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Irritable Bowel Syndrome

by Lynn Toohey, Ph.D.(more info)

listed in ibs, originally published in issue 14 - August 1996

IRRITABLE BOWEL SYNDROME (IBS) is a common condition in which the large intestine fails to function correctly. In fact, it is so common that it represents 30-50% of all referrals to gastrointestinal specialists. Even this may be a conservative estimate, as the number of people complaining of symptoms seems to be growing. Rosemary Nicol, author of, Coping Successfully with your Irritable Bowel, claims that one person in three suffers from IBS at some point in their life, and one in ten has it severely or often[1]. One health practitioner in Exeter reports that she hardly has anyone come through the door anymore without bowel problems. Why is it that this has become such a common affliction, and what can be done to eliminate the problem? In an attempt to answer that, let’s take a closer look at what is involved in IBS.

Irritable Bowel Syndrome is also known as mucus colitis, spastic colon and nervous indigestion, and is observed more often in women than in men. Symptoms of IBS include abdominal pain, excess mucus secretion in the stools, constipation, nausea, diarrhoea, anorexia, bloating, anxiety, flatulence, and depression. The etiology of IBS is not really defined, however, possible factors include (but are not limited to):

1) Low fibre diet
2) Food allergies
3) Dietary factors – including excess dietary fats and refined foods
4) Psychological factors – stress, anxiety, depression, fatigue
5) Candidiasis – complicates IBS and increases food sensitivities
6) Laxative and antibiotic abuse

The importance of the diet cannot be stressed enough. A low fibre diet is one of the major causes of IBS. The fact that the fibre in the average diet keeps declining as the incidence of IBS keeps increasing is no coincidence. Fibre keeps the muscles of the colon exercised; the contractions of the colon are quite powerful, and problems can arise when the contractions are made against minimal bulk. Fibre also helps to facilitate the passage of waste material and toxins out of the body, removing things such as secondary bile acids which can be carcinogenic[2]. Fibre has the capacity to draw out harmful pathogens residing in the colon, such as candida, which is known for its tenacious hold on the intestinal lining.

Just as a low fibre diet can be involved in the development of IBS, adding fibre back into the diet many times can alleviate IBS. Care must be taken, of course, in the cases of individuals who are so progressed that they may be sensitive to an increase in fibre. Care must also be taken to avoid fibres such as wheat, which can trigger food allergies. Oat and rice bran are excellent fibres; rice bran, in addition to providing benefits as a fibre, possesses potent antioxidant activity[3]. Vegetables and fruits are high in fibre, as are legumes, psyllium, and guar gum. Water intake should always be increased with increased fibre intake.

Food sensitivities have been implicated in the etiology of IBS. It has been estimated that approximately two-thirds of IBS patients have at least one food intolerance[4]. Most food reactions are caused by IgG reactions (delayed onset reaction; from one hour to three days), rather that the classic IgE reactions (immediate antibody reaction to an airborne allergy). For this reason, classic allergy tests, (skin-scratch tests and IgE RAST (radioallergosorbent test) are not good tests. The IgE-IgG RAST is better, but the elimination/challenge test is still the least expensive and produces the best results. Again, diet cannot be stressed enough. Helen Downs of Exeter (therapist, kinesiologist, and iridologist), uses an elimination diet similar to that recommended in the Nutritional Physiology book, which avoids dairy, wheat, sugar, coffee, alcohol, and chocolate. She recommends vegetable intake (both raw and cooked) to be increased to 50% of the diet. In a fortnight, she reports, bowel movements have usually improved before supplements or any additional treatment. Colon cleansers are then helpful to clear waste; Helen likes to use one with the bulking psyllium and other supporting nutrients.

The challenge test, as described in Nutritional Physiology, involves having the patient eat only hypoallergenic foods for one week to one month. For instance, foods such as chicken, lamb, rice, potatoes, basic fruits and vegetables – (some people are allergic to tomatoes and “nightshade” plants). Symptoms should disappear. If not, the diet needs to be further evaluated to make sure no allergy foods are being consumed. If foods are re-introduced one at a time every 3-4 days, the pulse should be monitored, and any foods that cause a reaction need to be avoided until the body is normalized.

