How to treat IBS (Irritable Bowel Syndrome)

Q: I’m not sure I am absorbing my nutrition.  I try to eat well; no alcohol, sodas or fried food.  Despite that I continue to gain weight, become hypoglycemic easily, have low energy and sometimes break out in hives.  My bowel function is all over the place.  Please tell me what I’m doing wrong — I have spent thousands of dollars on doctors already!

A: Sounds like you may have “Irritable Bowel Syndrome” or IBS. This is not so dire a problem as ulcerative colitis or Crohn’s disease, but the classic IBS symptoms of abdominal cramping, alternating bouts of diarrhea and constipation, bloating, gas, and mucus in the stool can certainly be uncomfortable and annoying.

Since IBS has received more airplay in the past decade, of course drug companies have rushed in to produce quick-fix pills.  These will not work.  IBS is not a disease, but a very common constellation of symptoms due to poor digestive function, which leads to reduced nutrient absorption and resultant low energy, over-eating and the blood sugar roller-coaster.  Some of the drugs “approved” for IBS (such as Alosetron for diarrhea and Tegaserod for constipation) have serious side effects, including decreased blood flow to the colon.

Optimal functioning of the digestive system starts in the mouth, and what you put into your mouth. Remember that up top you have teeth, and these should be used, with every single bite of food, to render the food “soupy” before swallowing.   Blenderize your food with your saliva in your mouth before it goes down the pike.  This tip alone will take care of many cases of IBS.   Chew your food 30-50 times per mouthful!  Slow down!  Don’t multi-task while eating!   Turn off the TV, even if you are eating alone.   Sit down.  Say a little “grace” before eating.  Another tip: do not drink more than a few ounces of water or other liquid during your meal.  You want to have your digestive juices work full-strength on the food.  Gulping water or tea or wine during a meal dilutes the digestive enzymes.  Do your drinking up to 1/2 hour before meals and then wait until 2 hours after a meal to resume beverages.  Water is always the best choice of beverage!

Once you have thoroughly and calmly masticated your bite of food and swallowed, the soupy food goes into the stomach and provokes secretion of stomach acid.  You absolutely need your stomach acid for optimal food, especially protein, digestion.  Please avoid acid-blockers, such as Tums, Nexium, Prevacid etc.  If you are taking acid-blockers because of heartburn (GERD) see a naturopath to help cure that problem.  Stomach acid is NOT the problem — you may have an H. pylori infection, or a diaphragm (hiatal) hernia, or stress ulcers and these can all be cured.

If you are not sufficiently helped by the simple suggestions above, you may need digestive enzymes with meals.  I prefer an enzyme “multi” that contains some amylase for the starch, lipase for the fat and protease for the protein component of food.  A good enzyme multi may also contain lactase for dairy products and cellulase for the fiber in food.  These enzymes add to the potency of your own natural enzymes in your saliva, stomach, pancreas and liver which all get secreted into the gastrointestinal tract (GI) during the process of digestion.

There are also a number of helpful carminative herbs.  Carminative means helping with digestion, or literally “carrying gas from the alimentary canal.”   A strong small cup of peppermint tea after meals, especially if you have a warm or hot metabolism, can be very effective — unless you have heartburn, in which case an enteric coated peppermint capsule is better, so the peppermint volatile oils get past the lower esophagus without irritation.   If you are treating a hiatal hernia, strong peppermint, coffee and chocolate should be assiduously avoided until the condition is resolved.  If you are a chilly person, then a strong small cup of ginger tea can be a delightful digestive aide.  You could also chew on a few fennel or caraway seeds after a main meal to stimulate optimal digestion.

Once the food gets past the stomach, into the small intestine with its thousands of slender, finger-like “villae” then the nutrients can be absorbed.   This requires good health of the villae and there are numerous potential impediments to absorption.  First, the food needs to be alkalinized before it is taken up into the blood, which has a mandatory neutral pH.  The pancreas is in charge of secreting juice very much like a baking soda slurry into the upper small intestine to begin the alkalinization process.  If part of your GI trouble is left side or central discomfort, up under the ribs, after eating, please see your naturopathic physician to evaluate your pancreatic function.  If you get stitching, sharp pains in the middle part of your belly that may extend to the sides, that is probably gas.  Gas is formed by carbohydrates fermenting or proteins putrefying.  The foods are just sitting there because they are having difficulty breaking down, and are actually starting to rot.  As a reminder — one of the very best ways to prevent gas is to thoroughly chew your food before swallowing.

