Functional Gastrointestinal Disorders (FGIDs) Support Protocol
Primary Stack
Core supplements with strongest evidenceModulates gut microbiome; reduces symptoms in IBS and other FGIDs; strain-specific effects
Antispasmodic; reduces abdominal pain and bloating in IBS; must be enteric-coated
Supporting Studies (1)
Supporting Stack
Additional supplements for enhanced resultsSoluble fiber regulates bowel function; better tolerated than insoluble fiber in IBS
Supporting Studies (1)
Supports gut barrier function; may help with leaky gut; studied for IBS-D
Supporting Studies (1)
May help with bloating from carbohydrate maldigestion; lactase for lactose intolerance
Supporting Studies (1)
Prokinetic; helps with nausea and gastroparesis symptoms
Supporting Studies (1)
May help with functional dyspepsia and IBS symptoms
Supporting Studies (1)
Demulcent; soothes GI tract; traditional remedy for digestive symptoms
Supporting Studies (1)
Deficiency common in IBS; supplementation may reduce symptoms
Supporting Studies (1)
How This Protocol Works
Simple Explanation
Functional Gastrointestinal Disorders (FGIDs) are conditions where the GI tract doesn't function properly, but no structural abnormality is found. The most common is Irritable Bowel Syndrome (IBS), but the category includes functional dyspepsia, functional constipation, functional bloating, and others.
COMMON FGIDs:
ROME IV CRITERIA are used for diagnosis.
LIFESTYLE MANAGEMENT:
WHEN TO SEE A DOCTOR:
* Probiotics have the strongest evidence for IBS - specific strains like Bifidobacterium infantis 35624.
* Peppermint oil (enteric-coated) reduces abdominal pain and is recommended in guidelines.
* Psyllium fiber helps regulate bowel function.
* Ginger helps with nausea and motility.
Expected timeline: Supplements typically show benefit within 2-8 weeks. FGIDs are chronic conditions requiring ongoing management.
Clinical Perspective
Functional GI Disorders: Rome IV criteria define; disorders of gut-brain interaction. Most common: IBS (affects 10-15% of population). Pathophysiology: visceral hypersensitivity, altered motility, gut microbiome dysbiosis, brain-gut axis dysfunction. Subtypes: IBS-C, IBS-D, IBS-M. Functional dyspepsia: EPS (epigastric pain syndrome), PDS (postprandial distress syndrome). Diagnosis: symptom-based criteria; limited testing for red flags.
CRITICAL: Rule out red flags (alarm symptoms). Rome IV criteria for positive diagnosis. Multifaceted approach: diet (low FODMAP for IBS), lifestyle, psychological therapies (CBT, gut-directed hypnotherapy), medications as needed. Probiotics and peppermint oil have guideline-level evidence for IBS. Avoid unnecessary testing and polypharmacy.
* Probiotics (A-grade): Strain-specific effects. Meta-analysis: (PMID: 29882905). Cochrane: (PMID: 25007694). B. infantis 35624, L. plantarum 299v. 10-50 billion CFU daily.
* Peppermint Oil (A-grade): Antispasmodic. Meta-analysis: (PMID: 27841938). 180-225mg enteric-coated TID. ACG guideline recommendation.
* Psyllium (B-grade): Soluble fiber preferred. Systematic review: (PMID: 25623152). 5-10g daily. Insoluble fiber may worsen.
* L-Glutamine (B-grade): Gut barrier. Review: (PMID: 29430697). 5-15g daily. Evidence growing.
* Digestive Enzymes (C-grade): Carbohydrate maldigestion. Review: (PMID: 28332116). With meals.
* Ginger (B-grade): Prokinetic; nausea. Systematic review: (PMID: 27841938). 250-500mg 2-4x daily.
* Artichoke Extract (B-grade): Functional dyspepsia. Review: (PMID: 26182896). 320-640mg 2-3x daily.
* Slippery Elm (C-grade): Demulcent. Pilot: (PMID: 19192328). 400-500mg 3-4x daily.
* Vitamin D (B-grade): Common deficiency in IBS. Meta-analysis: (PMID: 28750270). 2000-4000 IU daily.
Assessment targets: Symptom diaries, Rome IV criteria, quality of life scales (IBS-QOL), dietary triggers.
Protocol notes: Low FODMAP: evidence-based diet for IBS; 2-6 week elimination then reintroduction; dietitian guidance ideal. Psychological: CBT, gut-directed hypnotherapy effective; address stress and anxiety. Medications: IBS-D (loperamide, rifaximin, eluxadoline), IBS-C (linaclotide, lubiprostone), antispasmodics, low-dose TCAs/SSRIs. Probiotics: not all equal; strain matters; try for 4-8 weeks. Fiber: start low, go slow; psyllium better than wheat bran. SIBO: consider if bloating, flatulence prominent; breath testing. Bile acid malabsorption: consider in IBS-D; bile acid sequestrants. Pelvic floor dysfunction: consider in constipation; biofeedback effective. Patient education: explain brain-gut axis; validate symptoms. Avoid: unnecessary antibiotics, excessive testing, opioids.