Currently viewing the tag: "irritable bowel syndrome"

It’s not uncommon for the proponents of conventional and of holistic systems of medicine to feel that they inhabit competing camps in the war to alleviate human suffering. In fact, Western and Eastern medicine are essential branches on the great tree of scientific knowledge.  Many of us are working towards the ideal of a continuum of care that provides the very best treatment to all patients. Western medicine has achieved remarkable triumphs.  Vaccination against many infectious diseases has greatly reduced their incidence; science has eradicated smallpox and come close to doing the same for polio.  It has saved millions of children from the scourges that once prevented so many from reaching their fifth birthday.

The specialties of surgery and emergency medicine save countless lives every day.

After decades of clinical practice I still wonder; Where does Western medicine fall short?  In the promotion of lifelong wellness; in the diagnosis and treatment of complex disorders; in the unnecessary or excessive use of pharmaceutical drugs; in safe, effective, ongoing pain management.

We’re certainly making progress in bringing these two branches of medicine closer, for example;  acupuncture has been proven to offer effective pain relief and increasingly accepted in medical pain clinics, and it doesn’t carry the risks associated with drug-based analgesia. Integration of auricular acupuncture in addiction clinics is another measure of its success. There is worldwide recognition of acupuncture for anxiety and stress particularly in cancer treatment, post traumatic stress disorder amongst veterans, and its potential value as anesthesia during surgical procedures.

I have always found that it is necessary to treat the whole person, and not just deal with an immediate crisis or what presents as their most significant symptom. I wanted to share this story (to ensure anonymity names and certain details have been changed).

Ria’s Story-  “Please… I Just Want the Pain to Stop”.

In the hospital waiting room Ria’s stomach churns and twists once again sending shooting pains throughout her body, followed by a cold sweat.  Over the past six months, she’s seen six different doctors; has endured repeated blood tests and other procedures.  No one has been able to offer her a definitive diagnosis. After each visit, she’s sent home with different prescriptions but no effective treatment for the repeated, alternating bouts of diarrhoea and constipation, sometimes nausea too.  Pain medication doesn’t bring any relief.  Her husband Pete feels equally anxious and frustrated.

Visits to six different doctors, blood tests and investigations all have proven to be unhelpful – there is no definitive diagnosis. Each time she is sent home with new meds, pain medication doesn’t work, one tells her that she is stressed and emotionally disturbed and prescribes her antidepressants another says there is some inflammation in her spleen, but nothing else. Ria is desperate, her symptoms are worsening.

Ria is beginning to doubt herself; wondering if it really is “all in her mind.”  She’s afraid to eat because everything just makes her feel worse, and she’s now two sizes smaller.

After yet another round of tests, Ria’s new consultant is also perplexed by her symptoms.  His examination of her shows nothing significant.  He’s ruled out cancer or other serious disease; all her other results are relatively normal. But fortunately for her, this doctor takes the time to listed to her and has a positive view of complementary therapies; he understands that functional disorders often underlie a patient’s stress and anxiety.  He knows that food intolerance is increasingly common and is often very hard to properly pinpoint. He asks her if she would be willing to accept a referral to a holistic physician.  Ria has always had an interest in complementary therapies and gladly agrees. He also gives her advice on juicing and enrolls her on to a mindfulness course.

As a holistic practitioner, I see Ria’s physical and emotional distress to be strongly interrelated, but requiring individual attention, with this in mind I begin acupuncture treatments. Almost immediately, they help to ease her distressed state and bring some relief for her stomach pain.

Over a period of months I guide Ria to make changes to her diet.  Together we develop a plan to identify problem foods. She learns about carbohydrate intolerance and how the FODMAP diet can help.  Ria finds the mindfulness course very effective in relieving her anxiety.  She began to realize her physical and emotional distress began years before the manifestation of painful bowel dysfunction.

Six months after starting treatment, Ria has made great progress.  She knows it will take time to regain the good health she thought was out of her reach, but she is no longer frightened and discouraged.  She is starting to take pleasure in eating again.  She and her husband are now enjoying what they thought might never be possible again–everyday pleasures.

