Irritable bowel syndrome (IBS) is a catch-all term for any dysfunction of the large or small intestine for which there is no apparent physiological cause. Often associated with stress, IBS has also been called”nervous dyspepsia,” “spastic colon,” “irritable colitis,””nervous colitis,” or “intestinal neurosis.”
Twenty-five years ago, medical and nursing dictionaries didn’t even list IBS; today, thirty to fifty percent of all physician referrals to gastroenterologists are eventually diagnosed with IBS. Twenty to thirty percent of people in the United States have been diagnosed with this syndrome, and more than one third of the people in the Western world have experienced, at least temporarily, the full collection of symptoms known as IBS.
Women are three times more likely to experience chronic symptoms of IBS; however, since men are much less likely to go to a doctor when they are sick,the incidence among men may be significantly higher than it appears. The average age of onset occurs in the early adult years, between twenty and forty, although many people diagnosed with IBS recall suffering from IBS-type symptoms during childhood and/or adolescence.
Anxious and tense individuals are the most likely victims of IBS, and a clear connection has been established between the severity of symptoms and the level of stress in a person’s life. Sudden bouts of IBS can be triggered by eating unusual, exotic, or extremely rich foods, or simply by eating too much food at once (“holiday tummy”). Antibiotics can also inflame the stomach and intestines, upsetting the delicate balance of beneficial bacteria in the digestive tract and triggering an attack of IBS.
Symptoms: The most common symptoms include a combination of diarrhea and constipation, intestinal spasms, and acute abdominal pain. Other gastrointestinal symptoms include heartburn, regurgitating acid (acid burp), flatulence, nausea, loss of appetite,watery diarrhea (usually in the morning), and thick, pasty stools that are difficult to eliminate and have a foul odor. Fatigue, headaches, and general feelings of weakness and lack of energy are also common.
With any chronic digestive disturbance, your doctor will conduct a series of tests to rule out more serious conditions like ulcers, Crohn’s disease, ulcerative colitis, diverticulitis, gallbladder disease, bowel parasites (bacteria, amebic, or worms), or cancer. Specific diagnostic tests include a rectal exam; barium enema (GI series); various blood tests to check for infection, anemia, liver disease, or gallbladder disease;and a sigmoidoscopy, a procedure that uses an instrument for direct visual examination of the lower(sigmoid) colon. If all tests come back negative, the diagnosis will most likely be irritable bowel syndrome.
Because IBS has no obvious, easily identifiable cause and therefore defies the magic-bullet approach to healing, the doctor’s job is basically limited to offering symptom relief. Treatment varies according to the symptoms. If you appear extremely nervous,anxious, or tense, your doctor may consider the disease psychosomatic and offer a palliative drug such as a tranquilizer, muscle relaxant, or pain-killer, as well as an antacid drug like Tagamet or Zantac to reduce stomach acid levels. When the pain is extreme, antispasmodics (muscle-relaxing drugs with specificactions on smooth muscles like the bowels) may be prescribed, along with bulking laxatives to help restore normal conditions in the digestive tract.
Increasing numbers of doctors are including complementary treatments in their practices and offering their patients advice about dietary changes (particularly the need to test for food allergies or sensitivities and consume adequate dietary fiber) and various stress-reduction techniques. Acupuncture is increasingly recognized as a valuable treatment for numerous gastrointestinal problems.
TRADITIONAL CHINESE INTERPRETATION
In traditional Chinese medicine the constellation of symptoms included under the diagnostic label IBS are described as “constrained Liver chi invadingSpleen and Stomach.” The Liver is the main organ responsible for processing and eliminating stress, and any obstruction in the free flow of energy and blood immediately affects the Liver. When the Liver chi begins to stagnate, a common symptom is acute abdominal pain (colic).Deficient Spleen chi leads to problems with the absorption and assimilation of nutrients, causing loose bowels and lack of energy. The Liver controls the Spleen, and when the Spleen chi is weak, the Liver becomes domineering. “Liver Invading Spleen”symptoms include constipation and/or diarrhea, and acute pain in the upper and lower abdomen.
When the Liver is domineering, it also interferes with the natural descending actions of the digestive system, causing the Stomach to rebel and move food upward, which creates the nausea, belching,and acid-reflux burps so commonly associated with irritable bowel syndrome.
