Irritable Bowel Syndrome (IBS)

Frequently Asked Questions

• 1

  What is IBS?

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  Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder, estimated to be present in about 11-15% of the global population. Typical IBS symptoms include chronic abdominal pain, bloating, and varying bouts of diarrhea and constipation. The condition is generally associated with a reduced quality of life. IBS is a functional disorder, and as such has not been consistently linked to tissue damage or other biological markers that can be tested clinically. It is thought to be largely underdiagnosed.

  IBS should not be confused with inflammatory bowel disease (IBD). IBD includes Crohn’s disease and ulcerative colitis, which are characterized by inflammatory lesions in the intestines.

  Many are unaware that multiple factors may cause or exacerbate IBS symptoms. For example, stress, anxiety, depression, food sensitivities, small intestinal bacterial overgrowth, and hormonal fluctuations are all associated with IBS.

  Treatment of psychological conditions in IBS patients is especially important because irritable bowel symptoms often persist despite drug therapy if these issues are not addressed.

• 2

  What are the symptoms of IBS?

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  The cardinal symptom of IBS is abdominal pain that is relieved with defecation and associated with a change in stool frequency or appearance. Pain or discomfort associated with IBS typically “flares” for 2-4 days intermittently. Other symptoms not directly associated with the GI tract have been reported in some IBS patients, including headache, backache, and lethargy. People with IBS frequently experience symptoms for years after diagnosis; however, IBS does not increase risk for more serious conditions like colon cancer.

  Subcategories of IBS include constipation-predominant (IBS-C) and diarrhea-predominant (IBS-D), with the former associated with fewer than 3 bowel movements per week and the latter associated with more than 3 bowel movements per day.

  Diagnosing IBS is complex and often involves multiple tests to rule out several other diseases that may be associated with IBS-like symptoms such as hyperthyroidism, celiac disease, lactose or fructose malabsorption, IBD, microscopic colitis, colon cancer and/or pancreatic cancer. A complete blood count and blood chemistry panel may be ordered as well to assess for anemia or other abnormalities.

  The Rome III criteria have been developed in order to help facilitate accurate diagnosis of IBS. According to the Rome III criteria, a diagnosis of IBS requires recurrent abdominal pain or discomfort at least 3 days per month during the past 3 months associated with 2 or more of the following.

  • improvement with defecation
  • onset associated with a change in stool frequency
  • onset associated with a change in stool appearance
• 3

  What are the causes and risk factors of, or for, IBS?

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  The cause(s) of IBS are not clear. Stress, altered gut bacteria, genetics, and food sensitivities may all be involved. One theory proposes that altered serotonin metabolism within the gastrointestinal (GI) tract and/or abnormalities in pain perception pathways causes hypersensitivity to abdominal pain, while other hypotheses have pointed to stress-induced inflammation, gastroenteritis, and a history of traumatic events as factors that contribute to the development of IBS.

  Disrupted brain-gut communication

  Some evidence suggests that altered communication between the brain and gut may contribute to pain hypersensitivity and/or motility disturbances in IBS. The mechanisms behind these phenomena are unclear.

  Stress and anxiety appear to contribute, at least in part, to gut hypersensitivity via modulation of neural pain-processing hormones.

  Small intestinal bacterial overgrowth (SIBO).

  Small intestinal bacterial overgrowth is a condition characterized by overgrowth of microbes in the small intestine. As a result, fermentation of food begins before it has been thoroughly digested and absorbed, which can lead to gas formation. SIBO is more common in people with motility disturbances, low stomach acid production, and bowel obstruction. The prevalence of small intestinal bacterial overgrowth in IBS varies across studies, but estimates range from about 20-84%.

  Medications that may contribute to IBS development

  Certain medications may contribute to the development of IBS. Proton pump inhibitors (eg, omeprazole) which are used to treat heartburn, can alter intestinal barrier function, affect intestinal microflora, and are known to have a positive association with IBS. Similarly, many common analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs), are known to damage the intestinal epithelium, an important barrier against harmful substances. Although broad-spectrum antibiotics are designed to target systemic infections, antibiotics are known to alter the colonic flora. Indeed, a study showed that the use of broad-spectrum antibiotics, particularly macrolides, was associated with IBS development.

  Food sensitivities

  Food sensitivities may have a role in IBS. Please see "how to prevent" section lower down.

