ARTICLE #1 IBS
ARTICLE #3 Study links intestinal bacteria to irritable bowel syndrome (a half truth study)
ARTICLE #4 Digestive Problems
ARTICLE #5 Natural Treatments for Bacterial Overgrowth
ARTICLE #6 The Specific Carbohydrate Diet
One of the most common intestinal disorders seen by doctors today is irritable bowel syndrome (IBS). This disorder accounts for more than one out of every 10 doctor visits. It has been estimated that nearly one in five people has symptoms of IBS. Women out number men for this affliction 2:1. IBS, also called intestinal neurosis, mucous colitis, spastic colon, or spastic colitis, normally affects people between the ages of twenty-five and forty-five.
What happens in IBS?
In IBS, the normal rhythm of the muscular contractions in the digestive tract become irregular and uncoordinated. This interferes with the normal movement of food and waste material, and leads to the accumulation of toxins in the intestines. This accumulation of materials set up a partial obstruction of the digestive tract, trapping gas and stool, which in turn causes the symptoms of IBS. Irritable bowel syndrome may affect the gastrointestinal tract anywhere from the mouth to the colon.
What causes it?
Technically the cause is unknown. There are many theories that have been put forth. One theory is that irregularities in the intestinal hormones responsible for bowel motility (cholecystokinin, motilin, and vasoactive intestinal peptide) are behind this disorder. According to this theory, people with IBS have abnormal contractions of the smooth muscle of the digestive tract. In another theory, some scientists believe a virus or bacterium may play a role. Lifestyle factors such as stress and diet are probable common causes. More than half of patients with IBS who seek medical attention have underlying depression, anxiety, or somatization. Food allergies may be a big part in some individuals. Also, the overuse of antibiotics, antacids, or laxatives, which disturb the bacterial microflora of the bowel, may also be a factor.
All too often medicine looks at this one-disease-one-cause theory. In many cases it may be multifactorial.
I have personally had IBS. What I found that worked for me pertained to food allergies. I removed all gluten (wheat) from my diet and I quit eating chicken. I have never had a problems since.
What are the symptoms?
Symptoms of IBS include abdominal pain, anorexia (loss of appetite), bloating, constipation or diarrhea, flatulence, intolerances to certain foods, mucus in stool, and nausea. Pain is often triggered by eating and may be relieved by bowel movement. Abdominal pain usually is intermittent, crampy, and in the lower abdominal region. It may be relieved by defecation, worsened by stress, and worse for 1 - 2 hours after meals. It does not usually occur at night or interfere with sleep. Many patients report that they have a firm stool in the morning followed by progressively looser movements. The acute onset of symptoms raises the likelihood of organic disease. Nocturnal diarrhea, blood in stool, weight loss, and fever are incompatible with a diagnosis of irritable bowel syndrome and warrant investigation for underlying disease.
The criteria that doctors should use to diagnose IBS are either of the following:
The Manning Criteria
The Manning Criteria consist of six cardinal symptoms, which differentiate the painful variant of IBS from organic bowel disease.
........Those symptoms are as follows:
.................1. Visible abdominal distention
.................2. Pain relieved by bowel movement
.................3. More frequent stools with the onset of pain
.................4. Looser stools with the onset of pain
.................5. Rectal passage of mucus
.................6. The sensation of incomplete evacuation
The Manning Criteria do not require the presence of all six symptoms, although the more symptoms that are present, the more likely it is that patient has IBS. The Manning Criteria are not highly sensitive and do not clearly discriminate IBS from IBD (inflammatory bowel disease), laxative abuse, lactose intolerance, or non-ulcer dyspepsia. However, including the observation of stools that are loose and watery more than 25% of the time improves the criteria significantly.
The Rome Criteria
The Rome Criteria is an established standard for the diagnosis of IBS. The Rome Criteria define a functional bowel disorder as IBS if the individual reports at least 3 months of continuous or recurring symptoms of abdominal pain or discomfort that is relieved by defecation and change in frequency and/or consistency of stool. In addition, the Rome Criteria require the presence of two or more of the following symptoms on at least a quarter of occasions or days.
........Those symptoms are as follows:
.................1. Altered stool frequency with onset of pain
.................2. Altered stool form with onset of pain (lumpy/hard to loose/watery)
.................3. Altered stool passage (strain, urgency, feeling of incomplete evacuation)
.................4. Passage of mucus
.................5. Bloating or feeling of abdominal distention
.................6. Pain relief with bowel action
A recent study that excluded subjects with the "red flag symptoms" (blood mixed in bowel movement, documented weight loss, family history of colon cancer, recent antibiotic use, nocturnal symptoms, or abdominal physical findings) used the Rome Criteria and had a sensitivity of 65%, a specificity of 100%, and a positive predictive value of 100%.
Because of the pain, diarrhea, nausea, and sometimes severe headaches and even vomiting, a person with IBS may dread eating. Whether or not an individual with IBS eats normally, malnutrition may result because nutrients often are not absorbed properly. As a result, people with IBS require as much as 30% more protein than normal, as well as an increased intake of minerals and trace elements, which can quickly be depleted with diarrhea.
Can IBS be related to other problems?
