Irritable Bowel Syndrome | All You Need to Know

abominal pain

In the scary world of intestinal tracts, the most common ghost—unfortunately—is a mysterious disease that travels under the code name IBS. These three sinister initials are shorthand for irritable bowel syndrome.

People with IBS tend to have alternating constipation and diarrhea, bloating, unformed stools, gas, and sometimes, cramps followed by an urgent need to have a bowel movement. As the discomfort goes on, though, the root causes are frustratingly elusive.

IBS is not a disease, and rarely is there any inflammation of the bowel. Doctors who have studied the problem say that it’s probably related to stress and food intolerances.

“In my practice, I find that there are two kinds of people who get IBS. First are go-getters who are really stressed; they are hard-wired for stress to stimulate their colons. And then there are the folks who have an intolerance to certain foods,” says Leon Hecht, N.D., a naturopathic physician at North Coast Family Health Center in Portsmouth, New Hampshire.

Since the causes are elusive, finding an appropriate remedy can pose a real challenge. Some supplements, however, seem to make the symptoms of IBS more tolerable and possibly less likely to occur, says Dr. Hecht. These treatments—combined with lifestyle and diet changes and stress reduction—may be sufficient for some folks, he says.

Hydrate with Fiber and Water

To start, you need to get enough water, and that may be a good bit more than you’re accustomed to drinking. Some people with IBS have small, hard stools that are difficult to pass. By drinking water, they can add soft bulk to the stool and ease its passage through the bowel, says Melissa Metcalfe, N.D., a naturopathic doctor in Los Angeles.

“You should drink eight 12-ounce glasses of water a day, and more if you’re an active person,” says Dr. Metcalfe.

While you’re emptying your water bottle, also increase the amount of fiber in your diet, Dr. Metcalfe advises. Fiber absorbs water and helps move food and waste through the gastrointestinal tract more quickly. Some excellent sources of fiber are foods like prunes, apples, oat bran, and carrots.

If you need more fiber, you can benefit from a supplement. In a study published in a British medical journal aptly named Gut, 80 patients with irritable bowel syndrome were given either a supplement containing psyllium or a harmless, inactive substitute (a placebo). More than 80 percent of the group taking psyllium experienced relief from their constipation, while those in the placebo group noticed no change.

Dr. Metcalfe recommends taking two tablespoons daily—in two separate doses—of a fiber/nutritional supplement that contains psyllium husks. Fiber supplements like Metamucil come in a wide range of textures, and some are flavored to make them more palatable. Take them before meals, or take one tablespoon in the morning and another before you go to bed. Just make sure that you mix each tablespoon dose with at least two eight-ounce glasses of water, says Dr. Metcalfe.

Calming the Colon

Irritable bowel syndrome isn’t just irritating; it can be downright painful. When you’re having an attack, you can calm your aching colon by taking peppermint oil extract, an herbal medicine long used for digestive problems, says Dr. Hecht. To decrease the severity of your IBS symptoms, you can take it every day.

Peppermint oil extract relaxes the smooth muscles that line the intestines and other internal organs. The herb calms overactive peristalsis, the muscular contraction that moves food through the gastrointestinal tract, and relieves cramping. It also helps you belch and relieve gas buildup, according to Dr. Hecht.

In one German study, doctors combined peppermint oil extract with caraway oil and gave the mixture to 54 patients with IBS. Some patients were given 90 milligrams of peppermint oil extract combined with 50 milligrams of caraway, while others received a placebo. After four weeks of taking one capsule before meals, 63 percent of the patients given the oils found that they were pain-free. Only 25 percent of the placebo group noticed any improvement.

Dr. Hecht has found that even peppermint oil extracts alone are effective for some of his patients with IBS. To get the medicine to the intestines where you need it, look for a peppermint oil capsule or pill that’s enteric-coated. The coating protects the extract from the acid of the stomach and enables it to release its therapeutic benefits in the small intestine, explains Dr. Hecht.

He suggests a supplement that contains 0.2 milliliters of peppermint oil extract. “Take one capsule between meals three times a day,” he says, but he advises that you not take the capsule immediately after a meal.

You may have some discomfort if you take too much peppermint oil since it can cause some burning at the anus. “If that happens, just back off on the dosage and take less,” suggests Dr. Hecht.

Diet Detection and Bacteria Banishment

Food intolerance is often a contributing factor to IBS, but the reactions can happen hours after a meal, so people don’t always connect what they ate with how they feel, says Dr. Hecht.

