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Case Study Issue 150: Naturopathic Approaches to IBS: Two Case Histories

by Michael Franklin(more info)

listed in ibs, originally published in issue 150 - August 2008

Of all the chronic illnesses with unpleasant symptoms, Irritable Bowel Syndrome, or IBS as it is called for short, almost certainly gets less effectively treated than any other by the NHS.

There is even disagreement and confusion about what symptoms constitute IBS but, after five years of running the IBS and Gut Disorder Centre and seeing a huge number of patients with the syndrome, there is no doubt in my mind that the best way to define it is to say that someone has IBS when they have had at least two of the following symptoms for a minimum of three months:

• Constipation;
• Diarrhoea;
• Flatulence;
• Bloating;
• Abdominal pain.

Reasons Why Doctors Cannot Treat IBS

I think the major reason the NHS just cannot treat it effectively is because it is regarded by most doctors as a ‘dustbin diagnosis’, which means that they do not see it as a real illness, but simply a collection of symptoms that can be given the label of IBS only when more serious illnesses have been ruled out.

Palmed off with a Prescription

When a patient goes to their GP with any of the above symptoms, they are usually palmed off with a prescription for a medicine that can easily be bought over the counter, and which the patient him or herself has probably already bought and found has made no improvement. By the time they have seen their GP two or three times, they will probably get a referral to a gastroenterologist who will do a test to rule out either advanced stages of cancer, ulcerative colitis or Crohn’s disease. If these tests are negative, then the patient will be sent back to their GP and told they probably have IBS, and that they will just have to learn to live with it – a situation which is exemplified by a story I was told by a recent patient who said his GP had said to him, “Oh my God, it’s you with your IBS again. One of these days you’ll have a real illness to complain about.”

Drawbacks of NHS Tests

What doctors cannot comprehend is that IBS has more than one cause. They have spent six years in medical school but most of it has been spent studying anatomy, physiology, pharmacology, pathology, etc. They have spent very little time being taught how to help people with chronic symptoms such as fatigue, migraine or IBS. The tests used by orthodox medicine are all camera tests which look for information in the gut wall by means of a camera being sent down your throat in the case of an endoscopy, or up the backside in the case of a colonoscopy or sidmoidoscopy. They are all invasive and not really much fun to experience. What they don’t do, and what doctors just don’t seem to realize, is that they are looking solely at the gut wall and not at the contents of the bowel. The fact that they are not looking at what is swimming around in the gut means that those tests just do not enquire at all about three of the major causes of IBS: parasites, nasty bacteria and yeast overgrowth.

The tests we use to look for these three possible causes of IBS, and to quantify on a scale of 0-4 the amount of beneficial bacteria in the gut, involve the examination of stools, and is done by an American lab where techniques are considerably more sophisticated than any currently available in the UK. David Hopkinson was an example of this.

Case Histories

Case A

David had experienced quite bad diarrhoea for the last three years, accompanied by a certain amount of flatulence, bloating and abdominal pain, so life was no fun for him at all – particularly because the diarrhoea was always so bad in the mornings that he was frightened to leave the house before 11am. He had been to no less than three gastroenterologists because he was determined to get to the bottom of his symptoms. I saw a copy of the letters written by the Consultants to his GP, and there is no doubt that all of them had tried hard. But they all tried hard only with the tests which they used. They had never, as one long-term patient of mine often observes, “looked outside the box.”

David’s test had found no sign of cancer, Crohn’s or ulcerative colitis and so, in spite of having five different NHS tests, no answer had been found. He had been referred back to his GP, and guess what his GP had suggested? An anti-depressant.

Parasites and Foreign Travel

When David came to us, we sent him three long questionnaires; these ask so many questions that almost always lurking somewhere is an answer that gives a very strong clue as to the cause of the patient’s symptoms. In David’s case it was the fact that his symptoms had originated soon after a trip to the Dominican Republic, where he had had a fairly severe short-term upset stomach with diarrhoea and vomiting. When I told him this immediately suggested parasites as a cause, he said, “Yes, I know that, that’s why I went to a hospital and they found Giardia. I took a drug for it and three months later a re-test showed I was clear. So it can’t be that, and surely that means parasites are not the cause.”

