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Finding a Fix for IBS Second in a two-part series on IBS by Wenda Reed

As anyone who has suffered from irritable bowel syndrome will tell you, there is no easy fix even after you’ve received the diagnosis. After trying standard treatments like antidepressants, over-the-counter medications, prescription drugs or fiber supplements, many IBS patients still experience symptoms. When these traditional medical approaches fail, the next step is often alternative medicine, usually beginning with a naturopath.

Using an integrative approach that seeks to determine underlying cause on a case-by-case basis, naturopathic medicine has been effective in helping people find relief from IBS.
Stephen Wangen, N.D., was diagnosed with IBS in 1994 and received his doctorate in naturopathic medicine from Bastyr University in 1999. While in medical school he took a special interest in issues involving the digestive tract to find and treat the conditions that were causing his own symptoms. As he began his practice he found that he was concentrating more and more on digestive issues, and opened the IBS Treatment Center in 2005. He currently sees patients from around the country and the world.

“Instead of guessing at what may be causing symptoms or telling you to reduce stress or add fiber, we try to get to the root cause,” Wangen says. “We are very individualistic in our testing. One person has a big yeast overload. The next person’s problem is dairy and eggs. The next has problems with wheat and gluten. Some have parasites, such as tapeworms or hookworms. A lot of patients have a combination of things.”

FOOD ALLERGIES AND DIET

Colleen Prisock, of Bellevue, had already concluded that she may be lactose intolerant, so she cut out eggs and dairy products. After taking a complete medical history, Wangen tested Prisock’s blood and confirmed an allergy to eggs. “I’ve done much better,” she says. “I stopped having weekly attacks. The bloating is still there, but I can deal with it.”

Seattle resident Christine Larsen had a similarly positive response to food allergy screening. She went to a naturopath at Bastyr because she felt as though something she ate had upset her stomach, but she couldn’t figure out what it was. “We saw that eggs were off the chart for me — lima beans too, for some reason. Wheat and dairy were something that I could eat occasionally, but should avoid on a daily basis. After I stopped eating eggs and began watching my wheat and dairy intake, I felt so much better,” Larsen says.

Blood tests for food allergies involve looking for IgE and IgG antibodies to 96 foods. The presence of the antibodies indicates an allergic/immune reaction. IgE is an immunoglobulin involved in immediate hypersensitivity reactions to eating a particular food, and at its most extreme produces anaphylactic shock. IgG is an immunoglobulin involved in delayed hypersensitivity reactions. In the case of IgG reactions, “there is an underlying immune reaction, but it affects people differently as far as symptoms,” Wangen explains.

The lab issues a report that indicates the degree of sensitivity to each food and states whether it should be avoided completely or eaten in moderation on a rotating basis.

The ELISA/EIA (Enzyme Immunoassays) panels used to test the presence of IgG antibodies are somewhat controversial, and many traditional medical doctors discount them completely. In a recent report, Dr. Sheryl B. Miller, clinical laboratory director at Bastyr University’s Natural Health Clinic, agrees that the presence of IgG antibodies “may play a role in adverse reactions to food. It is, however, a testing method that is questionable in both its theory and validity. It is also costly and may not be reliable, depending on which laboratory you use,” she writes.

Food allergy testing wasn’t terribly helpful in my own case, partly because the list of allergens was discouragingly long and included wheat, gluten, baker’s and brewer’s yeast, coffee, and proteins found in milk and cheese. My first reaction was, “I just can’t do this,” but I buckled down and avoided wheat, dairy and yeast for a couple of years. I became an avid label reader and took along my own wheat-free crackers when I ate out.

My food diaries showed that I was still having digestive troubles and flu-like symptoms several days a month. The diary is filled with comments like, “Ate a couple of Rice Krispy treats with malt five days ago” or “Went out to dinner — half sip of beer, trace of cream sauce.” It felt as though I was being punished for every bad bite I took. For me, avoiding certain foods was not the complete answer.

Other IBS sufferers try exclusion diets — going off of a food they think triggers their symptoms for a week or two and seeing if they feel better, then adding it back in and seeing if symptoms return. This method has limitations because reactions to foods can be delayed and it may take a while for antibodies to go back down after eliminating a food, Wangen points out.

