Irritable bowel syndrome (IBS) is a common disorder that is often overlooked or undiagnosed. It affects the large intestine (colon) and commonly causes cramping, abdominal pain, bloating, gas, constipation and diarrhea. It is a chronic condition which, although rarely severe, needs to be clinically diagnosed and constantly managed. Diet and lifestyle modifications are often enough to eradicate the worst symptoms and some people may need medication and counseling.

The causes of IBS are not known, however, a number of issues can cause the syndrome. In order for the body to move food from the stomach to the rectum, the muscles in the walls of the intestines need to contract and relax as they move the matter. If, for some reason, this motion becomes sluggish it can cause constipation with hard dry stool. Or, if the motion becomes over-active, it leads to bloating, gas and diarrhea. Overreaction to stress, which may result in poorly coordinated signals between the brain and the intestines, can cause changes in the digestive process. This, in turn, can lead to pain, diarrhea or constipation, and an irritated bowel.

While the syndrome can be triggered by a variety of foods as well as stress, it can also be affected by hormones. Women are twice as likely to have IBS than men, due to hormonal changes. Many women find the symptoms are worse around their menstrual periods. Acute illnesses are sometimes a factor in the start of IBS, such as an episode of gastroenteritis, or food poisoning.

Food is absorbed through the intestine wall. 60 percent of your immune system is in the small intestine. There is a thin lining which is protecting your immune system from undigested food particles and bacteria. That lining can break down from stress, too many antibiotics and anti-inflammatories such as Advil, steroids, high-sugar, low fiber diets, and alcohol. The breakdown may trigger an active immune response, allergies and irritate the enteric nervous system – the second brain - leading to IBS.

IBS tends to occur in people under the age of 45. If there is a family history of IBS, this may increase the risk. Mental health plays a big part in the risk factor also, showing a higher incidence for people with anxiety, depression, personality disorders or sexual abuse.

If you have symptoms of IBS, you should seek medical attention for an accurate diagnosis. Blood tests can determine whether symptoms like diarrhea or constipation and abdominal pain are signs of IBS. In 1990, a group of specialists from around the world developed the “Rome Criteria,” a classification system currently used for all the functional GI disorders including IBS. These are symptom-based criteria, kept up to date as new information and knowledge improves the precision of diagnosis. IBS criteria states that the condition of recurrent abdominal pain, on average, occurs at least 1 day per week over the course of 3 months, associated with a change in frequency and form of stool. During the blood test a complete blood count is done to check for anemia and other abnormalities, including tissue damage, inflammation and celiac disease. Other tests for IBS include stool tests to check for bacterial infection, parasites or blood in stool; colonoscopy and barium enemas, as well as psychological tests.

References:
www.iffgd.org
www.drhyman.com
www.mayoclinic.org


Notes from the Naturopathic perspective:

Meditation and yoga, regular exercise, and deep breathing all help to control the effect of how we manage stress. Improve your outlook on life through positive affirmations and turning to a more positive mindset, since negativity tends to lead to depression and a sense of hopelessness. High fiber diet can greatly improve the chances of avoiding IBS and improve the recovery from the effects of IBS – a diet rich in vegetables and fruits, whole natural grains, and beans. Fiber is the part of the plant that the body cannot digest. It provides bulk in stool and serves to soften stool and control blood sugar. Biofeedback, cognitive behavioral therapy, and acupuncture can also help bring relief. Fermented foods like kefir and kimchi provide live friendly bacteria. A good probiotic will help to settle irregularities in bowel, and peppermint oil which works as an anti-spasmodic can help with the pain. Cleanse any sugar from diet and do a candida cleanse, especially if you have been taking any antibiotics over the years that led up to the IBS or wish to prevent IBS. Approaching menopause can lead to stress and hormonal imbalances which make you prone to IBS.

Dr. Sally Warren, Traditional Naturopath, PhD
sallyw@metrointegrative.com


Homeopathic Remedies for IBS:  

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Homeopathic remedies stimulate a healthy immune response and are a well-established means of safe and effective treatment of IBS. Because symptoms can vary from person to person, the correct remedy is the one which most closely matches your unique set of physical/mental/emotional symptoms. The right remedy can alleviate symptoms remarkably fast during flare-ups and strengthen against future recurrence of IBS episodes.

The following are the best homeopathic remedies and the IBS symptoms for which they are indicated. For mild to moderate symptoms, select one and take a 30C potency remedy 1-3 times daily for up to one week. Discontinue as soon as symptoms improve. See a qualified homeopath for best results in advanced and chronic IBS.

NUX VOMICA: a top remedy indicated when the person has frequent or constant urging for bowel movements accompanied by abdominal pain. He can pass only a small amount of stool at a time, which temporarily alleviates the pain. There is often a distended abdomen after eating, and he is aggravated by coffee, spicy food, alcohol which he also often craves. This remedy is suited to people who tend to be ambitious, irritable, and impatient and have IBS flare-ups resulting from anger or frustration.