Yes. It may be related to and sometimes confused with other diseases. Many diseases can be related to IBS, including candidiasis, colon cancer, diabetes mellitus, gallbladder disease, malabsorption disorders, pancreatic insufficiency, ulcers, and the parasitic infections amebiasis and giardiasis. Over 100 different disorders may be linked to the systemic effects of IBS. One disorder that is linked in about 25% of the cases is arthritis, usually peripheral arthritis, which affects the ankles, knees, and wrists. Less frequently the spine is affected. IBS can also be related to skin disorders.
Diagnosis of IBS requires ruling out disorders that can cause similar symptoms, such as, celiac disease (gluten enteropathy), colon cancer or benign tumors, Crohn's disease, depression, diverticulitis, endometriosis, fecal impaction, food poisoning, infectious diarrhea, ischemic or ulcerative colitis, and lactose intolerance. A physician may recommend one or more of a variety of procedures to do, including barium enema, colonoscopy, rectal biopsy, sigmoidoscopy, and stool examination to check for the presence of bacteria, blood, and parasites.
NOTE: I will attempt to wake the line between the reader being a health care professional and that of a patient. To get too technical will leave the average reader confused and to not be technical enough will get everyone bored. This information is what I would use in certain situations and is not meant to replace medical advice from a quality physician.
Sympathetic understanding plays a major role in the treatment. An explanation of the condition should be made and an assurance that there is no underlying organic disease should be afforded to the patient. Outline the extreme sensitivity of the patient's bowel to stimuli such as stress, food, drugs, and hormones. Remember that no two IBS patients are alike.
Although IBS affects a large percentage of patients and accounts for a substantial cost to the medical system, to date no single treatment is reliably effective for this condition. Patients often rely on a variety of approaches for symptoms management with varying success, including herbal, drugs, dietary modification, and counseling. Adequate clinical management of IBS may require a combined, individualized approach for each patient.
There are mountains of treatment options for this condition and it is up to the patient and/or doctor to find what is best suited for each individual. I have listed below many of those options. Read through them and decide what best fits your particular symptomology.
More than two-thirds of patients with IBS have mild symptoms that respond read illy to education, reassurance, and dietary interventions. Drug therapy should be reserved for patients with more severe symptoms that do not respond to the conservative measures. These agents should be viewed as being adjunctive rather than curative. Given the wide spectrum of symptoms, no single agent is expected to provide relief in all or even most patients. Indeed, there is no convincing evidence that any of these agents are superior to placebo, which results in symptomatic improvement in up to 70% of patients. Nevertheless, therapy targeted at the specific dominant symptom (pain, constipation, or diarrhea) may be beneficial.
Anticholinergic agents may ameliorate postprandial abdominal pain when given 30-60 minutes before meals. Side effects include urinary retention, tachycardia, and dry mouth. Available agents include dicylcomine, 10-20 mg orally three or four times daily; hyoscyamine, 0.125 mg orally as needed.
Opiod and other antidiarrheal agents may be useful in patients with frequent loose stools. They may best be used "prophylactically" in situations where diarrhea is anticipated (such as stressful situations) or would be inconvenient (social engagements). Agents include loperamide, 2 mg orally three or four times daily, and diphenoxylate with atropine, 2.5 mg orally four times daily.
A trial of fiber supplementation with bran, psyllium, methylcellulose, or polycarbophil is beneficial in most cases. Patients who are unresponsive to fiber may be extremely difficult to manage.
Some patients complain of chronic, unremitting abdominal pain. This small subset has a high incidence of underlying psychiatric disturbances and functional impairment and requires frequent office visits. These patients may benefit from antidepressants. Desipramine or imipramine may be started at a dosage of 25 mg at bedtime and increased gradually to 50 mg as tolerated. Serotonin reuptake inhibitors (sertraline 50-150 mg or fluoxetine 20-40mg) are now commonly used because of their lower side effect profile and better safety than tricyclic antidepressants, though there are no controlled trials supporting their use. Improvement should be evident within 4 weeks.
Etiology Association and Therapeutic Options for IBS
This is a general chart and more detailed alternatives follow below.
