Holistic Approaches to Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is the most common intestinal disorder seen by doctors, affecting approximately 22 million people in the USA. It causes 34,000 hospitalisations; 3½ million physician office visits; 2.2 million prescriptions are written for it; and 400,000 people become disabled by it.
The main symptoms of IBS are recurrent colicky stomach pain; abdominal pain and distension; bloating, wind and cramps, rumblings, belching; diarrhoea and constipation sometimes alternating, flatulence, mucous covered stools.
Secondary symptoms can include a feeling of incomplete emptying after going to the toilet, incontinence and bladder problems, nausea, heartburn, indigestion, feeling full, back pain, headaches, lethargy, anxiety and depression.
The number and severity of symptoms varies from patient to patient.
IBS isn’t a particular disease. It is diagnosed by excluding other diseases; problems like food poisoning, lactose intolerance, lipid malabsorption, gastrointestinal bleeding ulcer, polyp or tumour, inflammatory bowel diseases such as colitis or Crohn’s disease, coeliac disease, diverticulitis, leaky gut syndrome, colon cancer, yeast, parasites or bacterial infection.
Once left with knowing what it isn’t, the condition can be named. Now it can be treated in various ways depending on the predisposition of the doctor. This is usually by drugs, dietary advice (even though they have no training), or by referral to a psychiatrist (a good way of getting rid of a problem patient).
Drugs include antispasmodics to relax the muscles in the intestines; anticholinergics to control peristalsis; antidiarrhoea drugs do as suggested, and other drugs can help both diarrhoea and constipation. It goes without saying these drugs have some potentially nasty side effects particularly if the condition has been misdiagnosed because exhaustive tests were not carried out.
More fibre in the diet is a common recommendation. Some relief may be experienced; then again fibre may make the situation worse.
If the doctor thinks it’s ‘all in the mind’, then a psychiatric evaluation may be suggested.
The holistic practitioner has a far better armoury of kindly weapons than conventional medicine where friendly fire is a likely outcome.
Suggested aetiologies for IBS include gut motility disorder, psychological disorder, psychophysiological phenomena and colonic malfermentation. Although the cause of the condition is unknown and is not curable, it can be controlled. The places to look are diet - food intolerance; gut flora and stress/emotional factors.
The common advice to eat more fibre can be good or bad depending on the type. Fibre has been described as a ‘spectrum of concepts’ which has over 40 actions on digestive physiology. Since they have differing actions, treating it as a single substance is not helpful. People often say they eat a high fibre diet. What they mean is they eat a high wheat fibre diet.
Wheat can be rough and irritating to the digestive tract. And it’s in everything. From breakfast cereals, bread, cakes and biscuits to soups, gravy and sauces. A good place to start is to cut down on wheat and replace with other whole grains and vegetables. Fruit should be OK unless the patient has blood sugar problems in which case a low carbohydrate diet is indicated.
Milk, cheese and dairy produce may also aggravate the condition. Soya milk and yoghurt may be an alternative, then again they may not. People can be sensitive to these also and find them difficult to digest.
Other food items to avoid are sugar and yeast products.
According to Dr Vernon Coleman, a former sufferer, the following foods should be tested to see if they are upsetting: all fried foods, strong tea or coffee, fizzy drinks, alcohol, fatty foods, spicy foods, pickles, curry, peppers, mustard, broad beans, brussels sprouts, radishes and cucumber, unripe fruit, very hot or very cold foods, course bread, biscuits or cereals, nuts, dried fruit, chocolate, any tough food that can’t be chewed easily.
Food sensitivity should be investigated in all IBS patients especially if chronic diarrhoea is a major problem. An elimination diet is the best way of finding the culprits.
A study put 21 patients on an elimination diet, eating nothing but lamb and pears and water for the first week. Other foods were then introduced one at a time. 66% improved considerably and were able to identify the culprit foods.
This was followed up by a larger trial of 122 IBS patients. 70% responded favourably. A questionnaire was sent out to these patients 2-3 years later. 87% continued to follow their diet with offending foods eliminated, and continued to benefit from it.
Other Diet Related Advice
Increase fluids, especially water. Herbal teas and dandelion coffee can replace tea and coffee. Eat when hungry and not according to the clock. Eat slowly. Chew. Concentrate. Avoid large meals. Don’t stuff huge amounts of food into the mouth. In other words, look at how a teenager eats and do the opposite.
Air swallowing, a cause of wind can be reduced with the following advice: eat at a leisurely pace, don’t gulp drinks or sip through a straw; avoid open mouth chewing or talking with mouth full; correct loose fitting dentures. Avoid common wind causing foods such as beans, broccoli, cabbage, raisins, popcorn, peanuts, onions, chocolate, coffee, and milk.