IBS patients should avoid excess dietary fats and fried foods (this will happen as a natural consequence if more vegetables, fruits, beans and legumes are worked into the diet). A diet high in meat and dairy favors an imbalance of the essential fatty acids, in favor of the fatty acids which produce inflammatory and vasoconstrictive prostaglandins (hormone-like substances). Black currant seed oil, flaxseed oil, and linseed oil are examples of oils which help balance in favor of antiinflammatory and vasodilating prostaglandins. Food which has been fried at high temperatures is not only aggravating to the bowel, it gets oxidized; the body produces enough free radicals without ingesting more from oxidized oils. Cooking oils, once opened, get exposed to air, heat, and light, and are best refrigerated, which cuts down on the consumption of oxidation products.

Stress is highly associated with IBS, and when psychological factors are involved, it usually makes for a challenging diagnosis which requires integrative treatment. Hans Selye, who is best known for his research on stress in the 50s, said that, “a painful blow and a passionate kiss can be equally as stressful”. Anything which requires a return to homeostasis can be considered a stress, and that can include heat/cold, sugar, depression, environmental toxins, or any other challenges to return to a normal state of functioning. Selye also coined the definitions for the three stages of stress, which are: the alarm stage; the resistance stage; and the exhaustive stage. In the alarm stage, our sympathetic nervous system activates to rise to the challenge; this is the “fight or flight” reaction.

The last priority is the digestive system; blood vessels constrict as the blood is diverted to the main organs of the body which prepares it for “flight”.

In the resistance stage, the body is in a mode where the endocrine system stays activated with elevated levels of substances such as cortisol, to deal with the stress. Nowadays, suppressed immune systems have been linked to the result of this continued resistance stage. In the third stage, or the exhaustive stage of stress, supplies are exhausted, and the body loses the ability to cope with stress in a normal manner. 

Frequently, stress management can ameliorate IBS symptoms. Relaxation exercises, yoga, meditation . . . anything really which reduces the challenge to the system and allows the muscular contractions of the digestive system to work properly is helpful. Deepak Chopra, M.D., cites meditation studies which show that DHEA (di-hydroepiandosterone) is elevated in people who practice meditation. DHEA has been associated with anti-aging effects, is usually kept in a delicate balance with cortisol as an anti-stress hormone, and is lower than normal in many people.

In, Coping successfully with your Irritable Bowel, Rosemary Nicol proposes an interesting approach of “autogenic training”, which is an extension of hypnotherapy at a self-help level1. Most people accept that a state of mind can cause a physical illness, and a persistent illness can produce an upset state of mind. When they realize that the mind can affect the body in a harmful way, they can then realize that it can affect it in a good way. Autogenic training exercises involve visualization, such as that of a calm, healthy colon free from spasm. Patients may focus on the smooth muscle that propels the digested food, and visualize the sea and a sailboat moving peacefully along on the waves; transferring the image to the smooth, wave-like motion of the colon muscles, enables them to calm the peristaltic waves.

The neuro-hormonal component of the digestive system plays an integral role in the smooth operation of the system, and must be integrated sometimes with other therapeutic approaches. For instance, Dr. Edward Hamlyn, M.D., treated a patient with a suppressed immune system aggravated by wheat allergies. After removing some emotional blocks, the wheat allergy cleared. Peter Lomax, D.C. from Newcastle notes that there are many Scots who have wheat allergies. Proponents of the Paleolithic theory of nutrition theorize that one of the reasons wheat is such a major offender is because it was added to the food chain relatively recently in the scheme of things. Simply repeating the consumption of some foods over and over can cause food sensitivities; creativity is one of the keys in avoiding them.

Candidiasis is a condition which can complicate IBS and increase food sensitivities. Normally, the large intestine hosts a balance of beneficial bacteria (Lactobacillus acidophilus, bifidus, bulgaricus etc.) along with organisms such as candida. The beneficial bacteria helps keep harmful bacteria and pathogens like candida in check, until something happens to upset the balance[5]. An immune challenge can set the stage for candida overgrowth. Candida, “incites disease in hosts whose local or systemic immune system attributes have been impaired, damaged, or innately dysfunctional”[6]. The Lactobacillus flora in the gut are responsible for contributing to the integrity of the immune system. In fact, the Journal of Nutritional Medicine points out that immunostimulation is the most important mechanism by which Lactobacilli inhibit the growth of colon cancer[7].

