Wednesday, October 22, 2008

Irritable Bowel Syndrome, a misnomer?

The great catch all diagnosis when your doctor can’t find out what is going on in your gut. Some docs refer to it as the new “female hysteria” condition, seeing that the sex ratio is 2:1 in (dis)favor of women.

That said, it happens to be one of my favorite conditions to help patients with- mainly because after all the many doctors, tests and years of suffering without a reasonable grasp of the causes or treatments I can help patients investigate their situation in a methodical and purposeful way. Often, this leads to a new level of self awareness, much less a handle on what is at the bottom of their endless bottom problems, so to speak ; )

Irritable bowel syndrome can manifest in unruly ways that would leave anyone irritated- like getting ready for a party or a meeting or an exam, only to be running to the toilet every few minutes unable to leave the house on time, or at all. When you spend the day in bed worrying about the grumbling in your tummy or the next time you go to the bathroom if will there be any end, it can really degrade one’s confidence and set up a vicious cycle of opting out as a preventive measure.

And, let me tell you, life is a terrible thing to opt out of day after day. Staying home waiting for it to pass, may be a good way to prevent embarassment in public, with the bloating, flatulence and the grimace you wear from the painful spasms in your gut; perhaps you’ve noticed, though, it’s part of the problem. As Neil Young would say, don’t let it get you down. Because, I remind you in a hushed tone: the nervous system is listening. The more you stress about that abominable abdominal stress the more it continues to feed itself.

Still, I laugh to think of the 2+ years I took a prescription drug for IBS, that caused a few very undesirable side effects like fainting at work, dry mouth and dizziness. No stress there. My initial diagnosis of IBS was made in less than a 4 minute office visit with my then PCP. He prescribed me bentyl immediately. I asked him how he knew that was appropriate as he hadn’t done any testing; he said there were really no tests besides a colonoscopy which was highly uncomfortable. I insisted that I be tested as I didn’t believe in taking a prescription drug for something that lacked a clear diagnosis. Yes, I got to experience the charm and grace of a colonoscopy, and because there was no other finding other than pain the specialist said that IBS was indeed the diagnosis. Doctor’s aren’t always right, they do the best they can and they sometimes are just there to help us feel more ignorant, (though they may very well match us in that department at the time). And, anyway ignorance is bliss, right? Not!

So back to IBS, I think irritable bowel syndrome is a misnomer; it really stands for Irritating Bowel Symptoms. I know most everypart of my body has the ability to be irritated, but most everypart has been doing it’s job with no complaints. It’s like by some blind curse we’ve stirred up trouble in the bowel and we have got to step lightly around the volcano of our tummies-cause my goodness it’s active. And, many docs may prescribe you antidepressants or an antispasmodic narcotic to hush the volcano- they can help with those irritating symptoms, but they don’t treat the cause.

So, now, we see in the research that the gut contains nearly as many autonomic nervous cells as the central nervous system (that means your brain and spinal cord)—and that melatonin, the biorhythm hormone, is found in much higher concentrations in the gut than in the pineal gland. Interesting, huh? (As an aside, did you know that the pineal gland is just about where your third eye is? Nothing like unruly bowel habits to cloud your insight).

Traditional medical systems focus on the gut as the primary predictor and protector of health; basically, if the tummy no good, then the rest will go to pot. And, isn’t that so? IBS is now entwined with other diagnoses like fibromyalgia and chronic fatigue syndrome, where they see them as the IBS of the musculoskeletal and sympathetic nervous systems, respectively.
According to an article the Role of intestinal bacteria in nutrient metabolism, each of these diagnoses could be strongly related to a dysbiosis in the gut. Dysbiosis is the art of harmful bacterial anarchy in the gut; where the balance of good to bad bacteria is not happening (if only there were a Batman in our the Gotham city of our bowels, sigh). Yet, there is—lots of them, 2-8 billion cultures to be exact of bifidobacterium could set things aright again. Which leads me to the spiritual scientific part of this article; why are you bloated after you eat.

Why am I bloated all the time?

Though you may be feeling the effects of the bloating in your large intestine (the colon that leads to the area where you may feel the end result of all that bloating ; ), the origination may be due to what’s found in the small intestine—an overgrowth of bacteria that like to make sulphide. These bacteria are usually confined to the large intestine, and a few studies suggest that the type of food these bacteria need is not getting all the way down to where they were in the large intestine so the bacteria end up moving up to where they can get it in the small intestine. Yep, that’s right the kind of food you eat makes a difference. Simple white rice is already digested in the small bowel and doesn’t make it to the large intestine (thus bacteria will have to move up to get it); whereas legumes take a longer distance in the colon to get digested and thus the bacteria can stay put in the large bowel and still get their pickings. (By the way this is the spiritual part, in case it isn’t clear).

The starch in these foods is what the bacteria like to eat. And when you can get your starch in a more dense, complex fibrous form like artichokes it is more likely to go the distance, so to speak. It will also satisfy your hunger sooner; along with keeping the bacteria in your large intestine well-fed which enables them to rid your body of more byproducts that you no longer need-do you see the correlation with losing some weight and some irritable bowel symptoms, too?

Additionally, you could set out to supply your large intestine with all the delicacies it desires—propitiating the bowel, hmmm the newest religious rite. Foods like artichoke, garlic, onions, leeks and chicory are their faves because they have oligosaccharides. But, wait you say, “arent’ garlic and onions full of sulphur?” Why, yes they are and I’m glad to see you have been paying attention. My suggestion then is this, if you have a ton of bloating because of all that bacterial displacement why not eat lots of artichokes, chicory and foods with inulin and/or supplement with FOS (fructooligosaccharides) that when encapsulated are termed “prebiotics” until you’ve replaced the small bowel population with a new homestead in the large intestine.

Oh, and to ensure that those displaced small bowel bacteria don’t stay too attached to their current place, add in some, well lots, of probiotics-bifidobacterium and lactobaccillus to carry the torrent back into the large intestine? After some weeks, you can begin to add garlic and onions back in to your diet. Of course, if you’re like me and can’t be parted from garlic at least, don’t worry you can still take the pre/probiotics and it will be ok. Listen to your body, your whole body not just that joker in your mind that keeps pointing out the snowball donuts are on sale, and your bowels will be chiming in good time. Remember propitiate the bowel, and until, next time here’s a link for some lite reading. Stay in good health and good humor!

Reference: Role of intestinal bacteria in nutrient metabolism
JPEN: Journal of Parenteral and Enteral Nutrition, Nov/Dec 1997 by Cummings, J H, MacFarlane, G T

No comments: