:: October 2006 Volume 5/Number 7

Research Review
Irritable Bowel Syndrome:
Five Approaches to Healing at a Gut Level

By Felicia M. Tomasko

According to Ayurveda, our health begins with our digestive system. This is where the food we eat becomes transformed into ourselves. Whether or not we are digesting food thoroughly has a profound impact on our health. In addition to the actual process of transforming our food, the digestive system is often referred to as a second brain. This is because the tissues and organs of the digestive system are filled with receptors for neurotransmitters and hormones, and in fact themselves manufacture neurotransmitters. For this reason, our emotional state, and particularly our negative responses to stress and exhaustion, strongly impacts our digestive efficiency and our elimination patterns.

Of digestive diseases, irritable bowel syndrome (IBS) and inflammatory conditions of the digestive system are chronic, irritating in themselves and often debilitating. According to the National Institutes of Health, as many as 20% of American adults, or one in five people, have irritable bowel syndrome.i Other estimates suggest that 10-15% of Americans experience this type of digestive distress.ii Bloating, cramping, discomfort and abdominal pain are the most common symptoms, but other symptoms vary from person to person. These include difficulties with elimination patterns and can range from chronic or repeated constipation to diarrhea, gas, frequent trips to the bathroom, straining, passing mucus and difficulty eliminating wastes. For some people, this can be an impediment to leaving the house, keeping a normal schedule or eating out in a group.

Biomedicine

Steroids are a common therapy used to calm an irritated digestive system, but steroids often have significant side effects. Other tactics used are drugs that reduce the immune response, as well as antibiotics or other anti-microbial drugs. iii Medications are also given to influence motility, which is movement of the muscles of the intestines. Generally, people often look to complementary therapies because of dissatisfaction with allopathic treatments for IBS and other inflammatory conditions of the digestive system.iv

Diet

Diets high in fiber help to alleviate the symptoms of irritable bowel since they improve the overall health of the colon. In Ayurveda, a fiber supplement often used is Isapgol, more commonly known as psyllium seed husks. This is the main ingredient in bulking laxatives such as Metamucil and it is shown to be effective in regulating bowel function, although not for relieving pain and cramping.v,vi,vii

There are some links between gluten intolerance and irritable bowel syndrome, and eliminating wheat and other gluten-containing grains can be helpful. Caffeine is another culprit that upsets the digestive system.viii

Omega-3 fatty acids, one of the oils known as essential fatty acids because they cannot be made in our bodies, are important in digestive system health. Essential fatty acids (EFAs) are vital in hormone and neurotransmitter regulation. Specific to IBS, good research is scarce, but so far studies suggest a benefit from supplementation with EFAs.ix,x Omega-3 oils are found in many vegetable oils, including flax, hemp, evening primrose, olive, avocado, as well as dark leafy green vegetables and edible weeds like purslane. Since the irregularity of irritable bowel has a component of disturbed vata, the dosha of air that regulates movement in the body, including healthy oils or omega-3 supplements in the diet calms this disturbance.

Probiotics, or beneficial bacteria, are found to be helpful in the treatment of probiotics. Many people with digestive problems have an imbalance in the natural flora of the digestive system and supplementing with probiotics can be an important part of a therapeutic regimen, although more studies need to be done.xi,xii While yogurt or other cultured foods can be effective, make sure to choose yogurts with live cultures and without refined sugars.

