By Arden Moore
You beg off lunch dates. Say "no thanks" to weekend camping trips. Politely, reluctantly, decline invitations to go to the movies or a baseball game. All because you have a secret that's too embarrassing to tell even your best friend. And you don't want to explain why you keep excusing yourself to search for the nearest restroom. The reason? You have the nasty, chronic gastrointestinal disorder known as irritable bowel syndrome (IBS).
You're not alone. Nearly one out of every five Americans—about 50 million people—has IBS. It can cause any, or all, of the following symptoms, which vary in severity: abdominal cramps, diarrhea, bloating, gas, and, perversely, even constipation. For unknown reasons, IBS affects women more often than men.
Mark Stengler, ND, in private practice at Personal Physicians, an integrated medical practice in San Diego, became a naturopathic physician partly to find solutions to his own severe abdominal cramps, bloating, and gas symptoms. Dr. Stengler, author of The Natural Physician (Alive Books, 1997), joins a growing legion of people with IBS who are stepping forward to bring attention to this disorder that was once too taboo to discuss publicly.
Is it IBS?
Diagnosing IBS can be tricky and physicians aren't sure what causes it. Your doctor will typically identify IBS using blood test, x-rays, barium enemas, endoscopes, and other diagnostic tools to first rule out what it isn't. "IBS isn't a disorder that you can see, feel, or touch—such as ulcers, gallbladder disease, colon polyps, or colon cancer," says Neil W. Hirschenbein, MD, gastroenterologist and medical director of Personal Physicians.
Leading medical experts are convinced that there is a powerful connection between the mind and the gut, which "talk" to one another through nerve transmissions between the brain and the nerves lining the walls of the intestines. One theory is that people with IBS have sensitive gastrointestinal tracts that can be activated—painfully so—by certain triggers, including stress, caffeine, hormones, and some foods and medications.
"I hold to the theory that stress affects the weakest part of the body," says Dr. Hirschenbein. "When people who have IBS are under stress, it seems to set their symptoms off. When other people are under stress, they may complain of headaches, backaches, or chest pains—wherever their individual weak spots are."
In a recent study, Lin Chang, MD, assistant professor of medicine and codirector of the UCLA/CURE Neuroenteric Disease Program, tested patients with IBS by inflating balloons in their intestines. She measured pain sensitivity levels and the amount of tension in the muscles of the intestines before and after the balloon treatment.
Interestingly, she discovered altered responses by both the brain and the gut to balloon inflation in the intestines. The brain responses were measured using an imaging technique called positron emission tomography, or PET. "In IBS patients, the brain responds to stresses or stimuli in the gut differently than in healthy individuals, confirming that there is a definite brain/gut connection with IBS," says Dr. Chang.
In another study at the University of Washington in Seattle, researchers in the department of biobehavioral nursing and health systems found that psychological distress was a key factor in at least 40% of the women with IBS who were tested. Continued below..
Let Your Mind Ease the Pain in Your Gut
What happens in your head can have an impact on what's happening in your belly and below. "Your brain sends signals to your digestive system and influences activity there," says Michael Gershon, MD, author of The Second Brain (HarperCollins, 1998) and chairman of anatomy and cell biology at Columbia University College of Physicians and Surgeons in New York City.
And the reverse is true too—any distress that you feel in your bowel can also cause mental distress.
Along with mind/body techniques such as hypnosis, yoga, massage, and exercise, you may want to try cognitive therapy to get at your gut through your mind.
"When you have unpredictable, disruptive pain, as do many people with IBS, you can be overwhelmed by a profound sense of vulnerability," says Douglas A. Drossman, MD, gastroenterologist, psychiatrist, and associate professor of medicine and psychiatry in the division of digestive diseases at the University of North Carolina School of Medicine in Chapel Hill.
Cognitive therapy, he says, allows you to focus on your IBS symptoms and gain control over them.
This form of "talk" therapy helps you change how you view and react to your problems. Your therapist may ask you to keep a diary of your symptoms and how they make you feel.
During sessions, your therapist will examine your thoughts and feelings and help you reframe your ineffectual responses. Studies show that a 12-week program can be very effective in helping you feel better.
Promising New Prescriptions
While there is no cure for IBS, there are some promising treatments. Two new drugs may ease IBS better than currently available medications. In a study of 800 IBS patients, those who took tegaserod daily for 12 weeks reported 20% less abdominal pain and 25% less chronic constipation.
Meanwhile, a study of more than 600 people with IBS found that taking alosetron daily for 12 weeks reduced IBS-related abdominal pain and discomfort by 15 to 20%, urgency by 20%, and diarrhea by 20%. FDA approval for tegaserod is expected sometime in late 2000.
With research pointing strongly to a mind/gut connection, more physicians are adopting medical approaches that combine alternative and conventional treatments, theorizing that an integrative approach may hold the best hope for easing IBS symptoms. While each person's needs will vary, experts recommend these natural remedies to tame IBS complaints:
Fight stress with relaxation techniques. Consider deep breathing or meditation. Or try hypnosis, which has been shown to be very effective in reducing abdominal pain.
Avoid foods and substances that can irritate the digestive tract. Topping the list: caffeine, alcohol, tobacco, and refined sugars.
Reduce your intake of fatty and fried foods. They are more difficult to break down, causing more gas and indigestion. Watch out for french fries, hamburgers, cheese, and butter.
Battle your spastic colon with cramp bark, chamomile, or valerian. All three herbs relax the muscle cramps that are at the root of the alternating bouts of constipation and diarrhea, says Douglas Schar, DipPhyt, MCPP, a medical herbalist practicing in London and Washington, DC.
Valerian is especially useful when the condition is stress related; it seems to block the transmission of stressful nerve impulses to the bowel.
Choose soluble-fiber supplements over bran. Some IBS sufferers who eat bran and other insoluble fiber-rich foods experience a worsening of their symptoms.
In fact, in a study conducted by researchers at the University Hospital of South Manchester in England, more than half of the people questioned about their response to various high-fiber foods said that bran didn't agree with them. If you're one of them, switch to a soluble-fiber supplement such as psyllium.