Test for food allergies: The first step in treatment is to search for possible food allergies or sensitivities.We cannot state this too strongly: If you have been diagnosed with IBS or suffer from chronic intestinal symptoms, your problems may becaused by food allergies or sensitivities. Blood tests such as the Radio Allergo Sorbent Test(RAST) can detect immune reactions to food by measuring IgG or IgE antibodies to specific food allergens. If you suspect that you have a food allergy or sensitivity, ask your health care provider about these tests or try the Elimination Provocation Diet. Because people are generally more allergic to dairy products (milk, butter, cheese, cream, ice cream, yogurt) than to any other food, try eliminating these foods first.
Take dietary fiber: Adding dietary fiber to your daily menu is essential in the treatment of any bowel dysfunction. The typical American fast-food,refined carbohydrate diet does not provide us with sufficient roughage, which in itself may be a significant contributing factor to the epidemic rise in chronic intestinal disorders. Mucilaginous (slipperyor viscous) fibers like psyllium, pectin, guar gum,and oat bran work in two basic ways: First, they coat the bowel, which supports the healing process;and second, they bulk the stools, making them lighter and easier to eliminate.Psyllium is the main bulking agent in commercial laxatives like Metamucil and Fiberall, but it’s best to avoid these products because they are treated with artificial colors and flavors and are sweetened with sugar or artificial sweeteners. Furthermore, most commercially grown psyllium is heavily sprayed with pesticides. For a completely organic(nonchemically treated) source of psyllium, we recommend Yerba Prima Daily Fiber Formula, or Harmony Formula’s Fiber Formula, which is equally effective for diarrhea and constipation.If you can’t find Yerba Prima Formula or Harmony Fiber Formula at your health food store, ask the store owner for another organic brand of psyllium.
Bran (wheat bran), which is found in many cereals,is a hard fiber and can be abrasive to the intestinal lining, so use it with caution. Do not use bran products if you are allergic or suspect you might be allergic to wheat. Whenever you take dietary fiber, be sure to drink a full glass of water immediately afterward to expand and soften the fiber. If you don’t have enough water available in your system to “bulk” the fiber, it can thicken, harden, and actually obstruct your colon. A good general rule is to drink eight to ten 8-ounce glasses of fresh, filtered water daily.
Steam your vegetables: The Chinese believe that raw foods stress the Spleen, making it difficult to extract the essential nutrients from the plant. To help break down the tough cellulose coating that surrounds most vegetables, steam your vegetables before you eat them.
Eat plenty of complex carbohydrates: Complex carbohydrates-including whole-grain breads, cereals,and pastas, potatoes, brown rice, barley, oatmeal,millet, beans, and the like-are rich in natural dietary fiber and essential nutrients. Simple or refined carbohydrates (found in cakes, cookies, pastries,pretzels, chips, white bread, white flour, and refined pasta products) are stripped of bran, fiber,and virtually all nutrients.
Eat plenty of starchy vegetables: Winter squash,parsnips, turnips, yams, and butternut squash are alleasily digested, nonallergenic foods.
Eat simply: Avoid eating too many different food-groups at one sitting; different kinds of food stimulate the digestive system to release various and assorted enzymes, which may compete with each other and contribute to the distress of IBS. Try to stick to one or two food groups at each meal.Avoid spicy foods: Spicy, exotic, and highly seasoned foods are difficult to digest, so avoid them whenever possible.
Stress Reduction Techniques
Stress plays a major role in IBS. A healthy, optimally functioning Liver is able to neutralize stress and minimize its effects on the body, but when stress is excessive or prolonged (and IBS, like all chronic illnesses,creates significant physical and emotional stress), the Liver becomes agitated and “invades” the Spleen and Stomach, interfering with digestion and contributing to acid buildup, gas, bloating, and abdominal pain.
Stress is indigestible – you can’t swallow it and expect it to pass through your system without causing at least minor damage. To relieve the symptoms associated with IBS, practice stress-reduction techniques like deep breathing exercises, meditation, or massage therapy.
Regular exercise helps the Liver create a free flow of energy and blood; when the Liver works efficiently,you will feel less stressed, both physically and emotionally.Since irritable bowel syndrome is exacerbated by stress (or in Chinese terms, “constrained Liver chi”), exercise is extremely important for restoring balance and harmony.
During acute flare-ups of the disease, try gentle stretching exercises such as yoga or tai chi. In between flare-ups, feel free to exercise strenuously.
- Beta-carotene: This is a powerful antioxidant and immune stimulant. Take 25,000-50,000 I.D. daily.