Melatonin is a hormone produced by the pineal gland at the base of the brain; it regulates sleep/wake cycles. Additionally, melatonin is produced in the digestive system, where it regulates movement. People with irritable bowel syndrome who took 3mg of melatonin before bed experienced decreased pain after two weeks of continuous use.xiii

Stress and Stress Reduction

As mentioned previously, there is a strong connection between the digestive system and our emotional expression, and stress negatively impacts gastrointestinal disorders, particularly IBS.xiv Improving the body/mind’s ability to cope with stress is an important part of healing the digestive system. A lifestyle-based intervention combining yoga asana (posture) with meditation, pranayama (breath techniques), stress management and other practices reduced the experience of stress and improved coping in people with digestive disorders.xv Consistent yoga practice (asana and pranayama) is also shown to directly improve symptoms of irritable bowel syndrome, more so than conventional therapies.xvi

The use of cognitive therapies, or directed psychotherapy that focuses on the connection between mind and body reduced symptoms and was beneficial overall in people with irritable bowel syndrome. This is suggested as an important addition to a holistic regimen.xvii

Herbs and Ayurveda

Aloe vera gel is used in different medicinal systems, from Western herbalism to Ayurveda to reduce inflammation. Aloe vera coats and soothes mucus membranes; from an Ayurvedic perspective it reduces excess pitta, the dosha of heat and fire. Pitta plays a role when there is inflammation in the digestive system. The anti-inflammatory and anti-oxidant effects of aloe are observed in vitro studiesxviii as well as in people taking the herb: A study of people with inflammatory bowel disease found that taking aloe vera gel orally safely decreased symptoms.xix Derivatives of aloe vera are being developed for use as pharmaceutical agents to reduce inflammation and irritation.xx

Boswellia serrata is salai gugul, a resin used in Ayurvedic medicine. When Boswellia was tested for use in people with inflammatory disorders of the colon, it healed the lining of the colon, improved blood chemistry including iron and calcium levels and balanced immune system function.xxi Taking Boswellia with fats or oils improved its effects.xxii

Peppermint is another cooling, pitta-reducing anti-inflammatory. It is the most commonly enjoyed herbal tea with strong medicinal properties including relaxing the digestive system and reducing pain. It is also antimicrobial, protecting the body against a variety of pathogenic organisms which can exacerbate bowel conditions.xxiii,xxiv A study of herbal combinations including coriander, lemon balm, mint and psyllium, provided relief from bloating and pain.xxv

Acupuncture

Acupuncture is an important part of Chinese medical treatment for gastrointestional disorders, and is frequently use for treating irritable bowel, with reported good effects.xxvi,xxvii In a related disorder, colitis, which is inflammation of the large intestine, causing similar symptoms to irritable bowel, acupuncture and moxibustion (burning of specific herbs at acupuncture points) improved digestive system function and quality of life.xxviii

Conclusion

Since irritable bowel is a widespread condition, it may either affect our lives or the people we know. The most effective treatments are those that recognize the connection between mind and body and employ a multifaceted approach. Even for those of us who experience occasional upset stomachs and digestive disturbance, increasing our ability to cope with stress, practicing yoga asana and meditation, and employing complementary therapies as appropriate can support digestive health.

Warning: The information in this column is for educational purposes only. Please see a qualified healthcare professional for treating specific problems.

 

