The IBS-SIBO Link: What your Gut is Telling You

April is recognized as Irritable Bowel Syndrome (IBS) Awareness Month. If you have been dealing with ongoing abdominal pain, bloating, and irregular bowel movements, you are not alone. IBS affects millions worldwide and can significantly disrupt daily life, often without clear structural abnormalities in the gut.

In functional medicine, IBS is not viewed as an isolated condition but as a signal of deeper systemic imbalance. One commonly overlooked contributor is Small Intestinal Bacterial Overgrowth (SIBO), a condition in which excessive bacteria accumulate in the small intestine. This overgrowth leads to fermentation, gas production, inflammation, and symptoms that closely mirror IBS.

Functional medicine uses a systems-based framework to understand how symptoms connect across the body. In IBS and SIBO, this begins with assimilation, or how the body digests and absorbs nutrients. Bacterial overgrowth can ferment undigested food, leading to bloating and nutrient deficiencies, often contributing to fatigue.

Defense and repair are also impacted. Chronic exposure to bacterial byproducts can weaken the gut lining and impair immune function. This inflammation can disrupt energy production at the cellular level, increasing overall fatigue.

Communication refers to the gut-brain axis. Stress can heighten pain sensitivity and alter gut function. Transport, or gut motility, plays a critical role as well. Slower movement allows bacteria to accumulate. Biotransformation and elimination may also be impaired, leading to poor detoxification and recirculation of toxins that worsen symptoms.

A personalized lens is essential. Antecedents such as early antibiotic use or family history may predispose individuals. Triggers like infections, dietary changes, or stress can initiate symptoms. Mediators, including chronic stress or poor dietary patterns, perpetuate the cycle.

Lifestyle factors significantly influence gut health. Poor sleep, limited movement, imbalanced nutrition, and ongoing stress all contribute to dysfunction. Addressing even one of these areas can create meaningful improvement across multiple systems.

At its core, IBS often reflects disruption within the gut microbiome. SIBO may develop due to reduced stomach acid, impaired motility, prior infections, or certain medications. These factors create an environment where bacteria can overgrow.

Triggers such as processed foods, antibiotics, or acute stress can initiate imbalance. Over time, mediators like chronic stress and inconsistent eating patterns sustain it, forming a feedback loop.

This dysfunction extends beyond digestion. The gut communicates directly with the brain via the vagus nerve, influencing mood and pain perception. It also interacts with the immune system, contributing to systemic inflammation, fatigue, and even skin concerns.

Functional medicine considers SIBO a potential upstream driver in many IBS cases, particularly in constipation- or diarrhea-predominant types. However, proper testing is essential to confirm diagnosis and guide treatment.

By addressing IBS and SIBO through this interconnected approach, the goal is not simply symptom relief, but restoration of balance and long-term gut health. Working with a Carolina Total Wellness physician can help tailor this process to your individual needs.

March 20, 2026February 19, 2026

Colorectal Health: Simple Steps to Lower your Cancer Risk

Your colon plays a huge role in elimination, immune function, detoxification, inflammation control, and nutrient absorption—and keeping it healthy is one of the most powerful things you can do to support long-term wellness and reduce your risk of colorectal cancer.

The good news? Colon health isn’t complicated. It comes down to a few daily habits that add up over time.

One of the most overlooked parts of colorectal health is bowel transit time—how long waste sits in the body. Ideally, you want to be having at least one easy, complete bowel movement per day (for some people, 1–2 daily is normal).

If you’re often constipated, straining, or going days without a bowel movement, your body may be struggling with inflammation, dehydration, low fiber intake, or poor gut motility.

Try this:

Start your day with water (aim for 16–20 oz before coffee)

Add fiber-rich foods gradually (see below)

Walk daily—movement supports motility

Your colon is home to trillions of gut microbes, and they LOVE fiber. When your gut bacteria break down fiber, they create compounds that help protect the lining of the colon and support healthy cell growth.

Most people drastically under-eat fiber. A great goal is 25–35g per day, depending on your body and needs.

Easy fiber boosters:

Chia seeds or ground flax in smoothies

Lentils or beans

Raspberries, pears, apples, avocado

Broccoli, Brussels sprouts, artichokes

Chronic inflammation is one of the biggest drivers behind most modern health issues—including colon concerns.