- Vitamin C: This vitamin supports immune function,protects your cells from oxidative damage, and is vitally important in the repair and maintenance of the intestinal lining. Take 1,000 mg. three to six times (for a total of 3-6g) daily.
- Vitamin E: This vitamin strengthens the wei chi, which helps to fight off infection, protect the body from damage by free radicals, and shield the body systems from stress. Take 400-800 J.D. daily; the natural d-alpha tocopherol form is best.
- B complex: These vitamins calm the body and mind, protecting you against stress. Vitamin B6(pyridoxine), PABA (para-aminobenzoic acid), and folic acid are all actively involved in stimulating the metabolism of carbohydrates, fats, and proteins.Both pyridoxine and folic acid help regulate hydrochloric acid production. Take one B-50 or B-lOO complex daily.
- Alfalfa: Rich in chlorophyll, vitamins, and minerals,these tablets contain all eight essential amino acids. Alfalfa is a safe, nutritious supplement that will gently support your digestion and metabolism.Take one or two tablets with each meal. (Follow the directions on the product label.)
- Quercetin: This important bio-flavonoid will help your body digest food more efficiently, reducing or eliminating allergic reactions. Quercetin is most effective when mixed with a pancreatic enzyme like bromelain; take one 25o-mg. tablet three times daily, preferably a half hour before meals.
- Probiotics (Lactobacillus acidophilus and/or Lactobacillus bifidus): These friendly bacteria work to nourish and heal the entire digestive system.Healthy gut flora is vital to good health and supports bowel functions in general. Always take acidophilus if you have a yeast infection or if you are taking antibiotics, for it reintroduces friendly bacteria into the colon to restore normal bodily functions. We recommend enteric-coated capsules,which are coated to survive the acid bath in the stomach and release in the intestines where they are needed. In general we prefer a combination of Lactobacillus acidophilus and Lactobacillus bifidus such as the Probiotic Pearls available in our online apothecary.
- Magnesium: This anti-stress mineral relaxes the smooth muscles of the intestinal tract as well as the skeletal muscles, promoting relaxation both internally and externally. (Calcium tends to foster contraction,while magnesium encourages relaxation.) Magnesium also stimulates the enzyme activity necessary for metabolizing proteins and carbohydrates,assists in the absorption of nutrients from food, and relieves fatigue, anxiety, and insomnia.Take 500-1,000 mg. of magnesium daily; magnesium citrate, aspartate, or gluconate are easiest to absorb and better tolerated than magnesium oxide.If you take calcium, make sure your magnesium is at least equal to (and preferably double) the amount of calcium you take.
- Zinc: Zinc enhances immune function and fights free radical damage. Take 30 mg. daily preventively; zinc gluconate is particularly well tolerated and easy to absorb. Whenever you supplement zinc, you should take extra copper to maintain a healthy balance between the two minerals. The ratio of zinc to copper should be fifteen to one; thus, if you take 30 mg. zinc, take 2 mg. copper. Caution: Because zinc can be toxic in large doses, do not exceed 100 mg. daily.
The following herbs can be used alone or combined in a single formula. Popular formulas available at health food stores offer different combinations of these herbs, or you can contact a qualified herbalist,who will mix up a formula tailored to your specific needs. If you need help choosing the most effective formula or combination of herbs for your symptoms, consult an experienced herbalist.
- Lemon balm (Melissa officinalis): This herb has a generalized relaxing effect on the entire digestive system.
- Chamomile (Matricaria chamomilla): This herb helps relax the stomach and intestines and has a natural ability to reduce intestinal spasms and associated pain.
- Ginger (Zingiber officinalis): This herb has been used extensively for intestinal problems in virtually every country of the world. A warming herb, ginger relaxes the gut, helps expel gas, and supports the natural movements of the intestines.
- Licorice (Glycyrrhiza glabra): This herb lubricates the walls of the intestines and has natural anti-inflammatory actions.
Marshmallow root (Althaea officinalis): This herb can also be used for its lubricating effects.
In addition to the herbs described above, I often recommend the following herbal capsules for IBS:
- Slippery elm (Ulmus rubra): This herb contains a gentle, nutritive substance called mucilage that helps ease the irritation and soothe the inflammation associated with digestive problems ranging from diarrhea to colitis, gastritis, and duodenal ulcers. Always take this herb in enteric-coated capsules before meals to ensure that it is released in the intestines rather than in the stomach.