Dr R.C.Atkins’ Approach
In his Health Revolution the late Dr Atkins outlines the following regimen for dealing with his IBS patients.
1. Withdraw from pharmaceuticals (in collaboration with your doctor).
2. Withdrawal of foods for which the patient is sensitive using the cytotoxic test for food sensitivity. He finds the most common offender is wheat, followed by corn, dairy and yeast. Also test for improper food assimilation using the Indican test. Check for low stomach acid using the Heidelberg test.
3. Diet appropriate for blood sugar control. The majority of IBS patients show evidence of glycopathy (blood sugar imbalance).
4. Bowel cleansing. Most patients are given psyllium and bentonite preparations which may include many other bowel cleansing agents.
5. Nutritional supplementation. Supply full spectrum of vitamins and minerals plus additional panthothenic acid (vitamin B5) or pantothene (a B5 variant). Chronic diarrhoea can be normalised with megadoses of folic acid. This nutrient tends to be low in IBS patients in any case. Other important nutrients are vitamin A to protect the mucosal surfaces, zinc, magnesium, calcium and selenium. Calcium-EAP may also be prescribed as IBS may have an autoimmune component.
6. Action against pathological organisms. Endamoeba histolytica and Giardia lamblia are found in around half of all cases.
The faecal microflora in IBS has been shown to be abnormal with higher numbers of opportunistic organisms and low numbers of lactobacilli and bifidobacteria. The use of probiotics such as lactobacillus acidophilus and bifido bacterium are believed to be helpful in regulating peristalsis and reducing flatulence.
Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies show improvements in pain and flatulence in response to probiotic administration, whilst others show no symptomatic improvement.
It is very important to use supplements that are active. Unfortunately, tests on such supplements show that many do not have full biologically active ingredients.
Stress & Emotional Factors
Muscles in the bowel walls are as vulnerable to stress as any other. Overactivity of nerves that control bowel function may be brought on by long-term nutritional deficiencies, stress, or have a heredity component.
A history of anxiety and depressive disorders is associated with lower parasympathetic activity both in women with IBS and healthy controls. Further exploration is needed to understand if lower parasympathetic activity influences the pain and stool pattern changes seen in persons with IBS.
This proved so effective an NHS unit was set up especially for treating IBS.
An audit on the first 250 patients showed a marked improvement in all symptoms, quality of life and anxiety/depression. They concluded: hypnotherapy remains an extremely effective treatment. It may be less useful for men with a diarrhoea predominant problem.
These are the most commonly used by the public for treating IBS. There are many to choose from. Controlled trials suggest herbs are useful in the prevention and treatment of digestive disorders.
Ginger in nausea and vomiting, liquorice extracts in peptic ulceration, opium derivatives in diarrhoea and senna, ispaghula and sterculia in constipation.
Other useful herbs included rosemary, peppermint, balm, caraway seed, dill, fennel, artichoke and dandelion.
A randomised controlled trial of Chinese Herbal Medicine (JAMA 1998 Nov 11;280(18):1585-9) found patients in the active treatment groups had significant improvement in bowel symptom scores and global improvement as rated by patients and gastroenterologists compared to placebo. Patients reported treatment significantly reduced the degree of interference with life caused by IBS symptoms.
Padma Lax, a complex Tibetan herbal formula was found to be “a safe and effective treatment for constipation-predominant irritable bowel syndrome and may offer an alternative to the current multi drug approach.” (Digestion. 2002;65(3):161-71)
The herbal remedy that is officially endorsed by the German Kommission E (similar to the US Food & Drug Administration) is a combination of peppermint oil and caraway in an enteric coated capsule. It has been thoroughly researched and found to be an effective, safe treatment for IBS. It is called Regimint (Eden’s Best).
A double-blind study was published a few years ago on IBS patients. True and sham acupuncture was performed on 25 randomly assigned patients in two sessions.
The effect of the first true acupuncture on overall symptoms and abdominal pain was a clear and significant improvement, with consistently better results, although no comparable effect was seen in the second session (Digestion 2001;64(2):100-3).
An earlier German study found true acupuncture almost twice as effective long term than pseudo acupuncture (Z Gesamte Inn Med 1990 Oct 15;45(20):625-7).
IBS is a difficult condition to treat, but once all other possibilities are discounted, elimination diets or cytotoxic testing for food intolerances, vitamins, minerals, herbs and probiotic supplementation, Traditional Chinese Medicine, including acupuncture, and hypnotherapy are proven beneficial in both clinical trials and in practice. These options are preferable to current drug approaches.
This article was first published in Enzyme Digest No. 60, Spring 2003
Any health and medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.