........Usually associated with:
.................a) Food allergy
.................b) Inflammatory substances in the GI tract
.................c) Lactose intolerance
........Possible therapeutic interventions
.................a) Food elimination diet ( dairy, wheat, other grain glutens) or rotation diet to evaluate clinical response to
....................protein/antigen withdrawal and eventual reintroduction challenge
.................b) Dietary protein supplementation with oligoantigenic source ( rice protein concentrate-based formulation)
.................c) Dietary supplementation with L-glutamine, inulin, nicotinic acid (vit B3), pantothenic acid, and some
.....................highly absorbable form of zinc to support GI mucosal cell healing and energy needs
.................d) Avoidance of any known toxins (alcohol, drugs, caffeine, nicotine) or other things known to cause the
.....................individual symptoms or problems
.................e) AVOIDANCE of simple sugars
.................f) use of low glycemic index carbohydrates ( rice flour )
.................g) ensure adequate dietary fiber intake (hypoallergenic types)
.................h) MCT (medium chain triglycerides)
.................i) EPA and GLA fatty acid supplementation
........Usually associated with:
.................a) Inadequate dietary fiber intake
.................b) Inadequate, irregular fluid intake
.................c) Inadequate, irregular exercise
.........Possible therapeutic interventions:
.................a) Gradually increased regular dietary intake of soluble and insoluble fibers (hypoallergenic fibers)
.................b) Ensure adequate daily fluid intake
.................c) Ensure adequate daily and regular exercise
.................d) Test dietary nutrition composition changes to meet individual needs (magnesium and vit C supplements)
..........Usually associated with:
.................a) Inadequate secretion of digestive enzymes
.................b) Microfloral changes (dysbiosis)
.................c) Excess dietary intake of fermentable carbohydrates
.........Possible therapeutic interventions:
.................a) Eliminate fermentable carbohydrates (includes most grain carbs, except rice) with rotational
......................reintroduction to observe for symptom recurrence after initial symptoms have been alleviated
.................b) Use of digestive aids (plant enzymes, acidificants such as betaine HCL, pepsin and pancreatic enzymes)
.................c) Reinoculation of bowel flora with Lactobacillus acidophilus and Bifidobacteria (high quality forms)
.................d) Addition of fructooligosaccharides (FOS) to support desirable floral species
*** it should be noted that IBS commonly manifests as alterations or combinations of these three symptom complexes. Therefore, each individual must be assessed for his/her unique combination of symptoms and the program or therapy individually talored and readjusted to meet needs.
Dietary and Nutritional Measures
Patients commonly report dietary intolerances. Physicians should be open to the idea that dietary changes may provide symptomatic benefit. In some patients, a food diary, in which symptoms, food intake, and life events are recorded, may reveal dietary or phychosocial factors that precipitate symptoms. Malabsorption of lactose, fructose, and sorbitol may cause bloating, distention, flatulance, and diarrhea. Lactose intolerance should be excluded in all patients with a trial of a lactose-free diet. Sorbitol is present in a number of artificially sweetened foods and some medications. A variety of foods are flatulogenic, producing pain and distention in some patients. These include brown beans, Brussels sprouts, cabbage, cauliflower, raw onions, grapes, plums, raisins, coffee, red wine, and beer. Caffeine is poorly tolerated by patients with irritable bowel syndrome.
A trial of a high-fiber diet (20-30 g/day) should be recommended for most patients. This may be accomplished by giving 1 tbsp of bran powder two or three times daily with food or in 8 oz of liquid. Some patients report increased gas and distention from fiber supplementation with bran. Fiber supplements with psyllium, methlycellulose, or polycarbophil may be better tolerated.
- Removal of known food allergens or food irritants is imperative. The most common food allergens are dairy, wheat, corn, peanuts, citrus, soy, eggs, certain fish, and tomatoes. An elimination/challenge trial may be helpful in uncovering sensitivities. Remove all suspected allergens from the diet for two weeks. Add in one food every three days and wait for reaction which may include digestive upset, headache, fatigue, flushing, or worsening of symptoms.
- Fiber supplementation helps reduce abdominal pain, cramping, and gas. Supplements include psyllium, flax meal, slippery elm powder, marshmallow root powder.
- Digestive enzymes 20 minutes before meals can help enhance digestion and normalize bowel function.
- One teaspoon of raw bran with each meal plus extra water.
- Pro-flora supplements taken two or three times per day
- Magnesium 200mg two to three times per day with B-complex (50-100 mg/day) with extra B5 (100mg/day)
- Low fat diets may relieve abdominal pain following meals.
- Essential fatty acids (flaxseed oil or primrose oil)
- Avoid animal fats, butter, ALL carbonated beverages, coffee and all other substances containing caffeine, candy, chocolate, ALL dairy products, fried foods, ice cream, ALL junk foods, the additives mannitol and sorbitol, margarine, nuts, orange and grapefruit juices, pastries, ALL processed foods, seeds, spicy foods, sugar, sugar-free chewing gum, and wheat bran and wheat products. These foods encourage the secretion of mucus by the membranes and prevent the uptake of nutrients.
- Limit your consumption of gas-producing foods such as beans, broccoli, and cabbage if they cause any problems.
- Avoid alcohol and tobacco because these irritate the linings of the stomach and colon.
- When an intestinal upset occurs, switch to a bland diet. Put vegetables and nonacidic fruits through a food processor or blender. Organic baby food is good. If you are on a soft diet, take fiber and protein supplements.
- To relieve occasional gas and bloating, use charcoal tablets. Take 5 tablets as soon as this problem arises. Do not use charcoal daily because it absorbs needed nutrients, and do not take it at the same time as other supplements or medications.
- Chew your food well. Do not overeat or eat in a hurry.
- Do not eat right before going to bed. Wait one or two hours after eating before lying down.
- If you have IBS, it is wise to treat your liver as well as your digestive tract. Use Milk Thistle.
- Alfalfa contains vit K, needed to build intestinal flora for proper digestion, and chlorophyll for healing and cleansing of the bloodstream.
- Aloe vera is healing to the digestive tract. Take one half cup of aloe vera juice three times daily on an empty stomach.
