Irritable Bowel Syndrome by David Musnick MD
Irritable Bowel Syndrome(IBS) is a functional
gastrointestinal condition. It is the most common gastrointestinal condition
that is diagnosed in the US and Canada. The US prevalence is estimated at
10-15% of the population. There is a higher incidence in women than men and the
incidence appears to increase with age. The diagnostic criteria are:
1.
Recurrent and intermittent abdominal pain for at
least 3 days per month in the last 3 months. The pain is periumbilical and can
be fairly widespread. The pain is usually mild to moderate but not severe. The
abdominal pain can be set off by foods, stress etc. For the diagnosis the
abdominal pain must have been a consistent but not necessarily constant symptom.
And at least 2 of the following symptoms:
1.
Gas and bloating.
2.
Irregular frequency of stools. The patient may
have constipation or diarrhea. Often these patients have multiple unformed
stools per day. (Note: of concern is more than 4 watery stools per day. Also cause for concern would be any blood in
the stools as this is not associated with IBS).
3.
Mucous in the stools. This is a minor criterion.
4.
Straining and urgency with bowel movements or
incomplete emptying.
Causes of IBS
One known cause is post-GI infection IBS in which the GI
infection precedes the onset of IBS or makes it a lot worse.
There appears to be a dysregulation of the enteric nervous
system in all forms of IBS and thus there is sensitization of the GI nervous
system. This leads to abdominal pain with less provocation and less gas and
distention.
Patients with fibromyalgia are at more risk for developing
IBS and there appears to be some inflammatory cytokines involved in the
pathophysiology.
Contributing and Aggravating
Factors
1.
Food allergies can trigger worsening of IBS and
need to be tested for and treated.
2.
Gluten sensitivity and celiac disease need to be
checked with antibody panels or specialized arrays from Cyrex Labs.
3.
GI inflammation.
4.
Deficiencies of stomach acid and pancreatic
enzymes can make IBS worse
5.
Dysbiosis in the small and large intestine can
make IBS significantly worse. Small intestinal bacterial overgrowth can make
IBS worse.
6.
Leaky gut
7.
NSAIDS
8.
Stress
9.
Dysfunction of the enteric nervous system. There
appears to be sensitization of this system. The implications of this is that it
takes less to trigger and set off abdominal pain. A little gas may trigger pain
in a patient with IBS compared to a patient without IBS. The degree of this
sensitization can vary patient to patient.
10. Gastroenteritis can greatly flare up IBS.
11. Menstruation
can aggravate IBS.
Approach to
Treatment
1.
Determine if the patient has a constipation-dominant
IBS or a loose stool, diarrhea-dominant IBS. For constipation-dominant
recommend magnesium-rich foods. Add magnesium in supplement form in either a
powder or capsule. The oxide form is more likely to lead to bowel movement
output. Consider also powdered vitamin C 3-5 grams to achieve bowel movements
without an actual laxative. Also use aerobic exercise 20-40 minutes per day to
improve GI motility. Consider adding
some non-absorbable sugars like xylitol-containing gum unless that provokes
pain. For diarrhea and loose stool IBS limit all of the non-absorbable sugars. For
this type consider all of the below recommendations including a low FODMAPS
diet (fermentable oligo-, di- and mono-saccharides, and polyols) if the other
recommendations are not enough.
2.
When taking any mineral or bone products make
sure there is a balance of magnesium with it or take extra supplemental magnesium.
Evolving Nutrition offers Tri-Magnesium (BioGenesis).
3.
Use and introduce fiber in small amounts. Try to
use food-based fiber sources first and if unsuccessful introduce small amounts
of fiber in a supplement form. Monitor carefully to make sure the fiber does
not increase symptoms. Limit wheat bran fiber. If you use a fiber supplement do
not use it in the morning and use more soluble than insoluble fiber. Do not
introduce very much supplemental fiber especially in diarrhea-dominant IBS. Always
have a lot of water with the fiber.
4.
Consider the addition of lubricant type foods
such as: chia, flaxseed, toasted sesame oil, olive oil, okra, leeks, etc.
5.
Limit caffeine in diarrhea-prone IBS. Use
caffeine in constipation-dominant IBS.
6.
Limit or eliminate irritant-prone foods such as:
alcohol, sugar, non-absorbable sweeteners, sugar alcohols, etc.
7.
Use an anti-inflammatory diet.
8.
Avoid long periods of time with the patient
going without food. Ask them to eat protein regularly.
9.
Avoid eating sweets, chips and other non-nutritive
foods.
10. Test
for food allergies with at least an IgG panel as well as test for gluten
sensitivity.
11. Eliminate
all allergic foods. If the patient is gluten sensitive they must eliminate all
gluten completely and consistently.
12. Eliminate
NSAIDS and spicy foods.
13. Start
treating the leaky gut syndrome with supplements to heal the GI lining. Consider
Intestinal Repair Complex powder mixed in water in between meals for at least
one month. Consider adding extraL-glutamine powder with BioGenesis GlutaminePowder.
14. Use
a good probiotic that resists stomach acid or is protected from the stomach
acid and use at least 5 billion organisms per day. The strains that have been
tested and show efficacy in IBS are: Lactobacillus
rhamnosus GG and LC705, Bifidobacterium
breve, VSL#3, Bifidobacterium
animalis as well as Bifidobacterium infantis,
Streptoccocus thermophilus and Lactobacillus bulgaricus. Consider
BioGenesis Pro Flora Colonizer.
15. Run
a test for stool parasites and dysbiotic bacteria and yeast. If you find them,
treat them. Consider BioGenesis Para Biotic Plus to treat parasites and
dysbiotic bacteria.
17. If
necessary, support stomach acid with Betaine HCL.
18. Consider
zinc carnosine to also aid in healing the gut lining.
19. Consider
curcumin to treat the inflammatory component if the prior steps do not work
well enough. Use highly bioavailable forms.
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