IBS / Irritable Bowel Syndrome: Causes, Symptoms, and Treatments

Overview

IBS affects about 58 million people in the United States. 80% of the affected population are women. Although IBS is not life-threatening, symptoms of bloating, increased flatulence, abdominal pain, bowel urgency, diarrhea or constipation can get in the way of living a normal lifestyle. While some people can manage their symptoms, for others, IBS can undermine their ability to work, travel, and even socialize.

Causes

The medical community does not know why people get sick with IBS. What doctors do know is that IBS can be triggered by the following factors:

• Infections enteritis (inflammation of the small intestine) caused by parasites (giardia and ameba) and bacteria (C.difficile)
• Intestinal Dysbiosis (altered intestinal flora) and Candidiasis secondary to overuse of antibiotics and other medications
• Food allergies or sensitivities
• Fast food, fried foods
• Processed foods high in sugar
• Inability to handle stress resulting in increased intestinal spasms
• Overgrowth of bacteria in a small intestine

It is a known fact that IBS patients have very sensitive digestive systems. It is common for individuals with IBS to have bad gut reactions to coffee, alcohol, and smoking. Also, cruciferous vegetables (cabbage, cauliflower, broccoli, brussel sprouts) and beans can cause bloating and flatulence.

High fructose corn syrup, fructose, lactose, and sorbitol should be restricted. These sugars cannot be fully digested by the majority of IBS patients. The research team from Gastroenterology Institute, Shaare Zedek Medical Center in Jeruselem collected data from 239 patients, 94 patients with IBS. The results were stunning: lactose (milk sugar) caused malabsorption in 82% of the IBS group. A fructose-sorbitol combination caused malabsorption in 70% of IBS group. Scientists concluded: “Dietary restrictions of the offending sugar(s) should be implemented before the institution of drug therapy.” ¹

Signs and Symptoms

Doctors use the “Rome Criteria” (named after 1988 Gastroenterology Conference in Rome, Italy) to identify symptoms relevant to IBS. These include:

• Abdominal pain that is relieved by a bowel movement
• Diarrhea alternating with constipation
• Stool can appear as small, hard, difficult to pass pellets (constipation), semi-formed or watery (diarrhea) with mucus
• Feeling of bloating, abdominal pain; urgency to discharge feces or feeling of incomplete evacuation and straining; flatulence
• Nausea and vomiting
• Anxiety and/or Depression

When these symptoms are present for longer than 3 months, it is likely that the patient has IBS.

Diagnosis

Physical examination and detailed medical history must be done as a part of IBS assessment. Diagnostic tests such as: abdominal CT scan, CBC (Complete Blood Count), and stool cultures for parasites are usually done to exclude other diseases (IBD, colon cancer, parasitic infections, etc).

Can medications cure IBS?

The simple answer is NO. The following drugs for IBS have serious side effects, and some of the medications prescribed can cause you to suffer with more stomach pain, constipation and/or diarrhea.

Medication used for IBS treatments

Antispasmodics diminish the frequency of intestinal spasms.

• Bentyl (dicyclomine) side effects: constipation, stomach pain, nausea and vomiting.
• Buscopan (butylscoopolamine) side effects: difficulty urinating, diarrhea and nausea.
• Levbid, Levsin (hyoscyamine) side effects: diarrhea, hallucinations and impotence.

Laxatives used to promote regular bowel movements for constipated people. This type of medication does not address the real reason for constipation. Laxatives can be habit forming, and can cause nausea, gas, abdominal pain and electrolyte disbalance.

• Examples of laxatives: Milk of Magnesia, Miralax, Dulcolax, Correctol, Serocot.

Antidiarrheal medications are used to control diarrhea. Antidiarrheal side effects include: nausea, vomiting, constipation, abdominal cramps and pain. Examples of antidiarrheal medication:

• non-prescription: Imodium, Pepto-bismol and Kaopectate
• prescription: Lomitil. Avoid taking lomotil if diarrhea is caused by antibiotics or bacteria.

Lotronex is used to treat severe diarrhea. This drug is known to cause life-threatening side-effects (including death). It was pulled off the market in November 2000, then the FDA allowed it back on the market on April 2002. Dr.Raczkowski, FDA chief of gastrointestinal drugs reports: “this is the first time that a drug has been withdrawn from the market and has returned”.

Zelnorm is another drug pulled off the market by FDA in 2007 after over 20 studies demonstrated that Zelnorm increases risk of heart attacks, strokes, ischemic colitis and death. Antidepressants are used to treat anxiety, depression, pain and overexcited gut reactions.

Norpramin (desipramin) side effects: allergic reaction (face and throat swelling), tremors.

Elavil (amitriptyline) side effects: bleeding, vomiting, chest pain, seizures, hallucinations.

In sum, conventional medications often bring more distress than relief to IBS patient.

Erroneous Recommendations of Dietary Changes for IBS

Unfortunately, some doctors do not provide enough information about necessary dietary restrictions. The advice of most doctors is very generic: limit your intake of fried fatty foods, dairy products, caffeine and alcohol. Most physicians fail to test for gluten sensitivity or celiac disease, which are often major triggers for IBS. Also, food sensitivities should be identified by using elimination diet and blood tests. Numerous studies have proved that probiotics can help IBS sufferers by normalizing gut flora, improving digestion and suppressing bacterial overgrowth in the small intestine². However, most gastroenterologists are unaware of probiotics and its benefits in IBS.

Fiber is another controversial subject. If an IBS patient is constipated, many physicians make the generic recommendation of a high fiber diet. You will hear that eating apples, pears, peas, cereals, and whole-grain breads plus using fiber supplements like Metamucil will give you so much needed relieve from your constipation. Unfortunately, this advice is wrong: a sudden increase in fiber consumption (Metamucil plus raw fruits and vegetables) can irritate the sensitive gut causing gas, bloating, and abdominal pain. Also, flavored Metamucil has artificial flavors, artificial colors, and artificial sweetener (aspartame), which can irritate your gut.

Another scientific fact is being overlooked by medical community: the majority of IBS patient cannot fully digest high fructose corn syrup, fructose, and gluten.  These ingredients are found in the following foods:

• High Fructose Corn Syrup: soda, salad dressings, dry cereals, juice, ketchup and ice-cream
• Fructose: dry fruits and sweet fruits
• Gluten: breads and cereals

High fructose corn syrup (HFCS) can be found not only in soda (one can has up to 12 teaspoons of HFCS) but in supposedly healthy foods like low-fat, fruit-flavored yogurt (up to 10 teaspoons in one serving container), fruit juice, Mott’s Applesauce, English muffins, Ritz crackers, Jello and canned soups. HFCS is digested differently than plain white sugar. Unlike sucrose, HFCS moves directly to the liver for metabolism and storage as fat. Plus, HFCS is associated with the suppression of the hormone leptin, which controls appetite and feeling of fullness after the meal. Therefore, eating or drinking large amounts of HFCS causes weight gain³. With these risks for obesity, mercury poisoning, and digestive problems, it makes sense to eliminate HFCS from the diet.

Stress management

Using meditation, yoga, cognitive behavioral therapy, hypnotherapy and biofeedback can result in powerful relaxation effects.

¹Goldstein R, Braverman D, Stankiewicz H “Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints.”The Israel Medical Association Journal 2000 Aug;2(8):583-7

²Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’MahonyL, Kiely B, Shanahan F, Quigey EM ”Effecacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with IBS” American Journal of gastroenterology. 2006 Jul:101(7):1581-90

³Swan, Norman, Lustig, Robert H. “ABC Radio National, The Health Report, The Obesity Epidemic”.