Supplementation of probiotic flora can reestablish the balance of good bacteria in the gut. Lactobacillus flora also regulate peristalsis and reduce flatulence. Additionally, fructooligosacharrides (FOS) can foster the population of bifidobacteria. Fructooligosacharrides are composed of a fructose molecule attached to several glucose molecules, in a unique arrangement which evades digestion by the enzymes of the small intestine. The FOS pass into the colon, where they enhance the growth of probiotic flora. One practitioner who utilizes probiotic flora for rebalancing and acidifying the large intestine stresses the importance of drinking filtered water (4-6 pints) for efficacy of treatment.

Where malalignment occurs, adjustments can be helpful. “A series of autonomic nerve pathways exist between the organs and the spinal tissues and back again, and by using manipulation and other techniques the osteopath can break into these reflex pathways in an attempt to change or influence anything that is not working properly in the gut. Because IBS is a disorder in which abnormal reflexes lead to the abnormal working of the gut, often caused by stress, the osteopath attempts to treat the condition by using these reflexes themselves”1 p.104 One practitioner always checks alignment near the occipital lobe, since the vagus nerve is so highly connected to the digestive system. Quite often, the ileo-cecal valve won’t stay closed, and can be responsible for anything from acid reflux to IBS. Helen Downs notes that the change in diet helps to keep the ileo-cecal valve closed after adjustment.

Sometimes people are resistant to a change in diet, but then the so called, “modern diet” is at the root of a lot of disorders. Common excuses are that it is inconvenient to have a “different diet” when one is expected to cook and eat with a family. However, the healthy diet need not be “different”. Substituting wholesome food where refined, processed food has existed in the past can become a new way of life, one which will prevent the body from manifested dysfunction in the future. Children aren’t necessarily the ones who are resistant to changes in the diet. After excellent results from her treatment, one youngster reported back, “I’m going to make mummy keep doing this for me”.

Fibre is essential in the treatment for IBS, and many nutrients are helpful, including ginger, which is good for digestive complaints in general. Chamomile, valerian, passionflower, skullcap, rosemary and peppermint have antispasmodic effects on the colon. Chlorophyll is neutralizing, balancing, and detoxifying.

Exercise is a good part of the plan, and increases regularity. Some other recommended treatments have included lymphatic massage, hot and cold showers to increase circulation, herbal therapy, acupuncture, aromatherapy, breathing exercises, and reflexology.

It should be noted that many conditions mimic IBS, including: parasites, laxative abuse, inflammatory bowel disease, diverticular disease, candidiasis, cancer, lactose intolerance, malabsorption syndromes, and metabolic disorders including hyperthyroidism, adrenal insufficiency, and diabetes. Sometimes it is hard to discern where the origin of the disorder arose, especially since all individuals will manifest imbalances in different ways. Integrating therapeutic approaches while keeping in mind the structural, the neural, the hormonal, and emotional components of each individual presents the challenge of diagnosis and treatment.

Case History no. 1

A 28 yr. old female (single, self-employed artist) presented with lower abdominal pain, which had been quite intense for the previous 23 days. She was plagued with bouts of constipation alternating with diarrhoea. Her menstrual cycle was abnormal (32 days). A car accident six years prior was responsible for a smashed hip, adhesions, and joint problems. The patient also had psoriasis, candida, and gall stones.

Therapy consisted of 15 treatments over the course of time, and addressed some of the structural, emotional, and nutritional problems suspected in this particular patient. One of the first things addressed was an emotional bitterness toward the situation, which was treated with an herbal flower preparation. An adrenal glandular preparation was administered to boost the stress-fighting glands of the body. A homeopathic tincture addressed the energetic imbalance and joint problems. Nutritional supplementation of a complex of plant enzymes, along with the soothing demulcents slippery elm and marshmallow root, attempted to rebalance pH and help digestion, (which also increases nutrient supply to tissues).

Utilizing a structural plus technique, the body’s orientation was realigned, and proprioceptors normalized by adjusting L-4 and C-2. An applied kinesiology technique of ionization was incorporated to correct a charge imbalance by administering potassium. Homeopathy and dairy-free probiotics (Lactobacillus flora) were used for large intestine regeneration, with parathyroid glandulars for calcium metabolism. An herbal preparation including garlic, golden seal, and echinacea was used to eliminate candida. Also used were female glandulars, kidney support, and a regimen to clear the gall bladder. After a juice fast, nutrients including inositol, choline, lecithin, and phosphoric acid were administered, along with olive oil and lemon juice, with more phosphoric acid. The patient wound up passing a gall stone the size of a golf ball, in addition to little black stones the size of small grapes which continued to come out. (It should be emphasised that this procedure should only be conducted under qualified, clinical supervision, since the size of the gallstones can exceed the size of the bile duct and cause biliary colic.)

