Blog

You are currently viewing Functional Medicine for IBS

Functional Medicine for IBS

  • Post author:

What is Irritable Bowel Disease?

Irritable bowel syndrome (IBS) is a functional condition of the bowel that is diagnosed using clinical criteria.  IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their gastrointestinal symptoms.

These people do not have significantly different abdominal symptoms to those who do not consult, but they do have greater levels of anxiety and lower quality of life. Internationally, there is a female predominance in the prevalence of IBS. Irritable bowel syndrome (IBS) is a common condition that affects the digestive system.

Signs and Symptoms of IBS

The signs and symptoms of IBS vary but are usually present for a long time. The symptom severity can also be varied but typical common symptoms include:

  • Constipation
  • Diarrhoea
  • Passing mucus when you pass a stool
  • Bloating
  • Abdominal pain, cramping or stomach pains
  • Feeling nauseous
  • Gas production and passing excessive amounts of wind
  • Tiredness and lack and energy
  • Changes in the appearance of bowel movement
  • Changes in how often you are having a bowel movement
  • These symptoms often come and go and are usually worse after eating and relieved by passing a stool

What Caused IBS?

The precise cause of Irritable Bowel Syndrome isn’t known. Factors that appear to play a role include:

  • Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhoea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
  • Nervous system. Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhoea or constipation.
  • Severe infection. IBS can develop after a severe bout of diarrhoea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
  • Early life stress and stress levels. People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.
  • Changes in gut microbes. Examples include changes in bacteria overgrowth, fungi and viruses, which normally reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in healthy people.
  • A common factor in IBS is damage to the delicate lining of the intestines where food is absorbed. This can lead to undigested food particles passing through the barrier and interacting with the immune system. The result is inflammation and pain. There are lots of causes of intestinal damage. Food reactions, gut infections, stress and imbalances in the friendly bacteria in the gut can all play a role. The first step is to confirm that intestinal damage is present. Then it’s a case of finding and tackling the cause and using natural supplements to repair the damage. Functional testing is instrumental in uncovering the underlying causes of IBS. Stool tests can be used to assess digestive function, check for intestinal damage and identify gut infections and bacterial imbalances. Food intolerance testing can also help to identify problem foods that may be contributing to IBS – Irritable Bowel Syndrome symptoms.

Triggers

Symptoms of IBS can be triggered by:

  • Food. The role of food allergy or intolerance in IBS isn’t fully understood. A true food allergy rarely causes IBS. But many people have worse IBS symptoms when they eat or drink certain foods or beverages, including wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
  • Stress. Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn’t cause them.

 

Risk factors

Many people have occasional signs and symptoms of IBS. But you’re more likely to have the syndrome if you:

  • Are young. IBS occurs more frequently in people under age 50.
  • Are female. In the United States, IBS is more common among women. Estrogen therapy before or after menopause also is a risk factor for IBS.
  • Have a family history of IBS. Genes may play a role, as may share factors in a family’s environment or a combination of genes and environment.
  • Have anxiety, depression or other mental health issues. A history of sexual, physical or emotional abuse also might be a risk factor.

 

Complications

Chronic constipation or diarrhoea can cause haemorrhoids.

In addition, IBS is associated with:

  • Poor quality of life. Many people with moderate to severe IBS report poor quality of life. Research indicates that people with IBS miss three times as many days from work as do those without bowel symptoms.
  • Mood disorders. Experiencing the signs and symptoms of IBS can lead to depression or anxiety. Depression and anxiety also can make IBS worse.

IBS and Functional Medicine

IBS is usually a lifelong problem and it can have a big impact on your everyday life. The last 20 years have seen an increasing amount of research on the role of modifiable lifestyle factors in improving symptoms for patients with IBS.  Studies on perceived food intolerance show that 64-89% of IBS patients report their symptoms to be triggered by meals or specific inflammatory foods. There is no structural change to the gut but there is a change in how the gut functions.

So approaching IBS from a functional medicine model can help. A functional medicine approach aims to restore proper function, improve health and eliminate symptoms. Functional medicine interventions might comprise solely of dietary changes. But additional options include herbal remedies, lifestyle changes and stress management techniques. By taking a complete overview of digestive health functional medicine is often more successful in providing long term IBS relief than conventional treatment. It recognises that IBS is a multi-factorial condition where the causes are different for each person. Using accurate Food Intolerance Testing may help patients identify food triggers. Interesting studies have shown reduced IBS symptoms after the introduction of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP diet ) in patients with suspected or proven fructose or lactose malabsorption. In addition, probiotics may improve IBS symptoms through manipulation of the gut microbiota.

As a functional medicine doctor, I can assess the function of organs and organ systems in your body as well which are crucial for healthy digestion. Neurotransmitter imbalances, sub-optimal stomach acid levels, liver problems, damaged gut microbiome, and hypothalamus-pituitary-adrenal axis imbalances are all potential causes of IBS that are rarely investigated.