ALOE: another top remedy indicated when the primary symptom is a strong urge to pass stool soon after eating or drinking. The person often must rush to the toilet and passes a loose stool, often mixed with gas or mucus. There can also be abdominal pain before and during stool which is gone after the BM.

ALUMINA: Is most suited for people with IBS who are constipated. Even severe constipation can be alleviated with this remedy. Whether the stool is hard or soft, the person must strain with great effort. The intestines are very sluggish in such people who can go for days without urging for a bowel movement. Often he or she craves dry foods such as potatoes or rice, which only aggravates the condition.

CARBO VEGETABILIS: Indicated when distension and bloating are the primary symptom. The person feels tension and heaviness in the abdomen soon after eating, and it seems that any and all types of food turn to gas soon after a meal. Belching and or passing gas are quite common, which gives temporary relief. There are frequent loose stools with an offensive odor. He tends to crave fresh air or being fanned and may complain of stomach acidity and reflux.

LYCOPODIUM CLAVATUM: Indicated when the abdomen becomes distended and filled with gas after eating even a small amount of food. Cabbage, beans, and onions are especially aggravating. He prefers hot drinks and foods, and often alternates between having diarrhea and constipation. People who need this remedy usually crave sweets and have right-sided abdominal discomforts. Temperamentally suited to people who may appear confident to others but with an underlying insecurity.

SULPHUR: Indicated when diarrhea is much worse in the morning, often driving the person out of bed and straight to the bathroom. There may be rectal itching or burning, and burning in the abdomen as well. Such persons needing this remedy are often averse to fish and eggs and can have a Sulphur-like odor to the stool.  Generally intolerant of heat and prefer cooler air and weather, and may have a history of skin complaints with itching.

COLOCYNTHIS: Indicated in IBS where severe cramping in the abdomen, causing the person to double over with pain or twist and writhe on the bed. This remedy can be especially helpful in acute flare-ups when cramping is the main symptom.

ARGENTUM NITRICUM: Indicated for diarrhea from emotional excitement or with anticipatory anxiety. Suited for extroverted and excitable people who are lively and impressionable. Especially helpful before exams or performance when nervousness leads to frequent trips to the bathroom, with gas, distension, and diarrhea. This remedy will also relieve anxiety as well as the bowel symptoms.

Other remedies for IBS: include: Antimonium crudum, Pulsatilla, Mercurius solubilis, and Cinchona officinalis.

Laura Josephson, CCH


Dietary Tips for IBS from the Registered Dietician:

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Try to eat smaller meals more frequently throughout the day

A good goal to work toward is having 3 meals and 2 snacks throughout the day.
Try to  incorporate  a well-balanced meal or snack every 2-3 hours.

Reduce consumption of fat

High-fat, fried and greasy foods are common triggers for gastrointestinal distress in IBS patients.
Stick to leaner meats such as chicken, turkey, fish and aim to bake, roast, or grill foods.
Opt for low-fat or nonfat alternatives to full-fat dairy products or try plant based milks such as almond, coconut, hemp or oat which are naturally lower in fat.

Avoid gastrointestinal irritants including but not limited to, caffeine, chocolate, and alcohol

Reduce the amount of gas-producing foods and poorly absorbed natural sugars in your diet

Following a low FODMAP diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) helps alleviate IBS symptoms in some individuals.
According to the University of Virginia, foods that have been found to contain the highest amounts of FODMAPS and should be excluded are:

High fructose: Apples, pears, oranges, pineapples, melons.
High fructans: Onions, leeks, asparagus, artichokes.
Wheat-based and gluten products

Sugar alcohols: Including sorbitol and mannitol. These are used in many sugar-free gums, candy, and medicine. These aren’t always listed on the medicine label, so you may have to ask a pharmacist.
High Raffinose: Legumes, lentils, cabbage, brussel sprouts.

Consume adequate amounts of soluble fiber.

Soluble fibers (not insoluble) may alleviate some of your symptoms
Examples of soluble fiber foods include fruit, vegetables, whole grains and flaxseed.
When increasing soluble fiber in your diet, remember to drink plenty of fluids to help move the fiber through the gastrointestinal tract.

Supplement your diet as needed

When unable to find relief from symptoms through changes through your diet alone, nutritional supplements can help complement treatment.
At Metro Integrative Pharmacy, we offer a wide variety of probiotics, digestive enzymes, fiber pills and homeopathic remedies that can dramatically reduce symptoms of IBS - ask our practitioners for help in guiding to find a product that will work for you!

