There is no doubt about it, Irritable Bowel Syndrome (IBS) is a huge problem in our modern life. As much as 10 to 25 per cent of the general population have IBS.
IBS is found to be:
- more frequently diagnosed in women than in men,
- more frequently diagnosed in young people compared to older people
- more frequently diagnosed in western countries compared with the developing world
- often associated with emotional stress and is frequently triggered by life changes
IBS is known to be also referred to as spastic colon, mucous colitis, spastic colitis, nervous stomach and irritable colon.
What is it?
It is a functional gastrointestinal disorder (FGID) which means that the bowel does not work properly without there being an identifiable structural or biochemical cause.
The key point is that the gut becomes abnormally sensitive to its content (visceral hypersensitivity), causing changes in contractions and changes in bowel function. Fortunately enough, you can do things to live with IBS a lot easier and, in some cases eliminate it completely depending on the cause.
IBS does not have a single cause or treatment. (3,7). Many people diagnosed with IBS by their GPs are prescribed drugs that treat the symptoms, but unfortunately not the causes.
What are the typical defining symptoms of IBS? (3):
- abdominal pain or rumbling
- meteorism is caused by trapped intestinal gas, (this painful condition is not quite understood) (3). Bacterial decomposition of lactose can increase the amounts of gas, leading to meteorism, intestinal rumbling, flatulence, bloating, diarrhoea or bowel movement immediately after consuming dairy products.
- nausea, indigestion and loss of appetite (4)
- flatulence, constipation and diarrhoea [Constipation, diarrhoea (3).]
- abnormal stool characteristics (6)
- mucus or slime in the stool (4)
- the sensation of not empting the bowel properly (4)
Often, the intensity of the symptoms is most pronounced in the afternoon or evening, but it can happen any time depending on the trigger. Incomplete or faulty digestion may aggravate the symptoms while defecation or passing flatus may provide some relief. The symptoms may come and go over a period of months (3).
In theory IBS diagnosis should be done by the GP after a lot of tests to eliminate any other diseases.
Irritable Bowel Syndrome can be diagnosed based on at least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features:
1. Pain, bloating or discomfort is relieved with defecation; and/or
2. Onset associated with a change in frequency of stool; and/or
3. Onset associated with a change in form (appearance) of stool.
Symptoms that (describes the diagnosis of IBS) cumulatively support the diagnosis of IBS are:
- abnormal stool frequency (may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week);
- abnormal stool form (lumpy/hard or loose/watery stool);
- abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus;
- bloating or feeling of abdominal distension
(Courtesy of Rome II Criteria, Degnon Assoc. 2000 © All rights reserved.)
You need specific tests (gastroscopy, colonoscopy, ultrasound, barium studies or other) when there is unexplained weight loss, blood in stools, fever or an abrupt and continuing change in bowel habit. These are red flags for other bowel conditions.
Possible triggers of IBS
The following are some of the possible triggers that have been connected with the symptoms of IBS:
- food hypersensitivity or intolerances (1,7)
Food allergy and food sensitivity
The immune system is complex, and there are lots of responses to a specific food, drink or environmental agents. A person can have a response to the allergen from the IgE antibodies which is the common allergic reaction (testing by the doctors), the reaction is very strong such as the peanut reaction, eggs etc.
Most of the IBS triggers is probably due to sensitivity and to other immune antibodies responses then there is the IgG reaction which is a delayed reaction to food or drinks and can affect the gut, skin and brain as well. Still strong it can cause eczema skin itching, low energy, tiredness and fatigue.
There is also the IgA (gut and membrane reaction, localized sometimes to the gut only). IgM reactions, which can be felt up to three days later, can be just a raise in the heartbeat, to gut problems. Most blood tests done on IgE (NHS), IgG, IgM and cellular testing are from private laboratories.
Some people have blood tests and are very disappointed because they receive negative results to the problem. That is why I started using muscle testing, which I found with the elimination test to work pretty good in finding and eliminating the problem. Muscle testing works with the energy pattern of the body and the energy pattern of the food allergen. The allergen is put near the body and if the body energy does not agree with it the muscle becomes weak. The muscle will stay strong when any other non allergic food will be put on the body.
Food intolerances are thought to play a major role in the pathology of IBS. For example, people who are intolerant to lactose have been found to lack the enzyme needed to digest the sugar in dairy products (lactase). This can result in a bacterial fermentation of the sugar, creating an increase in hydrogen gas that may trigger certain IBS symptoms (1,3,5). Many Asians, Africans and Indian races are genetically lacking in the enzyme, so many will have a big problem digesting the lactose. But also as adults our lactase enzyme is enormously reduced, and in some people eliminated completely, which would trigger the IBS symptoms if any dairy would be consumed (yogurt is ok because the sugar in it is digested by the good bacteria).
- Lack of good friendly bacteria or an imbalance in them would trigger IBS symptoms, but also parasite, bacteria and yeast or candida overgrowth would trigger the symptoms.
- Low acidity in the stomach due to H. Pylory.
- Low enzyme activity to digest the food (might be due to low or deficiency in enzymes co-factors such as minerals and vitamins).
Emotional problems and stress (2,3 & 7)
- Psychologically, patients with IBS seem to experience more emotional disorders than non IBS sufferers (2,3).
- Anxiety neurosis, depression and other psychiatric disorders are most common, although it has yet to be indisputably established whether IBS leads to these disorders, or vice-versa. (3).
The gut is an important route by which emotion is expressed in the body. If ever you have felt your stomach knot up before a speech, you too know that the brain and digestive tract are holding hands. This constant dialogue is known as the brain-gut axis. Even perfectly healthy people can worry their way to stomach pain, nausea or diarrhoea. The sympathetic and parasympathetic nerves work together to help cope with stress or reduce stress. The sympathetic nerves are the ones that reduce function in the gut when stressed out (it makes you go to the loo first emptying the content of the gut and then run). The parasympathetic nerves will calm down the gut and make you digest the food better, as well as relax.
