Eat to beat IBS

Naturopath Jackie Arbuckle knows all too well the misery and frustration of irritable bowel syndrome (IBS): she not only treats the condition at her Melbourne practice but is a recovered sufferer herself. “While I was studying to be a naturopath I went through a very stressful time and my IBS started after a bout of gastro. I was going to the toilet up to 20 times a day for over a month, with a great sense of urgency,” she recalls. The normal frequency of bowel movements is one to three times daily.

“I basically didn’t leave the house for quite a few weeks. I didn’t want to eat anything for fear of going to the toilet again. I remember feeling very debilitated, tired and emotional. A common thing for people with IBS is that they know where every toilet is wherever they go and I certainly knew that. It was quite distressing, so I can fully understand what my patients are going through when they seek my help.”

Seeking help is exactly what IBS sufferers are doing in alarmingly increasing numbers. Official figures suggest as many as 15 per cent of Australians aged over 20 suffer from IBS to some extent. New Zealand figures are similar, suggesting between 15 and 20 per cent are suffering. In Australia alone that’s more than 3 million people dealing with abdominal pain, bloating and discomfort, constipation and diarrhoea — often on a daily basis.

The condition is twice as common in women as in men and young people seem to be particularly susceptible: about half of people seeking medical treatment for IBS are aged under 35. However, the fact that IBS can be difficult to diagnose, coupled with our natural reluctance to seek medical advice for problems “down there”, means the true number of people battling this frustrating and debilitating condition may be much higher.

In fact, a study of 1300 women by the Gut Foundation Research Institute at Sydney’s Prince of Wales Hospital found that about 17 per cent of people aged 18–49 experienced bloating every day, with some reporting their waist circumference expanded by up to 12cm over the course of the day.

Multiple causes

Part of what makes IBS so difficult to treat effectively is the fact that its precise cause remains unknown. It seems to be a modern malady, with the unpleasant by-products of our fast-paced lifestyles — such as stress, poor eating habits, lack of exercise and even bad posture — all playing a part.

Research has identified a number of other contributing factors, including hypersensitivity of the intestines, depression, anxiety and early life factors such as genetic background or cultural factors. IBS is not caused by a blood or biochemical disorder and does not cause cancer or ulcerative colitis.

As in Jackie Arbuckle’s case, there appears to be a definite link between IBS and a previous bout of gastroenteritis: it’s believed gastro leaves nerve pain fibres in a heightened state, altering mechanisms in the gut wall and resulting in ongoing pain.

Sydney chiropractor Dr Adam Meredith has identified a link between a condition called “sway back posture” — when the head and hips protrude forward — and IBS in many of his patients. “Most chiropractors will tell you they can treat IBS quite well. What we find is that the nerves that supply the colon emanate from (the hip) area. With sway back posture, we believe there’s a lot of nerve interference in that area,” he says. “What you’re getting is misinformation from the brain to the colon because the nerves are under extreme load and aren’t working normally.”

Ask any IBS sufferer, though, what they believe contributed to their developing the condition and stress — often coupled with a poor diet — is usually identified as a key precipitating factor. This was the case for Sydney publicist Sarah McMahon, who was diagnosed with IBS in 2000. “I was 16 and I didn’t know it at the time but I had begun to experience what would become very bad anxiety,” says McMahon, now 27.

“I didn’t know what was going on. I was constipated often, very gassy and couldn’t seem to digest anything properly. I was always bloated and never felt ‘normal’.” Her worries about her symptoms only seemed to exacerbate the problem. “It got in the way of everything. It ruined my already fragile self-esteem and was always on my mind,” she says.

The natural approach

So disparate are the symptoms and possible causes of IBS that Sydney nutritionist Sue Walter believes it is not a condition in its own right but rather a convenient catch-all term for a vast range of separate and complex problems. “I personally don’t think the term ‘IBS’ is useful because, while all people with IBS have digestive complaints, the causes of their poor digestion vary immensely. This means that an effective treatment for one person with IBS will be useless for another person with IBS,” she explains.

