The Natural Approach to Treat IBS
(Irritable Bowel Syndrome)
Written by ©: Arien van der Merwe MBChB (Pretoria) FRSPH (London) MISMA (UK)
NOTE: The natural treatment options and stress management tools discussed in this article, will of course alleviate symptoms of any disorder or disturbance in digestive tract function.
Irritable bowel syndrome (IBS) or spastic colon is a functional disorder that affects the bowel or parts of the gastro-intestinal tract. After colds, IBS is one of the most common health problems found in people. It has also been called nervous colon syndrome. It tends to be a chronic disorder, and the symptoms can come and go over many years. For some people, IBS represents mild discomfort, while for others it is a disabling condition, with the sufferer unable to work normal hours or unable to attend social events. However, in many cases of IBS people are able to control their symptoms through dietary and lifestyle changes, stress management and prescribed or natural medicines. Irritable bowel syndrome is believed to be an over-reactive response of the digestive system, especially the colon, to emotional triggers.
IBS could present with symptoms related to bowel function, such as abdominal bloating, indigestion, cramping and wind, mucus in stools, diarrhoea, alternating with constipation and irregular bowel habits. People suffering from IBS are often concerned that it could lead to colon cancer. The symptoms are related to abnormal muscle contractions in any part of the intestinal tract. A spastic colon does not adversely affect longevity or lead to more serious bowel diseases such as colon cancer, Crohn’s disease or ulcerative colitis (inflammatory bowel disease).
IBS is one of the most frequently diagnosed gastro-intestinal disorders and accounts for almost a third of all cases seen by gastro-enterologists. Up to 15% of the general population has IBS, although only about 20% of this group will ever seek medical attention. Only a small percentage has chronic symptoms. The symptoms of IBS typically occur early in life and half of those affected experience the symptoms before they reach the age of 30. Among adolescents, 5% males and 14% females are affected by IBS, while among adults, 19% males and 24% females are affected.
IBS tends to be more common in the following people:
- Younger than 35 – if symptoms occur for the first time after this age, a diagnosis of IBS becomes unlikely.
- With panic and/or anxiety disorder.
- A positive family history of IBS.
- With a history of physical or sexual abuse or other psychological trauma.
There is no known cause of IBS. Most symptoms are related to abnormal muscle movement or spasm of the lower part of the colon. Dietary, psychological, hormonal or genetic factors may play a role.
There is no specific diagnostic test for IBS, but a number of tests can rule out other conditions, such as food allergies, intestinal infections, parasites, diverticular disease, colon cancer, ulcerative colitis and Crohn’s disease. It is important, therefore, if you experience any of the listed symptoms, to consult with your family doctor for a thorough medical examination and necessary tests to confirm the diagnosis.
- Symptoms usually start during adolescence or early adulthood.
- Symptoms appear over periods of days to weeks.
- Abdominal pain and/or cramping occur. The pain can vary from mild to severe. It is usually felt in the lower abdomen, especially on the left side. The pain may be dull or sharp, and continuous or cramping in nature. Pain is relieved by passing wind or by defecation. It does not occur at night.
- Constipation or diarrhoea develops shortly after meals, over a period of several weeks. Symptoms vary from person to person and in one individual both constipation and diarrhoea or either one alone can occur.
- There may be a bloated feeling, abdominal distension, increased intestinal gas (flatulence) and belching.
- Bowel movements differ in frequency or consistency from a person’s normal pattern. During constipation, stools may be hard, small, pellet-like, and difficult to pass. A sense of incomplete evacuation may follow. Defecation may relieve the pain. The diarrhoea of IBS is usually small in volume, but occur frequently. The first movement may be normal, but followed by loose bowel movements throughout the rest of the day. Bowel movements may be associated with extreme urgency and can be explosive. Mucus may be passed in the stools.
- Symptoms usually get worse during times of stress.
- Heartburn, nausea and vomiting can sometimes occur.
- Loss of appetite may occur.
- Some women have co-existent painful menstrual periods, and experience pain during sexual intercourse.
- Symptoms rarely if ever occur at night and do not normally wake the person from sleep.