Focus on:

Colorful vegetables daily (especially leafy greens)

Omega-3 fats (salmon, sardines, chia, flax)

Olive oil, avocado, nuts and seeds

Herbs/spices like turmeric, ginger, garlic

And limit:

Excess alcohol

Processed meats (bacon, sausage, deli meats)

Ultra-processed foods and refined seed oils

Lifestyle matters, but screening saves lives. Colorectal cancer is one of the most preventable cancers when caught early. If you’re eligible for screening (or have family history), talk with your provider about your best option.

March 6, 2026February 19, 2026

The Alarming Rise of Colon Cancer in Young Adults

Colon cancer, also known as colorectal cancer (CRC), is an increasing health concern for people under age 50.

According to recent data, approximately 153,020 new cases are diagnosed in the United States annually, making it the third most common cancer, and it claims about 52,550 lives each year. While overall incidence has declined in older adults, rates are rising sharply among younger people. In 2023, nearly 20% of cases occurred in those under 55, up from 11% in 1995, with a 1-2% annual increase since the mid-1990s.

Alarmingly, CRC is projected to become the leading cause of cancer death in adults aged 20-49 by 2030.

Theories for this rise in early-onset CRC (under age 50) point to a mix of lifestyle and environmental factors. Key lifestyle contributors include sedentary lifestyles, heavy alcohol use, and diets high in processed foods and sugars, and low in dietary fiber. Environmental factors include antibiotics, microplastics, food additives (like artificial sweeteners and emulsifiers) and synthetic food dyes.

These environmental and dietary factors can disrupt the gut bacteria or microbiota and lead to gut dysbiosis. Gut dysbiosis is a disruption in healthy gut microbial balance, promoting CRC through inflammation, impaired barrier function, and altered nutrient processing and mucosal integrity.

Healthy microbiota produces short-chain fatty acids (SCFAs) like butyrate for anti-inflammatory effects. High-fiber, polyphenol-rich diets foster beneficial bacteria like Bifidobacterium and Lactobacillus, which suppress procarcinogenic species and lower inflammation. Pro-carcinogenic bacteria like Fusobacterium nucleatum can lead to chronic low-grade inflammation and DNA damage. Chronic inflammation and DNA damage can then result in cancer formation.

Screening is crucial for early detection, when cure rates exceed 90%. The gold standard is colonoscopy, recommended starting at age 45 for average-risk adults, which visualizes the colon and can remove precancerous polyps. Non-invasive options include Cologuard, a stool-based DNA test detecting altered DNA and blood, with 93.9% sensitivity for detecting colon cancer. Cologuard testing should be done annually while colonoscopy can be done every 3 to 10 years depending on risk and initial findings.

Emerging cell-free DNA (cfDNA) blood tests, are an option for those wishing to avoid colonoscopy or stool sampling. These tests currently offer 83.1% sensitivity for colon cancer detection and should also be done annually.

While early detection of colorectal cancer is vital, the functional medicine approach focuses on prevention.

Comprehensive testing can evaluate the health of your microbiota as well as exposure to certain harmful dietary and environmental factors. If you are interested in testing, please speak with your functional health provider.

Stay tuned for our next newsletter which offers recommendations on how to reduce your risk of developing colorectal cancer.

References

Siegel RL, Wagle NS, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023. doi:10.3322/caac.21772
Stoffel EM, Murphy CC. Epidemiology and mechanisms of young-onset colorectal cancer. Gastroenterology. 2020;158(2):341-353. doi:10.1053/j.gastro.2019.07.055
Giannakis M, Ng K. A common cancer at an uncommon age. Science. 2023;379(6633):eade7114. doi:10.1126/science.ade7114
Imperiale TF, Porter K, et al. Next-generation multitarget stool DNA test for colorectal cancer screening. N Engl J Med. 2024. doi:10.1056/NEJMoa2310336
Chung DC, Gray DM, et al. A cell-free DNA blood-based test for colorectal cancer screening. N Engl J Med. 2024. doi:10.1056/NEJMoa2304714
Botteri E, Peveri G, et al. Lifestyle changes and colorectal cancer risk. Am J Gastroenterol. 2022;117(4):558-567. doi:10.14309/ajg.0000000000002065
Collado MC, Castillo MJ, et al. Diet as a modulator of the tumor microenvironment in colorectal cancer. Int J Mol Sci. 2023;24(8):7317. doi:10.3390/ijms24087317
Adigun A, Adebile TM, et al. Causes and prevention of early-onset colorectal cancer. Cureus. 2023;15(6):e45095. doi:10.7759/cureus.45095

November 21, 2025November 6, 2025

The Candida Diet: Restoring Balance Through Nutrition

For many individuals diagnosed with Candida, guidance on the Candida diet—and its role in managing and preventing yeast overgrowth—is often overlooked. Here, at Carolina Total Wellness, we combine medications and supplements with personalized guidance to help our patients successfully navigate the Candida diet.

