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Doctors label IBS sufferers neurotic

Gut hunches

Doctors label IBS sufferers neurotic. But nutritional medicine has known for years that bowel problems are not all in the head.If you suffer from a general range of bowel problems that don't fall under any neat category, your doctor is more than likely to pack you off to a psychiatrist. Until recently, this problem has been tagged by orthodox medicine a "psychosomatic disorder". Indeed, some medical literature is downright scornful of the syndrome, judging from an article in a recent issue of The Lancet (2 January 1992), intended as a spoof and featuring a fictitious hapless neurotic down on his luck, who is meant to typify your average irritable bowel syndrome patient.

If this problem is psychosomatic, a term used when medicine hasn't a clue about a particular condition, then a very great number of lunatics are on the loose. Nearly a quarter of all questionnaire respondents in Southampton, thought to be fairly representative of the general population, complained of symptoms consistent with a diagnosis of IBS. Nutritionist Kathryn Marsden argues what naturopaths have known for years: that IBS usually has a physiological cause.

In most cases, irritable bowel syndrome is a cop out classification for a number of irksome conditions with similar symptoms which (medically at least) seem difficult to diagnose and impossible to treat. Your IBS might just as easily be called spastic colon, mucous colitis or non inflammatory bowel disease. They all mean much the same thing. And although many nutritionally ignorant doctors are unable to agree on the cause of IBS, most naturopaths have had a handle on it for years.

A number of conditions have similar symptoms to IBS and can be mistaken for it. These include coeliac disease, diverticulitis, intestinal candidiasis, laxative abuse, lactose intolerance, infestation with intestinal parasites, such as giardiasis, amoebiasis or blastocystis hominis, fecal impaction, Crohn's disease, ulcerative colitis, disturbed intestinal microflora, due to hormone, antibiotic or antacid usage, or even metabolic disorders such as diabetes mellitus.

The symptoms and their severity vary considerably from person to person, but can include: abdominal pain, bloating, flatulence, fatigue, mucousy stools, foul odour, bleeding, anal soreness, weight fluctuations, back pain, headache, intermittent bouts of constipation and diarrhoea, teeth grinding and jaw clenching, anxiety and depression. In some people, abdominal pain may be eased after a bowel movement, but the feeling of incomplete evacuation may remain.

True IBS is most usually caused and/or aggravated by several physiological factors. Food intolerance is high on the list (the worst offenders being wheat, sugar, yeast, milk, beef, pork, corn, coffee or orange juice), followed by neurological problems (please note, neurological, not neurotic!). Poor diet and nutritional deficiencies are also common. Hyperventilation, hypochlorhydria (low levels of stomach acid), achlorhydria (no acid at all), digestive enzyme insufficiency, antibiotic and steroid drugs, infestation with intestinal parasites and, of course, excessive stress in isolation or combination may all inflict further anguish.

While stress is often a significant factor in IBS sufferers, the problem with their inner workings is rarely only "all in the mind". Where it occurs, the most common psychological factor is that of relationship conflicts and/or an inability or reluctance to "cut the umbilical cord". Patients whose IBS has been triggered by parent problems complain of feeling "suffocated", "trapped", "possessive" or "possessed" (by another person). In such cases, psychotherapy, relaxation therapy and healing, in conjunction with nutritional treatment, can nearly always solve the problem.

The usual medical solution to IBS is to prescribe an antispasmodic, such as peppermint oil (Mintec, Colpermin), mebeverine or alverine. These drugs are supposed to work by relaxing the muscles of the intestine, but in many cases, only aggravate the problem.

Peppermint oil, for instance, can cause heartburn and local irritation, and also should not be administered to patients who suffer from ulcerative colitis. If a patient hasn't been correctly diagnosed, the drug can wreak havoc with his already delicate system.

Another category of drugs thrown at the problem is the anticholinergics, which block the effects of parasympathetic nerves controlling the rhythmic waves of contractions in the intestines. Again, they can cause problems with patients with ulcerative colitis.

Anti diarrhoea drugs like Imodium (loperamide) can depress your breathing severely if taken in overdose, and can cause coma, brain damage and even death. They can also cause confusion, delirium, disorientation, impaired attention, constipation, problems in urinating, sexual dysfunction and blurred vision or glaucoma. Again they can worsen an inflamed colon. Imodium is an opioid and so shouldn't be taken for prolonged periods.

Then there are drugs like Gaviscon, a combination of aluminium hydroxide and magnesium trisilicate (which act synergistically to help both diarrhoea and constipation) used to temporarily relieve heartburn. If taken over time, this drug can cause kidney stones, irregular heartbeat, mental changes, difficult or painful urination, swelling of the extremities, muscle weakness, bone pain, nausea, stomach cramps, diarrhoea in short, some of the problems you're trying to resolve in the first place.

Carol is a typical IBS victim of medical mayhem. When she went to her GP complaining of watery stools and conspitation, he told her, as most do, to eat more fibre. When she did so, her symptoms worsened to the point where she was passing blood.

Her GP then prescribed Colpermin. However, the peppermint oil burned her stomach and caused so much indigestion that she returned to her doctor, who this time offered mebeverine. When that also didn't do the trick, he prescribed Gaviscon, a reflex suppressant, which is supposed to soothe the gut, but only made her more ill.

