Irritable bowel syndrome [IBS] affects more than one-fifth of the world’s population. It is more widespread in women than men. It appears to be somewhat predominant before age 35 — but, is infrequent after age 40 — in half of the affected individuals. Statistics too suggests that IBS affects an estimated 10.5 per cent of the population. Research suggests that there may be a certain familial tendency, or ‘genetic’ vulnerability that may predispose us to IBS.
The word ‘syndrome’ includes all types of symptoms, including bloating and digestive pain, which is a typical IBS presentation, although the disorder, in effect, refers to a condition where the bowels have extreme reactions — such as alternating constipation and diarrhoea — which come and go on their own accord. Most clinicians refer to IBS as a form of depression — ‘depression of the intestines’ — highlighted by reduced amounts of the ‘feel-good’ chemical, serotonin, as it occurs in psychological, or emotional, depression. Here is how it happens. The nerve cells in the intestines synchronise digestion; they trigger the muscles of the intestines to contract. When serotonin levels are inadequate, the intestine gets perturbed. This leads to alternating bouts of too much, or too little, bowel activity, or general distress. The worst part is IBS symptoms may get aggravated by chronic constipation — which is not a pleasant prospect.
The sequel is predictable. When toxic waste resides in the colon, for long, the smart, also bright nervous system in the intestines alternates between primary panic and paralysis, while triggering diarrhoea to getting rid of the toxins, and making the IBS individual feel bloated, at the same time.
Research suggests that IBS could be treated naturally by restoring serotonin production to its optimal level and removing toxicity, through detox, although the idea is still in its nascent stage. This is paradoxical, because it was conventional [allopathic] medicine that first ‘pioneered’ the idea of treating IBS patients with antidepressants. The protocol evolved unintentionally, after some patients with depression were treated with selective serotonin reuptake inhibitors [SSRIs]. They unexpectedly, but expectedly, were relieved of IBS. This was not surprising, given the physiological action of neurotransmitters, such as serotonin, and the extent of suffering — something that in extreme cases could lead to unwanted surgeries, such as cholecystectomies [surgical removal of the gall bladder], hysterectomies [surgical removal of the uterus], appendectomies [surgical removal of the vermiform appendix] and back surgeries.
It may be mentioned that when antidepressants are prescribed to certain patients’ ‘psychological’ symptoms, it eases bowel conditions so tangibly that the treatment is today a standard protocol for IBS — whether the patient is emotionally depressed, or not. Yet, the irony is, no serious debate, discussion or long-term clinical study, has gone into why SSRIs help IBS patients to feeling better.
There is also a theory that IBS may result from abnormal contractions of the intestinal walls. Yet another factor may be food sensitivity, or increased sensitivity to certain foods, such as fruit, or the artificial sweetener, sorbitol, for example, contributing to the condition. IBS, as clinicians point out, may also sometimes occur after a gastrointestinal infection — more so, in individuals with a family history of IBS.
In a clinical study published in Neurogastroenterology and Motility, a team of researchers was able to ‘image’ the colon and divide it into three functional regions. The ascending colon is the storage and fermentation area, where unabsorbed food residue is broken down by bacteria. The transverse colon is the storage area for the residue left over after bacterial processing, while the descending colon pushes waste down and out of the body.
The research team, which used MRI scans, was able to measure the volumes of the three regions of the colon in patients with IBS in a way that was never done before. This, the study reported, allowed for comparing the movement of the ‘IBS-colon’ with that of a normal, healthy gut. The study also found that in IBS patients the ascending colon does not relax as much to make room for a meal as that part of the colon does in healthy people.
The study holds promise, although most clinicians believe that it is still early days for the ‘new protocol’ to be perfected, more so because the causes and symptoms of IBS fluctuate from one person to the other — and, this makes the disorder a wily customer for doctors to treat.
Studies have shown that many people with IBS have food sensitivities. Gas [flatulence] and other IBS symptoms are suggested to diminish when such sensitivities are treated and the ‘offending’ foods are restricted, or eliminated, from the diet.
