IBS? It May Be Something Else . . .

SIBOPeople often come to my office saying they’ve been diagnosed with IBS.  They may complain of intestinal pain, constipation, diarrhea, or all of the above, yet all of their test results come back “normal”, so they are prescribed anti-spasmodic medications to manage their symptoms, and sent on their way.

In my experience, IBS is merely a symptom of other underlying causes, rather than  a definitive diagnosis.  Whether it’s food intolerances, poor eating habits, or restoring optimal production of stomach acid and digestive enzymes, naturopathic medicine has a lot to offer when it comes to identifying and treating the underlying cause of IBS.

One cause in particular that’s often overlooked is small intestine bacterial overgrowth (SIBO).  It’s thought that SIBO is responsible for over 50% of IBS cases, and possibly as much as 84%.  SIBO occurs when bacteria that normally live in the bowels (E. coli, Bacteroides, etc.) are allowed to replicate to excessive levels.  This can occur for a number of reasons, but poor gastric motility (especially due to the use of proton pump inhibitors) is usually the main underlying cause.  The main symptoms of SIBO include: Bloating, gas, abdominal pain, cramping, nausea, heartburn, joint pain, and/or fatigue.

Testing for SIBO can be easily performed using breath tests that detect abnormal levels of hydrogen or methane gas that are produced by excess levels of bacteria.  Once detected, it can be effectively treated with either naturopathic or pharmaceutical interventions.  Eradication of SIBO usually leads to a 75% reduction in IBS symptoms, and is even more effective when combined with dietary interventions (especially low carbohydrates) and motility agents.  Once treated effectively, preventive measures can be taken to reduce the risk of recurrence, which can be high if measures aren’t taken to correct the underlying imbalances that led to SIBO in the first place.

So, if you’ve suffered from IBS for years, see to it that your medical doctor or naturopath test for SIBO, especially since the testing is simple and affordable.  If there’s roughly a 75% chance of your symptoms resolving, your years of waiting for relief are hopefully over!

Digestive Health In Early Life Linked To Allergies

dandelionAs a naturopathic physician, I’m always paying close attention to the connection between intestinal health and systemic complaints.  Allergies in particular are something that our profession has recognized as having strong ties to the digestive tract.  When people present to my office complaining of allergies, one of the first things I ask about is whether or not they’re having any digestive symptoms.  I also want to know about their history of antibiotic use, their diet, if they were breastfed as an infant, and whether or not they were born via Caesarean section.  So, what do these birth-related issues have to do with someone’s current allergy symptoms?  Well, we know that allergies are symptoms that result from antibody responses to antigens (dust mites, pollens, mold, etc.) that our body recognizes as foreign. But what your doctors don’t often discuss is why this occurs in the first place.

A recent study done at Henry Ford Health Center suggests that babies born by C-section are five times more likely to develop environmental allergies by age two than children who are born vaginally.  This mainly has to do with the bacterial exposure that occurs when babies pass through the birth canal, vs. if they’re removed via C-section.  Starting in the womb, the intestinal tract of babies is essentially sterile.  As they pass through the birth canal, they are exposed to the entire population of bacteria that resides within their mother’s vaginal and gastrointestinal tract.  This allows their immune system to learn the difference between “good” and “bad” bacteria.  A C-section prevents this critical exposure to bacteria, allowing the body to develop a sensitivity to allergens before the intestinal microbes have a chance to fully develop.

Of course, by the time most of us manifest allergy symptoms, it’s too late to do anything about how we were born!  However, there are still a number of intestinal-related factors that play a role in immune function, and how the immune system may recognize everyday substances as foreign.  But for expecting mothers, if you know you’ll be having a C-section, one of the best measures you can take to protect your child is by breastfeeding.  This will also help to pass on important bacteria that they won’t otherwise be exposed to with formula alone.  You can also supplement with probiotics, which are often formulated as powders with strains that are specific for infants.