Through trial and error, Seattle resident Heather Van Vorous gradually learned which foods aggravated her symptoms and which soothed them. “I was my own guinea pig,” she says. Eventually, she came up with an “IBS Diet” that is applicable to many sufferers and which has since been validated by scientific studies:

• Strictly limit the amount of dietary fat from red meat, dairy products, egg yolks, fried food and oils because fat is a GI stimulant.
• Eat soluble fiber (the kind that can be dissolved in water) with every meal or snack; sources include oatmeal, pasta, rice, potatoes and white bread.
• Be very careful with eating insoluble fiber (roughage that does not dissolve in water, found in raw fruits and vegetables).
• Eliminate coffee, carbonated beverages and alcohol.
• Avoid overeating and large meals.

Other IBS dietary suggestions from a variety of sources include limiting wheat or gluten, citrus fruits, bran, foods containing artificial sweeteners, and gas-producing vegetables such as broccoli and cabbage. Some people find symptoms are aggravated by spicy foods.

Experts agree there is no one diet for every IBS sufferer because each of us has different triggers for our symptoms. Fiber is especially confusing because it can help some people, especially those with constipation, and make others feel worse because of cramping, bloating and gas.

Even when we identify our trigger foods, we may be able to eat them on occasion. Van Vorous points out that stress, menstrual cramps, hot and humid weather or a night without good sleep can cause symptoms to flare up. Symptoms can also be affected by how much food we eat and whether it is on an empty stomach. “I ask myself, ‘How hyperactive is my colon today?’” Van Vorous says. “If it’s a good day, I can tolerate more of my trigger foods.”

Monica Jarrett, a professor of biobehavioral nursing and health systems at the University of Washington, is one of the lead investigators in the School of Nursing’s studies on improving management of IBS symptoms. “We encourage people to eat smaller, more frequent meals and to identify their triggers,” Jarrett says. “We had one participant, an accountant, whose IBS symptoms are worse during tax time. Then she can’t have any ice cream. If it’s not a stressful time, she can have some ice cream if she has some other food in her stomach first.”

STOOL TESTS TO FIND CAUSES

While diet plays a vital role in managing IBS symptoms, there are dozens of other factors that can aggravate them. A comprehensive stool test can find many of them. A naturopath will usually order these tests to indicate whether you are breaking down fats and proteins properly or if you are missing the enzymes and other chemicals used to digest them. The tests can also measure how well food is being absorbed, the immunology of the gut, any growths of yeast, and the presence of good and bad bacteria, among other things.

In my case, the levels of good bacteria were low, so I began taking probiotics and other products to increase them. I also took supplements to improve absorption of nutrients and kill bad microbes — a regimen that added up to about $200 a month, without much improvement. The breakthrough came when I began taking enzymes with every meal to supplement my low production of pancreatic and hydrochloric acids to properly digest my food. For the past nine years, I have been taking them at every meal and have virtually no symptoms. It was an expensive detective process to get here, but it finally led to a cure.

Prisock also had a stool test as part of her naturopathic workup. “We found there was no good bacteria — either that was my normal state or they’d been killed off from drugs or inflammation,” she says. “Yeast had taken the place of the good bacteria. We cleared out the yeasts, and I take probiotics three times a day.”

Probiotics are live microorganisms (in most cases, bacteria, such as Acidophilus and Bifidobacterium) that are similar to beneficial microorganisms found in the human gut. They can come from dietary supplements or foods, especially yogurt, fermented and unfermented milk, miso, tempeh, and some juices and soy beverages. They are a current fad, but scientific understanding of probiotics and their potential for preventing and treating health conditions is at an early stage, according to the National Institutes of Health.

Wangen says they are not appropriate for everyone. “I consider them just another of several hundred variables that we are considering when assessing and treating digestive problems,” he says. “They may be important or the key issue for some people, but not any more important than having a reaction to food or a problem with yeast.”

A stool test will also look for parasites, including giardia, which are more common than most people suspect, according to Wangen. Traditionally, labs screened for parasites by looking at a smear of fecal material under a microscope. The problem is that if the parasite isn’t in that particular smear, it can be missed. In the past year, Wangen has begun using the one lab in the United States that conducts DNA testing of the entire stool sample for a more accurate diagnosis.

THE ROLE OF STRESS

For those of us with IBS, all of the stress in our lives seems to “go to our gut.” The Digestive Diseases Information Clearinghouse, a subsidiary of the National Institutes of Health, lists “stress, conflict and emotional upsets” as factors that worsen the symptoms of IBS. Stress seems to stimulate colon spasms because the colon is partly controlled by the autonomic nervous system, which responds to stress. In addition, evidence suggests that IBS is affected by the immune system, which is also affected by stress.

