Irritable Bowel Syndrome: Western Epidemic

Irritable Bowel Syndrome (IBS) affects up to 20% of the people in this country. The numbers are similar for almost all other westernized nations. It is second only to the common cold as a cause for employee absenteeism with IBS sufferers being 3 times more likely to miss school or work than their normal counterparts. IBS visits account for 12% of primary care visits and fully 1/4 of all gastroenterology patients. The total cost of this syndrome is an estimated $8 billion burden on the US healthcare system. However, despite the enormity of the cost and burden, almost 80% of people with the condition never seek any health care at all.

IBS is just one of several functional gastrointestinal disorders. These disorders are characterized by an absence of obvious lesions or abnormalities that can easily be pointed to as the cause. The disorders are “only” functional in nature, i.e. the symptoms are the syndrome. In IBS, there are very clear and present disorders of function and these dysfunctions often lead to a significant impact on the quality of life of the sufferer.

The diagnosis of IBS has, until recently, been a vague process. Typically, doctors would test for everything that they could and when none of the tests came back positive, they would declare that you had IBS and should try to relax. The typical IBS patient had to go to 3 different doctors over the course of 3 years before obtaining a diagnosis-by-exclusion.

The most common symptoms seen with IBS are: constipation, diarrhea, or both, abdominal pain and/or discomfort, bloating, excess gas, a feeling of incomplete bowel movements, and mucus being present in the stool. It should be noted that constipation or diarrhea does not necessarily mean a change in frequency, it can be a change in consistency alone. A large number of IBS patients also experience symptoms outside of the G-I tract. Studies have shown, for instance, that IBS patients also present fairly commonly with asthma, fibromyalgia, and chronic fatigue. Further, IBS patients also have a very high degree of depression, anxiety, and/or poor coping mechanisms.

With advances in the research of IBS, certain trends and abnormalities have been found. The central abnormalities are alterations in intestinal motility and visceral hypersensitivity to gas and pain. Constipation predominant patients often have a decrease in their intestinal motility while diarrhea predominant patients have a significant increase in their motility (i.e. spastic colon). Furthermore, altered enzyme and neurotransmitter levels, prior gastrointestinal infections, stress and anxiety, learned illness behavior, a history of abuse, and up-regulated pain processing centers have all been implicated in the pathogenesis of the syndrome.

Treatment Options

Recently, one of the most promising drugs authorized by the FDA to treat IBS (actually it only treated women with diarrhea predominance) was pulled from the market because of lethal “side-effects”. Another drug which treats constipation predominance is in the works, but the main side effect of that drug is diarrhea! Other researchers are looking at the role of antidepressants in the treatment of IBS. However, as has been stated in many review articles, to date there has not been a truly effective drug produced for the treatment of IBS. Therefore, more and more people are turning to alternative options.

Food Sensitivities: It is my opinion that we all have foods that we are sensitive to. It is important to point out that this does not necessarily mean a food allergy, per se. There are more subtle responses to food that the body can have which invoke certain allergic mechanisms, but stop short of being an all-out “allergy”. Lactose (i.e. milk products) is the most common culprit. Studies have sown that up 30% of IBS patients are really just lactose intolerant. Other common offenders include: soy, wheat, citrus, and sugar. A trial of COMPLETELY ELIMINATING one of these for 3 weeks and then reintroducing it into your diet can help you determine if any of these foods is a problem for you. There is also a blood test which can help you narrow down which foods you should eliminate.

Fiber: Inadequate fiber is commonly seen in IBS, particularly among the constipation subtype. Patients can supplement with up 30g a day (work up to that dose gradually) of primarily water-soluble fiber such as oat bran and psyllium husks. It is very important that adequate water (at least 20 oz per dose of fiber) be taken in combination.

Anti-Depressants: The medical community is very excited about the use of these drugs in the treatment of IBS. However, alternative antidepressants, such as St. John’s Wort, Ginkgo, and 5-HTP may be just as helpful and without the added bonus of side effects. You should consult with your health care provider before starting a trial of these substances for safety and to obtain the proper dosing.

Peppermint: Peppermint oil has been found to be very effective in reducing intestinal spasm. It is very important that the capsules be enterically coated so that they don’t break down until they reach the intestine.

Stool Analysis: Your health care practitioner may know about certain specialty labs which do in-depth analysis of stool contents. Stool analysis can uncover hidden parasitic infections, enzyme and absorption irregularities, and intestinal bacterial imbalances which will contribute to symptoms. It is my opinion that all potential IBS patients have this analysis performed as it can yield invaluable information about the underlying causes of the problem.

Relaxation Techniques: Learning to relax and decrease your stress levels has been shown to be very beneficial in IBS and should be a part of any treatment plan. Yoga, Qi Gong, breathing exercises and visualization techniques are all potentially helpful

Psychotherapy: In addition to relaxation techniques, teaching patients to change the way they perceive stress and their symptoms has been shown to be extremely effective in treating IBS patients. Cognitive Behavioral Therapy, Hypnotherapy, and Biofeedback have all proven helpful.

Acupuncture: Numerous studies have shown acupuncture to be effective in dealing with IBS and other functional gastrointestinal disorders. According to the studies, acupuncture is particularly effective in dealing with the symptoms of pain and bloating as well as stress reduction.

Chinese Herbs: A study published in the Journal of the American Medical Association recently found the use of Chinese herbs to be very effective (70%!) in treating IBS. This success rate far exceeds any drug that has been tested to date. Furthermore, when patients received a custom Chinese herbal formula, as opposed to a pre-made formula, symptoms did not return after treatment stopped.

Other options: There are many, many other natural products and modalities which may be beneficial in IBS. However, due to the incredible variety in symptoms, the list would be too long to discuss here. Your natural health care practitioner should be aware of options other than the ones discussed above.

If you are afflicted with this stubborn and difficult to treat disorder, know that you are not alone. Also know that help is out there, if you know where to look for it. My mentor used to say, “If you continue to do what you have always done, you will get what you have always gotten.” It is important to realize that any successful treatment plan will likely include significant dietary and lifestyle alterations. Become pro-active in your treatment and you will achieve good results. Although some of the treatments described above are self-help type options, it is important to work in conjunction with a health care provider in order to rule out other conditions and insure proper synthesis of all available treatment options.