  Gluten sensitivity

  Gluten is a protein component of some grains, especially wheat. Sensitivity to gluten is common and is associated with a spectrum of symptoms ranging in severity from minor skin conditions to severe gastrointestinal compromise. Some evidence suggests gluten sensitivity potentially contributes to IBS symptoms. Although evidence is not yet strong enough to support a recommendation that all IBS patients avoid gluten, findings from at least one study indicate that using a blood test to detect immunoglobulin G (IgG) antibodies against components of wheat may help identify patients with diarrhea-predominant IBS who are likely to respond positively to a gluten-free diet.

  Post-infectious IBS

  Some cases of IBS arise following a gastrointestinal infection, usually with a bacterial or parasitic pathogen. This is called post-infectious IBS and occurs in up to about 30% of individuals who contract an acute gastrointestinal infection.

  Hormone fluctuations

  Some evidence suggests a potential role for sex hormone imbalance(s) in IBS. For example, women often experience worsening of IBS symptoms near menstruation, which coincides with natural changes in sex hormone levels. One study found that women with IBS have generally lower estradiol levels than their healthy counterparts. However, postmenopausal women have fewer symptoms compared to women who are still menstruating.

• 4

  Why does conventional medicine sometimes fail in efforts to prevent IBS?

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  Irritable bowel syndrome treatment aims to alleviate predominant symptoms, such as diarrhea, constipation, or abdominal cramping. Thus, it cannot control the disease entity, merely its symptoms. This is a massive drawback of conventional therapies

• 5

  How is IBS managed?

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  Bulking agents

  Bulking agents (ie, dietary fiber) are frequently used to treat both subtypes of IBS. Insoluble fiber facilitates defecation by reducing transit time, or the time it takes for the remains of ingested food to be excreted. While defecation generally alleviates IBS symptoms, a comprehensive review found conflicting effects of bulking agents on IBS severity.

  Laxatives and stool softeners are commonly used to treat IBS-C. These treatments typically provide rapid relief, but are not recommended for long-term use as they can cause electrolyte imbalances by enhancing the excretion of fluids. The most common laxatives work by osmosis, that is, they draw fluid into the intestine producing softer stools that are easier to pass.

  Antispasmodic medications

  Antispasmodics relax the smooth muscle of the lower GI tract and may be helpful in IBS, especially for abdominal pain; although more data from high quality randomized controlled trials are needed to thoroughly assess their effectiveness.

  Centrally acting

  Antidepressants are another class of therapeutic agents that can be used in IBS treatment. They do not address the underlying condition, but instead reduce feelings of discomfort. These drugs have demonstrated a modest degree of success. The selective serotonin reuptake inhibitor (SSRI) paroxetine (Paxil®) has shown some benefits, although results with another SSRI, citalopram (Cilift®) suggest that efficacy might be limited to IBS sufferers who are also clinically depressed.

• 6

  How is it managed at Health Renewal?

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  The initial medical consultation at Health Renewal will be approximately 45 minutes. You will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a full medical history from you to determine your personal risk . A physical examination will be done after which he will decide which blood tests need to be requested from your local pathology laboratory . These results will then be analyzed by your Doctor and this will be discussed with you at your follow up appointment. This will determine whether a definite deficiency exists and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted.

• 7

  What are the risks and complications of this condition and its management?

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  All the risks of this conditions' treatment are related to the benefit vs risk of the treatments. As none of them treat the causes of the issue, it can be argued that they are all unneccessary. That the risks outweigh the benefits. They will, however, bring symptom relief. but that will come with the side effects of the chosen treatment, whether it be a laxative, bulking agent or anti-depressant. The biggest risk, however, is that the condition itself is still not treated.

• 8

  What nutraceuticals will be recommended?

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  Peppermint oil, or Caraway oil

  Peppermint oil is a natural antispasmodic. In one study, an enterically-coated preparation of 225 mg peppermint oil taken twice daily was shown to reduce all IBS symptoms by over 50% in three-fourths of the patients, whereas only 38% of the placebo group improved (In another well-designed study, 187 mg of a similar peppermint oil product taken 3 times daily for 8 weeks led to a significant improvement over placebo with regard to abdominal discomfort, abdominal pain, and quality of life, but not in terms of diarrhea, constipation, or bloating. IBS patients treated with peppermint oil in yet another study reported benefits including decreased abdominal pain, less bloating and flatulence, decreased stomach growling, reduced stool frequency, and improved stool consistency.

  Probiotics

  Probiotics are microorganisms that may provide health benefits to their host when administered at sufficient levels.