 

A pragmatic randomised controlled trial of healing therapy in a gastroenterology outpatient setting

R.T. Lee, T. Kingstone, L. Roberts, S. Edwards, A. Soundy, P.R. Shah, M.S. Haque, S. Singh

Link to Full Article

Abstract     

Introduction

To determine the benefits of healing therapy (spiritual healing) as an adjunct to conventional management in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

Methods

200 outpatients with IBS or IBD were randomised to either conventional treatment (control) or conventional plus five sessions of healing therapy (intervention). After 12 weeks controls also had healing therapy. Outcomes used were, the Measure Yourself Medical Outcomes Profile (MYMOP). IBS-QOL, IBDQ, and symptom measures.

Results

There was a significant improvement in the MYMOP score at week 6 (p < 0.001) which was maintained to week 12 (p < 0.001) and 24 (p < 0.001). Improvements in MYMOP were significantly greater in the intervention group at both 6 (p < 0.001) and 12 weeks (p < 0.001) with effect sizes of 0.7 (95% CI: 0.4–1.1) and 0.8 (95% CI: 0.4–1.2). Condition-specific data for IBS showed that most QoL dimensions had a significant minimum 10-point score improvement at 6 and 12 weeks. The overall score improvement was 12.9 units at week 6 (p < 0.001), 12.4 units at week 12 (p < 0.001) and 13.8 units at week 24 (p < 0.001). In IBD there was also similar score improvement, but only up to week 12 were there associations of improved social and bowel functions (p < 0.001, respectively). Between group differences were identified for QoL scores in IBS at both week 6 (p < 0.001) and 12 (p < 0.001) but only for week 12 (p < 0.001) in the IBD group.

Conclusions

The addition of healing therapy to conventional treatment was associated with improvement in symptoms and QoL in IBS, and to a lesser extent in IBD.

 

If you are struggling with your Irritable Bowel Syndrome symptoms (IBS), don’t give up just yet instead, Take back control !

IBS is a functional disorder athat affects the colon and causes irritable of the lining of the colon. Symptoms can include; diarrhea and/or constipation, bloating, gas and abdominal cramps. Whilst a small proportion of sufferers need to take medication, most people can control it with dietary changes. Studies have shown that avoiding certain foods can help to reduced severity and fewer symptoms, with much improvement in quality of life.

All IBS Is Not The Same

Understanding your IBS is the best way to manage it. Some general tips are;

  • Have regular meal times, chew well and avoid eating in haste to help the process of digestion.
  • Drink at least 8 cups of fluids a day. This can include water, soups, herbal or non-caffeinated drinks.
  • Regular exercise has shown to help reduce symptoms.
  • Reduce stress
  • Benefit can be had from gaining advice on nutritional supplements e.g. multivitamins, essential fatty acids and probiotics to remedy any nutritional deficiencies that may have resulted due to prolonged IBS symptoms.
  • Complementary therapies like acupuncture can help to reduce symptoms and calm the digestive system. It is particularly effective for functional problems. It can also help to reduce stress caused by a busy and demanding lifestyle.

Dietary Changes

  1. Avoid or restrict drinking tea, coffee, alcohol and fizzy drinks.
  2. Avoid artificial sweeteners.
  3. Avoid fatty foods.
  4. Start to keep a food diary and when symptoms occur. This will help to identify problem foods.
  5. Avoid or limit foods that may worsen symptoms.
  6. If you have persistent or frequent bloating, a low FODMAP diet can help. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Essentially these are carbohydrate, but specifically FODMAPS are certain types of carbohydrates that are not easily broken down and so have difficulty being absorbed by the gut. Left undigested in the gut they quickly start to ferment to release gases resulting in bloating. Low FODMAP diet essentially involves restricting your intake of high FODMAP foods e.g. some fruits and vegetables, animal milk, wheat products and beans. There is a danger of eliminating too many foods, potentially impacting on general health. Thus seeking guidance from a knowledgeable professional will ensure that you maintain a healthy balanced diet. You can read more about the low FODMAP diet here.

Give Foods Another Chance

When you are actively experiencing IBS symptoms it can seem like you react to almost everything that you eat. Often people may have eliminated food that they are able to eat if their colon is not in a reactive state. Thus, after a minimum of 3-4 weeks of food avoidance or limitation, the colon will have rested and calmed down. At this time you can start to can bring back foods one at a time at a rate of one item per week. You might be pleased to discover that you’re only sensitive to one or two FODMAP carbs, not all of them e.g. wheat is a problem but dairy is OK.

