Solutions for Irritable Bowel Syndrome

• What Is Known About Irritable Bowel Syndrome
• Healthy Steps: Irritable Bowel Syndrome—First Steps
• Healthy Steps: Irritable Bowel Syndrome—Full Program
• From Dr. Deborah's Desk

Updated June 9, 2015

How complicated can digestion be? If you suffer from irritable bowel syndrome (IBS), you know that one of the body's natural processes can seem to go all haywire under certain conditions. You may have experienced how uncomfortable and even debilitating the condition's intestinal cramping, bloating, gas, diarrhea, and constipation can be. Fortunately, even though the symptoms of IBS can be severe, irritable bowel syndrome is not associated with more serious diseases such as colon cancer. You may also be relieved to know that irritable bowel syndrome doesn't cause permanent damage to your colon.

Despite the fact that IBS is a relatively benign disorder, it certainly doesn't feel that way when you're in the grip of an attack. Although the symptoms are unpleasant, the most serious issue associated with irritable bowel syndrome is likely its effect on your quality of life. People suffering from IBS may find themselves avoiding social engagements and other outings out of embarrassment or fear that they might suffer an attack. Because conventional medicine offers little relief for IBS, sufferers can end up feeling frustrated, anxious, and depressed, which exacerbates irritable bowel syndrome's symptoms.
Although it generally takes time and persistence, most people with IBS can control the syndrome-and often heal from it entirely-by making simple changes in diet and lifestyle. In addition, I recommend several natural supplements that can help create a healthy intestinal environment, alleviating irritable bowel syndrome's symptoms.

What Is Known About Irritable Bowel Syndrome

Everything we know about IBS is in the process of changing.  We once thought IBS difficult to diagnose because the symptoms range from mild to severe and may be chronic or intermittent. The actual symptoms vary from person to person. Most people with irritable bowel syndrome report periods of time when the symptoms are severe as well as spells when they improve or even disappear completely.

We now know that there are verifiable changes in the small bowel that can be relied upon to diagnose IBS definitively and confirm it as an organic, not a psychiatric disease! 

To help identify irritable bowel syndrome, researchers used to rely on a set of diagnostics known as the Rome criteria. For an IBS diagnosis, you must have abdominal pain and discomfort lasting at least 12 weeks (the weeks don't have to occur consecutively). In addition, you must also experience at least two of the following:

• A change in the frequency or consistency of your stool.
• Straining, urgency, or a feeling that you can't empty your bowels completely.
• Mucus in your stool.
• Bloating or abdominal distension.

For true IBS, we used to think there were a variety of contributory factors. We now know that IBS starts with a case of gastroenteritis, during which the body develops one and then a second set of antibodies that irritate the the bowel's normal function.. With IBS, instead of a coordinated rhythm, the contractions may be stronger or more frequent, causing food to move through too quickly, which can trigger bloating, gas, and diarrhea. Conversely, the intestines may contract slowly and irregularly, causing constipation. Other contributing factors include a lack of healthy flora in the intestinal tract, food allergies and sensitivities, and emotional stress.

The diagnostic tests for IBS are two: if you suspect IBS, you must be tested for Anti-CdtB and Anti-vinculin antibodies. If one or both of those are positive, you should be tested for SIBO with a lactulose (not glucose) breath test that looks for methane and hydrogen for a full 3 hours. (An upcoming article about SIBO will offer more details, but let's say it's been poorly understood before now, AND that it's very complicated.

If the antibody tests are negative, you do not have IBS. I remind myself with each irritable bowel patient that there are 6 possible conditions for which treatment can reverse the symptoms of IBS. Specific tests identify each condition, and treatment can be individualized according to diagnosis.

1. Intestinal infection of a sort that won't show up on a conventional stool test. A more comprehensive stool test from a specialized lab (I use Genova Diagnostics) is required to identify the nature of the infection or dysbiosis. The problem could be the presence of something unusual, or an abnormal amount (too little or too much) of a bacteria or yeast species normally present.
2. Food allergies. Again, routine food allergy tests are not usually helpful. An elimination diet, starting with The Paleo Diet, can be very informative. The most common food allergen is gluten or wheat, whether or not you've had a "test" for celiac disease. There are a variety of tests for celiac sensitivity, some more reliable than others and the existence of "non-celiac gluten sensitivity" has finally gained official recognition.
3. SIBO or small intestinal bacterial overgrowth: you can have SIBO without having IBS, although they often co-exist.. Bacteria should live in our colons and not so much in our small intestines. If they take up residence there, they can cause a great deal of bloating, rumbling, and discomfort, with or without cramping, diarrhea, constipation, anemia, and malabsorption.
4. Low grade inflammatory bowel disease. Your physician may determine that you don't have full-blown Crohn's or Ulcerative Colitis, but inflammation can be present to a lesser degree and addressed as if it were a mild case of one of the more common inflammatory conditions.
5. FODMAP sensitivity is widespread. FODMAPS are specific sugars that absorb water into the intestine and can cause high levels of fermentation that lead to IBS symptoms. Stanford Hospital's handout identifies the foods commonly problematic.
6. Abdominal adhesions can interfere with the bowel's normal physical movements and present symptoms much like IBS.