- Peppermint capsules: Used in Europe for IBS with considerable success, peppermint oil calms the intestines,relaxes the smooth muscles to relieve spasms, reduces gas, and alleviates abdominal pain.The oil must be in capsule form in order to release in the intestines rather than in the stomach. Take one capsule twice daily or as directed.
- Herbal teas: To soothe your stomach, put two or three drops of peppermint oil in a cup of warm water; this comforting tea can be sipped throughout the day. Wintergreen, catnip, or lemon balm can be substituted for peppermint, or you can safely combine all four herbs in a soothing, relaxing tea. Dosage: If you purchase your herbs in a healthfood store (either in tincture form or, as dried herbs,in capsule or pill form), follow the dosage instructions on the label. Because herbs in dried form tend to lose their potency rather quickly, be sure to check the label for the expiration date.
Complementary Herbal Formulations
(Traditionally, in both Western and Chinese cultures, the combining of herbs is of superior value than the individual parts. After over thirty years as an herbalist, the synergy of certain herbs became apparent and this understanding has been used to create our own Integral Health Apothecary formulas. We are also listing tradition Chinese herbal tonics which exemplify this synergy.)
- Shu Kan Wan (“Soothe Liver Pills”): This remedy invigorates and replenishes the chi, breaking up stagnation and relieving the pain that always accompanies obstructed energy. It is specifically formulated to restore the free and easy flow of Liver chi, resolving the adverse effects of energy blockage on the Stomach and Spleen. Peony root,which soothes and supports the Liver, reigns as Emperor and is assisted by the attending herbs cyperus root, peony root, aurantium fruit, amomum fruit, citrus peel, corydalis root, bupleurum root,moutan root-bark, inula flower, citrus qing pi, licorice, curcuma root, aquilaria wood, cardamom fruit, and santalum wood. Take one dropper-full twice daily.Caution: This is a strong combination of herbs, used to break up stagnation in the digestive tract and restore the free flow of blood and chi. Do not use during pregnancy.
- GI Revive – Patients with poor gut integrity (in particular those with IBS) easily develop food sensitivities and may have compromised nutrient assimilation. GI Revive is a convenient, crystalline powder that mixes easily into any beverage or other functional food powder. It provides therapeutic levels of L-glutamine, N-acetyl-glucosamine, MSM, DGL, slippery elm, marshmallow, chamomile, okra, TOA-free cat’s claw, quercetin, and mucin for comprehensive support of optimal gastro-intestinal health. Prunus and citrus pectin are included to aid regularity.
- Stomach 25 (“Heavenly Axis”): This point is used to regulate digestive and intestinal functions,strengthen Earth’s organs (the Spleen/Pancreas and Stomach), and resolve stagnation or “stuck” energy in the Stomach. Its balancing effects are thought to extend to the mind and spirit as well.Location: Stomach 25 is located approximately two inches from the belly button on either side. Gently massage each point in clockwise circles for two or three minutes.
- Liver 3 (“Great Rushing”): This point is often used when the Liver energy is constrained or deficient.Stimulating it helps to promote the free flow of chi and blood and expel Wind conditions, including tremors, muscle twitches, migrating aches and pains,dizziness, and headaches. Location: Liver 3 is located on the upper part of the foot, in the depression in the webbing between the big toe and the second toe; massage in clockwise circles for two or three minutes.
- Stomach 36 (“Walks Three Miles”): This point assists the Stomach and the Spleen in their task of transforming nutrients into usable energy. A powerfully energizing point, Stomach 36 supports the assimilation of food and fluids, regulates digestive problems, and rids the body of excess dampness. Location: Stomach 36 is located three inches below the dimple or depression on the outside (pinkyside) of the knee, in a groove or depression in the muscle. Massage in clockwise circles for two or three minutes.
Questions to Ask Yourself
Metaphors can be powerful agents in healing, helping you to imagine your illness and “talk” to it, asking the symptoms what they want from you. Overcoming fear and feelings of loss of control can significantly influence your ability to cope with IBS. These questions can help you identify the sources of your distress and guide you to potential solutions:
- Why am I afraid to open up to new possibilities in my relationships, career, and life in general?
- What am I afraid of losing?
- I feel as if too much is happening right now,and I’m losing control. Why am I so afraid to lose control?
- I feel stuck, particularly regarding my emotions.How can I learn to express my emotions rather than let them eat away at my insides?
- What am I unwilling to swallow and digest?
- What’s eating me up inside?