Creating Your Own Personalised Diet

The aim is to find out what foods or other factors (e.g. stress) trigger your IBS symptoms. In this way you can create your own personal diet which gives you all the nutrients you need but only includes the foods that you can handle.

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Irritable bowel syndrome (IBS) is a common chronic conditions of the digestiveStomach pain system found in around 1 in 5 people. Women are 2-3 times more likely to develop IBS. It is characterised by bouts of abdominal cramps, bloating, flatulence, diarrhoea and/or constipation. The severity varies from one person to another. They can last from a few days to months. Symptoms may ease after going to the toilet, often the condition is life-long. Unfortunately the cause of IBS is unknown, but most people find it is related to an increased sensitivity of the gut and problems with digesting certain foods. Stress is also a known contributor. IBS can be painful and debilitating affecting personal, social and professional life. Treatments for IBS are mainly limited to symptom control, stress reduction, altering the amount of fibre in the diet, regular exercise and identifying trigger foods in the diet.

IBS is described as a functional problem, which means that anatomically or physiological investigations are completely normal. Instead there is impairment of the body’s normal function. This makes it difficult to treat. An increasing number of studies have found that IBS can be safely and effectively managed using acupuncture.

In Chinese medicine, IBS is considered to be an imbalance between the liver and spleen. The liver is associated with emotions and stress, while the spleen is linked to digestive function in the body. A weak spleen Qi (energy) allows the liver to dominate. When this occurs over a long period of time the continued disharmony causes IBS symptoms to manifest.

Acupuncture
Research evidence has consistently demonstrated that a course of acupuncture improves IBS symptoms and general wellbeing. These include;
• Pain relief
• Regulating the motility and movement of the digestive tract
• Reducing gut sensitivity
• Reduce stress related sympathetic nerve impulses e.g. abdominal spasm, by increasing the parasympathetic tone of ‘rest and digest’.
• Reducing anxiety and depression by increasing production of mood altering chemicals serotonin and endorphins.

Nutrition
IBS related changes in diet are individualised. It should focus on identifying trigger foods and eliminating them from the diet. These can vary from wheat, dairy, alcohol, coffee, fatty foods and some fruits and vegetables In the case of constipation adding adequate fibre to the diet is helpful. Some people may find that soluble fibre like, oatmeal, berries, legumes, beans and lentils are easier than insoluble fibre from raw vegetables and bran. Probiotics, multivitamins and minerals can be helpful to normalise the digestive environment.

Life style changes
Some of the following lifestyle changes can benefit IBS symptoms, but are also good for general health and well-being.
• Regular exercise to relive stress, regulate the bowel and alleviate constipation
• Practicing meditation, mindfulness, yoga, breathing exercises will help to manage stress levels
• Good and adequate sleep is important for everyone, but particularly for those with IBS. It helps the body to rest and heal. Tiredness increases stress and irritability which in turn triggers IBS.

Book an appointment or Call  07810024687 to discuss your needs with Dr Rhonda Lee. Dr Lee is a Holistic Physician trained in medicine, acupuncture, nutrition, aromatherapy, massage and other techniques. She specialises in digestive disorder, chronic fatigue, pain management and stress and depression.

The importance of vitamin D has been often highlighted in recent years. A new study published in Dec 2015 by the University of Sheffield has found a significant link between vitamin D and the severity of irritable Bowel Syndrome (IBS) symptoms, and perceived quality of life. The trial on 51 IBS patients found that 82% had insufficient vitamin D Levels. With supplementation there was good improvement in patient vitamin D levels, however improvements in IBS symptoms were not significant. A similar study in the same year also showed such results with a deficiency in 82% IBS patients, compared to 31% in the control group. Researchers from both studies have recommended possible screening and further explorations of vitamin D for symptom management in IBS.
Given the nature of IBS it is not unreasonable to conclude malabsorption as a consequence of the condition. This is probably not isolated and will inevitably include other nutrients. The use of vitamin D in IBS followed by symptom improvement has been documented in a case study where the patient reported taking daily 2000-4000 IU (50-100 micrograms) vitamin D3 supplement. The dosage varied with the season, with higher doses in the winter months. Over a period of 3 yrs there was significant improvement to near normal bowel habits, with relapses only occurring if supplementation was stopped. Additionally, there was also resolution of co-morbid symptoms of depression and anxiety. Such studies give reason to consider vitamin D’s role in the treatment of IBS.