Healthy Steps: Irritable Bowel Syndrome-First Steps:

For the greatest IBS improvement with the fewest steps, do the following:

For IBS combined with SIBO, you will require treatment with an antibiotic, either herbal or pharmaceutical, as well as a prokinetic agent.

For IBS the treatment the most likely to be successful is a course of the the pharmaceutical antibiotic Rifaximin as well as attention to dietary triggers. 

• Avoid all glutens. Follow the Gluten-Free Diet. Symptoms may abate in days or not for many months if you have a gluten sensitivity. If you don't find relief after 30 days, eliminate dairy and legumes (that includes peanuts!) as well.
• Avoid all forms of sugar. Avoid all FODMAPs.
• Begin Barleans Omega Swirl, 1 Tbsp daily, or Designs for Health OmegAvail, 1 or 2 softgels daily.
• BioImmersion Original Synbiotic Formula. Start with 1/4 teaspoon and gradually work up to 1 full teaspoon daily.
• NOW Peppermint Gels. Take 1 softgel one to three times daily between meals to relieve cramping. Note: In some people peppermint causes heartburn. These softgels are enteric coated and should bypass the problem, but note your own response.

For either category of IBS, it would also be wise to attend to healing a possibly irritated lining of the intestine, with wise dietary choices (bone broth, fermented foods, and probiotics) as well as supplements such as colostrum, N-acetylcysteine, and/or L-glutamine. Look for more details in the upcoming SIBO article. 

Healthy Steps: Irritable Bowel Syndrome-Full Program

A comprehensive program involves many areas in which action steps can be taken gradually or all at once. Start by following the basic nutrition and healthy lifestyle guidelines with the following modifications:

Address the underlying problem

• For IBS combined with SIBO, you will require treatment with an antibiotic, either herbal or pharmaceutical, as well as a prokinetic agent.
• For IBS the treatment the most likely to be successful is a course of the the pharmaceutical antibiotic Rifaximin as well as attention to dietary triggers. 
• For either category of IBS, it would also be wise to attend to healing a possibly irritated lining of the intestine, with wise dietary choices (bone broth, fermented foods, and probiotics) as well as supplements such as colostrum, N-acetylcysteine, and/or L-glutamine. Look for more details in the upcoming SIBO article. 

Preventing IBS

We now know that irritable bowel syndrome results from a persistent and troublesome bacteria that takes advantage of a depleted microbiome following food poisoning, or some other virulent form of gastroenteritis with diarrhea. Restoring important lacobacillus species, particularly lactobacillus rhamnosus, can help prevent the development of IBS. L. rhamnosus is available in Allergy Research Group's Lactobacillus plantarum/rhamnosus/salivarum combination probiotic.

Savor Helpful Foods

• Eat more fats. Good bacteria love fat. Butter, meat fat, olive oil, and coconut oil are all excellent choices. Coconut oil and coconut meat soothe inflammation in the gut and actually kill the bad bacteria that can cause IBS.
• Bone Broth Soup. Enjoy 2 cups daily as a tonic for the intestinal walls (see Recipes).
• Organic flax seeds. Grind 2 teaspoons freshly each day and sprinkle over your meals to add a nice buttery taste. Flax seeds contain linolenic acid and water-soluble fibers called lignans, both of which will normalize your bowel movements. Flax is a high-quality source of omega-3 fatty acids, making it a much better choice than psyllium seeds. Drink 8 ounces of water after eating flax seeds.
• Fermented foods. Sauerkraut, lacto-fermented pickles, kombucha, and kefir made from raw milk are rich in friendly microorganisms that encourage healthy digestion. Fermented drinks like kombucha are superior to pure water for relieving thirst during or after physical exertion. Eat or drink a small portion of fermented foods at the beginning of each meal. This is particularly important if you have taken antibiotics in the last 6-12 months.
• Eat organic, unprocessed food.
• Vegetables are usually well tolerated, but you can improve your tolerance by cooking them well and avoiding vegetable peels. 

