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Irritable Bowel Syndrome
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by Dr. Patricia Margaitis
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The most frequently asked question in my practice involves digestive issues, especially the Irritable Bowel Syndrome (IBS). After discussing some of the possible contributing and causal factors, the known associated disorders, a brief discussion of the gut environment, the role of stress, and a sampling of ongoing theoretical research attempting to understand IBS I will present a brief overview of a holistic body/mind/ spirit approach to healing. This is based on respecting the fact that every individual is different and our bodies have an innate ability to heal given the right environment.
As the 22 million people diagnosed with IBS in the U.S. know, the symptom picture involves severe intestinal cramping, alternating constipation and diarrhea, a sensation of fullness, bloating and urgency. It is obvious that when severe, IBS can interfere with basic lifestyle. The condition is called a functional bowel disorder effecting both the small and large intestines. Men are diagnosed less frequently than women. Women in their teens, twenties and thirties are most commonly involved and many experience a worsening of symptoms at the time of their menstrual cycles during which time hormonal levels are problematic for so many. The diagnosis has now been extended to children. This syndrome is often associated with depression and/or anxiety, chronic fatigue, fibromyalgia and pelvic pain. The diagnosis is made after medical tests rule out serious illness.
Because depression is strongly correlated with hypothyroid function I always recommend that anyone with symptoms of depression or IBS insist on a minimal thyroid evaluation involving T3, T4 and TSH. Screening for pre-diabetes and diabetes is also critical. Any medical doctor can order these for you. Additionally, infection in the GI tract must be ruled out and the best assessment is a comprehensive stool analysis to determine whether bacterial or Candida yeast overgrowth are contributing to symptoms. For instance, the yeast Candida albicans , a normal resident in the GI tract, becomes problematic when the gut flora and environment become imbalanced.
A healthy gut has about three pounds of bacteria and other G.I. flora and is now considered to be an immune organ. (Science Daily 09/3/2004) When pathological organisms proliferate, they can literally drill holes through the intestinal wall allowing their waste (sewerage) to leak into the bloodstream. You just won’t feel well and bottles of arbitrary supplements won’t help you. I am always amazed at how many people keep buying the solution pill of the week as advertised in the various media. Obviously there is no magic pill.
Although no one cause of IBS is reported it is easy to suspect that environmental poisons in food, air, water, pesticides, herbicides, household chemicals, and the ubiquitous soft and hard plastics used to store food, water and nearly everything else are involved because they are known hormone disrupters. It seems that the wanton destruction of our earth is being reflected in our bodies.
Store food and water in glass containers. The literature is replete with information on the hormone (endocrine) disrupting qualities of phthalates and Bisphenol-A (BPA) found in plastics. These chemicals imitate estrogen in females and are called xenoestrogens. They also interfere with the male hormone testosterone. Current research (Swan et al) supports a strong association between phthalate levels in women and demasculinization of their baby boys’ genitals. (ourstolenfuture.com).
Since women are most vulnerable to IBS during the hormonal changes of menstruation and since plastics are hormone disrupters it makes sense to remove all plastics used to store food or water. In fact, I urge everyone to remove all plastics used on your body or as food or water containers.
No discussion of digestive issues is complete without considering the role of stress in this, the age of anxiety and fear.
We have all heard about the fight/flight syndrome originally presented by Hans Selye In his book “The Stress of Life”. Advances is stress physiology have further refined this work.
For simplicity’s sake, our autonomic nervous system releases adrenalin and cortisol coincident with real or perceived psychological or physiological stress. This affects not only the digestive system, but also raises heart and respiration rates, interferes with the immune system and produces muscular tension. There is a direct effect on the enteric (gut/brain) nervous system. Author J.D. Woods in the Journal Gut compares the enteric nervous system to a library of programs for different patterns of gut behavior. (Chris Woolston Consumer Health Interactive) How many of us are in a state of chronic stress?
When your body is concerned with survival (ongoing fear, worry or catastrophic thought) it cannot be concerned with digestion, immune surveillance, repair or reproduction. Food will rot (ferment) rather than be digested and result in bloating, gas and possible pain.