  A pathogenic alteration in the gut microflora – dysbiosis – is one consistent finding associated with both forms of IBS, which can cause or exacerbate IBS symptoms in a variety of ways. Dysbiosis is associated with increased intestinal permeability whereby pathogens, toxins, or undigested foods that are not usually absorbed are able to pass into the bloodstream. This can trigger abdominal pain and altered bowel habits. Dysbiosis can also lead to aberrant immune system activation, resulting in the release of cytokines that increase abdominal pain perception and alter bowel habits.

  A particularly important type of probiotic – bifidobacteria – is found in reduced quantities in the GI tracts of both IBS-C and IBS-D sufferers relative to healthy individuals. In one study, probiotic B. infantis 35624, in a dose of 10 billion colony forming units (CFUs), significantly improved abdominal pain/discomfort, abdominal bloating/distension, and difficulty with bowel movements in women with IBS after only 4 weeks.

  Another more robust finding supporting probiotic use in IBS comes from a study of the probiotic L. plantarum DSM 9843. In this study, 20 billion CFUs were administered daily for 4 weeks to IBS sufferers. Flatulence resolved rapidly, and improvements in overall GI function remained long after supplementation was discontinued.

  Collectively, these data suggest probiotics are effective in treating IBS, with strains of bifidobacteria being more favorable than lactobacilli, as lactobacilli are actually increased in certain populations with IBS.

  Artichoke

  Artichoke leaf has been used since Roman times as a traditional medicine that supports digestive function. It has been shown to promote the production of bile that helps digest dietary fats and reduce spasms and flatulence. In one study, 2 capsules of 320 mg artichoke leaf extract taken 3 times daily almost completely eliminated abdominal pain, cramps, bloating, flatulence, and constipation in a population of IBS sufferers who also exhibited nonspecific GI discomfort or dyspeptic syndrome

  Melatonin

  Melatonin is a multifunctional hormone that exhibits a variety of beneficial effects in gastrointestinal disorders independent of its more widely known effects on sleep. In one study of IBS patients with sleep disturbances, 3 mg of melatonin taken prior to bedtime for 2 weeks significantly decreased abdominal pain and rectal sensitivity. These findings were confirmed in a larger double-blind, placebo-controlled crossover study in which 3 mg of melatonin reduced abdominal pain and bloating in women with IBS. In a study that examined a wider array of symptoms, besides improving bowel function, melatonin was also associated with a marked reduction in lethargy in a group of IBS sufferers. Depending on other conditions you might also be prescribed other nutra-ceuticals. these are just common ones used in IBS.

• 9

  Why should one not self-medicate?

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  For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

• 10

  How do I get started?

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  Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he / she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

• 11

  How do we treat this at Health Renewal?

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  The initial medical consultation at Health Renewal will be approximately 45 minutes, where you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory. If you have medical aid, these should be able to be claimed as well.

  Once your blood results are received, they will then be analyzed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams/tablets, or alternatively to having bio-identical implants/pellets inserted.

  In office treatments such as Carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our Renewal Institute Diet may be recommended. All these recommendations will be summarised on a sheet / print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg( mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's). They are also free of gluten, preservatives, wheat, dairy, soy, yeast, sugar, artificial flavour, sweetener and colour. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time.

• 12

  What should you bring along to your appointment with your Health Renewal doctor?

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  1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.

  2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.

  Depending on the exact prescription given, you may be required to return to the doctor within 1-4 months’ time, in order to ensure optimum hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.

  You should ensure that you are current with your gynaecological visits/breast exams/mammograms (for female patients) and prostate exams (for male patients) as recommended by your GP/gynaecologist.

• 13

  How often should I see the integrative Doctor?

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  Depending on which form of supplementation you and your Health Renewal Doctor have decided on, one could expect to follow up with your physician from anything between every 3 months to once every 6 months.

• 14

  Health Renewal Tip: How does one prevent IBS?

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  The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

  Stress Reduction

  Stress associated with early life adverse events is implicated in the etiology of IBS; about 50% of individuals who seek IBS treatment have depression or anxiety. This relationship appears to be bidirectional, meaning that IBS may cause stress, and stress may contribute to IBS symptoms. This cycle may be partially attributed to enhanced sympathetic nervous system (“fight or flight”) signaling in IBS patients relative to healthy controls.

  IBS symptoms appear to respond positively to stress reduction. In one study, a meditation-based intervention known as mindfulness-based stress reduction (MBSR) reduced the severity of IBS and stress symptoms in IBS patients, although improvements in mood and quality of life were similar to those of a control group of IBS patients who were placed on a waiting list for MBSR.

