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