WELLNESS RX SPECIAL REPORT: Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) has become one of the most common and troublesome conditions for which patients seek medical attention primarily for symptoms of constipation, diarrhea, bloating, gas and abdominal pain. By far, it is the number one disorder of the gastrointestinal (GI) system. 

IBS can be constipation only (IBS-C), diarrhea only (IBS-D) or when a patient suffers from both constipation and diarrhea. 15-20% of patients in the Western world suffer from IBS, 60-70% of cases are women & IBS can impact both adults & children especially if they have experienced stressful events in their life. 

All research on IBS suggests that there is no one solution or cure for the treatment of IBS. This includes the many expensive medications that often prove to be disappointing for the patient. So, like a patient that suffers from chronic sinusitis, IBS patients must use preventive techniques & must try to reduce triggers that seem to cause their IBS attacks. 

The underlying problem appears to be that patients with IBS have parts of their colon that are highly sensitive & overreact to any stimuli such as gas, stress or eating high-fat or fiber-rich foods. This sensitivity tends to also cause muscles in the colon to overreact. While IBS itself does not cause inflammation in the GI tract, inflammation in the gut is always suspect in IBS patients and must be addressed. Doctors often suspect an IBS diagnosis when a patient reports that they experience a temporary relief of symptoms after a bowel movement or after releasing gas.

Traditional medical providers often prescribe anti-anxiety drug like Xanax to help IBS patients, an anticholinergic/antispasmodic medication like dicyclomine or hyoscyamine if pain is occurring after eating, a low-dose antidepressant medication to try to reduce the intensity of pain signals going from the gut to the brain (abnormal levels of the neurotransmitter serotonin in the colon can affect motility and bowel movement) or a series of Rx & OTC drugs for constipation or diarrhea. In patients with moderate to severe IBS that are not responding to first stage treatment, the provider may prescribe Amitiza (lubiprostone), Linzess (linaclotide) or Trulance (plecanatide) for IBS-C patients or for patients with chronic idiopathic (unknown) (CIC) disease. In both conditions, the drugs try to increase fluid secretion & movement in the GI tract. For patients with IBS-D, they may prescribe rifaximin (xifaxan). If the IBS is further diagnosed as ulcerative colitis they may prescribe a drug like mesalamine to reduce the production of prostaglandins which is intended to reduce inflammation in the colon and the symptoms associated with the disease. If the diagnosis is Crohn’s Disease or inflammatory bowel disease (IBD), they may prescribe heavy steroids or immunosuppressants to try to slow down the progression of the symptoms. Regardless of treatments, each year only about 10% of IBS patients get better. 

At Wellness Rx we try to balance or moderate the traditional approaches for treating IBS with a natural approach. We always first advise IBS patients to maintain daily hydration & to watch their diets. Outside of avoiding fried foods & for most IBS patients, increasing their consumption of cleansing foods like fruits & vegetables (especially organic lettuce), we advise patients to seek the professional help of a nutritionist or naturopath with experience with IBS since each IBS patient is different in both symptoms & intestinal damage. Often these professionals will recommend a plant based diet (animal proteins take longer to digest), to eliminate processed foods (best to avoid or limit smoothies or juices; just whole food) & to eliminate processed sugars & flour (even almond; nothing processed). Each IBS patient must rule out allergic conditions like gluten (celiac disease) or lactose (milk sugar) intolerance, develop stress management techniques, eat smaller meals, chew their food carefully (Ayurvedic medicine suggests that you bite your food 20 times before sending it to the stomach) & try to have their last meal in the early evening. Intermittent fasting is a technique where your daily eating window is between noon to 7 PM. 

The goals for the natural treatment of IBS are: reduce bloating, improve the digestion of food, reduce the frequency of attacks & improve relaxation. Patients are encouraged to maintain a daily journal to observe small gains and areas that need intervention.

At a minimum, we recommend the following for IBS patients to consider:

1). High dose multi-strain high-quality probiotic once or twice daily on an empty stomach

2). Taking a high quality digestive enzyme with each meal to help breakdown fats, sugars & proteins. (Ortho-Digestive enzymes are an excellent product to consider). The company also provides an excellent product Indigo Greens for patients who have a hard time maintaining a plant-based diet. 

3). Taking one ounce of unflavored Aloe Vera Gel in the morning & evening

4). Try using ginger to help with digestion & nausea, adding ginseng to your diet for its anti-inflammatory & immune boosting properties, using charcoal for bloating, trying alum root for diarrhea, Kiwi Fruit for constipation & experimenting with elm water, yellow saffron tea & a small amount of olive oil daily to improve digestion. 

5). Enteric-coated Peppermint oil capsules may help with pain, gas, bloating & constipation. The menthol in the oil dull pains receptors & relaxes muscles in the colon. Adults should take 0.2 to 0.4 ml of oil 3 times a day. Children over 8 years of age 0.1 to 0.2 ml’s

4). Maintaining an alkaline-reacting diet or adding a supplement that contains chlorella

5). The amino acid (protein builders) L-glutamine can safely be taken since tissues in the intestine use the amino acid as a fuel source to function well.

6). The use of soluble fiber (guar gum; pectin, psyllium, seeds; peas; beans; fruits; lentils or oats) draws water into the gut (stools become softer & easier to pass) & could be helpful for certain conditions. Insoluble or indigestible fiber (lignin; cellulose; methylcellulose) adds bulk to stool & may help food to move more quickly through the intestines to promote digestive regularity (use only for constipation). These products, however, may increase gas production or interfere with prescription drugs. Regardless of fiber source, gradually increase dosage to observe benefits or side effects.

Other recommendations include:

1). Consider internal cleansings like colonics or castor oil packs on an annual basis

2). Consider using a functional water product (oxygen is added during the bottling process) on a daily basis to help with hydration & the removal of toxins from the body

3). Using a high-quality CBD oil especially before stressful events

5). Many experts believe that pressures on nerve centers along the spine which influence the intestinal tract could be a cause of IBS. Consider a therapeutic massage, seeing a chiropractor for a spinal manipulation or seeing a cranial sacral expert for manipulation of the spinal fluid of the spine

In the end, patients with IBS must have patience, must keep a journal to document success & must have focus to stay the course of treatment. Patients must become their own investigator. Rarely, will one intervention work. Rather, success will be achieved with a combination of interventions that the patient has documented as providing symptom reduction and are realistic for their monthly budget.