i Irritable Bowel Syndrome. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.gov/ddiseases/pubs/ibs. Accessed 9/14/2006.
ii Hadley SK, Gaarder SM. 2005. Treatment of irritable bowel syndrome. American Family Physician. 72(12):2501-6.
iii Robinson M. 1998. Medical therapy of inflammatory bowel disease for the 21st century. The European Journal of Suigery. 582:90-98.
iv Quattropani C, Ausfeld B, Straumann A, Heer P, Seibold F. 2003. Complementary alternative medicine in patients with inflammatory bowel disease: use and attitudes. Scandinavian Journal of Gastroenterology. 38(3):277-82.
v McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. 1998. Psyllium is superior to docusate sodium for treatment of chronic constipation. Alimentary Pharmacological Therapy. 12(5):491-7.
vi Ashraf W, Park F, Lof J. 1995. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther. 9(6):639-47.
vii Fernandez-Banares F. 2006. Nutritional care of the patient with constipation. Best Practices in Research in Clinical Gastroenterology. 20(3):575-87.
viii Hadley SK, Gaarder SM. 2005. Treatment of irritable bowel syndrome. American Family Physician. 72(12):2501-6.
ix MacLean CH, Mojica WA, Newberry SJ, Pencharz J, Garland RH, Tu W, Hilton LG, Gralnek IM, Rhodes S, Khanna P, Morton SC. 2005. Systematic review of the effects of n-3 fatty acids in inflammatory bowel disease. American Journal of Clinical Nutrition. 82:611-9.
x Simopoulos AP. 2002. Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition. 21(6):495-505.
xi Faber S, Rigden S, Lukaczer D. 2005. The use of probiotics in the treatment of irritable bowel syndrome: two case studies. Alternative Therapies in Health and Medicine. 11(4):60-62.
xii Verdu EF, Collins SM. 2005. Irritable bowel syndrome and probiotics: from rationale to clinical use. Current Opinion in Gastroenterology. 21(6):697-701.
xiii Song GH, Leng PH, Gwee KA, Moochhala SM, Ho KY. 2005. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut.54(10):1402-7.
xiv Monnikes H, Tebbe JJ, Hildebrandt M, Arck, P, Osmanoglou E, Rose M, Klapp B, Widenmann B, Heymann-Monnikes I. 2001. Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterationis in gastrointestinal motility and sensitivity. Digestive Diseases. 19(3):201-11.
xv Gupta N, Khera S, Vempati RP, Sharma R, Bijlani RL. 2006. Effect of yoga based lifestyle on state and trait anxiety. Indian Journal of Physiology and Pharmacology. 50(1):41-7.
xvi Taneja I, Deepak KK, Poojary G, Acharya IN, Pandey RM, Sharma MP. 2004. Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study. Applied Psychology Physiology and Biofeedback. 29(1):19-33.
xvii Kennedy T, Jones R, Darnley S, Seed, P, Wessely, Chalder T. 2005. Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. British Medical Journal. doi:10.1136/bmj.38545.505764.06
xviii Langmead L, Makins RJ, Rampton DS. 2004. Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro. Alimentary Pharmacology & Therapeutics. 19(5):521-7.
xix Langmead L, Feakins RM, Goldthorpe S, Holt H, Tsironi E, De Silva A, Jewell DP, Rampton DS. 2004. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Alimentary Pharmacology & Therapeutics. 19(7):739-47.
xx Robinson M. 1998. Medical therapy of inflammatory bowel disease for the 21st century. The European Journal of Suigery. 582:90-98
xxi Gupta I, Parihar A, Malhotra P, Singh GB, Ludtke R, Safayhi H, Ammon HP. 1997. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. European Journal of Medical Research. 2(1):37-43.
xxii Sterk V, Buchele B, Simmet T. 2004. Effect of food intake on the bioavailability of boswellic acids from a herbal preparation in healthy volunteers. Planta Medica. 70(12):1155-60.
xxiii McKay DL, Blumberg JB. 2006. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.). Phytotherapy Research. 20(8):619-33.
xxiv Hadley SK, Gaarder SM. 2005. Treatment of irritable bowel syndrome. American Family Physician. 72(12):2501-6.
xxv Vejdani R, Shalmani HR, Mir-Fattahi M, Sajed-Nia F, Abdollahi M, Zali MR, Alizadeh AH, Bahari A, Amin G. 2006. The efficacy of an herbal medicine, carmint, on the relief of abdominal pain and bloating in patients with irritable bowel syndrome: a pilot study. Digestive Disease Science. 51(8):1501-7.
xxvi Takahashi T. 2006. Acupuncture for functional gastrointestinal disorders. Journal of Gastroenterology. 41(5):408-17.
xxvii Quattropani C, Ausfeld B, Straumann A, Heer P, Seibold F. 2003. Complementary alternative medicine in patients with inflammatory bowel disease: use and attitudes. Scandinavian Journal of Gastroenterology. 38(3):277-82.
xxviii Joos S, Wildau N, Kohnen R, Szecsenyi J, Schuppan D. Acupuncture and moxibustion in the treatment of ulcerative colitis: A randomized controlled study.

 

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