Natural Treatment of (IBS) Irritable Bowel Syndrome in Vermont
Are you troubled by abdominal bloating, discomfort or pain? Do you have gas, constipation, diarrhea, backache, fatigue, and possibly depression or anxiety? If so, you may have IBS.
Irritable Bowel Syndrome is the most common gastrointestinal disorder reported to general practitioners. Estimates of its frequency run as high as 15% of the population. Unfortunately there is no way to definitively diagnose irritable bowel syndrome, so it is therefore a diagnosis of exclusion. Conditions that must first be ruled out include infection by parasites, yeast, or pathogenic bacteria, diverticular disease, inflammatory bowel disease (such as ulcerative colitis and Crohn’s disease), gall bladder disease, and lactose intolerance. These conditions and others can produce symptoms that mimic those of IBS.
The good news is that naturopathic medicine has much to offer people with IBS.
Causes of Irritable Bowel Syndrome (IBS)
From a naturopathic medical perspective there are a variety of underlying causes of IBS that can be effectively treated. In my experience most people with irritable bowel will improve when these factors are addressed. These factors are as follows:
- Food allergy/sensitivity
- Small Intestinal Bacterial Overgrowth (SIBO)
- Yeast overgrowth/candidiasis
- Histamine intolerance
Irritable bowel syndrome, like most conditions, is multi-factorial. In any given person, a variety of factors will add up to cause the IBS. When enough of those factors are present (when a certain threshold is exceeded), the person experiences the IBS. To prevent the IBS, all of the factors don’t generally need to be addressed, just enough of the factors to take the person below this threshold.
Food Allergies in IBS Treatment
First and foremost, it is important to take a look at food allergies and sensitivities. Food allergies occur when the immune system reacts to foods in the same way it would to foreign bacteria, and are a very common cause of IBS.
Food allergies occur most commonly to dairy, gluten, eggs, soy, peanuts, corn, yeast, chocolate, almonds, and nightshades (potato, tomato, pepper, eggplant). The list of potentially allergic foods, however, includes pretty much everything a person eats. The more frequently a food is eaten, the more likely it is to be a food allergen.
While most people think of a food allergy as an immediate, severe reaction such as when someone eats a peanut or strawberry and can't breathe, this reaction is relatively rare compared to the much more common delayed allergic reaction. Delayed reactions are usually caused by an IgG or IgA antibody (rather than the IgE antibody that causes the immediate and severe reactions), and can occur anywhere from a few minutes to a couple days after eating the allergic food. The reaction is generally much more insidious, and can include things such as asthma, eczema, psoriasis, arthritis, ear infections, sinusitis, irritable bowel, inflammatory bowel disease, anxiety, depression, fatigue, hyperactivity, obesity, and post nasal drip. Most often people with delayed allergies don't realize they are allergic because of this and because they may be eating a variety of food allergens frequently.
There are many different options when it comes to diagnosing food allergies. The best is a blood antibody test, which is more accurate for this type of allergy than a skin prick test. Blood tests are available to check up to 96 or more foods all at once and are covered by most health insurance plans.
Food sensitivities or intolerances, which are different from food allergies, can also trigger IBS. These can include lactose intolerance, fructose intolerance, sulfite sensitivity, salicylate sensitivity, histamine intolerance, and others. Many of these intolerances have no specific test available to confirm the diagnosis. The best way to determine if any of these foods are problematic is to follow an elimination/challenge diet of the foods containing these substances.
Small Intestinal Bacterial Overgrowth (SIBO) in IBS Treatment
The second most common cause of IBS that I see in my practice is SIBO. SIBO is a condition in which relatively normal bacteria get into the wrong place, the small intestine. While there should be large amounts of bacteria in the large intestine, this is not true of the small intestine. When bacteria overgrow in the small intestine, they can produce all the symptoms of IBS.
There are two main types of SIBO, caused by hydrogen producing and methane producing bacteria, respectively. The hydrogen producing bacteria in SIBO cause diarrhea, while the methane producing type cause constipation. It is also possible to have both, which can produce alternating diarrhea and constipation. In either case, all the other symptoms of IBS such as abdominal pain, bloating, nausea, etc. can also occur.
There is a good test that is now available to check for SIBO. It is a breath test that is performed after drinking a solution containing lactulose, a fermentable sugar. The best tests measure both hydrogen and methane. This test now gets covered by most insurance.
The treatment for SIBO includes getting rid of the bacteria in the small intestine with either an antibiotic or a combination herbal formula. Either can work well if used appropriately. It is also important to change your diet to prevent a recurrence of the SIBO. These bacteria feed off of certain types of carbohydrates, so it is important to limit these foods to treat the problem effectively. While there are a number of different diets that may be effective, I recommend either the FODMAP diet (FODMAP=Fermentable Oligo-Di-Monosaccharides and Polyols) or Specific Carbohydrate Diet (SCD).
Another treatment approach that can be helpful is to improve small intestinal motility to help flush the bacteria into the large intestine. A low dose of the antibiotic erythromycin can be used for this.