The following may cause or exacerbate some of the symptoms:
- Stress, anxiety and depression
- Food sensitivity (up to 2/3 of people with IBS might have a food intolerance, allergy or sensitivity), especially as people age
- Overeating, binge eating, eating irregularly or too quickly
- Too much fat in the diet
- Lactose intolerance
- Sugar substitutes such as sorbitol and aspartame
- Certain antibiotics that alter the population of bacteria in the intestines
- Morphine and codeine
- Aluminium salts of antacids
- Tricyclic antidepressants
- Some antihistamines, mineral supplements bonded to mineral salts, diuretics, anti-psychotic drugs and sedatives
- Sensitivity to intestinal sensations
- Hormonal changes, for example during the menstrual cycle
When to see a doctor
- Your symptoms get worse, begin to disrupt your activities, or do not respond to natural treatment.
- You become increasingly tired.
- Your symptoms wake you frequently.
- You’ve been losing weight.
- Your appetite is poor.
- You experience abdominal pain that is not associated with changes in bowel function or that is not relieved when you pass wind or a stool.
- You have a fever.
- Mucus suddenly appears in your stools.
- Blood suddenly appears in your stools.
As IBS does not have a specific underlying cause, treatment is intended to relieve the symptoms. Conventional drug treatment of IBS is aimed at controlling the symptoms through improving gut motility and reducing gut sensitivity, thereby alleviating abdominal pain, bloating and constipation. Other conventional treatments include the prescription of dietary guidelines, lifestyle modification, laxatives, antispasmodics, antidepressants and tranquillisers.
Natural treatment options
The digestive tract is often called the second brain, as neurotransmitters are found abundantly along the whole tract. Neurotransmitters (90 have been identified so far – e.g. serotonin, the ‘feel-good’ neuropeptide), also called ‘molecules of emotion’ by Candace Pert, communicate in a two-way direction between digestive tract and brain and vice versa. Your gut literally ‘feels’ the way you do. The most important ‘treatment’ therefore,is stress management and relaxation training.
Certain foods may contribute to IBS by irritating the gastrointestinal tract. It is recommended to consult a registered dietitian, nutritionist, or natural health practitioner, to implement dietary changes and guidelines in your meal plans, since these guidelines could be as individual as the symptoms. To establish individual guidelines, a thorough history of eating habits relating to symptoms is very useful. It is recommended that you keep a journal of your symptoms along with your daily dietary intake.Add notes on your thoughts and feelings to this brew, and you will soon become aware if certain events, thoughts and feelings, together with certain foods, exacerbate the symptoms.
It may be necessary to cut the consumption of dietary fat, whether vegetable oil or animal fat, saturated or unsaturated. Other known irritants are eggs and dairy products, spicy foods and coffee. An elimination diet may help to discover food sensitivities. Do not eat a suspected food for 14 days. Then try it again and if you get an adverse reaction, avoid that food in future.
Most people do not eat enough fibre. It is therefore recommended that you gradually include the following one by one into your daily diet, while carefully monitoring your symptoms:
- Gradually increase the amount of fresh fruits and vegetables, whole grains and bran in your diet.
- Take one tablespoon of bran over your breakfast cereal, in salads, stews, soups, or stirred into a glass of fruit juice or water every day.
- Take one tablespoon of soluble fibre such as psyllium or guar gum in a glass of cold water or juice once a day.
- Wholewheat or brown bread, minimally processed cereals, such a brown rice, unsifted maize meal, sorghum porridge (Maltabella), bran-rich breakfast cereals and products like muffins made with bran cereal and/or wheat bran (obtainable from your local health shop)
- Raw, unpeeled fruit and vegetables, or lightly cooked vegetables, jackets potatoes, fresh fruit juices, and dried fruit soaked overnight in hot water, eaten with live AB culture yoghurt and All Bran flakes
- Legumes, such as dry beans, peas and lentils, and products made from legumes or soy. Try them one by one to notice of any one tend to increase intestinal gas or abdominal discomfort.
Always remember to drink 4-5 glasses of water in addition to your normal fluid intake. Water helps dietary fibre to swell and provide bulk in the intestines, thus improving regularity. However, overdoing water intake can lead to low calcium, magnesium and potassium levels. Drink eight glasses of water in total a day.
