Cause: The underlying problem is one of hyperactive and disordered gastrointestinal motility. The precise trigger for this is unknown. Exacerbating factors may include stress, food allergy or intolerance, intestinal yeast infection and altered bowel flora

Useful Supplements: Evening Primrose Oil, Lactase, probiotics, glutamine.

Useful Herbs: Caraway, Chamomile, Fennel, Peppermint, Psyllium, Flax Seed, Wormwood

Adjunctive therapy: Stress reduction, exercise

Further information: Irritable bowel syndrome describes a combination of abdominal pain and abnormal bowel function in the absence of any structural problems. Symptoms include abdominal pain (following meals or intermittent), bloating, abdominal distention, diarrhea, nausea, vomiting, or diarrhea and constipation alternating for more than six months.

It can mimic a variety of conditions including inflammatory bowel disease and diverticulitis. Because the colon is present in many areas of the abdomen, pain from IBS can be also be confused with pain from gallbladder, ulcer and even endometriosis.

Women are more likely to experience IBS than men. Factors leading to IBS may include improper digestion of proteins, yeast infection, diets high in sugar and refined foods, and use of laxatives. The condition is often exacerbated by stress.

The symptoms of IBS are caused by an unusual amount of spontaneous movement of the muscles of the GI tract, predominantly in the large intestine (colon). People with IBS may also have a diminished pain threshold in response to distension of the colon.

IBS is a diagnosis of exclusion; in other words, there are no specific tests to make the diagnosis, but other conditions such as colitis need to be excluded.

The only treatment for IBS is to relieve its symptoms and try to normalize bowel function. A high fiber, caffeine-free diet may help some patients. It appears that most people with IBS have food sensitivities,¹ therefore an elimination diet (avoiding potentially irritating foods) may help narrow down some irritating factors.

Two of the more common food sensitivities include wheat products and lactose. Many IBS patients are sensitive to all forms of wheat, including wheat bran (a common dietary fiber),² and thus avoidance of wheat is often helpful. Better sources of fiber may include rye, brown rice, oatmeal, or barley. When taking fiber supplements, IBS sufferers must be cautious to avoid fibers based on known food sensitivities.

If lactose intolerance is suspected, use of lactase enzyme supplements is beneficial. Since IBS is known to be exacerbated by stress, relaxation techniques may ease IBS symptoms in some patients. Avoidance of stressful situations and hypnosis³ appear to be the most effective methods. Regular exercise may also be helpful, in part because of its effect on stress reduction.

The following supplements and herbs may be effective in the treatment of IBS:
Many women have noticed that IBS symptoms ease and worsen in relation to their menstrual cycle. Taking Evening Primrose Oil or another supplementary form of gamma linolenic acid (the active ingredient in Evening Primrose Oil) may help ease these symptoms.⁴

Since lactose intolerance is a common cause of IBS, supplementation with Lactase may be helpful.

Because alteration of bowel flora is suspected, probiotics such as acidophilus may be benefical. The treatment of intestinal yeast infection (candida) has also improved symptoms in some individuals.

Chamomile, traditionally used for its calming effects, also is effective in soothing the digestive system, easing cramping and irritation.⁵ It appears especially effective in treating IBS characterized by alternating diarrhea and constipation. It can be taken as a tea or a supplement three times daily between meals.

Peppermint oil reduces gas and eases intestinal cramping. Taken several times daily, it is effective in treating IBS.⁶ Peppermint oil should not be taken by patients with heartburn, as it may exacerbate this condition.⁷

When combined, Peppermint, Fennel, caraway, and Wormwood appear to have a soothing effect on the intestines.

Psyllium and flax seed are excellent sources of fiber to help regulate bowel function.

Glutamine is the major nutritional source for the cells lining the colon wall, and may be beneficial in helping heal any irritated tissues.⁹

Many patients appear to respond well to Chinese medicinal practices and herbal combinations.⁸ Consult your health provider for recommended herbal mixtures.

References:

¹Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115–7
²Gaby AR. Commentary. Nutrition and Healing, Feb 1996:.1,10–11 [review].
³Harvey RF. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989;i:424–6.
⁴Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990; 421–6.
⁵Achterrath-Tuckerman U, Kunde R, et al. Pharmacological investigations with compounds of chamomile. V. Investigations on the spasmolytic effect of compounds of chamomile and Kamillosan® on isolated guinea pig ileum. Planta Med 1980; 39:38–50.
⁶Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: A multi-center trial. Br J Clin Pract 1984; 38:394–8.
⁷Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomed 1996; 2:285–91.
⁸Bensoussan A, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine. JAMA 1998;280:1585-9.
⁹Firschein, Richard. The Nutriceutical Revolution. Riverhead Books. 1998
¹⁰ Murray, Michael and Pizzorno, Joseph. Encyclopedia of Natural Medicine; 2nd ed. Prima Health: 1998