In a healthy system, Candida coexists with other microorganisms in the gut, mouth, and skin. However, when it grows excessively—often triggered by factors such as antibiotic use, high sugar intake, stress, or a weakened immune system—it can lead to a condition known as candidiasis.

Symptoms may include digestive discomfort, fatigue, brain fog, recurring infections, or skin issues. The goal of the Candida diet is to restore microbial balance by depriving yeast of its preferred food sources and promoting the growth of beneficial bacteria.

At its core, the Candida diet emphasizes whole, unprocessed, and low-sugar foods while eliminating ingredients that feed yeast or irritate the gut. Sugar—whether refined, natural, or artificial—is strictly limited because Candida thrives on glucose.

Key components of the Candida diet include high-quality protein sources, such as poultry, fish, eggs, certain plant-based proteins, and non-glutinous grains.

Healthy fats from avocados, olive oil, and coconut oil help stabilize blood sugar and support cellular repair.

Non-starchy vegetables—including leafy greens, broccoli, cauliflower, zucchini, and cucumbers—provide essential fiber and antioxidants that nourish beneficial gut bacteria and assist detoxification.

Equally important is avoiding foods that encourage yeast proliferation. These include sugar in all forms (including honey and maple syrup), white flour, alcohol, and high-carbohydrate foods such as potatoes, corn, and most grains. Fermented foods like vinegar, kombucha, and soy sauce are often restricted, as they may contribute to histamine buildup or trigger sensitivities during the initial healing phase.

The Candida diet also encourages gut restoration through probiotics and prebiotic foods. Probiotic supplements or naturally cultured foods like unsweetened yogurt and kefir (if tolerated) help replenish beneficial bacteria that keep Candida in check.

Adequate hydration, stress management, and proper sleep are additional pillars of success, since the immune system plays a crucial role in maintaining microbial balance.

While the Candida diet can be restrictive, many people report improved digestion, energy, and mental clarity after several weeks. Expert guidance from our team at Carolina Total Wellness helps you follow the Candida diet safely to restore gut balance and long-term wellness.

April 25, 2025April 23, 2025

The GLP-1 Connection: Boosting GLP-1 Naturally through Microbiome Mastery

Your gut microbiome is a pivotal player in your overall metabolic health. One of its significant roles involves influencing the production of glucagon-like peptide-1 (GLP-1), a hormone integral to regulating blood sugar, insulin secretion, appetite, and weight management. In developed countries such as ours, factors including the Western diet, physical inactivity and chronic stress contribute to depletion of the microbes that stimulate GLP-1 production. But all is not lost, keep reading for dietary and lifestyle ways to replenish your microbiome and improve your metabolic health.

Key Microbial Allies

If you are a Carolina Total Wellness patient, your doctor may have asked you to submit a stool test to assess the presence of various specific microbes in your GI tract. Recent research shows that certain gut bacteria are particularly influential in promoting GLP-1 secretion.

Three ways these tiny creatures influence GLP-1 production:

Fermenting the fiber you eat to produce short-chain fatty acids (SCFAs) and stimulate GLP-1 secretion by intestinal cells.
Modulating bile acids. Increasing levels to promote GLP-1 secretion.
Increasing GLP-1 receptor sensitivity, thereby improving the hormone’s ability to regulate glucose metabolism and appetite.

Several keystone bacteria are known ‘influencers’ when it comes to the above processes. Some you may look for on your stool test results include Akkermansia muciniphila, Bacteroides thetaiotaomicron, Faecali- bacterium prausnitzii and Lactobacillus. Akkermansia is especially known for its role in supporting GLP-1 production. Check out last week’s newsletter from our own Dr. Miraloglu to learn more about Akkermansia.