At first the amount of intestinal gas may increase, but it should subside as your body adjusts. Try to eat smaller meals more often or eat smaller portions of foods during meals.
Avoid smoking, as that in itself, can irritate the bowel.
Avoid excessive amounts of caffeine, for example in coffee, colas and chocolate.
Elimination diets: avoiding foods related to intolerance or eliminating all foods that could aggravate symptoms could be useful to delay or decrease symptoms.These include:
- dairy products (excluding organic live AB culture yoghurt)
- wheat products: possible wheat sensitivity and insoluble fibre
- fibre enriched foods: high content of insoluble fibre
- skins and pips: brinjals, tomatoes, berries, figs, raisins, nuts and seeds, whole peas and corn
- intestinal irritants: citrus fruits, tomatoes, chilli and spicy foods, caffeine, carbonated drinks
- smoked and processed foods: sensitivity to food additives
- gas-forming foods: lentils (whole), beans, onions, garlic, cabbage-family vegetables. Include these one by one after the elimination period. Chances are that not all of them will be culprits.
Elimination diets are not only useful to relieve symptoms, but also to identify whether food intolerance or allergies exist. Therefore, foods that cause or aggravate symptoms could be excluded from your diet as and when necessary.
The wheat and wheat bran controversy: Wheat bran, also known as digestive bran, is controversial in the treatment of IBS. It has been found that IBS symptoms could be aggravated with the inclusion of wheat bran into the diet. The possibility of wheat bran causing or aggravating inflammation is being investigated. Some people suffering from IBS also seem to have fewer symptoms when reducing their intake of wheat products. This could be related to the fact that wheat starch is more difficult to digest than other starches such as that found in potato or maize.
Fructose: Fructose, a natural sugar found in fruit, is often used to replace cane sugar. However, some people might have a fructose intolerance, characterised by diarrhoea, abdominal cramping and bloating after eating fructose rich foods such as fruit, fruit juices or pure fructose. People with IBS should be careful with the use of fructose, because with a fructose intolerance, their symptoms could be aggravated. Fructo-oligosaccharides such as found in asparagus, can however, be very beneficial for IBS.
Dietary fat: It has been found that intestinal contractions are exaggerated in people with IBS after eating a high fat meal, such as deep-fried foods, foods with fatty meats and creamy sauces. It is therefore recommended that the fat content of the diet should be within normal healthy recommendations.
Meal sizes and frequency: People with IBS are recommended to eat smaller, more frequent meals.
Get regular exercise to help regulate bowel movements. There are many different types of gentle exercise which can help you not only to de-stress, but also get your bowel motions back to normal. Yoga is probably the most relaxing exercise regimen available. Try and join a yoga class which emphasises relaxation and deep breathing. Taking leisurely walks in the fresh air is also a good idea. Swimming gentle laps or dancing to mood music will also help. Specific yoga asanas to try for symptoms of IBS include cat pose, sun salute, pawanmuktasana series (raised leg pose, leg rotation, cycling while lying on the back, leg lock pose, rocking and rolling, abdominal stretch, universal spinal twist, boat pose), all forward bend asanas, sitting in vajrasana (thunderbolt pose) for at least 10 minutes after meals.
Aromatherapy, therapeutic massage and reflexology are wonderful ways of getting rid of stress and making every part of your body, including your intestines, relax.
Natural antispasmodics, antidiarrhoeals or laxatives can be used for short periods when the symptoms of cramps, diarrhoea or constipation are severe. If you are depressed or under excessive strain, you might consider a herbal antidepressant such as St John’s Wort (SJW). It is important to realise that depression and anxiety need more than a symptomatic approach. By all means, use SJW if symptoms are severe, but also go for psychotherapy or group therapy to address the deeper emotional or even soul issues underlying IBS.