It was at that point that I first saw her. I took her off wheat and milk and suggested she return to her GP and ask to be taken off the drug.

When she finally mentioned her itchy nose and anus and very red blood in her stools, I was able to isolate the probable culprit: an intestinal parasite. I recommended that she take Biocidin and Biodophilus(see box, p 3). She again returned to her GP and told him what I'd said. He gave her a drug for the parasites in the form of Pripsen, a four sachet course of strawberry tasting powder usually given to children. For six weeks it made her feel better, after which all her symptoms returned.

She then agreed to continue with the course we'd outlined, and after two months all her symptoms disappeared. Nevertheless, when she reported the success of this approach to her GP, he managed to persuade her that the naturopathic approach was a waste of time.

When doctors do take IBS seriously, they invariably tell their patients to eat more bran which usually means coarse wheat bran. I question whether or not IBS was so prevalent before the advent of string and sawdust breakfast cereals. I see many patients who are puzzled by their condition because they eat lots and lots of fibre. Careful questioning all too often reveals an almost paranoiac tendency for "wheat with everything". Bran cereal (drowned in cows' milk another IBS agent) to start the day, biscuits (made from wheat, of course) for elevenses, sandwiches for lunch (bread wheat), cakes or sticky buns for tea. On top of all that, wheat flour can be found in gravies, soups, sauces, pastry, pies and a veritable multitude of processed, packeted and tinned foods. Many of these items also contain yeast and/or sugar, which only exacerbates the irritation, causes more gas and bloating, and gobbles up nutrients.

Although lack of dietary fibre is often blamed for IBS symptoms, the wrong kind of fibre is a much more likely culprit. Wheat is rough, coarse and irritating. One reason for its effectiveness as a bowel mover may be because it irritates the gut so much, the body can't wait to get rid of it, and in doing so, passes out waste products as well.

Although everyone knows that fibre is good for them, not many people understand why it is needed or how many different kinds there are. Indeed, high fibre food often appears extremely unfibrous. Depending upon size, a banana, for example, can contain from 4g to 6g of fibre (one third of the officially recommended minimum daily intake). Avocado pear, creamy as it is, nevertheless contains worthwhile amounts, and a kiwi fruit has four times the fibre of a stick of celery.

Fibre works by bulking the stool and giving the bowel muscles something to push against. Transit time is hastened and waste products don't get a chance to hang around and toxify the system.

Once the IBS sufferer moves away from copious quantities of bran and towards more fruit and vegetables, oats, brown rice, linseeds and pulses, his condition is likely to improve almost immediately. Where symptoms are particularly severe, fibre supplements such as Fibrina or those which contain psyllium husks (available from chemists and health food stores) are recommended.

Laxatives are the last thing anyone with an irritable bowel should take. Whether bulking agents, fecal softeners, osmotics, lubricants or stimulants, bought by prescription or over the counter, laxatives treat only the symptom of constipation and do nothing for the cause. In many cases, they make matters much worse by encouraging bowel laziness.

An increase in fibre demands an increase in fluid. IBS can be helped considerably if tea, coffee and cola are replaced by filtered water, herbal teas and dandelion coffee.

Twelve hours is considered by most nutritional practitioners to be a healthy transit time of food from mouth to anus. Unfortunately, our western diet and stressful lifestyle generally extends this to 24, 48, 72 or more hours. Partially decomposed and putrefying food waste lying around in an already irascible intestine will serve only to make it even more irate.

However, although more fluid and more fibre can certainly help, it is also important to respect your bowel's individual behaviour pattern and to understand its needs. Many people think that they have IBS just because they open their bowels two or three times a day instead of the accepted norm of once. It is always likely that a second or third motion is going to be softer or looser than the first, but this does not necessarily mean that your bowel is in IBS mode. Given the transit time already discussed, more than one passing per day is actually very healthy. It's only when your bowel habit becomes abnormal for you and your visits to the loo either increase or decrease significantly that you should be alerted to a possible problem.

Although bleeding is a common occurrence in IBS, it is always wise to ask for a medical examination. Very red blood is indicative of blood loss nearer to the rectum as a result of colitis, anal fissures or haemorrhoids. Bleeding farther up the tube, in the stomach for example, will darken the stools. Jet black and tarry wastes may signal a more serious disorder and should be investigated at once.

Overactivity of the nerves which control bowel function is another problem in IBS which may be inherited or brought on by long term nutrient deficiency and aggravated by stress. Whatever the reason, patients frequently misunderstand the messages which their gut tries to send them. It is a common misconception that any rush for the loo which occurs immediately after a meal involves the passing of the food just eaten. Not so. As the stomach fills up, messages are transmitted to the pelvic floor which relax the bowel and encourage it to empty, so that it will be able to accommodate the meal you are just beginning to eat. Where the messages are mixed up, bowel emptying may be more frequent than is necessary or not frequent enough.

It is useful for anyone with any kind of bowel or digestive disorder to learn to respond to their gut intelligence. For example, the need to open the bowels first thing in the morning is frequently ignored.


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