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Irritable Bowel Syndrome (IBS): Finding Physical and Emotional Well-Being

IBS Dr. Eric Viegas Naturopathic Medicine Ottawa

Irritable Bowel Syndrome (IBS): Finding Physical and Emotional Well-Being

Dr. Eric Viegas ND

 

Having an urgency to run to the toilet at all times of the day? Do you have abdominal pain that improves after passing a bowel movement? Bloating and gas with loose and/or constipated stools?

 

An estimated 5 million Canadians suffer from IBS, with 120 000 new cases each year (Fedorak RN, et al. 2012). 40% of Canadians suffering from severe IBS symptoms seek medical treatment, while patients with milder symptoms use a combination of lifestyle changes, food trigger avoidance, pharmaceuticals, and/or supplements to manage their wellbeing. The typical IBS sufferer misses 13 days of work per year (Fedorak RN, et al. 2012).

 

You have an increased risk for IBS if you have a family history of a first-degree relative (parent or sibling) with IBS. Onset is usually in a patient’s teenage years and is more common in women than men. Researchers have postulated that this gender difference exists because women are more likely than men to seek healthcare services for their symptoms, and clinical trials indicate that gender differences occur in responsiveness to drug treatment, pain processing, transit time (the time it takes for your food to move through your digestive tract), and effects of hormones (estrogen, progesterone) on digestive functions (Anbardan SJ., et al. 2012). In general, males tend to report a higher frequency of of loose bowel movements, and women tend to report more nausea and constipation  (Anbardan SJ., et al. 2012). Regardless of the gender differences, IBS can be a very debilitating and frustrating condition that leaves patients feeling powerless.

 

A patient fits the category of IBS if the symptoms have been present at least 3 days per month in the last 3 months, started at least 6 months ago, and symptoms (specifically, abdominal pain) are relieved after a bowel movement (Jung HK, 2011). Symptoms are associated with a change in stool number, stool appearance, and incomplete emptying of bowels. IBS sufferers may also have bloating, heartburn, and nausea (Jung HK, 2011). Other diagnostic methods should be used to rule out other serious conditions like colorectal cancer, inflammatory bowel disease, and celiac disease. There are currently 3 main categories of IBS; IBS-C (constipation dominant), IBS-D (diarrhea dominant), IBS-A/M (alternating/mixed). However, it is possible that a patient with IBS might not fit into any of these categories, and instead be classified into ‘pain-predominant’, or IBS-PI (post-infectious) patterns.

 

Some of the known causes of IBS include a history of gut infections, abdominal surgery, changes in diet, antibiotic use, and/or bacterial/hormonal/neurotransmitter imbalances. IBS pain is tied to changes in a healthy human microbiota (the friendly microbes in our gut), the immune system, and brain-gut communication (Grice EA, 2012). Think of brain-gut communication as our mind-body connection, one that exists through the central (mind) and enteric (gut) nervous systems.

 

Peristalsis is coordinated muscle contraction that promotes movement of food through the GI tract. In IBS, irregular peristalsis (spasm) can slow transit time or increase it through constipation or diarrhea, respectively. 95% of serotonin receptors are found in the enteric nervous system, and some of them increase or decrease peristaltic action (Gershon MD., 2005).

 

Peppermint oil is an effective tool in managing IBS symptoms (Cash et al., 2016). Menthol, an essential oil, is an antispasmodic and can help to calm the muscular and mucosal (mucus) walls of the intestine. Through this mechanism of action, peppermint oil helps abdominal pain and regulates peristalsis (Khanna et al., 2014). In an ancient Egyptian text from 1550 BC, mint was indicated for abdominal pain. In ancient Greece, Hades softened a spell on his mistress Minthe, so that ‘when people walked upon his lover they would smell her sweetness’. Mint has a relaxing effect to the enteric and central nervous systems, and has been shown to increase patient quality of life scores (Bharani et al., 2016).

 

Similar to peppermint, probiotics can be an effective symptom management tool. Studies have shown that certain probiotic strains, specifically the lactobacillus and bifidobacterium families, can relieve symptoms of abdominal pain, gas, and bloating (Majeed et al., 2016) (Moraes-Filho JP., Quigley EM, 2015). However, not all patients have the same reaction to probiotics. To give some perspective, the human microbiota is the size of an ocean compared to the small droplet of probiotics delivered to our bodies by supplements. Scientists still have many questions regarding the human microbiota. Does it control us? Do we control it? If so, how? The complex relationship between our mind and our microbiota is one that can be slightly altered through diet, environment, and our stress level (Grice et al., 2012).

