Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (116 page)

The Rome III criteria break IBS into different types: IBS-C for constipation, IBS-D for diarrhea dominant, or mixed. However, naming something gets us no closer to helping people, and still most physicians tell people to eat more fiber and go home and have a good life.

IBS has often been treated as a psychosomatic illness or just a lack of dietary fiber, and many people just learn to live with it. Yet the quality of life for someone with IBS is equal to that of someone undergoing chemotherapy for cancer or living with rheumatoid arthritis.

IBS sufferers often have reason to feel stressed, nervous, and depressed about their condition. Stressful situations can trigger IBS symptoms. IBS can significantly restrict one’s lifestyle. Most of my IBS clients know where every public restroom is in town. They can’t make morning appointments because of the unpredictability of their bowels, and eating away from home can be tricky. Their social lives are tricky or nonexistent.

There is no single cause for IBS, but hopefully we can find the causes for each person and work with him or her individually in response to the biochemical uniqueness.

The first place to begin is to look for small intestinal bacterial overgrowth (SIBO). If IBS is accompanied by either fibromyalgia, chronic fatigue syndrome, or restless leg syndrome, the diagnosis of SIBO is pretty assured. Recent studies suggest that IBS is actually SIBO. Dr. Mark Pimentel and his group report that 78 percent of people with IBS have SIBO. Forty-eight percent were successfully treated with antibiotics (Rifaxamin). Dr. Sergio Peralta reports that of 97 patients with IBS, 56 percent had SIBO. Three weeks after treatment with Rifaxamin for seven days at 1,200 mg, breath tests for SIBO were done. Half of the people had normal tests, and most people had significantly reduced symptoms. People with the best results were those who had alternating constipation/diarrhea-type IBS.

IBS can also be caused by other infections, food sensitivities, celiac disease, leaky gut, imbalances in serotonin, lactose intolerance, infection, mind-body interaction, malabsorption of nutrients, hormonal imbalances, endometriosis, AIDS, environmental sensitivities, and more.

In about 25 percent of people, IBS is initially triggered by infection. The infection causes inflammation in the mucosal tissues, which stimulates T-cell-mediated and smooth muscle changes. When this inflammatory response continues over time, the bowels learn to be over- or underreactive to stimuli. People with postinfection IBS are more likely to have diarrhea-type, as well as high serotonin levels. There is usually a good response in postinfectious IBS with use of probiotic supplements. Use of COX2 inhibitors helps to normalize bowel motility. Natural COX2 inhibitors include turmeric, boswellia, and Kaprex (a product by Metagenics).

Parasites and candida overgrowth are overlooked causes of irritable bowel syndrome. One study showed that 18 percent of the study participants had treatable parasitic infections, while another found giardia in 9 percent and parasites in 15 percent of the study population. Leo Galland, M.D., has found that giardia was responsible for problems in nearly half of his patients with IBS. Even benign pinworms can cause severe colonic cramping at a certain stage of their life cycle. Ask your doctor to order a comprehensive digestive stool analysis with parasitology to determine if parasites or candida are making you sick. (Read
Chapter 7
on dysbiosis.)

Women may experience a flare-up in their symptoms around their menstrual period. The most common symptom associated with IBS and menstruation is pain.

Other people have an insulin rise after meals, causing an increase in serotonin, which can cause diarrhea.

Dietary recommendations need to be tailored to your personal reactions. It is commonly advised to avoid alcohol and monitor sugar intake, coffee, beans, and cabbage family foods (broccoli, Brussels sprouts, cauliflower) because they can be difficult to digest. You need avoid those foods only if they bother you. I find that an elimination diet gives better results than simply eliminating these specific foods.

Food sensitivities are found in one-half to two-thirds of people with IBS and are more prevalent in those who have allergies or come from allergic families. The most common foods that trigger IBS are wheat, corn, dairy products, coffee, tea, citrus fruits, and chocolate. In a study in which people were put on an elimination diet for a year, bloating and distension were relieved by 88 percent, colic pain was reduced by 90 percent, diarrhea was reduced 85 percent, and constipation improved in 54 percent. Also, 79 percent of people who had other symptoms, such as hay fever, asthma, eczema, and hives, saw these symptoms improve.

Undiagnosed lactose intolerance is often the cause of IBS. In a recent study of 242 people, it was found that 43 percent had total remission of IBS when
they excluded dairy products from their diet, and another 41 percent had partial improvement. Taking the lactose hydrogen breath test is a valuable way to discover who would benefit from a lactose-free diet. (See
Chapter 11
.) You can also discover this by avoiding all dairy foods and any products that contain dairy foods for at least two weeks to see how you feel. If you have only moderate improvement, other foods may also be playing a role in your symptoms.

Lactose is not the only sugar to cause problems. Our cells use single-sugar molecules (monosaccharides), but many foods contain two-molecule sugars (disaccharides) that must be split. New research suggests that many people are unable to split mannitol, sucrose, sorbitol, fructose, and other disaccharides, and a high percentage of IBS sufferers are intolerant of one or more of these sugars. The result is diarrhea, gas, and bloating. These people find that fruit, especially citrus fruit, aggravates their symptoms. For these people the Specific Carbohydrate Diet, Atkins Diet, or a Paleolithic-type diet works best. It’s also important to rule out dysbiosis.

Breath tests can diagnose fructose, disaccharide, and lactose intolerance. You can do a self-test by avoiding all fruit and sugar for at least 10 days. Be sure to read labels carefully and avoid any product that contains glucose, sucrose, malt, maltose, corn syrup, fructose, brown sugar, honey, maple syrup, molasses, and lactose. You’ll find that sugar is everywhere, but if disaccharides are the cause of your IBS, it is worth the time and trouble. If sugars and fruits make you feel worse, do the self-test and a blood or stool test for candida infection or bacterial infection.

Antibiotics are well-known causes of temporary diarrhea and GI problems. Steroid medications can also affect the balance of flora. The good flora are eliminated, especially in people who are on repeated doses of antibiotics, which allows other microbes to dominate the intestinal tract. Acidophilus, bifidobacteria, and Saccharomyces boulardii supplements can help restore intestinal balance.

Mind-body techniques can help with IBS. There are good studies on yoga, bio-feedback, counseling, and more.

Comprehensive digestive stool analysis with parasitology

Lactose breath test

Hydrogen breath test for methane levels

Food allergy and sensitivity testing

Intestinal permeability screening

Organic acid testing

Look for infection.
Since most people with IBS have small intestinal bacterial overgrowth, this is a terrific place to begin your quest. It’s possible someone with IBS has a fungal infection, C. difficile or another type of bacterial infection, or Blastocystis hominis or other parasitic infection. (See treatment recommendations in
Chapter 9
and testing in
Chapter 11
.)