“People come to see me who have very large variations in digestive complaints who have all been diagnosed with IBS by their medical practitioner but have received no treatment. Some have diarrhoea, while others have pain or extra-abdominal symptoms. Others still have symptoms that fluctuate. To me, it makes as much sense as grouping someone with a broken arm together with someone with a broken leg, just because they have broken bones. The person with a broken arm would not benefit from a cast on their leg and a pair of crutches.”

Walter’s concern is that this one-size-fits-all approach tells people diagnosed with IBS that their condition cannot be cured and they will simply have to put up with it. She has first-hand experience: suffering from constipation, nausea, reflux and abdominal pain herself, Walter saw some 30 health practitioners over three years, including a gastroenterologist and other specialists. “It was depressing. I was in pain every day and it was a struggle to enjoy myself. Most doctors could only tell me it must be stress,” she says.

This was also the message Perth PR consultant Heather Olsen* received when she began experiencing digestive problems eight years ago. “I didn’t go to a GP or anywhere else for a long time. A friend said that my symptoms were IBS and that there wasn’t a ‘cure’ for it or anything that could be done. It was something I had to live with,” Olsen recalls.

“It affected me terribly. I’d be in the middle of Grocery shopping and feel that urgent need to go to the toilet and would have to run out, leaving a full trolley of groceries so I wouldn’t have an accident. I felt nervous going into places or situations where there wasn’t a close-by toilet available.”

McMahon was also frustrated by her attempts to seek orthodox medical treatment. “My GP just didn’t seem all that interested in helping me or all that aware of how bad my situation was,” she says. “I just felt like there was nothing anyone could do.”

As for Walter, she was ultimately diagnosed with an intestinal parasite she had picked up while travelling in Africa and, after six months of “healing myself with food and natural supplements”, returned to full health.

Jackie Arbuckle believes natural treatments go “a step further” than orthodox medicine in dealing with IBS. “Orthodox medicine regulates the bowel function, stopping the diarrhoea or constipation,” she says. “However, I believe that natural medicines repair the damaged bowel wall and address why the person has IBS in the first place.”

Food is the best medicine

Walter says a deficient diet is at the root of most gut-related health problems. “While awareness is increasing, it still surprises me that so many people fail to recognise the link between good food and good health,” she says. “Poor eating habits directly contribute to poor gut integrity. Food is the only way we can get the energy we need to live the life we want, so it makes sense that the more nutritious the food, the better you and your gut will feel.”

Olsen eventually consulted a naturopath about her condition, who prescribed a strict elimination diet designed to identify the specific cause of Olsen’s digestive distress. For three months, she stopped eating wheat and gluten, dairy, sugar, coffee and soy.

“After the initial three months I was able to eat limited dairy, but only every second day, and I was limited to certain cheeses and yoghurts,” she says. Several studies (including some financed by marketers of yoghurt brands) have found that probiotic bacteria found in fermented foods such as yoghurt and sauerkraut can help alleviate pain associated with IBS. Arbuckle says that, while probiotics can be helpful, they are best used in conjunction with naturopathic treatment. “It’s important to prepare the bowel walls before probiotics are given. Just like when you lay tiles in the bathroom, you have to clean the wall, lay the glue and then stick the tiles on,” she explains.

Olsen also avoided onions and mushrooms, gave up beer for two years and wine for six weeks. She increased her protein intake and took a multivitamin as well as magnesium salts and fish oil. “Magnesium can reduce the sensation of incomplete evacuation, along with the cramping, and is also brilliant for the nervous system, so it addresses the stress aspects of IBS,” says Arbuckle.

While Olsen has now relaxed her diet somewhat, she says the effect of her new eating habits on her IBS has been remarkable. “Within a few weeks I felt a hundred times better and within two months I felt like a new person. I was full of energy again and got the spring back in my step,” she says. “I manage my IBS now. I listen to my body and adjust my diet accordingly. If I get an upset stomach, I know why.”

Changing her diet brought Sarah McMahon similar success. She also visited a naturopath in her native New Zealand and was advised to cut out bread and cheese and eat more wholefoods. “I was a teenager and did not have much of an idea as to how to eat well or what would trigger it,” McMahon explains. “I saw an improvement pretty quickly but it was not perfect for a long time. Knowing the foods to avoid helped a lot and whenever I did eat them I always regretted it afterwards.”

