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Ask the Doctor
About Irritable Bowel Syndrome (IBS)
By Tom Cowan, MD
Question: I am a 40-year-old woman who has suffered from abdominal
pain and alternating constipation and diarrhea for at least the past
five years. I have tried many diet changes, including adding more fiber
to my diet, all with very little relief. Recently I had a full evaluation
with a gastroenterologist who, after many tests, concluded that I have
Irritable Bowel Syndrome. He prescribed a high-fiber diet, a fiber supplement
and, to my surprise, an antidepressant. I am wondering whether this
is the correct approach for me and why he would prescribe an antidepressant.
I would not be depressed if my darn bowels would behave!
Answer: In a recent issue of the New England Journal of
Medicine there was a major review article on the causes and treatment
of Irritable Bowel Syndrome (IBS). The authors point out that 15 percent
of American adults suffer from symptoms consistent with IBS. Previously,
I have discussed a related issue, the causes
and treatment of constipation. To recap, to have normally functioning
bowels means that you should have at least one bowel movement per day
and that you should feel that you have completely emptied your bowels
at least once per day. There should be no discomfort with the bowel
movements nor should there be abdominal cramps, bloating or excessive
gas. If these symptoms are present, it is a clear sign of intestinal
dysfunction.
For years, modern gastroenterology has put its whole emphasis on the
fiber theory of bowel function which, briefly stated, is the theory
that those who consume lots of fiber will have healthy bowel function.
Fiber, by the way, is a term that encompasses the family of complex
carbohydrates and other substances that are present mainly in the cell
walls of plants used as foods. The term includes cellulose, gums, mucilages,
pectins and lignins. Humans cannot digest fiber, but these substances
are said to contribute to the health of the digestive tract.
As I discussed in the article on constipation, this theory is inadequate
to explain the complex dynamic of healthy bowel function. Rather than
focusing entirely on fiber, we should look at the intestines as a complex
ecosystem. Like all ecosystems, the intestines are populated by a wide
variety of organisms all of which interact with each other and with
their host. Each organism needs to be fed and its waste products eliminated,
and each individual organism and the organisms as a whole have a profound
connection with the health or disease of their host.
When the bowel system shifts towards disease, we see very characteristic
changes in the population of organisms inside the bowel and in the characteristics
of the bowel wall itself. Inside the bowel, the numbers of beneficial
bacteria decline while the amount of undigested or partially digested
food stuff increases. Pathogenic bacteria and fungi proliferate along
with the toxic by-products that these abnormal microorganisms produce.
Undesirable changes begin to occur in the lining of the bowel, and in
the small intestine the fine hairs or villi become disturbed and deformed.
The passageways through which absorption of food occurs become altered
and we see abnormal neurological functioning within the intestinal walls.
The combination of all these changes result in the disturbing symptoms
so familiar to the many sufferers of IBS.
For years, holistic physicians have maintained that the health of
this bowel ecosystem is the key to the health of the entire person.
Nearly one-quarter of all traditional herbal medicines are directed
at improving bowel health. Many traditions describe the intricate, complex
decisions that the bowels must go through in "deciding" which foods
to absorb and which to pass on. The recent discovery that the bowel
wall contains all of the same neurological processes and receptors that
are found in the brain has turned the orthodox medical world on its
head, but this discovery comes as no surprise to holistic practitioners.
The discovery of sense receptors in the bowel is the reason that your
gastroenterologist has prescribed an antidepressant. While I do not
agree with the antidepressant, that fact that your doctor has suggested
it is a sign that orthodox medicine has finally admitted that bowel
health involves some of the most complex higher "reasoning" known to
science. Put another way, managing your internal ecosystem and deciding
what to absorb and what to discard is an example, albeit subconscious,
of higher mental functioning. We can achieve good bowel health and overcome
IBS only if we understand and work with this complexity.
The first step in treating IBS is to adopt a diet based on the cookbook
Nourishing Traditions. Not only will this diet provide you with
enough fiber to stimulate healthy bowel movements but, more importantly,
because the diet supplies plenty of healthy fats and lacto-fermented
foods, it is virtually the only dietary approach that feeds the healthy
organisms populating your inner ecosystem.
A few points in the diet are worth highlighting. First, the good bacteria
in our bowels thrive on fat and are poisoned by simple sugars. The Nourishing
Traditions approach provides ample fat intake and strictly limits
the refined carbohydrates and sugars that so undermine our health. Second,
IBS patients need to consume lacto-fermented foods daily, including
condiments like sauerkraut and beverages like kefir and kvass. Lactobacillus
plantarum, found on vegetable leaves, is perhaps the most beneficial
microorganism in our bowels and its numbers are greatly increased during
the fermentation process.
Third, the Nourishing Traditions approach calls for the soaking
of all grains for 12-24 hours and this practice is essential for anyone
suffering from the symptoms of IBS. There is a growing body of scientific
literature that supports this traditional practice because we have discovered
that unfermented grains contain chemicals that irritate and inflame
the bowel wall, and can even cause it to spasm. The practice of consuming
large amounts of whole grains and rough bran, which has been the cornerstone
of treatment for constipation, can actually lead to IBS.
Finally, broth made from bones should be used liberally by all those
suffering from IBS. It seems as though the specific amino acids in soup
broth act as a kind of tonic for the bowel wall, perhaps by providing
compounds that function like antidepressants, much like the serotonin
drugs which you were prescribed.
These four steps constitute the dietary approach for IBS. I also add
an herbal intervention to help speed up the recovery process. It is
called Okra-Pepsin, made by Standard Process. The preparation includes
okra, which is a very mucilaginous plant, digestive enzymes and allantoin,
a substance typically found in comfrey leaves. Among herbalists, okra
is considered a demulcent in that it soothes and nourishes the intestinal
wall. The digestive enzymes aid with the digestion of the food, thereby
making it less irritating to the intestinal lining. And the allantoin
stimulates the regeneration of the cells that form the inner lining
of the intestinal wall.
In addition, I will often prescribe old fashioned castor oil compresses
for one hour, two to three times per week, over the abdomen. This therapy
relaxes the bowels and aids elimination.
Finally, I encourage my patients to embark on a regular exercise program
that includes abdominal muscle strengthening exercises.
This program of therapy should have your bowel function normalized
by six weeks and provide a huge boost to your overall health. . . and
in your outlook on life.
About the Author
 Thomas
Cowan, MD, is a physician in private practice in San Francisco, California,
a board member of the Weston A. Price Foundation, and a regular contributor
to our "Ask the Doctor" column. His book The Fourfold Path to
Healing is now available from NewTrends Publishing, http://www.newtrendspublishing.com/.
Visit Dr. Cowan's website at http://www.fourfoldhealing.com.
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