Health care providers may prescribe stress-reduction training and relaxation therapies such as meditation, counseling and support. Some sufferers can find relief through biofeedback, massage, regular exercise, yoga, adequate sleep, progressive relaxation techniques and deep breathing.

Dr. Craig Pepin, a gastroenterologist with the Polyclinic in Seattle, makes removing or managing stress a major part of his treatment protocol. “I ask whether depression and anxiety are playing a role in symptoms,” he says. “If so, they won’t get better until anxiety and depression get better.” Pepin says much more research is needed on the link between the brain and the gut, but when researchers look at areas of the brain, they see different activity when patients say they’re hurting from IBS.

Although she acknowledges that stress contributes to symptoms, Van Vorous bridles at the suggestion that it causes IBS. “It’s not a mental problem; it’s not stress-induced,” she says. “It’s not right for doctors to say, ‘You just need to relax.’ It’s strictly a physical problem, not mental.”

Nevertheless, VanVorous endorses audio hypnotherapy tapes for the relief of symptoms. She bases this on 15 years’ worth of studies documented on her Web site (www.helpforibs.com), including a study at the University of Manchester in England, published in the June 2008 issue of the Journal of Psychosomatic Research. The researchers concluded that although the mechanism is unknown, “there is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years.”

Jarrett and her colleagues at the University of Washington’s School of Nursing have conducted two studies on IBS management, finding that participants had fewer symptoms and a better quality of life after receiving cognitive behavioral therapy. The therapy teaches people to change their thinking to reduce “dysfunctional emotions” and then alter behavior.

“We look at belief systems,” Jarrett says. “We have our patients ask themselves, ‘Do I have to be perfect all the time?’ If they make a mistake, do they tell themselves, ‘I’m a terrible person’? We concentrate on the way you treat yourself when you talk to yourself because you will feel it in your gut.”

In a more generalized sense, participants are taught to “build a little relaxation into their lives, especially around eating,” Jarrett adds. “Before your body takes in food, ask yourself, ‘Are my muscles tense?’ Can you take a deep breath and settle yourself?”

“We don’t cure IBS,” says Jarrett of the combination of dietary counseling and cognitive behavior therapy, “but we usually reduce the impact. As one participant told us, ‘IBS used to be at the forefront of my life, and now it’s in the background.’”

Indeed, many people, including Van Vorous, insist that there is no cure for the gut/brain disorder that causes IBS.“Anything that is identifiable and can be treated — like yeast or parasites — is not IBS,” she says.

This does not need to be a cause for despair, Van Vorous says. “Relax. Take a deep breath. Realize you are not alone and that there are countless things you can do to lead a happy, healthy life.”

Wenda Reed is a Seattle-area writer who suffered with IBS for 20 years.

If you are suffering from persistent abdominal pain with diarrhea and/or constipation, bloating and gas, the most important first step is to get an accurate diagnosis to see if you have a structural problem or if it’s irritable bowel syndrome. This was discussed in Part 1 of this series, “What’s Wrong with Your Gut: Finding a Diagnosis for Irritable Bowel Syndrome,” published in our May 2009 issue.

PARTICIPANTS SOUGHT FOR TWO IBS STUDIES

The University of Washington’s School of Nursing is seeking participants for current phases of two ongoing studies on irritable bowel syndrome. Participants will receive $500 for completing each of the two studies, in addition to free treatment.

“Nursing Management of IBS: Improving Outcomes” is open to women and men, ages 18 to 70. Participants will keep a food diary for four weeks to identify triggers and will receive results of stool, urine and blood tests as part of the assessment process. Those in the treatment group will then receive eight weeks of cognitive behavioral therapy to learn how to self-manage stress and IBS symptoms. Those in the control group will not receive the training, but will have a session with the research nurse as well as written materials. There will be two follow-up visits. This phase of the study is ongoing for the next three years. Call 206-616-9955 for information or to enroll.

“A Nursing Study of Gut Function in Menstruating Women” is open to women ages 18 to 45, with or without IBS. Participants will spend three nights in a sleep lab to see how sleep characteristics (sleep efficiency and self-report of poor sleep) affect IBS symptoms. Researchers will study the effect of acute stress exposure on nighttime sleep, the balance of the autonomic nervous system, and neuorendocrine markers in women with severe IBS with diarrhea and with constipation. This study goes through January 2010. Call 206-616-5168 for more information.

©2009 Caliope Publishing Company