Nutritional supplements, natural or complementary remedies to help
treat some of the symptoms of IBS:
- One of the most helpful supplements are the beneficial bacteria Lactobacillus acidodiphilus and Bifidobacterium bifidus, to restore normal gut flora and assist in digestion and absorption of food. These are found in powder and capsule form from most health shops. Be sure to get a product with 2.5 billion live organisms per gram and take 1 000 to 4 000 mg per day
- Digestive enzymes are also very helpful: these can be found in supplement combinations containing pancreatic enzymes (amylase, protease, sucrase, malt diastase, lipase, cellulose, lactase), papain form paw-paw, bromelain from pineapple stem and cultured moulds from Aspergillus species.
- Herbal remedies:
- peppermint (Mentha piperita) has a long history of use for intestinal problems ranging from indigestion, cramping, bloating, fighting infection, reducing inflammation and relieving pain. Mint tea is useful for tummy upsets, but the essential oil of peppermint is better for IBS. Take 1-2 capsules containing 0.2ml of enteric coated peppermint oil 2-3 times a day as needed, or dilute a few drops of the oil in 2 tbl spoons of vegetable oil and rub over area of discomfort. Do not use peppermint oil internally when there’s heartburn or oesophageal reflux
- psyllium (Plantago ovata) is rich in fibre similar to those in oat bran, flaxseed meal and guar gum. Use up to 1 tbl spoon of seed husks or 10ml of powdered seed stirred into 250ml water once a day. Drink another glass of water afterwards and don’t take it within 1 hour of eating or taking other drugs
- camomile (Matricaria recutita) acts as a sedative, relieves wind, calms intestinal spasm and reduces inflammation. It soothes the gastrointestinal smooth muscle and helps for diarrhea and constipation. Drink 3-4 cups of tea per day or 10-40 drops of tincture 3 times per day. Avoid in case of heartburn or allergy to plants in the aster family
- dandelion (Taraxacum officinale) could help relieve constipation. Drink as a tea 2-3 times a day or take as capsules
- valerian tea helps for anxiety and stress, to relax and sleep peacefully
- ginger is a well-known remedy for digestive disturbances, such as indigestion, nausea, flatulence and colic. Drink tea made from fresh ginger 15 minutes before meals.
- Aromatherapy oils and flower remedies are useful to help treat some of the symptoms of IBS. It is recommended to consult a registered aromatherapist for the safe and optimal use of aromatherapy oils. Aromatherapy oils are extremely concentrated and should be diluted in carrier oils by using half the amount of drops for the volume of carrier oil, for instance 5 drops lavender oil could be used in 10 ml of sweet almond oil.
- Lavender is well-known for its relaxing and analgesic properties. Use 2-3 drops in an aromatherapy burner, or use diluted in a massage oil, applied to the abdomen
- Chamomile’s antispasmodic properties help to relieve abdominal cramping or discomfort. Use 1-2 drops in an aromatherapy burner, or diluted in a massage oil, applied to the abdomen
- Peppermint oil can be diluted in 2 tbl spoons of vegetable oil and rubbed or massaged over the area of discomfort or a few drops can be used in an aromatherapy burner.
- Rescue Remedy helps to treat anxiety and stress. Use 3-4 times a day
- Vitamin B-complex with vitamin C are important for a healthy nervous system. Lecithin is a natural source of choline and inositol, both important nutrients for nerve cells. Use in combination with an antioxidant formulation.
The cause of IBS remains uncertain, but the following trends that might help people make sense and find meaning in their symptoms, have been identified in IBS:
- They experience a lowered threshold for pain
- There exists a biological predisposition to respond to emotional stimuli with colon hypermotility (increased colon smooth muscle contractions)
- There are findings of mildly elevated test scores on depression, anxiety, neuroticism
- There tends to be a preoccupation with physical symptoms
- Increased tension, leads to an increase in symptoms
- ½ of patients reported psychological loss or threat of loss preceding the 1st episode
- There is a perceived, subjective experience of stressful life events
- Family history shows a tendency for special treats during childhood illness – treats for illness becomes a learned response
- Mind-body issues: fear of letting go; insecurity; lack of self-confidence, self-esteem and personal power; tending to be easily intimidated by others, finding the expression of their own ideas and opinions very difficult
Mind-body treatment options that have proven very successful for IBS:
- Self-awareness of stress triggers through stress assessments
- Coping skills training for handling interpersonal conflicts positively
- Hypnotherapy, autogenic training, biofeedback to control internal smooth muscle contraction
- Relaxation training, incl. relaxercises, movement
- Rest, massage
- Family therapy: patient contracting to talk about IBS symptoms only with the health care practitioner, who should be sympathetic, but not indulgent); family members to ignore any complaints in the home
- Group therapy – lectures, discussion, relaxation training, journal keeping
Relaxation to build resilience to stress
- Innercise as well as exercise.
