HOLISTIC HEALTH - November 2017 - Kansas City

Treat the Causes, Not the Symptoms of Irritable Bowel Syndrome

By Nancy Russell, M.D.

 

There are several approaches to irritable bowel syndrome (IBS); getting to the root of the problem is the best goal. Conventional medicine defines irritable bowel syndrome as a group of symptoms including abdominal pain and changes in bowel movements patterns without any evidence of underlying damage. These symptoms occur over a long period of time, often years. IBS has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common, or neither  (IBS-D, IBS-C, IBS-M or IBS-U respectively). Holistic, integrative and functional medicine physicians assess for possible causes so as to diagnose and treat underlying issues.

 

Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS. Other common names for IBS are spastic colon, nervous colon, mucous colitis and spastic bowel. The frequency is 12.5 percent of the population in the developed world. It is twice as common in women compared to men and typically occurs before age 45.

     

To evaluate the situation of IBS regardless of symptoms would be to start with a full blood examination: complete blood count, metabolic panel with liver panel, C-reactive protein, and celiac disease panel. Abdominal ultrasound to rule out gallbladder, liver and pancreas problems is imperative. Endoscopy by a gastro-enterologist specialist to rule out stomach ulcers, celiac disease, helicobacter pylori infection, inflammatory bowel disease, polyps and cancer is the next step.

    

If this evaluation does not reveal an answer or only partially relieves the symptoms, continue to investigate further. Even if celiac disease is not diagnosed, foods may be aggravating the symptoms. Food allergies are diagnosed with IgE blood tests or skin prick allergy testing. Another form of food reaction, called food sensitivities or food intolerances are somewhat controversial but can be diagnosed with IgG blood tests of other immune mediator testing. Whereas food allergy symptoms consist of hives, swollen throat or even life threatening symptoms, food sensitivities are more delayed reactions from a few minutes to more than 24 hours after ingestion and mimic IBS symptoms, as well as potentially causing sinus congestion, fatigue, headaches, skin rashes, etc.

     

Food sensitivities may be the tip of the ice berg and underlying issues can be assessed with comprehensive digestive stool analysis, hydrogen breath testing, and evaluation of potential medication or supplement side effects. Comprehensive stool analysis can assess for maldigestion, malabsorption, abnormalities in metabolism, bacterial overgrowth, yeast and candida overgrowth, inflammatory disease markers, and parasites. Other issues to be considered that can mimic IBS are endometriosis, interstitial cystitis and bile acid malabsorption.

    

For treatment of IBS, the first step in a food elimination diet based on the blood testing or eating a low FODMAP diet. The FODMAP diet restricts various carbohydrates which are poorly absorbed from the small intestine, as well as fructose and lactose. To avoid being on these diets long term, many people can treat the underlying causes and gradually resume eating many of the foods restricted initially. Underlying causes may be SIBO- small intestinal bacterial overgrowth, candida or other yeast overgrowth and/or parasites. These situations are treated with proper nutrition, probiotics, prescription and/or herbal antimicrobials for at least six weeks and usually longer.

     

Fiber and prescription medications can help or hinder IBS people.

For constipation, not improved with increasing water, exercise and better diet, soluble fiber at up to 20 grams a day can be helpful. Fiber may aggravates some people’s symptoms. Proton pump inhibitors, PPI’s, such as Prilosec, Protonix, Nexium, etc. can aggravate IBS as it blocks over 95 percent of normal acid produced and prevents adequate digestion of some foods. PPI’s may also cause bacterial overgrowth leading to IBS symptoms. Sedative-hypnotic drugs like benzodiazepines, such as Valium, Ativan, Xanax can have a side effect in some people that mimics IBS symptoms.

     

Many medications are used to treat IBS symptoms that give temporary relief include laxatives, opiod analogs, serotonin meds, antispasmodics, tricyclic anti-depressants, and domperidone. These medications are generally for symptoms.

     

Functional medicine approach would be to treat with nutrition, stress relief, probiotics, herbal remedies, prescriptions when needed and acupuncture. These would be guided by blood testing, stool testing and nutritional testing. The physician and patient work together to assess and treat IBS and get to the root of the problem.