For the rest of us, it’s still important to take steps to normalize the microbial environment of the intestines as much as possible when trying to minimize the body’s allergy response.  Ways to do this include consuming more sources of fermented foods, such as yogurt and kefir, and supplementing with mixed strains of probiotics (bifidobacter, lactobacillus, etc.).  You can also look at stool tests to measure the amount of healthy bacteria within your intestinal tract, along with making sure that unwanted microorganisms aren’t present.  The bottom line is that there is much more we can do when it comes to allergies than just loading up with anti-histamines and allergy shots.  The immune system is extremely intelligent and sophisticated, so let’s start giving it a little more credit!

What Can I Do About C. diff?

A patient came to me recently after finishing her 2nd course of antibiotic treatment for Clostridium difficile (C. diff) infection.  Despite some temporary relief during while taking the medication, her symptoms were beginning to return to the same level of intensity that she was experiencing before the treatment.  The patient’s gastric distress was so severe that she barely had the ability to function at work, having to take both prescription and OTC pain relievers just to get through the day.  She was reluctant to go through another round of antibiotics, since they weren’t giving her any relief, and were causing other side-effects as well.

In most cases, C. diff infections are acquired in hospitals or long-term care facilities, especially in patients who have been taking antibiotics.  However, due to an increase in antibiotic resistance, more and more patients who are otherwise healthy, and not in a hospital setting, are acquiring C. diff infections.  The patient in question fits into this category-she is young, active, and doesn’t have a history of any serious medical complaints.

Fortunately, Saccharomyces boulardii exists as a viable treatment option for C. diff infections.  Saccharomyces boulardii (SB) is a non-pathogenic strain of yeast that is isolated from lychee and other tropical fruits.  Since it is a yeast, rather than a bacteria, it’s not susceptible to being affected by antibiotics, as are other beneficial microorganisms within the intestine.  SB has been proven to effectively treat C. diff infections, and may prevent the recurrence of C. diff infections by up to 50%.  This is especially important for patients undergoing immunosuppressive therapy for inflammatory bowel disease, along with those in a hospital or long-term care setting.  Given the evidence, it should be standard practice for doctors to be recommending SB for at-risk patients, or those with an active infection.  Unfortunately, I’m not seeing it done nearly enough!

In the instance of the aforementioned patient, a week-long course of treatment with SB completely resolved her gastrointestinal symptoms.  Repeat stool testing showed no sign of C. diff, and other infections were ruled out as a precaution.  Frankly, I was even amazed at how effective the treatment was, given the nature of most C. diff infections!  If you’re someone who is potentially at risk of acquiring C. diff, just know that drugs aren’t the only available treatment option.  Tell your doctor that you’ve read about the effectiveness of SB, and make sure you start taking it ASAP!


Celiac Disease or Gluten Intolerance?

When people are experiencing nutritional deficiencies, anemia, weight changes, and/or other symptoms that seem to be of an unknown origin, it’s fairly common practice for doctors to rule out the presence of celiac disease with a small intestinal biopsy. While this is certainly considered the “gold standard” for identifying the pathological changes associated with celiac disease, many experienced physicians are finding that patients can still have a sensitivity to gluten containing grains, making celiac disease and gluten intolerance separate entities altogether.  This led experts at the recent International Celiac Disease Symposium to define the term gluten insensitivity for patients who don’t meet the criteria for celiac disease or wheat allergy, yet improve dramatically when following a gluten-free diet.

The incidence of Celiac disease has doubled since 1974, and gluten sensitivity alone is estimated to be 6 times the prevalence of celiac disease. Fortunately, for patients and doctors who have recognized this phenomenon for quite some time, there is finally a more established definition of gluten sensitivity. Some of the criteria being used to separate gluten sensitivity from wheat allergy and celiac disease include: Negative testing for the presence of IgE antibodies to wheat; Negative endomysial and ttg antibodies (typically present with celiac disease); Negative small intestinal biopsy; Resolution of symptoms following as gluten-free diet. Researchers have concluded that the genetic makeup and immune response of gluten sensitivity patients is unique, and may be more enzyme mediated (like lactose intolerance), rather than immune based.

Since objective testing is still lacking, people who are symptomatic should consider implementing a gluten-free diet. Some of the most common symptoms associated with gluten sensitivity include abdominal pain, rashes, headaches, “brain fog”, fatigue, depression, anemia, and joint pain. If your doctor tells you that celiac testing is negative, don’t give up hope!