Once the cause of your symptoms being analysed,  then we plan how to control or alleviate your symptoms entirely. Not only can your symptoms disappear, but your whole body can drastically improve in its overall function.

It is very interesting that digestive disorders may have an impact on different systems in our body,  developing,’brain fog’, joint aches, sleep disorders, low libido, and weight imbalances.

 

References

1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91. [PubMed] []
2. Videlock EJ, Chang L. Irritable bowel syndrome: current approach to symptoms, evaluation, and treatment. Gastroenterol Clin North Am. 2007;36(3):665–85. x. [PubMed] []
3. Pare P, Gray J, Lam S, Balshaw R, Khorasheh S, Barbeau M, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clin Ther. 2006;28(10):1726–35. discussion 1710–1. [PubMed] []
4. Paterson WG, Thompson WG, Vanner SJ, Faloon TR, Rosser WW, Birtwhistle RW, et al. Recommendations for the management of irritable bowel syndrome in family practice. IBS consensus conference participants. CMAJ. 1999;161(2):154–60. [PMC free article] [PubMed] []
5. Jackson JL, O’Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;108(1):65–72. [PubMed] []
6. Schoenfeld P. Efficacy of current drug therapies in irritable bowel syndrome: what works and does not work. Gastroenterol Clin North Am. 2005;34(2):319–35. viii. [PubMed] []
7. McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol. 2008;14(17):2625–9. [PMC free article] [PubMed] []
8. Hussain Z, Quigley EM. Systematic review: complementary and alternative medicine in the irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(4):465–71. [PubMed] []
9. Whitehead WE, Levy RL, Von Korff M, Feld AD, Palsson OS, Turner M, et al. The usual medical care for irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20(11–12):1305–15. [PubMed] []
10. Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46(1):78–82. [PMC free article] [PubMed] []
11. Lacy BE, Weiser K, Noddin L, Robertson DJ, Crowell MD, Parratt-Engstrom C, et al. Irritable bowel syndrome: patients’ attitudes, concerns and level of knowledge. Aliment Pharmacol Ther. 2007;25(11):1329–41. [PubMed] []
12. Dhaliwal SK, Hunt RH. Doctor-patient interaction for irritable bowel syndrome in primary care: a systematic perspective. Eur J Gastroenterol Hepatol. 2004;16(11):1161–6. [PubMed] []
13. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998;93(7):1131–5. [PubMed] []
14. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med. 2003;163(3):265–74. [PubMed] []
15. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14(17):2650–61. [PMC free article] [PubMed] []
16. Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19(3):245–51. [PubMed] []
17. Bian Z, Wu T, Liu L, Miao J, Wong H, Song L, et al. Effectiveness of the chinese herbal formula TongXieYaoFang for irritable bowel syndrome: a systematic review. J Altern Complement Med. 2006;12(4):401–7. [PubMed] []
18. Webb AN, Kukuruzovic RH, Catto-Smith AG, Sawyer SM. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2007;4(4):CD005110. [PubMed] []
19. Gholamrezaei A, Ardestani SK, Emami MH. Where does hypnotherapy stand in the management of irritable bowel syndrome? A systematic review. J Altern Complement Med. 2006;12(6):517–27. [PubMed] []
20. Wilson S, Maddison T, Roberts L, Greenfield S, Singh S Birmingham IBS Research Group. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(5):769–80. [PubMed] []
21. Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn. 2006;54(1):7–20. [PubMed] []
22. Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125(1):19–31. [PubMed] []
23. Boyce PM, Talley NJ, Balaam B, Koloski NA, Truman G. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003;98(10):2209–18. [PubMed] []
24. Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T. Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. BMJ. 2005;331(7514):435. [PMC free article] [PubMed] []
25. Van Dulmen AM, Fennis JF, Bleijenberg G. Cognitive-behavioral group therapy for irritable bowel syndrome: effects and long-term follow-up. Psychosom Med. 1996;58(5):508–14. [PubMed] []
26. Blanchard EB, Lackner JM, Sanders K, Krasner S, Keefer L, Payne A, et al. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther. 2007;45(4):633–48. [PubMed] []
27. Zuckerman MJ. The role of fiber in the treatment of irritable bowel syndrome: therapeutic recommendations. J Clin Gastroenterol. 2006;40(2):104–8. [PubMed] []
28. Manning AP, Heaton KW, Harvey RF. Wheat fibre and irritable bowel syndrome. A controlled trial. Lancet. 1977;2(8035):417–8. [PubMed] []
29. Quartero AO, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2005;2(2):CD003460. [PubMed] []
30. Miller V, Lea R, Agrawal A, Whorwell PJ. Bran and irritable bowel syndrome: the primary-care perspective. Dig Liver Dis. 2006;38(10):737–40. [PubMed] []
31. Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet. 1994;344(8914):39–40. [PubMed] []
32. Snook J, Shepherd HA. Bran supplementation in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 1994;8(5):511–4. [PubMed] []
33. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007;75(7):1027–30. [PubMed] []
34. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L. Peppermint oil (mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007;39(6):530–6. [PubMed] []
35. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125–8. [PubMed] []
36. Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32(6):765–8. [PubMed] []
37. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J. 1979;2(6194):835–6. [PMC free article] [PubMed] []
38. Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: a multicentre trial. Br J Clin Pract. 1984;38(11–12):394–8. [PubMed] []
39. Lawson MJ, Knight RE, Tran K, Walker G, Roberts-Thomson IC. Failure of enteric-coated peppermint oil in the irritable bowel syndrome: a randomized, double-blind crossover study. J Gastroenterol Hepatol. 1988;3(3):235–8. []
40. Nash P, Gould SR, Bernardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract. 1986;40(7):292–3. [PubMed] []
41. Lu W, Kaptchuk TJ, Wong H, George C. Chinese herbal medicine for irritable bowel syndrome. JAMA. 1999;282(11):1035–7. [PubMed] []
42. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with chinese herbal medicine: a randomized controlled trial. JAMA. 1998;280(18):1585–9. [PubMed] []
43. Wang G, Li TQ, Wang L, Xia Q, Chang J, Zhang Y, et al. Tong-xie-ning, a chinese herbal formula, in treatment of diarrhea-predominant irritable bowel syndrome: a prospective, randomized, double-blind, placebo-controlled trial. Chin Med J (Engl) 2006;119(24):2114–9. [PubMed] []
44. Leung WK, Wu JC, Liang SM, Chan LS, Chan FK, Xie H, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101(7):1574–80. [PubMed] []
45. Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. A novel treatment for constipation-predominant irritable bowel syndrome using padma lax, a tibetan herbal formula. Digestion. 2002;65(3):161–71. [PubMed] []
46. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther. 20041;19(3):271–9. [PubMed] []
47. Liu JP, Yang M, Liu YX, Wei ML, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006;1(1):CD004116. [PubMed] []
48. Shi J, Tong Y, Shen JG, Li HX. Effectiveness and safety of herbal medicines in the treatment of irritable bowel syndrome: a systematic review. World J Gastroenterol. 2008;14(3):454–62. [PMC free article] [PubMed] []
49. Quigley EM, Flourie B. Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to date. Neurogastroenterol Motil. 2007;19(3):166–72. [PubMed] []
50. Camilleri M. Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. J Clin Gastroenterol. 2006;40(3):264–9. [PubMed] []
51. Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. BMJ. 2007;334(7603):1105–9. [PMC free article] [PubMed] []
52. Lackner JM, Mesmer C, Morley S, Dowzer C, Hamilton S. Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol. 2004;72(6):1100–13. [PubMed] []
53. Whorwell PJ. Review article: the history of hypnotherapy and its role in the irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22(11–12):1061–7. [PubMed] []
54. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984;2(8414):1232–4. [PubMed] []
55. Galovski TE, Blanchard EB. The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback. 1998;23(4):219–32. [PubMed] []
56. Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci. 2002;47(11):2605–14. [PubMed] []
57. Roberts L, Wilson S, Singh S, Roalfe A, Greenfield S. Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial. Br J Gen Pract. 2006;56(523):115–21. [PMC free article] [PubMed] []
58. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133(5):1430–6. [PubMed] []
59. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52(11):1623–9. [PMC free article] [PubMed] []
60. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol. 2002;97(4):954–61. [PubMed] []
61. Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. BMJ. 2007;334(7603):1105–9. [PMC free article] [PubMed] []
62. Palsson OS. Should we incorporate psychological care into the management of IBS? Nat Clin Pract Gastroenterol Hepatol. 2006;3(9):474–5. [PubMed] []
63. Enck P, Martens U, Klosterhalfen S. The psyche and the gut. World J Gastroenterol. 2007;13(25):3405–8. [PMC free article] [PubMed] []
64. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006;4(4):CD005111. [PubMed] []
65. Schneider A, Enck P, Streitberger K, Weiland C, Bagheri S, Witte S, et al. Acupuncture treatment in irritable bowel syndrome. Gut. 2006;55(5):649–54. [PMC free article] [PubMed] []
66. Forbes A, Jackson S, Walter C, Quraishi S, Jacyna M, Pitcher M. Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. World J Gastroenterol. 2005;11(26):4040–4. [PMC free article] [PubMed] []
67. Lowe C, Depew W, Vanner S. A placebo-controlled, double-blind trial of acupuncture in the treatment of irritable bowel syndrome (IBS) Gastroenterology. 2000;118(4 Suppl 2):A3168. []
68. Liu GZ. Treatment of acupuncture and moxibustion plus psychotherapy for irritable bowel syndrome [Chinese] Zhongguo Zhen Jiu. 1997;10:611–2. []
69. Liao YC. Acupuncture treatment for 132 cases of irritable bowel syndrome. Clin J Acupunct Moxibustion. 2000;16(6):13. []
70. Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World J Gastroenterol. 2007;13(25):3417–24. [PMC free article] [PubMed] []