Avoid Problematic Foods

• Sugar of all kinds. Sugar feeds the bad bacteria. Stay away from cane sugar, brown sugar, honey, maple syrup, molasses, and sorbitol (found in sugar-free gum and mints) as well as fructose from high-sugar fruits such as apples and pears, especially in the form of juice.
• Gluten. For many people, the elimination of gluten seems daunting at first and a tremendous relief once the gluten is gone. True allergies may show in blood tests, but gluten sensitivity is most convincing when dietary elimination yields great results. Wheat, rye, spelt, and barley (and thus beer) are the biggest contributors of gluten. For more information, read the information in the article on Gluten-Free Diet.
• Legumes. These produce unwanted gas. If you find relief by avoiding legumes, some people can re-introduce properly prepared (sufficiently soaked and cooked) legumes.
• Dairy. Unfortunately, dairy can be a provocative food in many people. Avoid all dairy for one month, and if you find relief, re-introduce dairy foods one at a time. Best tolerated dairy products are butter, cream, and, of course, raw dairy. 
• Food additives and caffeine.
• All refined carbohydrates and processed foods. This includes bread, cakes, cookies, and cereals.
• Foods you are allergic to. Allergic reaction is a major source of IBS symptoms, and avoiding these foods has produced a 73-percent improvement in research settings. Besides gluten, other possible triggers include corn, dairy, eggs, onions, chocolate, coffee, tea, citrus, potatoes, soy, peanuts, yeast, pork, and oats. You may have an allergic reaction to more than one of these foods. The only effective method of discovering which foods you are allergic to is by testing them on yourself. RAST and other allergy tests are not reliable. Follow our Allergy Elimination Diet.
• FODMAPS is an acronym that covers many of the commonly offending foods in IBS. The list of foods is long and includes fructans (wheat, onions, leeks, asparagus, chocolate and artichokes are examples of fructans), galactans (legumes), polyols (apples, pears, nectarines, avocados, cauliflower, mushrooms and artificial sweeteners), lactose (dairy), and high fructose sources. Do a two-week trial avoidance of these foods to see if it helps. Consult Stanford Hospital's guide to identify the common culprits in FODMAP sensitivity.
• Wheat bran fiber. This may do more harm than good because many people are allergic to wheat products.
• Candida. If you have symptoms such as vaginitis, thrush, diabetes, or immunodeficiency, you may benefit from an anti-candida diet. Follow our Candida Diet.
• Antibiotics. Whenever possible, avoid antibiotics. This is especially true for pregnant women and children, whose gut bacteria may never recover from a single dose of antibiotics. Conventionally raised meat is a significant source of antibiotics. Choose local, organic, and drug-free meat from grass-fed animals.

Supplements Can Help

• Begin Barleans Omega Swirl, 1 Tbsp daily, or Designs for Health OmegAvail, 1 or 2 softgels daily.
• BioImmersion Original Synbiotic Formula. Start carefully with 1/4 teaspoon and work your way up to 1 full teaspoon. Take the smallest dose that does not activate your symptoms; only increase your dosage as symptoms are alleviated.
• Thorne Research Zinc Picolinate. Take 15 mg daily.
• Thorne Research Melaton-5. Take 5 mg at bedtime for six months. Research has shown melatonin to be extremely effective in IBS patients.
• NOW Peppermint Gels. Take 1 softgel one to three times daily between meals to relieve cramping. Note: In some people peppermint causes heartburn. These softgels are enteric coated and should bypass the problem, but note your own response.

Daily Life Activities

• Slow down and chew thoroughly. Anticipating, savoring, and chewing your food completely all contribute to healthy digestion. Eat more slowly, relax, and enjoy your meals with companions if possible. Don't bring up controversial topics at the dinner table. Practice putting your fork down between bites to give your digestion time to work naturally.
• Drink before meals. Drink a large glass of water half an hour before meals and limit your mealtime beverages to 1/2 cup of water or tea. Avoid carbonated water with meals, but enjoy it between meals if you tolerate it. 
• Exercise promotes healthy bowel function. This is a trick well known by surgeons, who want to let their patients leave the hospital as soon as their bowels move. Get the patient walking even up and down the hallway gets the bowels to move as well. Elderly patients particularly might benefit from more activity if they are home bound or no longer very active.
• Avoid industrial pollutants. These include toxic cleaning chemicals for the home, chlorinated water, and antibacterial soaps. Avoiding pollutants will help your healthy gut bacteria survive and thrive.
• Practice relaxation, meditation, hypnotherapy, dynamic psychotherapy, or cognitive behavioral therapy. All of these techniques have a positive effect on IBS. According to research, mindfulness training (a form of meditation) produced significantly greater improvements than those experienced by the control group (26 percent versus 6.2 percent).
• Talk with your doctor about irritable bowel syndrome. Any persistent or severe abdominal pain, particularly if associated with fever or a change in bowel patterns, always requires medical evaluation. Minor discomfort that persists also requires a full evaluation. Consider asking about some unusual problems when you chat with your health care practitioner.
  • Have your doctor check your stool for parasites. When problems persist despite a healthy diet and appropriate supplements, it may be that some form of parasite or imbalance needs to be identified. This may be the cause of your irritable bowel. Identification of small intestine bacterial overgrowth (SIBO) requires special testing. Happily the special testing is non-invasive and abundant probiotics and some dietary restrictions are usually effective. One of the medical treatment options for SIBO includes an antibiotic called Rifaximin that acts only within the intestine, with little absorption into the rest of the body and little in the way of serious side effects.

