An Integrative Approach to IBS

Irritable Bowel Syndrome (IBS) is a common motility disorder of the gastrointestinal (GI) system, affecting up to about 15% of the U.S. population, according to epidemiologic studies. In fact, this disorder is very personal to me as I, like many college-aged women, dealt with a severe form of IBS in my late teenage years and early 20s. 

The syndrome is characterized by abnormal stooling patterns consisting of chronic constipation, chronic diarrhea or alternating constipation and diarrhea. Frequent complaints associated with the syndrome include, but are not limited to, abdominal bloating, abdominal pain that is relieved by having a bowel movement and a sense of urgency in getting to the bathroom in order to have a bowel movement. IBS typically affects females more commonly than males and is associated with acute and chronic stress as well as anxiety, depression and other psychological disorders.

It is a commonly seen condition in primary care clinics and there are some medications that can help along with many effective natural treatments for the condition. The purpose of this article is to highlight some of the natural treatments available for IBS.

Diagnosis
Because IBS is a diagnosis of exclusion (meaning there is no definitive test for the syndrome and the diagnosis is made by ruling out other conditions), diagnosis is not made by any blood work or other tests. Diagnosis is instead made by taking a thorough history from a patient. 

Based on the symptoms experienced, IBS is then characterized in to one of three categories: Constipation-Predominant IBS (IBS-C), Diarrhea-Predominant IBS (IBS-D), or Mixed-type IBS (IBS-A). If a physician suspects a more serious illness is occurring in the GI tract, other tests such as a colonoscopy, flexible sigmoidoscopy and/or upper GI endoscopy can be performed. These are not generally done to diagnose IBS.

Natural Cures for IBS include but are not limited to the following suggestions:

Stress management – Acute or chronic stress plays a major role in the pathophysiology of IBS. This likely occurs due to changes in neurotransmitters (specifically serotonin and adrenaline) and nerve firing in the gut. When we are stressed, our adrenaline levels increase and digestion shuts down. This is due to blood being shunted towards the brain, heart and large muscle groups and away from the digestive tract in order to allow our bodies to flee if in danger. When this occurs, we are in what is called the “fight or flight” response.

To improve gut function, one needs to activate the “rest and digest” parasympathetic nervous system.  When this response is activated, our adrenaline levels decline and we feel a sense of calm take over us. It is then that our digestion can occur effectively and most efficiently.

Acupuncture – Because acupuncture works by decreasing the fight or flight response of the body, it can be a very useful tool for IBS. The medical studies done on it to date, have shown mixed reviews, however, in my personal practice, I find it to be extremely effective. 

Probiotics - Probiotics, and the foods that support probiotic growth, know as pre-biotics, are also research-proven to help with IBS symptoms.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886445/

There are thousands of different types of bacteria in the gut and therefore it is difficult to know where to start with a probiotic. I recommend restoring the beneficial yeast, Sacchromyces Boulardii (aka S. boulardii) first and rotating with a different probiotic every few months. 

Dietary Changes -  Many patients find relief from IBS by removing dairy and gluten from their diets as proteins such as gluten and casein (found in cow’s milk) in these foods cause inflammation in the gut leading to IBS and inflammatory bowel disease.
Simply removing dairy and gluten from the diet can dramatically help many people with IBS. 

When that doesn’t do the trick, the FODMAPs diet can be helpful.

FODMAPS Diet – This acronym for a diet is quite a mouthful when it is spelled out but can be very helpful for those with IBS.

The acronym FODMAPS stands for “Fermentable Oligo-, Di-, Monosaccharides And Polyols”. These compounds are found in many fruits and vegetables and in all beans and legumes. They are thought to worsen gut function by an unknown mechanism in some individuals suffering from IBS. Therefore, a low FODMAPS diet can be beneficial for those with IBS. For more information, please see:  https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf

Movement  - Physical activity and movement is one of the most important things one can do to prevent and treat medical problems. Physical activity is particularly important in the treatment of IBS and has been clinically proven to improve symptoms of the illness.  Anywhere from 20 to 60 minutes of physical activity a day can greatly improve IBS symptoms. http://www.medscape.com/viewarticle/737389. 

Meditation – Meditation engages the Relaxation Response that is crucial in decreasing the sympathetic tone of the gut. The gastrointestinal tract consists of 100 million nerve endings and is overseen by the brain. One part of the nervous system, the parasympathetic nervous system, is mostly in charge of digestion, thus proper engagement of the parasympathetic function is necessary for optimal digestion. 

One way to learn to meditate is by doing deep belly breathing. This type of breathing is a learned skill that occurs when you focus on allowing an inward breath to inflate your lungs and your abdomen. The increased amount of oxygen in your body automatically normalizes the stress response and can lead to your heart rate and blood pressure lowering. It’s a practical, portable and FREE modality that can be learned at any age!  

A wonderful technique I learned in my Integrative Medicine Fellowship is Dr. Weil’s 4-7-8 breath. http://www.drweil.com/drw/u/VDR00112/The-4-7-8-Breath-Benefits-and-Demonstration.html

If you have a hard time learning how to do deep belly breathing on your own, you can learn from most psychotherapists and/or yoga teachers.  

For constipation-predominant IBS: 

Water – Most Americans don’t drink enough water. This inhibits gut function as the colon and kidneys are responsible for reabsorbing the precise amount of water from the intestinal lumen (where the food goes) in order to keep the delicate balance of hydration going in the body. I recommend at least eight tall glasses of water per day and more for those who are constipated or who work outside or live at high altitudes. In this case, water is your friend!

Aloe vera – We all know and love this plant for it’s external healing effects on skin. But many people are unaware that they can reap the same benefits by drinking the juice that comes from the inner fillet of the plant. In fact, aloe vera juice is one of my most favorite recommendations for constipation-dominant IBS.  It can also be useful in diarrhea-predominant IBS.

The way aloe vera works in the gut is still unknown, however, it basically coats and soothes the digestive tract allowing for better transit of fecal matter. But, be forewarned, the whole leaf of the plant is a STRONG cathartic laxative – meaning you will clear out your bowels in a very dramatic way if you ingest it! Therefore, I recommend 1-2 oz. of the juice from INNER FILET ONLY! And make sure you get an unflavored or flavored bottle if you are sensitive to tastes as aloe vera juice can be very bitter if left untouched.
 
For diarrhea-predominant IBS: 

Enteric-coated peppermint oil – Peppermint has long been known for it’s useful digestive properties. Fortunately, the medical scientific literature has found similar results in that patients with IBS generally find significant improvement in their symptoms when taking peppermint oil. The key to the remedy here, though, is the delivery system. 

Enteric-coated peppermint oil is created for digestion in the small intestine and thus works it’s magical effects there and not in the stomach. In this formulation, the herb works just as well as many anti-spasmotic medications for IBS.  It is extremely safe to use with the main adverse reaction being heartburn due to the menthol in the peppermint plant itself. Thus, it is not to be taken if you have GERD (gastroesophageal reflux disorder) or are prone to developing heartburn. I recommend taking one capsule of the enteric-coated oil it 30 minutes before a meal for best results. 

As you can see, there are many effective, natural ways to manage Irritable Bowel Syndrome. It is best to work with a knowledgeable healthcare practitioner to figure out which techniques may work best for you.