I told him that was not the case, and that parasites could indeed still be the cause, because we have often found that when a previous test has found only Giardia, a subsequent test applying the very sophisticated techniques of the American lab we use, will find that the Giardia has indeed gone, but that the patient still has one or even two other parasites that have never been fully eradicated. This is what happened in David’s case. The test found both Blastocystis hominis and Dientamoeba fragilis, two parasites which are surprisingly common in British patients who have IBS-type symptoms.1 With the appropriate treatment, David got a lot better and his diarrhoea went away.

Case B

The case of Annie Lee was rather different. She had major diarrhoea and bloating with some abdominal pain, for 34 years. She had found her GP very unhelpful, and was annoyed that he continually blamed all her symptoms on stress without looking for an underlying cause. Annie could have had parasites too but, looking at her questionnaires, it looked unlikely, because there were several other factors that gave a very strong indication of another cause. Her weight had increased by over a stone in the last three years; something you would not expect in the case of parasites because, to a degree, parasites eat the food we eat, and so someone harbouring parasites in their gut would tend, although they can be of normal weight, to lose weight and be on the thin side of normal.

Thrush and Other Symptoms

What was most significant in Annie’s case was that she also reported troublesome vaginal discharge and persistent vaginal itching, both usually symptoms of thrush. She had given these symptoms a ten out of ten on her Candida questionnaire, and also reported occasional itching in many different parts of her body, along with urinary urgency and frequency. These are all tell-tale symptoms of yeast overgrowth – as was the fact that Annie craved sugar and was extremely fond of wine. Yeast organisms in the gut feed on sugar and yeast and so, where a patient has this problem, they are very likely to crave sugar and be very fond of red wine or beer or bread or Marmite, all foods which contain a lot of yeast.

What had happened in Annie’s case was that the antibiotics she had taken for several years for acne when in her teens, had acted like a hoover in the small intestine and had swept out all the friendly bacteria, in addition to the bacteria they were intended to kill. As she then knew nothing about the beneficial effects of probiotics, she had not tried to re-populate her gut flora by taking probiotics, and so this had left the yeast organisms in her gut free to proliferate. As Annie was eating several foods containing sugar and yeast every day, they were proliferating to the extent that they caused Candida overgrowth.

Chocolate and Sugar

In Annie’s case the symptoms were very severe, but then when I looked carefully at her history I could see why. As a child she had craved chocolate so much that her mother bought her endless tins of another food to act as a substitute – because she thought chocolate was bad. Unfortunately, the substitute was toffee – and of course that contains even more sugar than chocolate. She was also taking one spoon of sugar in every cup of tea (and she had five a day), and she put two teaspoons of sugar on her cereal every morning. Also, because she had developed asthma as a teenager, she had used steroid inhalers on and off for 36 years. Steroids, as every well-informed practitioner knows, causes Candida to increase, and it is very hard to get rid of it unless the steroids are stopped.

After treatment with probiotics, appropriate natural anti-fungals, a glutamine-containing supplement to heal intestinal permeability, and following a strict sugar-free, yeast-free diet, Annie’s symptoms got better and better.

Conclusion

What these two case studies illustrate is that what causes IBS in one person is different to what causes it in another. The symptoms may be very similar, but the causes can be very different, and this is what GPs, with a consultation time of only seven minutes, cannot get to grips with nor really understand. Treatment with a Nutritionist or Naturopath who fully understands IBS has a high chance of success, because consultations last at least an hour and are so thorough that each and every one of the possible causes can be looked at. Other additional causes are food intolerances (which have to be looked for by means of a blood test) or pathogenic bacteria, such as Citrobacter freundii or Klebsiella, which can be looked for in the same stool test that looks for parasites.

References

1.    Franklin M. The Real Causes of IBS: Parasites Revealed by Digestive Stool Analysis. Positive Health. Issue 12. March 2006.
Truss O. The role of Candida albicans in human illness. The Journal of Orthomolecular Psychiatry. 10(4). 1983.
Truss O. The Missing Diagnosis. Birmingham. Alabama. 1983.
Madden J and Hunter J. A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics. British Journal of Nutrition. 88: (Suppl. 1) s67-s72. 2002.
Hamilton-Miller J. Can probiotics improve health? Pulse. 60(6): 53,57. 2000.
King T, Elia M and Hunter J. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 352: 1187-9. 1998.
Galland L M.D. Power Healing. Random House. New York. 1997.

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About Michael Franklin

Michael Franklin is the founder of the IBS and Gut Disorder Centre which has branches in Oxford and London. He may be contacted on Tel: 0845 456 0944 or Tel: 01865 459553;  www.ibs-solutions.co.uk

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