive-related cancers.Blood tests can be done to rule out Celiac Disease and to evaluate for nutritional deficiencies that may be indicative of malabsorption. There are many methods to investigate food intolerances, including blood tests, Biomeridian testing, or an elimination diet; these methods can be helpful in discovering whether a reaction to a specific food - or multiple foods - is playing a role in your symptoms.Additionally, investigation into the microbiome - our personal ecosystem of microorganisms - can determine whether parasites, fungal overgrowth, or small intestinal bacterial overgrowth (SIBO) are at the root of your digestive imbalance. It is suspected that anywhere between 4-78% of patients with IBS actually have SIBO.(8)

Although the diagnosis of IBS has become common, it cannot be considered normal; digestive symptoms provide us with an indication that our system is under distress. A full history and review of diagnostic testing can help your doctor to determine the root cause of your symptoms.
Even if you have come to accept a certain level of discomfort in your day-to-day, you may not have to; there is likely an imbalance and/or trigger at the root of what you’re experiencing.
Talk to a Naturopathic Doctor to create a plan to investigate your symptoms, common or not.
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2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402625/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588233/
6. https://www.ncbi.nlm.nih.gov/pubmed/29447494 
7. https://www.merckmanuals.com/en-ca/professional/gastrointestinal-disorders/irritable-bowel-syndrome-ibs/irritable-bowel-syndrome-ibs 
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/
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