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The Center for Integrative Medicine

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Irritable Bowel Syndrome

By far the most common reason patients visit gastroenterologists is for help with irritable bowel syndrome, or IBS, also known as spastic colon. Although the condition is not dangerous, nor does it lead to anything serious, IBS is a real challenge to treat effectively. In fact, conventional medical textbooks advise doctors to tell their patients that the condition is incurable, and many patients have come to believe that the best they can expect from conventional medicine is only limited relief. All doctors, including myself, hesitate to use the word “cure.” But at WholeHealth Chicago, we’ve found that a more integrated medical “toolbox” has dramatically improved our success rate.

What is Irritable Bowel Syndrome?
The most common gastrointestinal complaint in the United States, irritable bowel syndrome (IBS)–also known as spastic colon, mucous colitis, and nervous bowel–affects 15% to 20% of the adult population. It afflicts twice as many women as men, usually developing in late adolescence or early adulthood. The condition is characterized by intermittent periods of constipation or diarrhea, often accompanied by bloating or abdominal pain. Once partly digested food has left the stomach, it’s moved through the digestive tract by rhythmic contractions of the muscles in the intestinal walls, a process called peristalsis. In irritable bowel syndrome, these muscles go into spasm for unknown reasons, becoming so uncoordinated that they move residues either too quickly (causing diarrhea) or too slowly (causing constipation).

Although IBS is uncomfortable, inconvenient and sometimes quite painful, luckily this digestive disorder is not at all dangerous or life threatening. Nor does it ever lead to anything more “serious,” like colon cancer or ulcerative colitis. For doctors, IBS can be challenging to diagnose, because tests often show no abnormalities even though symptoms are often all too real. As a result, a diagnosis of irritable bowel syndrome is usually arrived at by process of elimination, after other disorders with similar but more serious symptoms–such as diverticulitis, ulcerative colitis, Crohn’s disease, or intestinal parasites–have been ruled out.

Just as there’s no cure for a tension headache (which also has “normal” test results), there’s no cure for IBS. And, just as you can take specific steps to avoid a headache and treat it when it occurs. so it is with IBS. This condition is both avoidable and treatable through a combination of a sensible diet, stress management, and a program of therapeutic supplements and/or prescription drugs.

Key Symptoms

  • Diarrhea, constipation, or alternating bouts of both for several months
  • Abdominal discomfort, pain, or cramps (often relieved by a bowel movement)
  • Bloating and excess gas
  • Nausea
  • White mucus in the stool
  • A feeling that the bowels have not emptied fully
  • A worsening of symptoms after eating a large meal, during or just before menstrual periods, or while under stress

What Causes Irritable Bowel Syndrome?
While experts have suggested many potential possibilities for irritable bowel syndrome, no single cause has been established beyond a reasonable doubt. The list of possible culprits has ranged from parasitic infections and lactose (dairy) intolerance to food allergies and overuse of antibiotics. Whatever the source, researchers do agree on one thing: Stress seems to aggravate the condition.

Treatment and Prevention

Conventional Medicine

The usual approach of a conventional physician is to increase the fiber in your diet (psyllium <Metamucil> is commonly recommended) and prescribe one of the anticholinergic drugs to block the nervous impulses from the brain to the intestines. These include such brands as Donnatol ®, Bentyl ®, Lomotil ®, or one combined with tranquilizers (Librax®). Although this approach is sometimes effective, many patients are disappointed with the results. In addition, side effects include dry mouth, blurred vision, difficult urination and mental fuzziness. For women with a “diarrhea predominant” irritable bowel, the prescription drug Lotronex® has been helpful but has had a stormy course during the last year. Initially regarded as a godsend, the drug was withdrawn by the FDA several months ago for severe side effects, including bowel obstruction. Many gastroenterologists felt this withdrawal was done too hastily and the drug has recently returned to the market but with numerous warnings regarding potential dangers.

Our Approach to Irritable Bowel Syndrome at WholeHealth Chicago

Virtually all cases of irritable bowel syndrome fall into one or more of the following groups: (1) an “inappropriate” reaction of the intestines to stress; (2) food sensitivities and intolerances; (3) abnormal digestive function; (4) unbalanced intestinal bacteria or the presence parasites.