  Exercise

  Exercise also appears to be beneficial for IBS patients. In one study, subjects who engaged in 20–60 minutes of moderate to vigorous physical activity 3 to 5 days per week experienced a marked improvement in quality of life that was associated with reduced IBS severity.

  Acupuncture

  Some clinical trials suggest that acupuncture may alleviate symproms, but a 2012 comprehensive review found that evidence remains inconclusive. Although more trials are needed, acupuncture may be a useful adjunct to conventional IBS treatment and is not likely to cause significant side effects.

• 15

  Health Renewal's 10 Inspiring Quotes For Healthy Living:

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  Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives: Health and intellect are the two blessings of life.

  • “The best diet is the one you don't know you're on.” ― Brian Wansink, Mindless Eating: Why We Eat More Than We Think
  • “I never touch sugar, cheese, bread... I only like what I'm allowed to like. I'm beyond temptation. There is no weakness. When I see tons of food in the studio, for us and for everybody, for me it's as if this stuff was made out of plastic. The idea doesn't even enter my mind that a human being could put that into their mouth. I'm like the animals in the forest. They don't touch what they cannot eat.” ― Karl Lagerfeld
  • Finally, remember that we cannot give what we do not have. If we do not love ourselves, we will be hard pressed to love others. If we are not just with ourselves, we will find it very difficult to look for justice with others. In order to become and remain a social justice advocate, you must live a healthy life. Take care of yourself as well as others. Invest in yourself as well as in others. No one can build a house of justice on a foundation of injustice. Love yourself and be just to yourself and do the same with others. As you become a social justice advocate, you will experience joy, inspiration and love in abundant measure.” ― Bill Quigley
  • “Would it really be so bad if you slowed your life down even a teensy bit? If you took charge of the ingredients of your food instead of letting corporations stuff you and your family, like baby birds, full of sugar, corn products, chemicals, and meat from really, really unhappy animals?” ― Catherine Friend, Compassionate Carnivore: Or, How to Keep Animals Happy, Save Old Macdonald's Farm, Reduce Your Hoofprint, and Still Eat Meat
  • “Regaining health is more difficult an objective then becoming ill. Becoming ill is a random act of ignorance and regaining health is an intentional effort in frustration.” ― Richard Diaz
  • “The concept of disease is fast replacing the concept of responsibility. With increasing zeal Americans use and interpret the assertion "I am sick" as equivalent to the assertion "I am not responsible": Smokers say they are not responsible for smoking, drinkers that they are not responsible for drinking, gamblers that they are not responsible for gambling, and mothers who murder their infants that they are not responsible for killing. To prove their point — and to capitalize on their self-destructive and destructive behavior — smokers, drinkers, gamblers, and insanity acquitees are suing tobacco companies, liquor companies, gambling casinos, and physicians.” ― Thomas Stephen Szasz
  • “When you feel yourself to be in critical condition, you must treat yourself as gently as you would a sick friend.” ― Julia Cameron, Finding Water: The Art of Perseverance
  • “Man is more miserable, more restless and unsatisfied than ever before, simply because half his nature--the spiritual--is starving for true food, and the other half--the material--is fed with bad food.” ― Paul Brunton
  • “Connection is health. And what our society does its best to disguise from us is how ordinary, how commonly attainable, health is. We lose our health - and create profitable diseases and dependences - by failing to see the direct connections between living and eating, eating and working, working and loving. In gardening, for instance, one works with the body to feed the body. The work, if it is knowledgeable, makes for excellent food. And it makes one hungry. The work thus makes eating both nourishing and joyful, not consumptive, and keeps the eater from getting fat and weak. This is health, wholeness, a source of delight. (pg.132, The Body and the Earth)” ― Wendell Berry, The Art of the Commonplace: The Agrarian Essays
  • “Sometimes customizing is necessary because of an injury or the inability to do, for a short or long period, the kind of exercise you formerly did. When you're used to customizing for fun, doing it under duress won't seem like such an imposition. Either way, experiment until you find activities that make you happy as well as healthy. Choose your exercise using the same criteria you'd apply to choosing a date--that is, attractive to you and able to hold your interest for an hour.” ― Victoria Moran, Younger by the Day: 365 Ways to Rejuvenate Your Body and Revitalize Your Spirit
  • “I was very surprised when last I bought a packet of cigarettes and had to request a refund as I read a warning that told me "smoking can cause fatal lung cancer".” ― Robert Clark