A physician won’t find anything wrong but the misery is real enough. It is suggested that patients with IBS have more emotional upset than healthy people or patients with other gastrointestinal diseases and have experienced more traumatic life events and difficult life situations both in adulthood and childhood.
About the brain-gut axis:
The digestive tract is supplied by extrinsic and intrinsic sensory neurons which, together with endocrine and immune cells, form a surveillance network that is essential to gut function. The three players for this are gastrointestinal tract (GIT), central nervous system (CNS) and enteric nervous system (ENS) and they communicate with one another via parasympathetic and sympathetic pathways, each comprising efferent fibres such as cholinergic and noradrenergic, respectively, and afferent sensory fibres required for gut-brain signalling. In a nutshell the brain communicates with the intestinal tract and vice versa, any stress to the gut, the brain feels it and any stress to the brain the gut feels it.
- The brain-gut axis is relevant not only to normal digestive function but also to abdominal pain and heightened sensitivity to pain.
- The neural network of the brain, which generates the stress response, is called the Central Stress Circuitry (CSC). It receives input from tissue and organs (somatic and visceral) feedback pathways and also from the organ (visceral) motor cortex. The output of this CSC is called the emotional motor system and includes automatic efferents, the hypothalamus-pituitary-adrenal axis and pain modulatory systems.
- Severe or long-term stress can induce long-term changes in the stress response (plasticity). Corticotropin Releasing Factor (CRF = the fight or flight hormone) is a key mediator of the central stress response.
So what does stress actually do to you?
Well the brain, adrenal, pituitary and thymus glands produce more adrenaline and noradreanaline, plus more corticosteroids, which initially are released as part of the coping mechanism and eventually the nutritional supplies are outstripped. In the gut stress increases the intestinal permeability to large antigenic molecules i.e. molecules venture where they should not and thus may evoke an allergic response.
The responses can:
- lead to mast cell activation and degranulation (i.e. histamine reactions) and colonic mucin depletion (loss of protective barrier)
- cause a reversal of small bowel water and, electrolyte absorption occurs in response to stress and is mediated cholinergically
- lead to increased susceptibility to colonic inflammation by lowering the immune system and therefore being more susceptible to parasites and bacteria overgrowth (Bhatia)
A small proportion of people develop IBS for the first time after a bout of gastroenteritis, raising speculation that, although the infection clears up, this experience might make the gut more sensitive. In support of this, recent research has shown that the small proportion of people with post-infectious IBS also tends to have a mild, ongoing inflammation of the gut which begs the question, why do some people have persistent bowel symptoms after an attack of gastroenteritis while most others get better?
Research has shown that post-infectious IBS is much more likely if the person was anxious, depressed and was experiencing difficult life situations at the time of the original illness. Psycho-neuro-immunology established that such scenarios lower ones immune response.
Perhaps ongoing emotional upset creates the nervous tension that maintains a low-grade bowel inflammation. Alternatively, the memory of the bowel upset was recruited by brain-gut connections to express an unresolved life situation. Similar observations have been made for IBS occurring for the first time after hysterectomy. An attack of gastroenteritis or the antibiotics given to treat it can alter the balance of bacteria in the colon, reducing populations of beneficial anaerobic bacteria and encouraging the overgrowth of pathogenic species.
Intestinal infections and inflammation caused by parasites or unfriendly bacteria. These can cause an increase in intestinal mucosal permeability (Leaky Gut Syndrome), which allows food and chemicals to enter the blood stream before they are properly digested. This can overload the immune system and cause an increase in the body’s inflammatory response, triggering mucosal sensitivity, abnormal motility and secretory response (8). Dysbiosis (the imbalance between the good and bad bacteria in the intestinal tract). Altered bowel flora can be the result of antibiotics, laxatives, diarrhoea or low dietary fibre.
Diet and Lifestyle
Diet can have a strong modifying influence on the symptoms of IBS. Eliminating food intolerances and repair the gut. The most reacting food from big to small are: eggs, wheat, all type of dairy, soya, gluten (rye, barley and oats if not gluten free). Also some people react to animal or food contaminated with the above food. In my experience you can be overreacting to any food, so need to investigate it yourself if you cannot afford a therapist by having a simple diet with few but nutritious food (protein, carbohydrate, vegetables and fruits, fat from animal or vegan). Also eliminating bad bacteria, parasite, can help. This should be tested in order to be eliminated (candida, yeast overgrowth, other bacteria, dysbiosis, etc).
An increase in the intake of water and dietary fibre, mainly from fruit and vegetables, can be quite beneficial, as can a reduction in the consumption of diuretic beverages – tea, coffee and other caffeinated drinks (3).
Warning: IBS should be clinically diagnosed by your GP after he or she has conducted a series of tests to eliminate other possible causes of the symptoms. These may include taking a medical history, a physical examination, proctoscopy, a routine blood tests (haemoglobin, sedimentation rate, white cell count, creatinine, aspartate aminotransferase, alkaline phosphatase) and urinary tests (glucose and protein). A barium enema is obligatory, except in young patients. A gynaecological examination and a lactose tolerance test should also be considered (3).
© Maria Esposito BSc (Hons) Nutritional therapist NAET practitioner – R-Craniosacral therapist- NAET practitioner – Certified Angel Guide – Meditation teacher
I deal with over-reaction to food and environmental allergens through the NAET method. I have used this method for more than 14 years and it works for adults, babies and children with eczema and more.
To read more about NAET method and testimonial click here
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