After a detailed gathering of your medical history and a physical examination, diagnostic laboratory tests frequently include:

Comprehensive Stool Digestive Analysis (Great Smokies or U.S. Biotech Labs): this is a “take-home” kit in which you collect stool specimens in small plastic vials and send them via AirBorne Express to the laboratory for testing. The specimens are analyzed to determine how well you digest and absorb food, the metabolic function of your intestinal lining, the bacteria in the stool, and whether excessive candida (yeast), parasites, or ova (eggs of parasites) are present.

Food Sensitivity Testing (Great Smokies or U.S. BioTech Labs): this is a blood test in which levels of two antibody groups (IgE and IgG) are measured against approximately 90 commonly eaten foods. It is generally agreed that high levels of an antibody against a particular food is sufficient evidence that your immune system regards that food as “enemy” and it’s presence in your intestines may be contributing to your symptoms.

Other diagnostic tests may be ordered depending on your overall clinical situation as well as the results of these first tests. The majority of patients with irritable bowel syndrome do not need these additional tests. These include:

Intestinal Permeability Assessment: (Great Smokies Diagnostic Lab) this tests for excessive permeability of the intestinal lining (“leaky gut syndrome”). Chronic inflammation from any cause (Crohn’s disease, NSAID drugs, parasites, food sensitivities) can damage the intestinal lining. Symptoms of ‘leaky gut’ are widespread and include: joint pains, sinusitis, skin rashes and fatigue.

Anti-Gliadin Antibody Assay (US Biotech Lab): tests for gluten intolerance (also called celiac disease or sprue)

Bacterial Overgrowth Testing (Great Smokies): by measuring the content of certain substances in your exhaled breath (collected by a special apparatus), this determines if an overgrowth abnormal bacteria exists in your small intestine

Lactose Intolerance Testing (Great Smokies): lactose intolerance is not the same as a dairy allergy, but instead occurs when an enzyme needed for digesting dairy is missing. A breath test determines if this condition is present.

Treatment

At the end of your visit, you will be given a copy of “Your Healing Path,” an individually prepared summary of what will be planned during the next few days or weeks. On the Path, you’ll see what tests have been ordered (and why), medications, nutritional supplements, diet instructions, and (if needed) referrals to either conventional specialists or alternative practitioners.

The main areas addressed for irritable bowel syndrome are:

Food sensitivities: while awaiting test results, many patients benefit from undergoing intestinal detoxification. To do so, you will be instructed on an allergy-free eating program using a nutritional product called Ultra Clear Sustain. A surprisingly large number of patients feel dramatically better after detoxifying their system and cleaning up their diet. After detoxification, you will be instructed about how to re-introduce foods, the result of which can sometimes reveal the “culprit” responsible for your symptoms.

Stress: for many patients, symptoms of irritable bowel syndrome are intimately correlated with stress. We now understand the relationship between the stress reaction (“fight-or-flight response”) and the brain chemical serotonin. (see “The Chemistry of Stress” in Dr. Edelberg’s article section of this site). A variety of therapies are very helpful in teaching you to ward off the ravages of stress and may include: St. John’s Wort with 5HTP to raise serotonin; traditional Chinese medicine; psychologic counseling, meditation, yoga, t’ai chi, biofeedback.

Parasites and inappropriate bacteria: depending on the results of your stool analysis, you may need therapy for parasites, candida, or bacterial dysbiosis.

Maldigestion: again, depending on the results from your stool analysis, you may need digestive enzymes or additional stomach acid (taken during mealtimes).

Supplement Recommendations

Ultra Clear Sustain (Metagenics)

This product was designed by Jeffrey Bland, Ph.D. and has been the ‘gold standard’ intestinal detoxifier for individuals with both functional and pathologic gastrointestinal problems

Fiber Formula

Available either as a powder or in capsules, this is a blend of dietary fiber and botanical extracts for gentle gastrointestinal support

Earth Dragon (Allergy Research)

Several years ago, the A.M.A.’s journal “Archives of Internal Medicine” reported the therapeutic success of a Chinese herbal formula. “Earth Dragon” is as close to that combination as is available in the United States.

Mentharil (PhytoPharmica)

The use of encapsulated peppermint oil has been documented in conventional medical literature as being a useful adjunct in IBS treatment

Ultra Dophilus DF (Metagenics)

Two potent combinations of “probiotics,” the so-called good bacteria, necessary for healthful gastrointestinal function. An increasing number of articles in conventional medical journals are recommending probiotics for IBS.

