In the list of common chronic disorders of digestion, irritable bowel syndrome (IBS) ranks high in the ability to wreak havoc on the sufferer’s social life, occupation and personal comfort.
The symptoms that accompany IBS (also known as spastic colon or mucous colitis) – constipation, diarrhoea, bloating and flatulence, searing abdominal pain spasms – can throw a monkey spanner into all aspects of the sufferer’s quality of life. Sufferers refer to it as ‘a little monster living inside’ that dominates their whole life, bringing depression and anxiety.¹
HOW COMMON IS IT?
IBS is very common. As many as one person in six adults in developed countries are afflicted with IBS, and it is apparently the second most common reason people miss work (after the common cold). Twice as many women than men succumb to it.²
DIAGNOSIS IS A PROBLEM
In conventional, allopathic medicine, IBS is a diagnosis of exclusion, arrived at when other pathological contenders have been ruled out. A host of other disorders masquerade as IBS: lactose intolerance, fungal infection, diverticulitis, laxative or antibiotic use (or abuse), so these are tested for initially (and ruled out) before any diagnosis can be made.³ In practice, the doctor will most likely detect tenderness on the surface of the abdomen that may be widespread or localised. A tender and squelchy lower gut will be noticed by skilful palpation by the fingertips. Loud gurgles (‘borborygmus’) due to gas and fluid movement in the gut may be only too evident. A battery of confirming tests include ultrasound, microscopic examination of stool, barium meal X-ray and endoscopic examination.
The natural-medicine practitioner will, in a face-to-face discussion, seek evidence of inner disharmony, and the underlying causes for this – lack of dietary fibre, poor lifestyle, intolerance to certain foods, and latent psychological stress. The outcome of these patient/practitioner discussions will point to the route of treatment.
WHAT CAUSES IBS?
The causes of IBS are not known. It is a mysterious, baffling disorder, accounting for the majority of visits to gastro clinics in developed countries. Research has revealed that it is probably due to a disorder affecting the body’s ‘second brain’ – the network of millions of nerve cells which envelop the gut from mouth to rectum, the so-called enteric nervous system (ENS).4,5 When the dynamic harmony between the true brain and the ENS is upset, the gut fails to function as it should. Everything from swallowing food, the release of digestive enzymes, blood flow to the stomach, to intestine and gut motility are impaired, so provoking its typical and unpleasant symptoms.
In spite of intensive research, the true origin of IBS has yet to be identified. However, it’s evident that a number of foodstuffs can have a marked impact on the gut’s functioning. Natural medical systems, such as Tibb and naturopathy, consider a dysfunctional lifestyle, especially involving a low-fibre diet, lack of physical exercise, and mental stress, as the likely culprit. Conventional medicine, on the other hand, feels that disorders of serotonin (a neuro-chemical involved in nerve transmission) acting on the ENS are largely the source of IBS.
This malabsorption disorder, aka gluten intolerance, is an inflammatory disorder with signs and symptoms often mistaken for IBS. This is an immune system reaction to the complex carbohydrate present in cereal wheat. Nutrients from ingested food cannot be properly absorbed due to damage to the structural inner lining of the small intestine. The main signs are progressive weight loss, iron deficiency, and low blood protein and electrolyte levels.6
There is certainly no quick fix for either IBS or coeliac disease.
First priority is ameliorating the troublesome symptoms. Laxatives, stool softeners, antispasmodics, herbal pain relievers, and low-carb dietary changes are employed to good, although temporary, effect in many sufferers.
Many IBS patients benefit from gradually increasing their intake of seasonally fresh fruits and veggies, which is an attractive and pleasing option for South Africans. Supplementing their daily food intake with soluble fibre contained in oats, bran and psyllium husk helps many who are plagued with diarrhoea, although rebound constipation may ensue. Wheat products should be eschewed, as these often give rise to allergies.
Dietary changes feature large in coeliac disease. Excluding gluten from the daily diet is the primary route – wheat, barley, rye or oats in whatever form should be banished. Forever. Dietary and vitamin supplements should be considered, especially for children. Children need more frequent check-ups to assess growth on their gluten-free regimen. Adding pancreatic enzyme products may also help, at least early on.
The secret to benefiting from dietary changes is to ‘start low, go slow’.
Increasing water intake is recommended. Refined products, especially sugar, have come under the spotlight lately, and curtailing these may offer relief. For those with confirmed coeliac disease, exclusion of gluten from the diet is the only treatment option.²
Many IBS sufferers get relief from abdominal pain and spasms with ginger concoctions or peppermint oil. Excess flatulence often responds to aniseed, and bloating to cardamom. If constipation is the dominant symptom, then cascara, senna, fennel or Aloe vera based remedies should help. Cinnamon and chamomile are claimed by many to counteract diarrhoea effectively.7
Probiotics are a popular choice at present, but they need to be taken regularly. Also, a multi-strain probiotic may be more effective than a single-strain form.
Supplementation with the friendly bacteria Bifidobacterium and Lactobacillus have been shown in a number of studies to improve gastrointestinal function, faecal properties and the health of the microbiome. This leads to a significant reduction in abdominal distension commonly associated with IBS. This probiotic also increases bowel transit times (which reduces cancer risk).8,9,10
Many sufferers swear by colonic cleansing or irrigation, convinced that toxins gradually build up in the digestive tract, and need to be flushed out regularly – otherwise lowered vitality and poor health results. Unfortunately, the procedures can be risky, often leading to bloating, cramping, nausea and vomiting. Over time they can increase the risk of dehydration, electrolyte imbalance and microbial infection.11
IBS is a complex and tricky disorder, accounting for the majority of referrals to gut specialists. Although non-life threatening, it can, and does, incapacitate many sufferers, seriously damaging their quality of life. Changes to food and lifestyle form the bedrock of treatment.
Coeliac disease is similar in symptoms, although weight loss, vitamin deficiency and fatty stools are more prominent. Gluten intolerance, the basic cause, is neutralised by appropriate dietary changes.
References A list of references is available from the Natural Medicine office. Tel: 021 880 1444