Homeopathic Remedies for IBS

Match the remedy description to your most consistent irritable bowel symptoms. Take two pellets of the 30C remedy at the start of any symptoms. Repeat twice daily as needed. Take the remedy less frequently as you improve. Lack of improvement after a week would suggest the need for picking a second choice remedy. Symptoms noted in bold are the most helpful, match those first. Remedies are available through my office by following this link.

Aloe

• Diarrhea with much gas and sputtering of stool.
• She is worse in the morning, often upon first waking.
• Effortless, involuntary stool that may have jelly-like lumps of mucus.
• Rumbling, gurgling in bowels with sudden urging.
• She may have hemorrhoids like bunches of grapes.

Antimonium Crudum

• Patient has a big appetite, and eats beyond capacity of his digestion.
• He is made worse by overeating.
• His tongue is thickly-coated and a white color.
• Diarrhea and constipation are alternating.
• Gassiness with rumbling in stomach.
• Headaches from disordered stomach.
• Constant belching and bloating after eating.

Argentum Nitricum

• Diarrhea from emotions-nervousness, apprehension and fear.
• Watery, noisy, green “like chopped spinach,” and offensive smelling stool.
• She gets nervous diarrhea after sugary sweets, ice cream, rich food.
• Diarrhea with marked belching.
• Abdominal pain with noisy gas.

Arsenicum Album

• Burning pain in stomach sometimes with nausea and vomiting
• IBS accompanied by chills, anxious restlessness and exhaustion.
• His diarrhea is worse from Midnight to 2 am.
• Stool is pungent, rice watery, burning and sometimes bloody.
• He is better with warm drinks, heat or milk. Worse with cold drinks.

Carbo Vegetabilis

• Greatly distended (bloated) abdomen, especially upper portion.
• Gas pains forcing her to bend double.
• She feels worse while eating, but better from belching.
• She feels chilly, but craves open air or being fanned.
• Digestion is slow, food putrefies before it is digested.
• Contraction pains extending to chest while bloated.

China

• Liver and spleen swollen.
• Gallstone related intermittent pain.
• He is gassy and belching, but it gives no relief.
• Pain darts crosswise across stomach.
• Stools are undigested, frothy, and foul.
• Dirty yellow coating on tongue.

Colocynthis

• Agonizing cutting pain in abdomen causing her to bend double.
• He is easily angered and irritable, pain made worse by anger/humiliation.
• Pains come in waves and are better with hard pressure.
• Diarrhea after eating or drinking even small amounts. He is better with coffee.

Lycopodium

• Pain is usually associated with acid reflux and bloating.
• She is made worse by cold food while craving everything warm.
• Stool begins formed, then turns soft or watery.
• Symptoms move right to left, and often occur between 4-8 pm.
• Noisy gas, her abdomen is bloated and full.
• She desires sweets, but aggravated by cabbage, beans, oysters and onions.
• Stool is hard, difficult, small and incomplete.
• Full upon eating only a little.

Phosphorous

• His stomach pain feels better with cold drinks, food and ice cream.
• Vomits as soon as liquids warm in his stomach.
• A very weak, empty, “all gone” sensation in abdomen.
• Sour taste and belchings after every meal.
• Great weakness after stool.
• He is worse laying on his left side.
• Watery stool, like “rectum is loose or like a fire-hydrant.”

From Dr. Deborah's Desk

Over the years I'd say about a third of people complaining of any kind of bowel troubles are easily relieved by following the nutritional suggestions above, another third with the right homeopathic remedy, and the final third seem to need a lot of sleuthing and attention to figure out the problem.

Ben came to see me about a year ago for an unusual problem which was a strange consciousness and discomfort in the lining of his mouth, affecting his tongue and gum tissue. It was hard to describe but it wasn't hard to remember when it started: right after those antibiotics he took for the travelers' diarrhea he had a few years previously. He had other problems but the tongue bothered him the most. Only after a couple months of probiotics restored his mouth to normal did we turn our attention to his abdomen which was still cramping and uncomfortable despite the probiotics. It's amazing that the tongue discomfort was that much worse than the IBS symptoms.

Full court press on the IBS included digestive enzymes, night time Melaton-5 and a constant struggle to resist the antibiotics his other physician hoped might help. Finally taking fruit out of his diet, as well as the morning breakfast cereal (processed grains, gluten containing and pasteurized milk), seems to be helping. If the problems persist, he did test positive for SIBO, so the antibiotic Rifaximin is one I won't mind him taking.