Saccharomyces boulardii

Another of the probiotics, a’friendly’ yeast designed to keep the healthful balance of bacteria maintained

Other supplements may be recommended, depending on specific clinical conditions. These may include:

St. John’s Wort

Hundreds of studies published worldwide attest to the effectiveness of this herb in the treatment of stress. Doctors believe it alters serotonin metabolism and may be helpful for a variety of serotonin-related disorders. This freeze dried form is definitely more costly than brands available at Wal-Mart, but felt by herbalists to be the most clinically effective.

5 Hydroxytryptohan (5 HTP)

Converts to serotonin in the body and complements St. John’s Wort’s effects.

PMS Herbal

Any symptom (including IBS) that worsens during the week or so before menses is probably a variation of PMS which itself is an imbalance between estrogen and progesterone. This herbal combination which includes chasteberry (vitex) and dong quai, balances the hormones and for many women relieves PMS within two or three cycles.

Similase, Carbo-Similase, Lipo-Similase or Betaine

These are plant based enzyme combinationscapable of facilitating the digestion of all food groups. Carbo-Similase enhances carbohydrate digestion while Lipo-Similase enhances breakdown of fats. Betaine HCl increases stomach acidity for patients with hypochlorhydria (low stomach acid)

Alternative Therapies Used at WholeHealth Chicago for IBS

Traditional Chinese Medicine (Mari Stecker, Lic. Ac.)

The diagnostic approach of a practitioner of TCM differs considerably from that of a conventionally trained physician. An evaluation includes a thorough medical history and special examination of the pulse and tongue. A course of therapy would include a series of acupuncture and individually formulated Chinese herbal tonics.

Homeopathy (Sujatha Mannal)

This two hundred year old form of treatment addresses the deepest causes of why symptoms develop. After an extremely detailed interview (approximately two hours), Sujatha will prescribe miniscule amounts of natural substances to facilitate the body’s self healing capabilities

Counseling and Chi-Lel® (Larry Stoler, Ph.D.)

Understanding the sources of stress in your life and learning healthful ways to deal with them is vital for a lifetime of overall well-being. Dr. Stoler is a psychologist who also teaches Chi-Lel, a form of Chinese energy medicine related to T’ai chi.

Nutritional Counseling (Marla Feingold)

If food sensitivities or candida are at the source of your symptoms, you may need some help and guidance with planning a healthful and balanced diet.

Self-Care Remedies
Experiment with fiber. Some people find that a high-fiber diet relieves their symptoms, while others discover that it only makes things worse. For instance some people do not tolerate the natural chemicals in high fiber beans or react to the natural chemicals in wheat bran. If you do add high-fiber foods to your diet, do it slowly to minimize bloating and gas. High-fiber foods include fruits, vegetables, grains, and beans.

Avoid high-fat foods, such as bacon and vegetable oils, and gas-producing foods, such as beans and broccoli.

Be on the lookout for sorbitol, an artificial sweetener found in candy, gum, and other sugarless products, that may trigger diarrhea.

Eat smaller, more frequent meals–they’re easier to digest.

To pinpoint any food sensitivities in your diet, start keeping a food diary. You may also want to try a food elimination diet, which will help you figure out exactly which foods are the culprits.

Here’s how to find out whether you’re lactose intolerant, which may be triggering your IBS symptoms. Drink two glasses of nonfat milk on an empty stomach. If you experience gas, diarrhea, pain, or bloating within four hours, redo the test with lactase-treated milk. If no symptoms occur, stay away from dairy products.

Exercise for at least 20 minutes a day to keep the bowels moving normally. Walking is especially good for this.

Meditation, biofeedback, and other relaxation techniques may help reduce stress.

Quit smoking and limit your intake of caffeine, artificially sweetened beverages, and alcohol, which all may irritate the digestive tract.

When to Call a Doctor

  • If symptoms are so frequent and/or severe that they interfere with normal activities.
  • If you have abdominal pain along with changes in bowel patterns or in stool size or consistency.
  • If blood shows up in your stool.
  • If you experience unexplained weight loss.
  • If you are taking drugs for treatment of other medical or emotional problems, discuss the IBS symptoms with your physician.
  • If abdominal pain is constant, severe, and if it is accompanied by fever.

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