-Peppermint aids in healing and digestion, and also relieves upset stomach and gas or that full feeling. It must be taken in enteric coated capsule form to prevent the oil from being released before it reaches the colon. Do not take any other form or heartburn may result.
Pertaining to food allergies. You must understand that delayed food allergies are different from the immediate type of food allergies that an allergist is familiar with. Allergists only understand immediate IgE allergies as in Celiac Disease. If an allergist can't see an immediate response by his testing methods, then to him there is no cause in his mind and drugs are used. Classically an allergist is trained in this way. IBS, as related to foods, is just too foreign to him. Immediate reactions DON'T cause chronic conditions like IBS, delayed mediated responses DO.
You may feel that to follow this there is nothing left to eat (try the Alkaline Diet). That is very commonly heard as well as "You want me to give up everything I like". Nine times out of ten, the food that you love the most is causing the problem. Over time, If one continually eats the same food, you will most likely become allergic to it. This is why rotating foods and eating a variety of foods is pushed so much for proper health (along with assuring proper nutrition). If you want to end this affliction it is up to you to make the changes. Once you have found what offends you then you can go back to some things that please your tastes. If, in following proper advise, you change your lifestyle you will feel better and live better...trouble free.
Remember that the body never forgets the foods to which it is sensitive. If you return to bad eating habits, IBS will return and so will poor health.
Always remember to "Eat Live, to Live".
Causes and natural treatments of irritable bowel syndrome
Irritable Bowel syndrome is a gastrointestinal motility disorder for which there is no organic or structural cause. Since the symptoms of IBS can mimic other disorders such as hypothyroidism, IBS is diagnosed when all other local and systemic conditions have been ruled out.
Characteristic symptoms of IBS include recurrent abdominal pain, abdominal pain relieved by defecation, disordered bowel habit, including constipation, diarrhea, or an alternation between the two, and abdominal distension and bloating.
IBS is also associated with non-gastrointestinal conditions such as headache, low back pain, arthritis, non-cardiac chest pain, difficult urination and fibromyalgia.
Alternative Treatments for Irritable Bowel Syndrome
A naturopathic doctor or other appropriately trained health practitioner can perform specific tests to assess the above factors and design a treatment protocol most suitable for the individual.
Peppermint oil (Mentha piperita) - Abdominal pain, the most frequent and disabling symptom of IBS, improves when the intestinal smooth muscles are relaxed. Peppermint oil can reduce abdominal pain and distension of IBS, possibly by blocking the influx of calcium into muscle cells and inhibiting excess contraction of intestinal smooth muscles. It is a carminative, which means it helps eliminate intestinal gas.
Peppermint oil should only be used in enteric-coated capsules to ensure that it reaches the intestines intact, otherwise, the oil can relax the lower esophageal sphincter and cause heartburn.
Fennel seed (Foeniculum vulgare) - Fennel is another herb that is used to relieve spasm of the gastrointestinal tract, feelings of fullness, and flatulence. In Germany, fennel seed is licensed as a standard medical tea for dyspepsia.
Gamma-oryzanol - Gamma-oryzanol is a natural substance isolated from rice bran oil. Studies have shown that it protects the mucus lining of the gastrointestinal tract by regulating nervous system control and exerts anti-oxidant activity. Clinically, gamma-oryzanol has been found to be effective in a broad range of gastrointestinal complaints, including irritable bowel.
Magnesium is a mineral that has been used widely for treating abdominal cramps and constipation. It is obtained naturally from the diet, and is required for many metabolic activities in the body. Absorption of magnesium is reduced by high intake of calcium, alcohol, surgery, diuretics, liver or kidney disease, and oral contraceptive use.
Fatigue, fibromyalgia, migraine, premenstrual syndrome, and dysmenorrhea are conditions associated with magnesium deficiency. Women with premenstrual syndrome who were found to have low magnesium were more likely to have excess sensitivity to pain with generalized aches and pains.
Identify and remove food intolerances - A trained practitioner can supervise an elimination diet. Many foods are removed from the diet for a brief period of time, then re-introduced sequentially to isolate the body's reaction to the offending foods. Since grains are a common culprit, it is important to remember that carbohydrate digestion begins in the mouth and that chewing grains thoroughly allows amylase, the digestive enzyme present in saliva, to digest the grains.
Improve gut motility - Soluble fiber increases bowel transit and stools and relieves constipation. Wheat bran has been used in some research studies, however, it is not recommended for people who may have intolerances to wheat. Psyllium is a good source of soluble fiber and is readily available. Sufficient water should be taken or fiber can have the opposite effect and result in greater constipation.
Flaxseed (Linum usitatissimum) also acts as a gentle laxative. It is useful for chronic constipation, damage to the colon wall from laxative abuse, irritable colon, and to soothe gastrointestinal inflammation. Dandelion root (Taraxacum officinale) is licensed in Germany as a standard medicinal tea to treat distension, flatulence, dyspepsia, lack of appetite, and other digestive complaints
Restore a healthy balance of bacteria in the gut - Lactobacillus acidophillus and bifidobacterium bifidum can help to restore healthy balance of bacteria in the gut. They can decrease the amount of bacteria with gas-producing abilities and relieve IBS symptoms such as abdominal distension and flatulence. Bifidobacterium acts as a barrier against colonization of the gastrointestinal tract by pathogenic bacteria, and lactobacillus inhibits the attachment of pathogens onto the intestinal mucus lining.