McMahon also took aloe vera juice after a friend recommended it. “I took it morning and night and it helped soothe the irritation a lot. I always felt worse if I missed my dose,” she says. “Although I occasionally still get upset stomachs I barely notice my IBS in my day-to-day life. I eat good, whole foods and avoid processed ones and I really do feel very good now.”

Eating slowly and chewing food well may also help to reduce bloating, gas and irritation.

Walter believes it is possible to cure IBS. “I think the most important thing is that the cause of the IBS is identified. Once this occurs, a cure is not usually that difficult,” she says. “However, it is not a quick fix and the person with IBS will need to be committed to learning to take control of their health so they can achieve a symptom-free state. The benefits of this type of healthcare are enormous for all aspects of one’s future health.”

What else works?

Chiropractor Dr Adam Meredith says treating sway back posture usually leads to a significant improvement in IBS symptoms within a matter of weeks. “We correct so the client’s posture comes back into normal limits (and) I normally see changes and improvements in symptoms in four weeks,” he says.

“We don’t ‘fix’ people, we simply restore them to what Mother Nature intended. If I’m seeing that the sway back posture is improving but the IBS symptoms aren’t, I would conclude that they’re not related in that particular patient. The vast majority have dramatic improvement.”

Dr Meredith also recommends improving posture with core-strengthening exercises such as Pilates. “You can certainly help yourself by strengthening your core muscles and lengthening your hip flexors,” he explains. “Anything that changes your posture back to normal limits and takes pressure off the nerves will help.”

Other forms of exercise may also be useful. A Swedish study published in The American Journal of Gastroenterology found that a 12-week exercise program can significantly relieve symptoms of IBS. IBS sufferers who participated in activities such as walking, cycling, swimming and jogging for 20 to 60 minutes three to five times a week reported an average fall of 51 points on the IBS severity scoring system over 12 weeks, while study participants who did not exercise reported an average five-point decline.

Hypnotherapy has also proven to be useful in the management of IBS. Research shows hypnosis is more than 80 per cent effective in relieving abdominal pain and distension. Among people with severe chronic IBS, hypnotherapy patients showed dramatic improvement in all symptoms and had maintained that improvement two years later.

“Hypnosis is helpful and beneficial for all IBS sufferers as it targets the use of their own inner resources,” says Bruni Brewin, President Emeritus of the Australian Hypnotherapists’ Association. He says IBS sufferers are likely to see an improvement in their symptoms after six to eight hypnotherapy sessions.

“We approach the treatment from a ‘physical’ perspective, helping patients to develop mental skills and techniques to control physiological mechanisms not normally under conscious control,” Brewin explains. “They are learning to take control over their gut rather than the opposite being true.”

Ultimately, says Sue Walter, it is vital to remember that IBS is not a life sentence — help is available. “I was scared that I was going to feel like this for the rest of my life. I will never take for granted how wonderful it is to feel normal,” she says.

The power of peppermint and ginger

A cup of peppermint tea could be a potent weapon in the treatment of IBS, according to new research by the University of Adelaide’s Nerve-Gut Research Laboratory. Researchers found that peppermint prompts an “anti-pain channel” called TRPM8, which works to reduce pain in the gastrointestinal tract that is brought on by foods such as mustard and chilli. “This is potentially the first step in determining a new type of mainstream clinical treatment for irritably bowel syndrome,” says researcher Dr Stuart Brierley. Peppermint oil in enteric-coated capsules has also been shown to provide symptomatic relief of IBS.

Ginger can also be helpful in relieving IBS symptoms. Long used to treat nausea associated with pregnancy, chemotherapy and motion sickness, its mildly inflammatory action and antispasmodic properties may also help to soothe pain and discomfort associated with IBS. Fresh and dried ginger root are available in healthfood stores, greengrocers and most supermarkets. The root can be grated and steeped in boiling water to make tea. Ginger capsules are also available from healthfood stores.

References available on request

* Name has been changed

Laura Greaves is an award-winning freelance writer who specialises in health and wellbeing. Find out more at www.lauragreaves.com