Cramping, abdominal pain, increased gas, altered bowel habits, mucus in stools, food intolerance, and bloating are all symptoms associated with IBS. There are three different forms: IBS-D (characterised by chronic or recurrent diarrhoea), IBS-C (abdominal pain or discomfort associated with constipation) and IBS-A (alternating diarrhoea and constipation). Genetics and prior adverse life experiences, such as trauma or infection, may predispose someone to develop IBS. A diagnosis of IBS is based on the duration (minimum six months) and frequency (minimum three times a month) of symptoms, along with ruling out all other possible conditions. However, a relatively new blood test, IBSchek™, enables a quick and reliable diagnosis IBS.
The naturopathic perspective
Conventional treatment is to either stop diarrhoea or enhance defecation, with painkillers taken as needed. From a naturopathic perspective the various considerations include:
Managing the MMC: IBS patients are susceptible to an enhanced visceral (tissue) sensation and sensitivity to pain, a condition also known as visceral hyperalgesia. A patient may have a small intestinal bacteria overgrowth (SIBO) or increased lower abdominal pressure due to a higher colon fermentation process. The large colon may not be as effective at producing short-chain fatty acids, which assist bowel health, and a higher concentration of pathogenic Enterobacteriaceae microbes, causing gastric upset. The migrating motor complex (MMC) may be delayed, leading to constipation, or excited, leading to diarrhoea, or disruptive, causing a bit of both. The MMC is a distinct pattern of electromechanical activity that occurs in gastrointestinal smooth muscle during the fasting periods between meals. It’s believed to serve a “housekeeping” role, sweeping residual undigested material through the digestive tract. Low-grade gastrointestinal inflammation is associated with the disruption of the MMC.
Diet Changing your diet may help, but first check with your GP to confirm that you’re not coeliac as symptoms can be similar. Research shows up to 76 percent of IBS patients achieve relief from following the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet. Studies reveal the small intestine in IBS may lack the ability to digest FODMAPs effectively, which has a knock-on effect of increasing the amount of liquid in the colon, creating gas, pain and fermentation by colonic bacteria. Generally, the foods we consider as beneficial for the bowel are unsuitable for IBS sufferers. Broadly, these include: brassicas (broccoli, cauliflower, Brussels sprouts, bok choy, collards, kale), beetroot, alliums (onions, garlic), whole grain wheat and rye, soy products, higher-fibre foods, dried legumes, berries, cherries, apples, watermelon and dried fruit, honey and agave nectar, and sorbitol. The MMC is activated during the fasting period, around three to four hours after food is eaten. In a healthy colon, once the MMC commences it empties the components of the gastric mucosa, stomach, small intestine, and eventually the large bowel in bouts that occur every 90-120 minutes. Once we eat again, the MMC stops. For this reason, snacking may not be ideal for IBS patients. Black tea brewed with the traditional Indian chai herbs ginger, cardamom, cloves, a pinch of chilli, and black pepper, strained and sweetened with a little stevia, has a calming effect on the gut.
Supplements: Carminative and antispasmodic herbs lessen intestinal spasm by reducing inflammation in the stomach and small and large colon. The most popular treatment is a registered herbal formula that contains a combination of scientifically evaluated extracts of bitter candytuft or clown’s mustard (Iberis amara), angelica (Angelica archangelica), German chamomile flower (Matricaria recutita), caraway fruit (Carum carvi), milk thistle fruit (Silybum marianum). Ginger (Zingiber officinalis) triggers the prokinetic motion of the gastric system of the MMC. Boil a five cm piece of fresh peeled ginger in 500ml of water for 10-15 minutes and drink just before meals.
Probiotics: These are a little tricky to prescribe as some aggravate IBS. Clinical trials suggest the species L. Plantarum 299 for relieving IBS pain and bloating as this probiotic can reduce several pathogenic bacteria. Start slowly with probiotic foods (kefir or non-dairy yoghurts) and ask a qualified practitioner about a probiotic suitable for you.
Prebiotics: Some contention exists as to whether these help or hinder IBS sufferers. While prebiotics are great for the general population to enhance bacterial bowel health and function, they’re largely found in the FODMAP groups, which makes them unsuitable for IBS patients. My general recommendation is to treat all other areas of inflammation with gut-healthy microbes first and then slowly re-introduce prebiotics to ensure they’re tolerated. Non-FODMAP prebiotics are found in slightly unripe bananas and cooked cooled non-wheat grains.
If you experience any change in bowel movements, it’s critical to speak with your doctor as this can indicate a more serious condition.
The stress connection
Psychological stress is one of the most important factors in IBS. It impacts bowel motility, sensitivity to pain, small intestine permeability and migration to SIBO, and activation of the immune system in the entire gut, causing alterations in the nervous tissue. This is called a neuroendocrine-immune pathway and links the gut to the brain, enhancing the flare-ups that occur with IBS. Stress activates chemical messengers inciting the hormone cortisol, which directly and indirectly causes growth of pathogenic microbiota, affects the MMC and increases the sympathetic nervous system, giving the sensation of being on high alert 24/7. Anything you can do to reduce stress is beneficial. I suggest:
* joining a meditation group
* performing yoga or qi gong
* practising mindfulness
* walking on grass or the beach for a negative ion boost
* hypnotherapy for trauma release
Teresa Mitchell-Paterson BHSc (CompSci) MHSc (HumNut) is a member of the Australian Traditional Medicine Society (ATMS). www.atms.com.au