Low fiber intake is associated with an overgrowth of toxin-producing bacteria and a lower percentage of lactobacillus acidophillus. A diet high in dietary fiber increases the formation of short-chain fatty acids, such as butyrate, which is the preferred energy source of the cells that line the colon.
Pancreatic enzymes help to inhibit the growth of bacteria in the small intestine. They help to improve protein digestion. Goldenseal (Hydrastis canadensis) also inhibits bacteria, and prevents the conversion of proteins to vasoactive amines.
5-HTP is a precursor to serotonin that is available in supplement form and may be helpful in the treatment of IBS. Pharmaceutical drugs that increase the action at one type of serotonin receptor (5-HT4) have been clinically shown to improve constipation. Further studies, however, are needed to determine the precise mechanism involved. It is interesting to note that IBS is associated with depression, anxiety, and sleep disturbances, conditions that are believed to be due to low serotonin levels.
Mind-body therapy - Brief psychotherapy was found to be helpful in improving IBS symptoms of pain and diarrhea.
Relaxation training to induce whole-body relaxation and stress management, hypnosis, and biofeedback have all been helpful in treating IBS.
Possible Causes of IBS
Food Intolerance - True food allergy is mediated by the immune system and is associated with hives, asthma, eczema, nasal discharge, and positive skin prick, RAST scores, or other allergy tests. However, food intolerance, rather than true food allergy, is believed to be more significant in IBS. Between 33-66% of IBS patients report having one or more food intolerances. The most common culprits are dairy (40-44%) and grains (40-60%). The resulting gastrointestinal bloating, flatulence, and pain caused by this reaction appears to be mediated by inflammatory prostaglandin synthesis.
Neurochemical Imbalance - Interaction between the brain and the gut occurs via nerves that send neurotransmitter signals. An imbalance between two of these neurotransmitters, serotonin and norepinephrine, are implicated in IBS. Constipation may result when levels of norepinephrine increase, causing a reduction in serotonin levels and inhibition of another neurotransmitter called acetylcholine. Conversely, diarrhea can occur when increased serotonin inhibits norepinephrine and causes levels of acetylcholine to increase. For IBS patients, such an imbalance in the nervous system can lead to the fluctuating bowel symptoms of constipation and diarrhea.
History of Analgesic Use - Use of acetaminophen, a common pain-relieving medication, is associated with diarrhea-predominant IBS. Its action may be due to an imbalance in the neurotransmitter serotonin. Since acetaminophen can cause elevated levels of the serotonin by-product 5-HIAA in the urine, it is possible that acetaminophen somehow interferes with serotonin metabolism. Plasma serotonin levels have indeed been shown to be elevated after eating in patients with diarrhea-predominant IBS. Clinically, a drug that blocks the 5-HT3 serotonin receptor (5-HT3 receptor antagonist) is effective for women with diarrhea predominant IBS. It is interesting to note that asthma, another condition associated with disordered smooth muscle function, was recently found to be associated with acetaminophen use.
Reproductive Hormones - IBS occurs more than twice as frequently in women than in men and tends to follow a cyclic pattern, with aggravation during the postovulatory (progesterone-dominant) and premenstrual phases of the menstrual cycle. Progesterone is known to delay gastric emptying and cause constipation. Constipation with straining and the frequent passage of hard stools is a more prevalent IBS manifestation in women, especially during the postovulatory phase. At the end of the postovulatory phase, the sudden withdrawal of progesterone that occurs with the start of the premenstrual phase may trigger increased bowel activity. Women frequently report loose stools and diarrhea before or with the onset of menstruation. In contrast to progesterone, estrogen has not been associated with exacerbations of IBS symptoms.
In one study, high levels of luteinizing hormone (LH) were found in women with IBS. Drugs that decreased LH levels and consequently suppressed ovarian production of estrogen and progesterone resulted in significantly improved IBS symptoms. LH is a reproductive hormone responsible for the production of testosterone in males and estrogen and progesterone in women. In men, the opposite result was found: low LH and low testosterone tended to be associated with IBS symptoms. High LH therefore appears to cause exacerbations in women by stimulating progesterone and estrogen, yet have a protective effect in men.
Along with progesterone levels in women, prostaglandins E2 and F2 alpha also increase in the premenstrual phase. Since they are powerful stimulants of bowel contractions, it is possible that women with IBS may have an exaggerated response to these prostaglandins.
Mood - Anxiety, hostile feelings, sadness, depression, and sleep disturbance are associated with IBS. Adverse life events such as family death, marital stress, financial difficulties, and especially physical and sexual abuse, have also been reported more frequently in IBS patients than in the general population. However, it is possible that IBS patients with this social or psychological background may be more likely to seek medical treatment or participate in research studies.
The impact of stress on bowel motility and pain were explored in one study by administering corticotrophin-releasing factor (CRF), a hormone released in the body during stress. CRF increases motility of the descending colon and can induce abdominal pain. The researchers found that IBS patients had greater colonic motility and more abdominal pain after receiving CRF than controls.