 

Kelly Johnston, MS, RDN, CDN


Notes from Functional Nutritionist:

Low FODMAP diet
Elimination Diet
Identify food allergies and food sensitivities (Most common food allergies milk, wheat, eggs, dairy products, corn, peanuts, soy)
Eat more soluble fiber       
            Flax seed
            Psyllium husk
            Oat Bran
Avoid eating raw fruits and vegetables
Avoid refined carbohydrates and sugar
Eat bone broth
Eat small meals
Don’t rush your meals
Chew food really well
Avoid excess liquid at meals
Avoid heavily processed foods, preservative, additives, food coloring


Herbs:

• Valerian Root - 1-2 500mg capsules in the evening
• Fenugreek - 300-600mg 2x daily
• Hypericum Perforatum - St John’s Wort Standardized Extract 300mg 3x daily
• Fennel – 1 tsp. dried seeds in 8 oz. hot water, steep covered for 30 minutes, drink 3 cups per day
• Artichoke leaf – 2 capsules 2x daily
• Turmeric - 250mg - 500mg 3x daily
• Aloe juice – 300mg 2x daily
• Peppermint essential oil – 1 capsule 3x daily
• Oil of Oregano – 50mg 3x daily
• Roman Chamomile
• Licorice
• Ginger
• Boswellia
• Cat’s Claw
• Yarrow
• Plantain
• Wild Yam

Teas:

• Peppermint
• Caraway
• Licorice
• Lemon Balm
• Milk Thistle
• Angelica
• Celandine
• Bitter Candytuft (Iberis amara)
• Chamomile

Supplements:

• Betaine HCL
• Iberogast – 1 mL 3x daily
• L-glutamine 5 grams 3x daily
• Melatonin – 2mg daily
• Magnesium
• Probiotics

Strains
Bifidobacterium infantis
Lactobacillus acidophilus
Lactobacillus fermentum
Lactobacillus plantarum
Lactobacillus rhamnoses GG
Saccharomyces cerevisiae Biocodex VSL#3

Galactooligosaccharides (GOS):

3.5 g/day
start with low dose and slowly increase until full dose

Pancreatic enzyme:

lipase, protease, amylase

Stress reduction:

• Hypnosis
• Relaxation
• Yoga

Acupuncture

Massage colon

IBS diarrhea

• excess of serotonin
 remove higher carbohydrate foods

IBS constipation:

Deficiency of serotonin
• Increase insoluble fiber
• Elimination diet

Medical tests from your doctor:

IgG food sensitivity testing
Comprehensive Stool Analysis Test for Candida and Parasites
Organic Acids Test for yeast, metabolic and overgrowth concerns
Small Intestinal Bacterial Overgrowth (SIBO) hydrogen breath test
• Lactose Breath Test

Suggested reading:

Digestive Health with Real Food: A Practical Guide to an Anti-inflammatory, Lowirritant, Nutrient-dense Diet for IBS & Other Digestive Issues. Jacob, Aglaée. Bend, Or.: Paleo Media Group, 2013. Print.  

The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders. Shepherd, Sue, and P. R. Gibson. New York: Experiment, 2013.  

The Whole-food Guide to Overcoming Irritable Bowel Syndrome: Strategies & Recipes for Eating Well with IBS, Indigestion, and Other Digestive Disorders. Knoff, Laura J. Oakland, CA: New Harbinger Publications, 2010.  

Resources:
Gaby, Alan R. MD. Nutritional Medicine. New Hampshire: Fritz Perlberg - 2011, pages 816-7.
Hawrelak, Jason: Gastrointestinal Imbalances – 2014.
Nakayama, Andrea: Digestive Intensive – 2016.
Pizzorno and Murray. Textbook of Natural Medicine, 3rd Edition, 2 Volume Set. Publisher: Churchill Livingstone Elsevier / 2006 ISBN# 0-443-07300-7, pages 1350-1354.
Snow, Rebecca: Functional Digestive Disorders - 2016.
Snow, Rebecca: Digestive complaints and Food Allergies - 2016.
Winston, David: Materia Medica – 2016.


Karen Wright, MSHNFM, Naturopath, FNLP, CNHP, CHC, LE, DD, Functional Nutrition Health Coach
Certified Nutrition Specialist, Metro Integrative Pharmacy
karenw@metrointegrative.com


A note from the Pharmacist:

Taking a probiotic is very important for a person suffering from IBS. The choice of the right probiotic is essential for relieving specific symptoms of bowel inflammation. For example, if you have diarrhea, consider taking Florastor by Biocodex or Sacro-B (Thorne).

If you have pain and inflammation, try Probiotic-225 by Ortho Molecular Products or VSL-3, recommended by many doctors.

Some patients feel anxious and/or depressed; Pro-Bio Mood by Pure Encapsulations is the best choice for the mental component of IBS.

To supplement fiber from food sources, Metro Integrative Pharmacy has a very good selection of products, such as MediBulk by Thorne, Ayur Triphala by Douglas and Fibermend by Thorne. Don’t forget to take your daily serving of anti-inflammatory fish oils, such as ProEPA, Pro-Omega 2000 capsules, or ProOmega liquid by Nordic Naturals.

Please ask our practitioners for advice, since everybody’s situation is different and needs an individual approach.


Yeva Pisarevsky R.Ph., Nutritional Pharmacist
yevap@metrointegrative.com


Metro Integrative Pharmacy

This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your medical condition. The information in this article is for educational purposes only.