Irritable Bowel Syndrome – Nutritional Management
Renata Trister DO
Irritable bowel syndrome (IBS) refers to a collection of intestinal symptoms that take place in the absence of a particular disease or biochemical abnormality. Its primary symptoms are abdominal pain and altered bowel habits (eg, constipation and/or diarrhea), but these symptoms have no identifiable cause. IBS affects approximately 15% to 20% of the general population, and ranks second only to the common cold as a cause of missed work time. Several treatments and therapies are available for irritable bowel syndrome. These measures help alleviate symptoms, but do not cure the condition. The chronic nature of irritable bowel syndrome and the challenge of controlling its symptoms can be frustrating for both patients and healthcare providers.
Patients with IBS may have painful cramps in the lower abdomen along with diarrhea, constipation, or alternating bouts of both. Typically, the pain flares up after a meal and goes away after elimination. Many patients also experience gas and bloating. The symptoms tend to come and go and can occur in any combination. While many IBS patients have relatively mild symptoms, up to 25% of all patients experience severe symptoms that can have a significant impact on their quality of life. For these patients, the symptoms often cause a withdrawal from normal activities. While symptoms eventually fade completely for about 30% of patients, most live with IBS for their entire lives.
There is no cure for IBS, and conventional treatment generally focuses on the relief of symptoms through the use of drugs such as antidiarrheal agents, laxatives, and antidepressants. However, this method of treatment has been met with limited success in relieving symptoms and, as with many conventional drug therapies, has adverse side effects. Fortunately, there are several natural treatment options that can promote significant relief of symptoms. These natural treatment options, along with a healthy lifestyle, are designed to lessen both the physical and emotional suffering of IBS patients.
The Causes of IBS
There are a number of theories about how and why irritable bowel syndrome (IBS) develops. Despite intensive research, the cause is not clear.
One theory suggests that irritable bowel syndrome is caused by abnormal contractions of the colon and intestines (hence the term “spastic bowel,” which has sometimes been used to describe irritable bowel syndrome). Vigorous contractions of the intestines can cause severe cramps, providing the rationale for some of the treatments of IBS, such as antispasmodics and fiber (both of which help to regulate the contractions of the colon). However, abnormal contractions do not explain irritable bowel syndrome in all patients, and it is unclear whether the contractions are a symptom or cause of the disorder.
Some patients develop irritable bowel syndrome after a severe gastrointestinal infection (eg, Salmonella or Campylobacter, or viruses). It is not clear how the infection triggers IBS to develop, and most people with irritable bowel syndrome do not have a history of these infections.
People with irritable bowel syndrome who seek medical help are more likely to suffer from anxiety and stress than those who do not seek help. Stress and anxiety are known to affect the intestine; thus, it is likely that anxiety and stress worsen symptoms. However, stress or anxiety is probably not the cause. Some studies have suggested that irritable bowel syndrome is more common in people who have a history of physical, verbal, or sexual abuse.
Food intolerances are common in patients with irritable bowel syndrome, raising the possibility that it is caused by food sensitivity or allergy. This theory has been difficult to prove, although it continues to be studied. The best way to detect an association between symptoms of irritable bowel syndrome and food sensitivity is to eliminate certain food groups systematically (a process called an elimination diet), which should only be considered for patients in the care of a doctor or nutritionist. Eliminating foods without assistance can lead to omission of important sources of nutrition. In addition, unnecessary dietary restrictions can further worsen a person’s quality of life.
Although the causes of IBS are not well understood, a number of factors have been linked to its onset. Current research indicates that the typical IBS patient has a higher level of sensitivity and reactivity in the colon, with a lower threshold of pain.
In addition, IBS is often thought to be associated with emotional conflict or stress. In fact, a large percentage of IBS patients seeking medical care have comparably higher levels of stress and anxiety. More recent research suggests that IBS may result from a dysregulation of the complex communication pathways between the intestinal tract and the brain. Thus, it is not thought that stress causes IBS, but it does worsen symptoms.
Dietary Changes and Fibers
Dietary factors can trigger symptoms of IBS. For instance, large amounts of fat in a meal often cause the colon to contract more rapidly, which stimulates various IBS symptoms. Foods such as chocolate, dairy products, caffeine, or large amounts of alcohol, as well as certain medicines, may also trigger IBS symptoms. Elimination diet in order to determine possible food intolerances is of the greatest benefit. Please see previous article regarding elimination diet protocol and ask your primary care physician with assistance in starting this protocol.
For many people, eating a proper diet reduces IBS symptoms. A diary of food intake and resulting symptoms can be useful in identifying foods that worsen symptoms of IBS. Because large meals can cause cramping and diarrhea in those with IBS, eating smaller meals more often or eating smaller portions may help ease symptoms. Avoidance of foods that tend to produce gas is also recommended.
Increased dietary fiber may lessen IBS symptoms in many cases due to the fact that fiber may help to normalize and modify bowel and colon movements. It is best to add a small amount of dietary fiber to the diet (5 grams per day) and gradually increase the amount to 25-30 grams per day.
Herbal Remedies that Support the Relief of Symptoms
The following natural remedies often prove effective in relieving potentially debilitating IBS symptoms. These remedies have a long history of use in traditional folk medicine.
Peppermint (Mentha piperita) Evidence of the medicinal use of peppermint dates back thousands of years to ancient Egypt where it was used as a digestive aid and carminative (relief of flatulence). Today, it is still known for its ability to lessen the symptoms of indigestion; hence, the common practice of eating mints after a meal. Peppermint oil can provide significant relief for IBS patients because of its antispasmodic properties. These properties refer to the oil’s ability to relax and restore tone to the intestinal muscles, which in turn reduces abdominal pain.
Chamomile (Matricaria recutita) Chamomile is one of the oldest herbal remedies. Like peppermint oil, chamomile has antispasmodic properties. While researchers have been unable to fully determine the way that chamomile works, animal studies have nevertheless supported chamomile’s potential in relaxing intestinal spasms.
Lavender (Lavendula angustifolia) Lavender is used as a carminative and diuretic; or, to put it more simply, lavender is used to “comfort the stomach.” In addition, lavender oil has been shown to improve sleep, decrease anxiety, and improve mood.
Lemon Balm (Melissa officinalis) The dried leaves of lemon balm are used as digestion promoters, gas relievers, mild tranquilizers, and antispasmodics. Therefore, lemon balm may not only help to relieve IBS symptoms and reduce stress, but may also help to promote a healthy intestinal environment.
While the symptoms of IBS are generally associated with altered colon function and hypersensitivity, an overgrowth of harmful bacteria in the intestinal tract may also play a role. Several studies have shown that probiotics work to support a balanced bacterial ecology of the gut, and therefore enhance the health and proper function of the intestinal lining. These include Lactobacillus acidophilus and Bifidobacterium infantis—two common species of “friendly” bacteria that reside in the intestinal tract. These probiotic species can help restore healthy gut ecology and function, and thus may offer an effective therapy in the treatment of IBS.