Antidepressants have been shown to be very effective for treating bowel motility and visceral nerve responses, in addition to addressing the emotional component of IBS.
Small Intestine Bacterial Overgrowth - Excess bacteria in the small intestine, an area that is normally relatively free of bacteria, is being recognized as important in the development of IBS. When these bacteria are present in the small intestine, excessive gas, bloating, abdominal distension and pain, and altered gut motility can result.
Causes of small intestine bacterial overgrowth include decreased gastric acid secretion (possibly due to natural aging, stomach ulcer, and colonization by helicobacter pylori bacteria), decreased bile flow, or decreased pancreatic enzymes with poor absorption of carbohydrates, fats, and proteins. The resulting undigested and unabsorbed carbohydrates in the small intestine and colon cause excess fermentation and encourage growth of unwanted bacterial species. An abundance of gas is produced, as well as short-chain organic acids such as lactic acid, which can damage the mucus lining of the intestines and further aggravate carbohydrate malabsorption.
In addition, putrefaction of proteins in the small intestine produces substances called vasoactive amines that can affect intestinal muscles.
(NOTE: in red is and explanation by Dr. Warber)
(This study is an example of the medical community not
understanding the whole truth)
December 13, 2000
LOS ANGELES, California (Reuters) -- Irritable bowel syndrome, a chronic condition believed to plague 20 percent of the adult population in developed countries, may be caused by too much bacteria in the small intestine, researchers said Wednesday.
It was the first time a potential cause for the disease has been identified and could lead to a radical shift in treatment, according to the lead investigator in the study.
"This is really exciting because it points to the cause of the disease. Treatments for irritable bowel syndrome (IBS) to this point have been directed at symptoms, not any cause," said Dr. Mark Pimentel, who is also assistant director of the gastrointestinal motility program at Cedars-Sinai Medical Center in Beverly Hills, California.
Symptoms of IBS, which is diagnosed in twice as many women as men, include gas, bloating, abdominal pain, constipation and diarrhea.
"We found that 78 percent of IBS patients have bacterial overgrowth in the small intestine. Antibiotics got rid of the disease in half of the patients that got rid of the overgrowth," Pimentel said.
Treatments for the gastrointestinal condition currently range from anti-depressants, which are supposed to alter nerve endings in the abdomen, to advice to eat more fiber in order to alleviate constipation.
Last month, the IBS drug Lotronex was pulled from the market by its maker Glaxo Wellcome after the U.S. Food and Drug Administration voiced concerns about side effects and said three deaths might have been related to the product.
Lotronex, marketed as a treatment for women with diarrhea-predominant IBS, was linked to reports of a bowel condition called ischemic colitis, which restricts blood flow to the colon. Some Lotronex users also reported severe complications from constipation.
Zelmac, an experimental drug described as a treatment for women with constipation symptoms of IBS, is expected to be approved by the FDA and launched by its maker Novartis AG by the middle of next year.
But Pimentel said pharmaceutical companies may want to redirect their research efforts to target alternatives for eradicating bacteria in the small intestine.
"Once they see this trial, they will really wonder what they're doing," Pimentel said.
Cedars-Sinai investigators evaluated 202 patients who underwent a specialized breath test to determine the presence of small intestinal bacterial overgrowth, a condition in which bacteria typically found in the colon makes its way up into the small intestine.
"The bacteria produces the bowel symptoms. The fact that we found the overgrowth in almost 80 percent of patients with IBS is quite dramatic," Pimental explained.
He noted that there are several mechanisms designed to prevent the build-up of bacteria in the small intestine, but researchers do not know what goes wrong to allow the bacteria to accumulate.
Participants in the study were treated for 10 days with antibiotics, which eliminated signs of the disease in 25 of the 47 patients who returned for follow-up exams. Treatment with alternative antibiotics has been effective in about 90 percent of patients at the Cedars-Sinai clinic, Pimental said.
Of the 25 study patients in which no small intestine bacteria was detected after treatment with antibiotics, 12 reported no symptoms of IBS and 13 reported significantly reduced symptoms, the researchers said.
"We are concerned about overtreatment with antibiotics and potential resistance to antibiotics. We are currently studying other therapies for eliminating the bacteria, but the results so far are not objective," the Cedars-Sinai doctor said.
The Cedars-Sinai team, which published its study results in the December issue of The American Journal of Gastroenterology, is currently conducting a double-blind study comparing treatment with antibiotics to placebo in IBS patients.
Copyright 2000 Reuters. All rights reserved.
(While it is true about the medications and their problems, the whole truth about the TYPE of bacteria is not conveyed. Yes there is an overgrowth of bacteria that occurs, but they fail to clarify which type. There are GOOD bacteria and there are BAD bacteria. The problem occurs when there is an overgrowth of BAD strains of bacteria. Knowing this, to use antibiotics to kill ALL bacteria in the intestines is NOT a solution. The relief occurred because the bad bacteria is temorarily removed which abates the symptoms. Understand...it is temorary! Once this harmful bacteria regrows again, the symptoms will come back. The key is to remove the BAD and not the GOOD! Once the harmful bacteria OUTPOPULATE the beneficial bacteria....problems occur. Therefore, a common sense equation would be to raise the level of GOOD bacteria to kill the BAD. Probiotics is the answer.....not antibiotics!)