Functional Strategies to Enhance GLP-1 Naturally

To support natural GLP-1 production through microbiome modulation, consider the following approaches:

Increase Prebiotic Fiber Intake: Foods rich in soluble fiber, such as oats, asparagus, garlic, onions, microgreens, flaxseeds, legumes, and sweet potatoes, serve as prebiotics, nourishing beneficial gut bacteria and promoting short chain fatty acid production (SCFA).
Incorporate Fermented Foods: Regular consumption of fermented foods like yogurt, kimchi, and sauerkraut introduces beneficial microbes that can support gut health and GLP-1 secretion.
Supplement Wisely: Specific probiotic supplements can ‘seed’ your microbiome with akkermansia and other beneficial bacteria. Compounds like berberine and N-acetylcysteine (NAC) have been shown to support metabolic health and may enhance GLP-1 levels. Talk to your provider about which supplements may be the best fit for your unique microbiome.
Diversify Plant Intake: Aim for a variety of plant-based foods to promote microbial diversity, which is linked to robust GLP-1 responses. Can you eat at least 20 different plants each week? Think outside the box, some particularly effective ideas include black or green tea, fruits and vegetables rich in polyphenol antioxidants like apples, beans, berries, cloves, dark chocolate, olives, plums, concord grapes, cranberries and rhubarb.
Manage Stress: The gut-brain axis is strong. When you experience chronic, unmanaged stress your body diverts resources from the gut to respond to the stress. Regular exercise, a contemplative practice like meditation or yoga and consistent, quality sleep are all beneficial to your microbiome.

The Positive Feedback Loop

Enhancing GLP-1 production not only improves metabolic parameters but also fosters a healthier gut environment. This creates a beneficial cycle where a balanced microbiome supports GLP-1 secretion, and increased GLP-1 further promotes gut health.

By focusing on dietary and lifestyle interventions that support the gut microbiome, we can naturally enhance GLP-1 production, offering a holistic approach to metabolic health. This aligns with the functional medicine principle of addressing root causes rather than merely managing symptoms.

See your functional medicine team at Carolina Total Wellness for tailored recommendations to optimize your microbiome and GLP-1 production.

To schedule an appointment with one of our certified Functional Medicine Physicians, please give us a call. We are excited to partner with you on your journey to optimize your health and wellness through personalized care tailored to your unique needs.

919.999.0831

Your Partner In Health,

Erica Nelson

Health Coach
Carolina Total Wellness

FAQ

WHAT IS GLP- 1 , ANYWAYS?

GLP-1 stands for glucagon-like peptide-1. It is a hormone, produced in the intestine and important for regulating blood sugar, insulin secretion, appetite, and weight management.

WHY ARE SO MANY PEOPLE ON GLP- 1 MEDICATIONS?

In developed countries such as ours, factors including the Western diet, physical inactivity and chronic stress contribute to depletion of the microbes that stimulate GLP-1 production. People with lower GLP-1 production are more susceptible to a wide variety of maladies including (but not limited to) diabetes, obesity, bowel diseases and metabolic disorders.

HOW CAN I HELP MY BODY MAKE MORE OF MY OWN GLP- 1 ?

Increase prebiotic fiber and fermented food intake, eat at least 20 different plants each week, manage stress and consider supplementing with a probiotic known to support GLP-1 production.

April 11, 2025April 9, 2025

Unveiling the Buzz! The Surprising Benefits of Akkermansia

Akkermansia is a fascinating bacterium that plays a key role in maintaining gut health and may offer potential benefits for metabolic health, obesity, and inflammation. Research into its therapeutic applications continues to evolve, and it could be a key player in future microbiome-based treatments.

WHAT ARE SOME OF THE KEY POINTS OF AKKERMANSIA?

1. Role in the Gut:

Akkermansia muciniphila is a type of mucin-degrading bacterium, meaning it breaks down mucin, which is a major component of the mucus lining the intestines. By doing this, Akkermansia helps maintain the integrity of the gut lining and may play a role in gut health.

2. Health Benefits:

Research suggests that Akkermansia may have several beneficial effects on health, including:

Improving Gut Barrier Function: It helps in maintaining a healthy mucus layer in the intestines, which acts as a barrier to harmful pathogens and supports gut health.
Metabolic Health: Studies have shown that higher levels of Akkermansia muciniphila are linked to improved metabolic health. It may help with weight management and insulin sensitivity, potentially reducing the risk of obesity and type 2 diabetes.
Anti-inflammatory Properties: Akkermansia may help reduce inflammation, which is associated with many chronic diseases, such as cardiovascular disease, inflammatory bowel disease (IBD), and others.
Gut Microbiome Balance: Akkermansia is considered a “beneficial” bacterium, and higher levels of it may be associated with a more diverse and healthy gut microbiome, which is crucial for overall health.