During the course of treatment, the patient was prescribed antibiotics from a medical doctor. A urinary tract infection was treated with homeopathy, and administration of probiotic flora helped to restore the balance of good bacteria in the gut. In the last month of treatment, Chinese herbals, nutrients to regulate blood sugar, and a comprehensive vitamin-mineral support for the general circulatory system helped to restore balance, and the patient was able to report that she was symptom-free and felt the best she had since her accident six years previous.

Case History no. 2

A 52 yr. old female complained of uncomfortable symptoms in the bowels, and irregularity in bowel habits. Suspecting possible dysbiosis, a stool sample was sent to the lab for analysis. Results showed that bacteria were actually fairly balanced with no parasitic invasion, and metabolic markers were normal. However, there was a slight abnormality in the absorption rate of long chain fatty acids. The patient was treated with digestive enzymes, and IBS symptoms dissipated shortly thereafter.

Case History no. 3

A 55 yr. old male presented with IBS symptoms; pain coupled with movements, straining, small, hard stools, excessive flatulence. Patient was diagnosed with several chemical sensitivities, and was put on a detoxification program which included vitamin and mineral support to clear toxins from the body, conjugating nutrients to bind to the toxins and make them excretable, and Chinese herbals to restore energy balance. Candida was diagnosed and treated with an herbal preparation containing garlic, golden seal, and caprylic acid. Bowel detoxification included a high fibre-supplement, montmorillinite clay for toxin-binding, and healing demulcents such as slippery elm, aloe vera, cabbage, and deglycyrrhizinated licorice. Dairy-free Lactobacillus cultures were administered to restore the balance of gut flora, build immunity, and regulate peristalsis.

Quercitin, a bioflavonoid, scavenges free radicals and was given to aid in tissue repair. L-glutamine is a nutrient that is a major fuel of the intestines, and heals intestinal cells; it has been postulated that glutamine works, “possibly by protecting the host from microbial invasion and associated infection” Ann Surg 1991; 214(4):385-93.

With thanks

The author would like to extend special thanks to the doctors and practitioners who contributed information and case histories to this article. They include: Steven Johrre, Applied Kinesiologist, Edinburgh, Scotland; and Michael Ash, Osteopath, Exeter, England, and Jake Fratkin, OMD, L. Ac., Doctor of Oriental Medicine, Boulder, Colo. USA; Helen Downs, (therapist, kinesiologist, and iridologist) Exeter, England; Edward Hamlyn, M.D. Ivybridge, England; Peter Lomax, D.C. Newcastle, England.

References

1. Nichols, R. Coping successfully with your irritable bowel. Sheldon Press, London, England. 1991.
2. Scand J Gastrol Suppl 1993;200:80-6.
3. Life Sciences. 1993;53:1283-9.
4. Murray, M. and Pizzorno, J. Encyclopedia of Natural Medicine, Prima Publishing, CA, p. 397.
5. Microbios 1990;62(250):37-46.
6. Bodey, GP, ed. Candidiasis: Pathogenesis, Diagnosis, and Treatment. 2nd ed. Raven Press Ltd. NY, NY 1993, p. 13.
7. J Nutritional Med. 1994;4:179-98.


Michael’s Story

Michael Jefford, at thirty-seven, always prided himself on having an iron gut. ‘If someone had described to me when I was twenty-seven what would happen, I just wouldn’t have believed it. I couldn’t have conceived something as awful as this.’

Michael has had IBS for seven years. It came on suddenly – there was no warning, no traumatic event – and he lives daily with a catalogue of appalling symptoms. ‘For me a typical bad day will start with me feeling I need to go to the toilet the moment I get up. I will go and my stools are very loose – they are never properly formed. Going to the lavatory is a totally ineffectual experience.

‘Ten or fifteen minutes later you feel you need to go again, and this can go on all day. I’ve got to the stage now that I try to ration myself – if I went every time I felt I needed to go I would spend the whole day on the toilet. I don’t get abdominal pain, but I get a dull ache in the upper stomach usually after one of these ineffectual bowel movements.

‘People say they have constipation or diarrhoea – I would say I have “constarrhoea” because the stools are very hard to pass, but when you do pass them they are like diarrhoea. Every day, I dread it. It’s always at the back of my mind. I find it very difficult to trust my body. After a fashion I can control it. So far I haven’t had any accidents, but you wonder how close you come to having one.’