Bacterial overgrowth in the small intestine is a relatively common condition that can be present for years before it is detected. That's because despite overuse of antibiotics, antacids, and other medications that wipe out friendly intestinal bacteria, many physicians don't test their patients for it.
Instead, people with chronic digestive problems such as gas, bloating, diarrhea, and/or constipation are often told they have irritable bowel syndrome (IBS) when the underlying problem is actually small intestine bacterial overgrowth. Given that IBS is the number one gastrointestinal diagnosis, bacterial overgrowth could be greatly underdiagnosed.
For instance, a study by researchers at Cedars-Sinai Medical Center in California examined 202 people who met the diagnostic criteria for irritable bowel syndrome and gave them a test for bacterial overgrowth called the lactulose hydrogen test.
Researchers found that 157 of the 202 people (78%) had bacterial overgrowth. When the unwanted intestinal bacteria were eradicated, symptoms of IBS improved in 48% of the subjects, particularly diarrhea and abdominal pain.
It's not just people with IBS-like symptoms that have bacterial overgrowth. Bacterial overgrowth can also present with non-digestive symptoms such as fatigue. It's believed to be involved in chronic fatigue syndrome, fibromyalgia, allergies, arthritis, lupus, autoimmune diseases, diabetes, and many other chronic conditions.
What is Bacterial Overgrowth?
It's not an overstatement to say that the small intestine is the most important segment of the entire digestive tract, which starts at the mouth and ends at the rectum. Nutrients we eat -- carbohydrates, proteins, fats, vitamins, and minerals -- are absorbed in the small intestine. If anything interferes with the absorption here, nutrient deficiencies can result.
The small intestine normally contains relatively small numbers of bacteria. However, certain factors can cause the growth of excess bacteria.
Through a process called bile acid deconjugation, the unwanted bacteria causes fat malabsorption. It also blocks carbohydrates from being absorbed. Intead, they're left to ferment in the intestines, resulting in gas, bloating, pain, mucus in stools, foul-smelling gas and stools, and diarrhea. Sweets and starchy foods cause the worst symptoms.
Toxic metabolic substances produced by the bacteria injures intestinal cells and impairs absorption, resulting in nutrient deficiencies, food allergies and intolerances, and poorly functioning digestive enzymes.
What Causes Bacterial Overgrowth?
Decreased motility in the small intestine - caused by excess dietary sugar, chronic stress, and conditions such as diabetes, hypothyroidism, and scleroderma. In the United States, up to 40% of chronic diarrhea in people with diabetes is associated with bacterial overgrowth.
Hypochlorhydria - as people get older, the amount of stomach acid they secrete decline. Because stomach acid is acidic and helps to kill bacteria in the small intestine, if there is less stomach acid, bacteria are more likely to proliferate. Another very common cause of hypochlorhydria is due to excessive use of antacids.
Structural abnormalities in the small intestine - gastric bypass surgery, small intestinal diverticula, blind loop, intestinal obstruction, and Crohn's disease fistula are some of the structural causes of bacterial overgrowth.
Other causes include immune deficiency, stress, certain medications such as steroids, antibiotics, and birth control pills, inadequate dietary fiber, and pancreatic enzyme deficiency.
abdominal bloating and gas after meals
chronic loose stools or diarrhea - studies have found 48% to 67% of people with chronic diarrhea had bacterial overgrowth.
soft, foul-smelling stools that stick to the bowl
fatigue - megaloblastic anemia due to vitamin B12 malabsorption
nutritional deficiency despite taking supplements
mucus in stools
bloating worse with carbs, fiber, and sugar
Natural Treatments for Bacterial Overgrowth
It can be difficult to get proper testing and treatment for bacterial overgrowth, because some doctors don't understand this condition. The conventional treatment for bacterial overgrowth is antimicrobial drugs.
There are three parts to the natural treatment of bacterial overgrowth:
1. Diet - Low carbohydrate diet
2. Eradicate unfriendly bacteria in the small intestine using herbs such as peppermint oil.
3. Replace - Bacterial overgrowth impairs friendly bacteria ("probiotics") and digestive enzymes.
The most studied natural treatment for bacterial overgrowth is enteric coated peppermint oil, which is peppermint oil that has an edible, hard shell around it so that the capsule doesn't open until it is in the small intestine. It kills bacteria in the small intestine.
The course of treatment is usually 1 to 6 months. A typical dose of enteric-coated peppermint oil is one to two capsules three times a day, taken in between meals with a glass of water. Side effects can include heartburn, rectal burning, and minty burping.
Other herbal antimicrobials used to treat bacterial overgrowth are:
Grapefruit seed extract - for people who don’t like taking capsules, grapefruit seed extract can be found in liquid form. Add a few drops to a glass of water and drink in between meals.
Oregano oil capsules
Berberine - goldenseal, oregon grape
Olive leaf extract
During treatment, it is necessary to limit intake of sweet and starchy foods. People usually experience a noticeable decline in bloating, gas, indigestion, diarrhea, and other digestive symptoms.