Small Intestinal Bowel Overgrowth and IBS

I’m posting a link here that explains in detail the symptoms of Small Intestinal Bowel Overgrowth (SIBO), and how it is often an underlying cause of IBS. In my clinic, I’ve diagnosed this several times, even after people have already consulted with their gastroenterologist, which indicates that SIBO is not “mainstream” enough for most doctors to pursue the appropriate testing. All that is required is a simple breath test-Once diagnosed, this condition is easily treatable, so talk to your doctor about performing the test if you’re experiencing recurring digestive symptoms, or have been diagnosed with IBS. 


IBS and “Mindfulness”

A therapy that combines mindfulness meditation and gentle yoga may help soothe symptoms of irritable bowel syndrome, a small clinical trial suggests.

In a study of 75 women with the digestive disorder, researchers found that those assigned to “mindfulness training” saw a bigger improvement in their symptoms over three months than women who were assigned to a support group.

The findings, they say, suggest that the mindfulness technique should be an option for treating irritable bowel syndrome (IBS).

A doctor not involved in the study agreed.

“I think people with IBS should learn mindfulness skills,” said Dr. Delia Chiaramonte, director of education for the University of Maryland’s Center for Integrative Medicine in Baltimore.

Learning such skills, she said in an interview, is “100 percent safe,” and it could offer people a way to help manage IBS symptoms on their own, long term.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. The typical treatment includes diet changes, as well as anti-diarrhea medication and, for constipation, laxatives or fiber supplements. There’s also some evidence that regular, moderate exercise helps.

The exact cause of IBS is unknown, but anxiety and less-than-ideal coping strategies — like avoiding going out because of your symptoms — are thought to make IBS worse for many people.

Because of that, psychological counseling is sometimes used. The best-studied form is cognitive behavioral therapy, which tries to change the unhealthy thinking patterns and behaviors that contribute to people’s health problems.

For the new study, Susan A. Gaylord and colleagues at the University of North Carolina, Chapel Hill, looked at a different approach to managing the “brain-gut” connection — known as mindfulness-based stress reduction.

The researchers randomly assigned 75 women with IBS to either undergo the mindfulness training or attend an IBS support group once a week for eight weeks.

The training included lessons on meditation, gentle yoga postures and “body scanning,” in which people focus their attention on one body area at a time to detect muscle tension and other sensations.

Gaylord’s team found that three months after the therapy ended, women who’d undergone mindfulness training were faring better than the support group.

On average, their scores on a standard 500-point IBS symptom questionnaire fell by more than 100 points, with a 50-point drop considered a “clinically significant” improvement.

In contrast, women in the support group averaged a 30-point decline, according to results in the American Journal of Gastroenterology.

Chiaramonte said the trial was “tremendously well-designed,” and set up to address the common criticisms of studies of mind-body therapies. Testing mindfulness training against a support group, for example, helps control for the fact that people involved in any form of therapy may simply expect to get better — and, therefore, do.

In surveys, the researchers found that women in the support group were as likely to expect benefits as those in the mindfulness group.

“And still, the mindfulness group did better,” Chiaramonte said. “So it’s not just the contact with another human being, or not just that they expected to get better.”

It also makes sense that mindfulness training would help people with IBS, according to Chiaramonte. “Part of the problem in IBS,” she explained, “is the attention people give to the physical discomfort, and what the mind then does with that.”

With mindfulness training, the goal is to help people become aware of what they are feeling, but then “let it go” instead of ruminating, and potentially making the physical symptoms worse.

Of course, naturopathic medicine automatically takes “mindfulness” into account, so this is nothing new from my perspective. By always assessing people’s mental/emotional state, along with implementing diet and lifestyle changes, it’s not uncommon for me to see people’s IBS symptoms improve dramatically. It’s unfortunate to see so many patients who come to me after undergoing multiple symptomatic treatments (steroids, anti-spasmodics, etc.), only left to be feeling worse. 

Once again, this study demonstrates what naturopathic med
icine already practices-The impact of the mind on physical health cannot be avoided!

SOURCE: http://bit.ly/lfYimf American Journal of Gastroenterology, online June 21, 2011.