Many naturopathic doctors suggest that their patients try to find out what’s causing the problem by a process of elimination. This is called, logically, an elimination diet. The first step is to cut out the foods that are most likely to be irritants. Many people, for example, have adverse reactions to sugar, wheat, and corn. Milk and other dairy products are common culprits. Chocolate may also be a problem, and a high-carbohydrate diet is involved in 30 to 50 percent of Dr. Hecht’s cases. Sometimes, blood testing or allergy testing can provide clues as well, he notes.

For many people, refined sugar is the culprit, says Dr. Hecht. He compares it to fertilizer for yeast. Although yeast is always present in the body, dietary sugar can lead to an overgrowth in the intestinal tract, resulting in gas, bloating, and pain and triggering cramps and other symptoms of IBS.

In the meantime, if bad microorganisms in your intestinal tract start to crowd out the good ones, any problems that you have with food sensitivities or with indigestion may be intensified. One way to combat the problem is to repopulate the gut with good bacteria. Usually, that means that you need to take acidophilus, says Michael Gazsi, N.D., a naturopathic doctor in Ridgefield, Connecticut.

Acidophilus supplements come in various dosages, depending on the manufacturer, says Dr. Gazsi. Your best bet is to follow the directions on the label of the supplement and then observe any changes in your condition. A typical dose is one capsule with a meal twice daily.

Some Mint for Movement Here’s a medicine that’s good for you, and it tastes good, too. Peppermint has been a popular flavoring agent in candies for centuries, but it has important healing properties as well. It stimulates digestion, relieves gas and bloating, and makes you burp.

The herb’s therapeutic qualities are related to its menthol content. Peppermint oil extract contains 50 to 70 percent free menthol, a compound that stimulates bile flow and other gastric secretions in the digestive system. The herb’s active oils also have an effect on the sphincter muscle at the lower end of your esophagus. By temporarily changing the behavior of that muscle, peppermint oil extract promotes belching.

Strangely, peppermint also inhibits hunger pangs in the stomach by suppressing peristalsis, the muscular contraction that moves food through the gastrointestinal tract. When the effects of the herb begin to subside, however, the peristaltic movements come back even more strongly.

With more gastric secretions and stronger stomach movements induced by peppermint, food spends less time in your stomach. It is passed along to the small intestine more rapidly, and that means digestion improves.

As a supplement, peppermint oil extract usually comes in capsules. You can also drink peppermint tea.

“If the bowel continues to feel really irritated, I’d back off the dosage a bit or try a different brand,” says Dr. Gazsi. “Unfortunately, there’s not a lot of quality control with some of these supplements. There’s no way of knowing if you’re getting enough or too many of the bacteria. You just have to see how you’re reacting and adjust accordingly.”

Eventually, the good bacteria should re-establish themselves, and you can forgo the acidophilus supplement. Or you can continue taking it. “It’s one of those things that you can take indefinitely,” says Dr. Gazsi.

Bring On the Enzymes

Bacteria aren’t the only player’s indigestion. You also need plenty of digestive enzymes, specialized proteins that break down the food chemically and make it available for use by the body. If enzymes don’t do their work properly or are in short supply in the gastrointestinal tract, food passes undigested through the small intestine. As that undigested food reaches the bowel, it may be attacked and consumed by bad bacteria, which in turn causes gas and bloating.

If you’re having an irritable bowel problem partly because you lack enough digestive enzymes, you may benefit from taking a supplement to make up the shortage, says Dr. Gazsi. There are several types on the market. Look for a product that contains plant-derived enzymes and follow the dosage recommendations on the bottle.

Another way to get your enzymes is to eat more fresh, uncooked vegetables and fruit. You don’t get the enzymes from canned, processed, or cooked food, since many of the natural plant enzymes are destroyed by cooking and processing, according to Dr. Gazsi.

“You don’t want to eat too much raw food all at once, though,” he says. “Some people try to change their diets too quickly, which may make their irritable bowels even worse.”

Coat and Soothe

Although the exact cause of IBS isn’t known, herbs that are generally soothing and healing to the digestive tract can be helpful. These herbs, known as demulcents, have the ability to coat mucous membranes.

By direct contact, the demulcents help relieve inflammation and are therefore very soothing, explains Pamela Taylor, N.D., a naturopathic doctor in Moline, Illinois.

A good example is a slippery elm. When a dose of one to two tablespoons of liquid extract is dissolved in water or juice or added to a cooked cereal as a demulcent, it forms a soothing coating that bathes the intestinal walls. “Demulcents such as slippery elm also have a wound-healing effect,” she says.

Supplement combinations of demulcent herbs usually include slippery elm, marshmallow root, echinacea, goldenseal, and geranium. This combination is commonly known as Robert’s Formula and is often recommended by naturopathic physicians, says Dr. Taylor.

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