It is also known that the gut/brain sends signals to your brain and many IBS sufferers have unusually low thresholds for enteric pain. Some investigators have proposed a serotonin deficiency or excess in the gut. People are often surprised to learn that most of our serotonin (a neurotransmitter) is made in the gut and not the brain. In fact every neurotransmitter is found in the gut. Neurotransmitters are chemicals that send messages between cells. Some energize us, some calm us and all must be in balance. It has also been postulated that childhood trauma and abuse contribute to IBS and I have found this connection in my practice. Unresolved issues will be expressed somewhere, perhaps in a “gut feeling”. Finding a trustworthy therapist is an excellent idea in these situations.
Relaxation, meditation, and prayer are proven behavioral practices for stress reduction. The very easy method of relaxation outlined in The Relaxation Response by Dr. Herbert Bensen will help many of you begin an intentional relaxation practice.
One of my favorite relaxation techniques involves having clients sit Yoga style with hands gently folded on the lap. Learn how to breathe from your diaphragm rather than your chest. Sit very straight (sternum up), close your eyes and slowly inhale through your nose to a slow count of three, pause for a count of three and exhale to a count of three and silently think “one”. Repeat and focus on the counting and breathing cycle. Expect distractions and always return your focus to breathing and counting. You can obviously choose any word or phrase meaningful to you. End with a deep breath and stretch. You may find that more time has passed than expected.
We now know that our brains can be physically changed for the better throughout our lifespan by continually challenging ourselves with new material and not relying on the same old comfortable patterns of behavior. We also know that our thoughts tend to become our reality. If I believe that I cannot improve my health, I won’t improve my health. If I am willing to inconvenience myself and implement certain known health promoting behaviors I will improve my health.
Let’s look at a few other health promoting behaviors to calm the irritable bowel. Dietary choices are crucial. Remove all processed and synthetic food items and eat as much organic fresh food as possible. Remove all wheat and grains. Not only do they contain gluten but also residues from multiple chemical sprays during growth. Many people seem to have a sub-clinical sensitivity to gluten and improve dramatically when wheat and other gluten containing grains are eliminated. Try this for 30 days. Also eliminate dairy. You may need to pursue an elimination diet to discover other food sensitivities and triggers. Your healthcare provider may want you to test for heavy metals. This can be accomplished with a hair analysis from a reputable lab.
Use only non- altered whole food supplements and whole herbs from companies who assay each batch for purity and consistency to supplement your diet and feed your starving cells. The whole food supplements contain known and unknown naturally occurring components all working together. You may want to try digestive enzymes. People experiencing digestive dysfunction are not absorbing or able to utilize nutrients. Enzymes break down proteins and will prevent or minimize fermentation. Check with your healthcare provider, especially if you have ulcers.
Chew each mouthful of food twenty or thirty times. Enzymes in your saliva initiate the digestive process. Drinking liquids during meals dilutes the enzymes and stomach acid required for digestion.
Eat in a calm environment-no television.
Try enteric coated peppermint oil taken just before or after meals. You can also try Chamomile or Fennel tea to reduce bloating and gas. Marshmallow root calms inflammation and provides a soothing mucilaginous coating in the intestinal tract. Ginger root is often relied on to aid digestion and quell inflammation.
Consider replenishing your gut bacteria with human grade probiotics to build up the good bacteria. This is necessary if you have taken antibiotics.
Add regular exercise for it’s profound effects on your physiology.
Select from an array of foods without concern, walk barefoot on the grass, view the stars at night, enjoy driving to your destinations, walk in a stream or lake for pleasure, let your dog run free, wander in the woods or a meadow and wonder at the mysteries occurring inside the safety of a pregnant woman’s womb. Yes, the earth is in an “irritable state.”
You now know what IBS is, some of the associated disorders and contributing factors, a little about the theoretical research, the role of stress and environmental factors and a few self help behaviors.
Side effects of implementing any or several of these ideas include a greater sense of control over your situation and likelihood of feeling better by helping your body’s innate ability to heal itself.
Information in this article is not intended to diagnose, treat or prevent any medical issue. Always consult with your doctor before changing your diet, adding supplements, or implementing an exercise program.
Patricia Margaitis PhD LCSW, BCNC, DAAIM
When health is the only alternative
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