Vitamin D is a fat soluble vitamin that is naturally occurring in some foods, but our body should be able to produce enough vitamin D if there is sufficient exposure to ultraviolet B (UVB) rays in sunlight. Despite this many people do not get enough sun to generate adequate vitamin D. This is particularly in winter and resident in the northern latitude where the sun rays are not strong enough to stimulate production in the winter. Skin melanin content, sunscreen, window glass, cloud cover and atmospheric pollution also blocks UVB rays. Complete cloud cover or atmospheric pollution can reduce UVB rays by 50%. With age the ability to manufacture vitamin D decreases.

IBS is a chronic condition causing stomach cramps, diarrhoea and/or constipation profoundly affecting the individual’s quality of life. One in five people develop IBS. The cause of IBS is poorly understood, and generally there are multiple factors. Most hypothesis include; changes in the intraluminal milieu, immune function, neuromusclular dysfunction and brain-gut axis deregulation. Intestinal microbiota are also suspected of playing a role in bacterial infection, antibiotic use and ongoing low-grade inflammation resulting in the onset of IBS. Aside from the absorption of calcium and regulation of calcium and phosphorus to help build strong bones and teeth, scientists have also highlighted the importance of vitamin D in cell growth, inflammation and healthy functioning of the neuromuscular and immune system. Vitamin D receptors have been identified on immune cell, and together they reduce levels of inflammatory proteins (cytokines), increase antimicrobial proteins thus enabling our innate immune system to fight infections more effectively. One study reported that people with low vitamin D levels had double the risk of getting flu. Scientific research on the epithelial small intestine in mice shows that after leaving the thymus intraepithelial lymphocytes (immune cells) directly seed in the intestinal epithelium. Here they interact with cytokines, nutrients (including vitamin D) and antigens to guide gene expression and cell function. This cell function requires communication through constant cell-to-cell contact which also tunes its antigen sensitivity.

Notably like vitamin D deficiency and the prevalence of multiple sclerosis (MS) is also higher in the northern hemisphere. From an MS research perspective vitamin D deficiency is an important consideration. Pathologically in MS there is degeneration of axons and neurons. Researchers have demonstrated that the biologically active form of vitamin D gives the body protection against T cell mediated killing of human neurons in laboratory cultures. Similarly, in mice vitamin D autoimmune experiments have resulted in axonal loss. This may throw some new insight on how vitamin D deficiency can affect immune and neuromuscular function in IBS. In a  cross-sectional study on the protective effects of vitamin D on 3,121 adults aged 50yrs or less (96% men) underwent a colonoscopy and found the 10% had at least one advanced cancerous lesion. Participants with highest vitamin D intake (>645 IU/day) had a significantly lower risk of lesions. However, a cancer and vitamin D study on 36,282 post-menopausal women of various races and ethnicities found there was no significant difference in the incidence of colorectal cancer over 7 yrs between the intervention and control groups.

Vitamin D is not routinely prescribed for IBS and there are no recommended vitamin D daily target levels set for adults. Safe daily intake levels are 25 micrograms in children and 50 micrograms in adults (12-70yrs). Optimum levels for good health varies depending on age and stage of life. Considering the reported case study for IBS the therapeutic dose may be closer to 50-100 micrograms daily. This can be added to by increasing the intake of vitamin D rich foods e.g. oily fish (salmon, sardines, and mackerel), eggs, organ meats and vitamin D fortified foods. Further enhancement in the summer months by exposing bare skin to the midday sun (April –Oct), 10-15 min for people with fair skin; 30 min in Asians; and 120 min in African or Afro-Caribbean is helpful. There is no danger of vitamin D toxicity from sunlight as it is effectively  gotten rid of by the body. Toxicity is mostly through supplementation sources, symptoms are non-specific e.g. anorexia, weight loss, headache, nausea, vomiting, heart irregularities resulting in subsequent damage to the heart, blood vessels and kidneys.

 

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