Finally, it is important to ensure that there is adequate stomach acid. Stomach acid kills most of the bacteria present in the food we eat on its way through the stomach. Approximately 2/3 of people taking antacids for acid reflux or stomach ulcers develop SIBO. There are also effective natural treatments for people with acid reflux and ulcers that don’t require taking antacids.
Yeast Overgrowth (Candidiasis) in IBS Treatment
Yeast overgrowth (candidiasis) is a common condition and frequent cause of IBS. Yeast is omnipresent in our environment, so most people are exposed to it. It is not a true pathogen, but more of an opportunist. It overgrows in the gut when it is given the opportunity to grow by being fed what it likes to eat, which is sugar (and starches such as bread and pasta which our guts rapidly convert into sugar for the yeast to eat). Recurring vaginal yeast infections in women is a strong indicator of intestinal yeast overgrowth. There are stool and blood tests that can be used to diagnose an intestinal yeast infection, but the blood test cannot differentiate between a current and past infection, whereas the stool test will only show a current infection. Treatment for intestinal yeast should include the following three interventions:
1. Kill the yeast – herbal medicines such as goldenseal and oil of oregano can be very effective. Prescription drugs such as nystatin and Diflucan can be very effective. Yeast can become resistant to many of these medicines, but stool cultures that are used to diagnose candidiasis will generally do a sensitivity test to determine which natural and prescription medicines will be effective at killing your particular yeast.
2. Stop feeding the yeast – I recommend eliminating added sugars such as cane sugar, honey, and maple syrup, and reducing the intake of starches such as bread, pasta, and cereals to no more than 1 serving per day. I do not find that it is necessary for most people to eliminate fruit, fermented foods, and all starch as many anti-candida diets recommend.
3. Replace the good bacteria – these organisms help to prevent the overgrowth of yeast. Probiotics such as acidophilus and bifidobacteria can be used. Alternatively, prebiotics such as the vegetable fiber inulin can be used to preferentially feed the beneficial bacteria.
Histamine Intolerance in IBS Treatment
Histamine intolerance is a condition in which the body cannot adequately metabolize the compound histamine. Histamine is best known for its role in allergic diseases such as hay fever, hives, and asthma. When histamine is released by cells in the body it causes a runny nose, sneezing, watery eyes, and itching. Histamine is also found in many of the foods we eat, however, and can build up to excessive levels without allergen exposure when an individual has a decreased capacity to get rid of excessive histamine. One of the main causes of this is an impairment in the enzyme diamine oxidase (DAO), which is responsible for metabolizing histamine. There are common known genetic variations which can impair the function of this and other enzymes and cause histamine intolerance. When this happens, it can also cause symptoms of IBS, headaches, flushing, and asthma in addition to the typical allergy symptoms listed above. For people with IBS and these allergy symptoms, histamine intolerance is more likely to be the culprit. Food allergies, however, can also cause all of these allergic symptoms, so this alone is not enough to confirm histamine intolerance. A low histamine diet, which restricts fermented foods such as beer, wine, hard cheese, vinegar, and sauerkraut, as well as bananas, avocadoes, cured meats, dried fruits, and other high histamine foods, can be an effective tool in the diagnosis and treatment of histamine intolerance.
Maldigestion in IBS Treatment
Maldigestion, or inadequate secretion of digestive enzymes such as pancreatic enzymes or stomach acid, is another cause of IBS in some people. It is less common in my experience than the other causes listed above, but common enough to be worth looking at if the above approaches are ineffective. Testing options for this condition are limited, so I generally just recommend a clinical trial of digestive enzymes or hydrochloric acid. This should not be undertaken without the advice of a physician, as hydrochloric acid can cause side effects in some people.
Herbal and Nutritional Medicines in IBS Treatment
In addition to the treatments discussed above, which are designed to identify and treat the underlying causes of irritable bowel, there are a number of herbal medicines that can offer safe and effective treatment for the symptoms of IBS. Here are two of the best examples:
Enteric coated peppermint oil - peppermint is an effective inhibitor of colon contractions or spasm and also relieves gas. Peppermint oil should only be taken in enteric-coated capsules. These capsules aren’t digested until they pass through the stomach and reach the small intestine. This prevents the peppermint oil from contacting the stomach where it can cause acid reflux and heartburn.
Iberogast – a combination of 9 different herbal medicines, including chamomile and licorice, that is often effective in the treatment of IBS.
Bottom Line for the Natural Treatment of IBS
Natural IBS treatment should begin with identifying and treating the underlying causes that can contribute to irritable bowel. Specifically, I recommend:
- Get a blood test for food allergies – Easy and accurate, this can be extraordinarily helpful
- Get tested for Small Intestinal Bacterial Overgrowth (SIBO)
- Get tested for yeast overgrowth (candidiasis)
- Try a low histamine diet
- Treat maldigestion with pancreatic enzymes
- Try herbal medicines such as enteric coated peppermint oil and Iberogast
How We Can Help
Naturopathic doctors are physician experts in treating the underlying cause of disease and using natural medicines to help people get and stay well. To find out which natural treatments are appropriate for you or to be tested for food allergies or other causes of IBS, schedule an office visit or food allergy test.
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