Research suggests that wheat is one of the most common food sensitivities in people with IBS. Some people with IBS-like symptoms may not be able to digest sugars, lactose [found in milk] and fructose [in fruit juice and dried fruit]. The artificial sweetener sorbitol [found in diabetic and sugar-free products], is also reported to make diarrhoea worse.
Research shows that in a large majority of IBS patients with lactose [milk] malabsorption, a lactose-restricted diet can improve their symptoms markedly — in the short-term and the long-term. Fructose- and sorbitol-free diets in people with fructose malabsorption reduce gastrointestinal symptoms, such as bloating, cramps, diarrhoea and other IBS symptoms.
It is for this reason that clinicians suggest that individuals having, or diagnosed with, IBS should deem the likelihood of milk, fruit juice, dried fruit and products containing sorbitol, or other artificial sweeteners, as the most likely triggers for their IBS symptoms.
Research suggests that a microbial imbalance in the gut [dysbiosis], primarily caused by antibiotic excess is common in people with IBS. One study found a reduced number of ‘good’ bacteria, such as Lactobacilli and Bifidobacteria and an elevated number of harmful, or ‘bad,’ bacteria in individuals with symptoms of IBS. Besides, the proliferation of yeast organisms, such as Candida albicans [a fungus that is a causal agent of opportunistic oral and genital infections], also appears to be frequent in people with IBS. Reducing yeast in the gut is, therefore, effective in improving IBS symptoms.
Probiotic, prebiotic — non-digestible fibre compounds that pass undigested through the upper part of the gastrointestinal tract and stimulate the growth and/or activity of advantageous bacteria that colonise the large bowel — and, synbiotics, including nutritional supplements that combine probiotics and prebiotics, evidently help people having IBS — especially with symptoms of pain and flatulence. High fibre intake, such as flaxseed, for example, is also evidenced to help in IBS, although a few studies report that people with IBS may not benefit much by adding wheat bran to their diets. In fact, some people feel worse after taking wheat bran supplements. Also, fibre from other sources, such as psyllium [20-30gm per day], may improve symptoms.
Depression, as already highlighted, is prevalent in IBS patients, as is diminished quality of life [QoL]. IBS can affect sleep, sexual functioning, business and personal obligations and social life too. The condition may be complicated by other conditions, such as fibromyalgia [chronic widespread pain and a heightened painful response to pressure], chronic fatigue syndrome [CFS] and thyroid disorders. Certain prescription medications may not be as effective in the long-term; they are also laden with side-effects, some of them serious. For individuals who suffer from long-term IBS, the idea of using mind–body therapies, along with adjuvants [supportive therapies], such as relaxation, or self-hypnosis, including homeopathy and Ayurveda, may be therapeutically useful.
Psychotherapy sessions, or counselling, likewise, are evidenced to be useful in patients with severe IBS.
Relaxation and biofeedback — the process of gaining greater awareness of physiological functions by using instruments that provide information on the activity of bodily systems, with a goal of being able to manipulate them at will — have also shown success in alleviating some of the flagrant symptoms of IBS and preventing the condition from recurring. A study reports that using biofeedback and relaxation therapy, along with medications, was effective in two-thirds of patients who did not experience benefit using medications alone.
Yet another approach, which employs progressive muscle relaxation, is thermal biofeedback — a type of treatment that uses a person’s body temperature to assess that person’s physical state. Over time, the individual could be trained to control their body temperature by monitoring real-time changes to their thermal state and, as a result, have a useful level of control over certain physical issues. Cognitive behavioural therapy, or CBT — a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviours, cognitive processes and contents through a number of goal-oriented, explicit systematic procedures, counselling and health education — reportedly has a 50 per cent success rate. When patients were evaluated four years later, they still showed improvement.
Hypnosis, as a useful adjuvant, has been proven to improve IBS symptoms, even in severe cases and, in other instances, where psychotherapy had failed.
Mind-body therapies are effective in IBS and also in alleviating depression and improving one’s quality of life [QoL]. A self-help programme that includes meditation and visualisation, along with state-of-the-art medical treatment, has proven useful in improving abdominal discomfort, while reducing, or eliminating IBS symptoms, and providing long-term relief.
— First published in India First