3. Factors Affecting Its Levels:

The levels of Akkermansia muciniphila in the gut can be influenced by various factors, including diet, lifestyle, and overall gut health. For example:

Dietary Fiber: A diet rich in dietary fiber, especially from fruits, vegetables, and whole grains, can promote the growth of Akkermansia.
Prebiotics and Probiotics: Certain prebiotic fibers and probiotics might help increase the abundance of Akkermansia in the gut.
Obesity and Metabolic Disorders: Lower levels of Akkermansia have been found in individuals with obesity, type 2 diabetes, and metabolic syndrome.

4. Potential Therapeutic Uses:

Researchers are investigating the use of Akkermansia muciniphila in therapeutic applications, including as a probiotic. The potential benefits include:

Weight Management: Studies have suggested that Akkermansia supplementation may help with weight loss and metabolic health, although more research is needed.
Gut Health: Akkermansia supplementation may help restore balance to the gut microbiome and improve conditions like irritable bowel syndrome (IBS) or IBD.
Type 2 Diabetes: There is ongoing research into how Akkermansia may help improve insulin sensitivity and glucose metabolism.

5. Research and Future Directions:

While much of the current research into Akkermansia is still in the experimental stages, its potential for improving gut health and metabolic conditions is promising. However, more clinical trials are necessary to fully understand its therapeutic applications and optimal usage.

At Carolina Total Wellness, we evaluate the levels of Akkermansia through a stool test and treat you accordingly on whether this probiotic would benefit you.

Come see us about what the hype is all about!

919.999.0831

October 4, 2024October 3, 2024

Making Healthy Choices in our Modern Society

April 14, 2024April 14, 2024

Part II – Low SIgA And How Do We Treat

Shane Hemphill, MD

Part II – Low SIgA And How Do We Treat

So your functional medicine provider ordered a Comprehensive Stool Analysis and your SIgA levels are found to be low. What is your next step? The answer is going to vary from person to person, but the ultimate answer is in finding the root cause.

This may include evaluating for and removing a food sensitivity, mold sensitivity, or infection that has over time depleted the immune response.

Once we have eradicated our offending agent we need to look at ways to improve our SIgA levels.

As a general rule the first step is to use an anti-inflammatory diet such as a Mediterranean diet. This is rich in fruits, vegetables, nuts, legumes, olive oil, and fish and low in red meat and saturated fats. One can also eliminate fried foods, processed foods, sugary snacks and soda.

More specific treatments Include:

A diet rich in Polyphenols such as cacao, green tea, and grapeseed extract which have shown to increase SIgA levels.

Saccharomyces Boulardii – This probiotic yeast has been shown to raise SIgA levels while also being very effective against Clostridium Difficile and Candida Overgrowth.

Colostrum – an Immunoglobulin secreted in the early stages of breast-feeding. This has shown to stimulate SIgA levels.

Beta Glucans – This is a type of soluble fiber found naturally in a variety of food sources including oats, barley, rye, rice and mushrooms like Reishi and Shiitaki.

Bone Broth – This is made by simmering the bones and the connective tissue of animals. This forms a stock for making soups, sauces and gravies. Depending on which part you use it contains vitamins, minerals as well as collagen and other amino acids that increase SIgA levels.

Fat Soluble Vitamins – Vitamin A is needed for the transport of SIgA over the mucosal lining. It is suggested that Vitamin A is also involved in the synthesis of other immunoglobulins and has an important influence on our humoral immune system.

Stress Management – Last but not least, Cortisol is the main stress hormone that can decrease SIgA levels. We need to look over your current stressors or perceived levels of stress and then work to reduce them. This can be done through aerobic exercise, yoga, breathing techniques, meditation as well face to face conversations with your friends, family or therapist.

Our functional medicine physicians can help you understand the root cause of low SIgA and design a treatment plan specifically for you, please call our office at 919-999-0831 to get scheduled.

Your Partner in Health!
Shane Hemphill, MD