Fiona’s story

Fiona, a twenty-nine-year-old theatre box-office assistant from Wales, has had IBS since she was fourteen, but was diagnosed only four years ago.

‘When I get an attack, I get stomach ache, gripes, diarrhoea, pains, and I feel sick. I can usually tell when an attack is coming on. I feel tired and I get a backache and stomach ache and I know what is going to happen.

‘It’s usually worse in the mornings, then I start going to the toilet – then that’s it for a couple of hours. You don’t always know when an attack is coming. I can usually tell, but not always.

‘I’ll phone up work and say, “I’m going to be late, it’s the usual”, and I’m in and out of the toilet for a couple of hours. Then it gradually stops and if it gets too bad I’ll take something for it. It makes me very very tired.
‘Most of the time I cope not badly, but sometimes it does get me down and I get quite depressed about it. If I go out I always make sure if there is a toilet nearby. I don’t think doctors realise how upsetting it can be. I don’t think anyone can until they’ve experienced it.’


Christopher’s Story

When forty-nine-year old Christopher Brown thinks back, he now sees that his IBS symptoms had been building up for some time. ‘I remember lying in bed about six years ago and it was almost as if my tummy was bubbling, almost exploding. It was violently bubbling and churning and was quite frightening really – almost as if an alien would burst out, like the film.

‘From then on it has slowly developed. When I have a bout I have to go to the loo a lot, and have a lot of uncomfortable wind, as if it gets trapped. It’s painful when it’s in the gut – you almost want to bend double, quite often after you’ve eaten.

‘It’s controllable, but I have to go the the cloakroom because you daren’t risk relieving yourself – because there are pockets of matter interspersed with the wind. You can’t guarantee that it’s just wind.
‘I went out for a meal the other day and went to the loo and it was just wind. But if I hadn’t have gone it would have built up and it could have been extremely painful. I don’t understand where all the wind comes from.’


Linda’s story

Twenty years ago, Linda Robinson, now forty-one, and her husband decided they would go somewhere exotic for their holiday.  They plumped for Egypt, but it left Linda with a legacy from which she is only beginning to recover.  She caught food poisoning – salmonella – and it left her with IBS.

‘I was ill for about two months and when I recovered, my bowels were in a bad state. It recurs from time to time – it’s almost like a mini-food poisoning for a few hours. There are long periods of time – up to three or four month – when I don’t get it at all. Then I’ll suddenly get it for no apparent reason.

‘It usually starts with pains in my lower stomach, then I get diarrhoea and at that point it’s very difficult to be away from the toilet for more than a few minutes. That could last from an hour up to half a day.

‘The worst thing about the diarrhoea is that it starts fairly late. I can’t sleep because of it and then I start the next day really tired. I’ve learnt to cope to a degree at work. All I’ve got to judge is have I got long enough to (a) get to work (b) get home.

‘I know where all the public lavatories are on the route, but in this area, West Yorkshire, there aren’t that many. Once I was in the embarrassing situation of making a mess of myself – fortunately it happened after I had got off the bus. I had to run down the road, rush into the house and get into the bath as fast as I could.

‘I don’t think people realise how awful it can be. This is why some sufferers can get into a rut of not wanting to do anything.  After twenty years I’ve got past that and now I go to the places where I know there will be toilets. We holiday in Scarborough and they have plenty of toilets in Scarborough.’

Extract from this the previous page extracted from the book The Troubled Gut by Barbara Rowlands. Published by Headline Book Publishing, 338 Euston Road, London NW1 3BH


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About Lynn Toohey, Ph.D.

Lynn Toohey received her PhD in Human Nutrition from Colorado State University (CSU), Fort Collins, Co. Mark Smith received his PhD in Physiology from CSU. Both authors graduated with a master's in Exercise Physiology from CSU. The current article incorporates some recent information uncovered by a research team headed by Dr. Loren Cordain (CSU) connecting food and autoimmune reactions to diseases such as MS. Lynn's latest publication in The Journal of Nutrition was chosen by the American Institute of Nutrition for National press release, and she currently has one in press concerning vitamin C and hypertension. She has co-authored a book with Sylvia Kreutle MS, entitled Nutritional Physiology; Clinical applications and scientific research, available from Nutri Ltd. 01663-746559.

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