A popular diet for bacterial overgrowth is the specific carbohydrate diet by Elaine Gottschall. This diet limits grains, starchy vegetables, and some legumes, and was created to address digestive disorders such as bacterial overgrowth, Crohn's disease, and ulcerative colitis.
Medium Chain Triglycerides - Unlike regular oils, which a person with bacterial overgrowth may not be able to assimilate, medium chain triglycerides are absorbed directly without the need for digestive enzymes. Medium chain triglycerides are often recommended for people with bacterial overgrowth or any type of malabsorption. Coconut oil is a medium chain triglyceride.
Digestive enzymes - Digestive enzyme supplements can support the body's digestive enzymes until function is restored. They should be taken before meals. A typical dose is one capsule before each meal.
Vitamins and minerals that may be deficient in people with bacterial overgrowth include vitamin B12, magnesium, calcium, iron, zinc, copper, vitamin A, D, E, K.
Probiotics - needed to replace healthy bacteria in the intestines. Lactobacillus plantarum and lactobactillus GG are some types that have been used for bacterial overgrowth.
Getting a Diagnosis
The "gold standard" test is to take bacterial cultures of small intestine fluid.
Lactulose hydrogen breath test - The most common test is the lactulose hydrogen breath test because it is less invasive. Lactulose is a non-absorbable sugar that's fermented if there is intestinal bacteria, resulting in hydrogen production. If there is bacterial overgrowth, fasting hydrogen levels will be high. In addition, after ingesting glucose, there will be a significant rise in hydrogen.
Other tests are the schilling test (for b12 deficiency). A small bowel follow through may be done to look for structural problems.
One of the underlying causes of bacterial overgrowth is insufficient stomach acid, called hypochlorhydria. Stomach acid naturally declines with age. Take the hypochlorhydria screening test.
What Conditions Can Bacterial Overgrowth Lead to?
leaky gut syndrome
vitamin and mineral deficiency
non-alcoholic steatohepatitis (NASH)
chronic fatigue syndrome
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The Specific Carbohydrate Diet (SCD) is a strict grain-free, lactose-free, and sucrose-free dietary regimen intended for those suffering from Crohn's disease, ulcerative colitis, celiac disease, inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).
The Specific Carbohydrate Diet was developed by Dr. Sydney Valentine Haas. Elaine Gottschall helped to popularize the diet, after using it to help her daughter recover from ulcerative colitis. Gottschall continued research on the diet and later wrote her own book, Breaking the Vicious Cycle: Intestinal Health Through Diet.
What is the premise of the Specific Carbohydrate Diet?
Dr. Haas believed that carbohydrates, being forms of sugar, could promote and fuel the growth of bacteria and yeast in the intestines, causing an imbalance and eventual overgrowth of bacteria and yeast. Bacterial overgrowth can impair the enzymes on the intestinal cell surface from functioning and prevent the digestion and absorption of carbohydrates. This would cause the carbohydrates to remain undigested in the intestines and provide even more fuel for bacteria and yeast.
Toxins and acids can be formed by the bacteria and yeast and injure the small intestine lining. Excessive mucus may be produced as a defense mechanism against the irritation caused by toxins, acids, and undigested carbohydrates.
With time, a number of illnesses can develop from this altered digestive balance:
inflammatory bowel disease (IBD)
irritable bowel syndrome (IBS)
The Specific Carbohydrate Diet was designed to correct the imbalance by restricting the carbohydrates available to intestinal bacteria and yeast. Only the carbohydrates that are well absorbed are consumed on the diet, so that intestinal bacteria have nothing to feed on. This helps to correct the bacterial overgrowth and the related mucus and toxin production.
Digestion and absorption of nutrients improves, leading to improved nutritional status. Immune system function improves. The diet is continued until there is a return to health.
Proponents of the diet claim that there is an 80 percent recovery rate for Crohn’s disease and a 95 percent recovery rate for diverticulitis. Improvement can occur after as little as three weeks. Full recovery has been acheved in many cases of diverticulitis, irritable bowel syndrome, and celiac disease after one year.
What are the guidelines of the diet?
Foods to avoid
ALL SOFT DRINKS
Canned fruits, unless they are packed in their own juices
All cereal grains, including flour, potatoes, yams, parsnips, chickpeas, bean sprouts, soybeans, mung beans, fava beans, and seaweed
Processed meats, breaded or canned fish, processed cheeses, smoked or canned meat
Milk or dried milk solids
Buttermilk or scidophilus milk, commercially prepared yogurt and sour cream, soymilk, instant tea or coffee, coffee substitutes, beer
Cornstarch, arrowroot or other starches, chocolate or carob, boullion cubes or instant soup bases, all products made with refined sugar, agar agar, carrageenan or pectin, ketchup, ice cream, molasses, corn or maple syrup, flours made from legumes, baking powder, medication containing sugar, all seeds
Foods to eat
Fresh and frozen vegetables and legumes
Fresh, raw, or dried fruits
Fresh or frozen meats, poultry, fish, eggs
Natural cheeses, homemade yogurt, dry curd cottage cheese
See the Specific Carbohydrate Diet website for recipes and information.