- Helps you to learn to keep your mind, emotions and body quiet or silent in order to optimise your efficiency, energy resources and enjoyment of the present moment.
- Help you to access your own inner peace at any time when you need it.
- Not to teach you to permanently shut off the stress response.
- Increase range of responses to familiar stressors
- Have a diversified range to choose from to help you respond to stressors more effectively, productively and creatively.
- Rather than a worry, fear or anger response to triggers: become quiet, focused, aware of feelings, consciously relaxed, able to react pro-actively, responding, rather than reacting to stress triggers.
- Any imaginary activity created in mind’s eye, experienced as real
- Examples: meditation techniques, progressive muscle relaxation, visualisation and guided imagery, breath awareness, journal writing, mindfulness based stress reduction, etc.
Learn to breathe
- All techniques make use of breathing as start for, or as a complete relaxation exercise in itself
- Breathing is an Involuntary function that we can control
- Shallow, short breaths: sympathetic drive increases, leading to feelings and symptoms of distress
- Slow, deep breathing: parasympathetic drive, leading to deep relaxation, the opposite of the stress response
- When pressure due to expansion of the chest wall & muscular contraction is taken off the thoracic cavity, sympathetic drive decreases, leading to relaxation
The relaxation response
- Dr Herbert Benson, cardiologist, demystified and secularised Eastern meditation techniques
- quiet environment to exclude external disturbance
- mental device (such as a simple word, phrase, positive affirmation or mantra, gazing at a candle or flower, focusing on a sound; as focal point for concentration to replace stressful thoughts
- passive attitude to be receptive, open for thoughts to flow through rather than blocking them
- comfortable position
- regular practice
- This is how you do it: Sit quietly, becoming aware of your physical body, alternately tensing and relaxing muscle groups starting at the feet, moving up towards the face, head and neck. Then concentrate on your breathing. Make it slow and deep. Add a count of 4 (or whatever is comfortable to you) as you breathe in, hold for a count of four, breathe out to a count of 6. Repeat this for a few minutes. If your attention wanders, gently bring it back to your nostrils, the cool air on inhalation, the warm air on exhalation. You only need your own breath to become quiet, focused, serene. Once you’re completely relaxed, start repeating your chosen mantra over and over for a few minutes. Become aware of your body, wriggle your toes, feet, fingers and hands. Slowly come back to normal awareness. Rub the palms of your hands vigorously together and place it gently over your closed eyes. Open your eyes, and carry on with your day, knowing that your inner retreat can be accessed any day, any time.
- I deeply relax my muscles
- I can do this
- I will succeed
- I am confident in every social situation
- I am calm in my body, in my mind and in my emotions; or just: I am calm
- I am in touch with my peaceful inner centre
- Let go, let God
IBS can seriously curtail quality of life. It is important that a medical doctor should make a diagnosis before any treatment regime is started. Knowing about all the natural therapies available, can help you obtain sense of control over your health, while improving your quality of life and sense of wellbeing. Adapt your diet and lifestyle, practice regular stress management and relaxation techniques, and make use of the natural remedies to help you cope with the symptoms!
Stress Solutions, Arien van der Merwe; Tafelberg Publishers 2004
Health & Happiness, Arien van der Merwe; Tafelberg Publishers 2002
Herbal Remedies, Arien van der Merwe; Tafelberg Publishers 2003
The Creation of Health, Norman Shealy & Caroline Myss; Stillpoint Publishing 1999
Mind Matters, JR Millenson; Eastland Press 1999
Encyclopedia of Natural Medicine, Michael Murray & Joseph Pizzorno; Little Brown & Company 1998
The Herbal Drugstore, Linda White & Steven Foster; Rodale Inc. 2000