 

The ability of your body to fully digest and absorb the calories from the food you eat is controlled by your own microbiota (Grice et al., 2012). Avoiding dietary triggers that alter the capacity of friendly microbes, and possibly feed the harmful ones, should be a treatment goal to reduce inflammation within the digestive tract. Our microbes have the ability to heal the gut wall and mucosa, so the diet and lifestyle factors necessary are those that create the ideal conditions for the friendly bugs we were born with.

 

Acupuncture tends to be favoured by IBS patients over traditional pharmaceutical approaches (Manheimer et al., 2012). Acupuncture, an effective tool in IBS management, assesses and treats the individual patient holistically. IBS patients receiving acupuncture for symptom management reported greater improvement than patients receiving only pharmaceutical therapy (Manheimer et al., 2012). It is important to keep in mind that IBS affects both physical, and mental-emotional wellbeing. Patients should receive an IBS treatment plan that addresses both physical and psychological factors. IBS can be very difficult to deal with, but its symptoms can be managed and so can your stress.

 

Always consult your doctor before taking any new supplement or medication

 

 

References:  

 

Fedorak RN., Vanner SJ., Paterson WG, Bridges RJ. Canadian digestive health foundation public impact series 3: irritable bowel syndrome in canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol 26(5); (2012): 252-256. Print.

 

Anbardan SJ., Daryani NE., Fereshtehnejad S-M., Vakili ST., Keramati R., Ajdarkosh H. Gender role in irritable bowel syndrome: a comparison of irritable bowel syndrome module (rome iii) between male and female patients. J Neurogastroenterol Motil 18(1); (2012): 70-77. Print.

 

Jung, Hye-Kyung. “Rome III Criteria for Functional Gastrointestinal Disorders: Is There a Need for a Better Definition?” Journal of Neurogastroenterology and Motility 17.3 (2011): 211–212. PMC. Web. 23 Nov. 2016.

 

Gershon MD. Nerves, reflexes, and the enteric nervous system: pathogenesis of the irritable bowel syndrome. J Clin Gastroenterol 39(5); (2005): 184-193. Print.

 

Cash BD., Epstein MS., Shah SM. A novel delivery system of peppermint oil is an effective therapy for irritable bowel syndrome symptoms. Dig Dis Sci 61; (2016): 560-571. Print.

 

Bahrani HR., Hamedi S., Salari R., Noras M. Herbal medicines for the management of irritable bowel syndrome: a systematic review. Electronic Physician 8(8); (2016): 2719-2725.

 

Khanna R., MacDonald JK., Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol 48(6); (2014): 505-512. Print.

 

Majeed M., Nagabhushanam K., Natarajan S., Sivakumar A., Ali F., Pande A., et al. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study. Nutrition Journal 15(2); (2016): 1-10. Print.

 

Gerritsen J., Smidt H., Rijkers GT., de Vos WM. Intestinal microbiota in human health and disease: the impact of probiotics. Genes Nutr 6; (2011): 209-240. Print.

 

Moraes-Filho JP., Quigley EM. The intestinal microbiota and the role of probiotics in irritable bowel syndrome: a review. Arq Gastroenterol 52(4); (2015): 331-338. Print.

 

Maron DF. Does our microbiome control us, or do we control it? Scientific American. January 13 2016. Retrieved from www.scientificamerican.com/article/does-our-microbiome-control-us-or-do-we-control-it/

 

Grice EA., Segre JA. The human microbiome: our second genome. Annu Rev Genomics Hum Genet 13; (2012): 151-170. Print.

 

Manheimer E., Wieland LS., Cheng K., Li SM., Shen X., Berman BM. Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol 107(6); (2012): 835-848. Print.

Understanding irritable bowel syndrome (ibs). Canadian digestive health foundation. Retrieved from http://cdhf.tdcbeta.com/bank/disorder_pdf_en/12-irritable-bowel-syndrome-ibs.pdf#zoom=100

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