To determine which foods your body accepts as nutritious, and which will present difficulty digesting, the very best way is to undertake an elimination and challenge diet.  I have details about this process elsewhere on this website.  The basic idea is that you eat very carefully for 2-4 weeks, avoiding alcohol, caffeine, corn in all forms, dairy products, eggs, peanuts, red meat, shellfish, all soy products, tomatoes and wheat.   This will cover most people’s food sensitivities.   However, I have not infrequently seen problems with aspirin and other NSAIDS, chocolate, citrus fruits, garlic, and any gluten-containing grain.  You may look at this list and think “what can I eat then??”

You can enjoy delicious vegetable recipes — time to get a new vegetarian cookbook.  Steamed cauliflower, baked yams, grilled red peppers, steamed asparagus, chopped red cabbage and shredded carrots, sauteed onions and mushrooms.  Yum yum yum!  Oats and rice are almost always “safe” foods for everyone. Fruits and seafood (except the crustaceans) are generally extremely health-promoting for everyone, with the exception of large tuna and swordfish which unfortunately contain more mercury than is safe to eat.  After enjoying a delicious clean diet for a few weeks, carefully “introduce” the ingredients listed above, in 3-day increments.

This means, get organized with your calendar about which food is going to be introduced, and eat plenty of it over a 3-day period, without adding any of the other possible allergens yet.   Carefully observe any changes in your skin, mood or bowel function.  If, for example, you are re-introducing wheat into your diet after 4 weeks of abstaining, you may have toast in the morning, a bagel at noon and a bowl of wheat pasta in the evening.  If you notice hives or rashes or an outcropping of pimples, or a mood shift to sad, irritable or angry, or if your stomach hurts or your bowel function changes, take note. You could try the experiment again, or you could decide that wheat just doesn’t sit well in your body.  If that is the case — join the ranks of up to 30% of the US population for whom wheat is a small intestine irritant.  The extreme form of wheat sensitivity, which is a reaction to all gluten-containing grains, is called celiac disease, and is considered still to be one of the most under-diagnosed GI problems.

Take your time introducing the potentially offending foods into your diet in 3-day increments. If you decide that, for example, wheat is bad for you, please don’t force yourself to eat it 3 times daily for 3 days. Just wait out the 3-day period and try the experiment again with the next item.   Be methodical!  This is the only way to get definitive answers about which foods “work” for your body and which do not.

If you have had irritable bowel symtoms for a while (more than a year) you will most likely benefit additionally from a high quality pro-biotic 2 to 3 times a year for 1-4 weeks depending on the potency of the probiotics.  I like brands that contain not only the well-known lactobacillus species, which work higher up where the GI environment is more acidic, but also the bifido species, that prefer a more alkaline environment, such as in the colon (large intestine).  Look for a probiotic that also has a “pre”-biotic such as lactoferrin (ideally) or FOS (fructo-oligosaccharides).  The pre-biotic is food for the probiotics.

Besides chewing and using carminative herbs, you may want to experiment with “priming” your stomach with an acid stimulant.  For example, you could take a half ounce of “Swedish Bitters”, available in most health food stores, usually featuring Gentian and other bitter tasting herbs, to stimulate secretion of hydrochloric acid in the stomach just before meals.  You could also try a small amount of vinegar-honey water (equal parts vinegar and warm water with 1/3 tsp of honey).  The juice of 1/2 a lemon in a 1/4 cup of water works just as well.

Everyone has heard the phrase “real food takes time.”  Avoid eating haphazardly.  Plan ahead.   Make time to buy fresh produce, ideally grown nearby in organic soil.  Respect your body and feed it the finest “fuel” available.  Be willing to engage with healthy eating as a commitment and a pleasure, as opposed to an exercise in deprivation.   There are many healthy choices out there, although sometimes the junk food advertising screams louder!