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digestive system
Irritable bowel syndrome
Integrative Therapies

Home Care

This program will provide information on inflammatory bowel disease, ulcerative colitis, and irritable bowel syndrome. To differentiate between these, see a physician. Crohn's disease and ulcerative colitis are characterized by recurrent inflammation of the intestines.

In both cases, there may be fever, weight loss, mild abdominal tenderness, inflammation, and bloody stools. These symptoms are due to inflammatory changes in the intestinal walls.


THE FOLLOWING SUPPLEMENTS CAN BE TAKEN UNTIL SYMPTOMS IMPROVE:

1. Vitamins A and D - 50,000 Units per day of vitamin A. Pregnant women or women who may become pregnant should not take more than 10,000 Units of vitamin A per day.

2. Zinc – 50 milligrams 2 times per day.

3. Magnesium – 300 milligrams, 3 times a day.

4. Multi-vitamin and mineral supplement – according to the manufacturer's recommendation. Make sure the supplement is hypoallergic and does not contain any sugar, dairy products, corn, yeast, or artificial ingredients.

All of these supplements are better taken in a liquid form for better absorption.

5. Fish oils – 1 caplet per meal. These oils have anti-inflammatory properties.

People with colitis, inflammatory bowel disease, and irritable bowel syndrome are often deficient in certain nutrients because they cannot absorb them properly.


REGARDING THE PROPER DIET FOR BOWEL DISORDERS:

1. An important consideration is food allergies. Certain foods seem more likely to cause colitis, inflammatory bowel disease, or irritable bowel syndrome. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible for the problem. The main problem foods are dairy products (including milk, cheese, ice cream), eggs, wheat, corn, oranges, and sugar.

After eliminating all of those allergic foods from the diet, and the symptoms have gone away, 1 food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. If you need more information, refer to article program on food allergies.

Carageenan is a food stabilizer that is added to many processed foods and dairy products. Since it may worsen colitis, try to avoid it.

2. Consider fasting on juices for 2 or 3 days. The juices of choice are apple, carrot, beet, and spinach juices. Herbal teas such as Chamomile and Slippery Elm tea may also be used. Fasting should be done under a doctor's supervision. Pregnant women should not fast. Break the juice fast with a grated apple, and later in the day, eat some well-cooked brown rice.

For the next few days eat the following foods: steamed yellow vegetables such as carrots, squash, sweet potatoes, parsnips, and pumpkin; apples, both raw or cooked; bananas, avocados, and juices. Also include well-cooked brown rice.

If after a few days on this diet your symptoms have improved, you may try adding fish and salads. Soy products may be also added if you are not allergic to them.

It is recommended to stay off meat and poultry for several months, and it is especially important to eliminate any fried foods from your diet. Replenishing healthy bacteria, such as Acidiophilus and Bifidus, in the intestines can often stabilize the digestion and reverse the process called "leaky gut syndrome" in which the digestive lining becomes damaged and inflamed. You may also benefit from bulk-forming laxatives such as psyllium seed husks.


HERBS USED FOR BOWEL DISORDERS:

1. Slippery Elm powder – Steep 1/4 to 1/2 teaspoon in 1 cup of boiling water. Cool and drink at least 4 cups per day.

2. Golden Seal – 2 capsules 3 times per day.

3. Licorice, as a solid extract – 1/4 teaspoon, 2 times per day or drink it as a tea. Mix 1 teaspoon in 1 cup of boiling water. Simmer 5 minutes. Steep 15 minutes. Drink 4 to 6 cups per day. If you have high blood pressure licorice root may raise your blood pressure. Make sure that you get licorice that has been deglycyrrhizinated, often called "DGL".

4. Peppermint oil – 2 to 3 drops in a cup of hot water with meals.

5. Robert's Formula is an excellent herbal preparation that contains most of the previously mentioned herbs and additional useful ones – 2 capsules, 3 to 4 times per day.


HOMEOPATHY:

From the following homeopathic medicines, choose the one that best matches your symptoms. Dissolve 3 pellets under the tongue.

• Mag phos 12C: For cramping pains in the abdomen that are relieved by rubbing or warmth and also associated with bloating and passing gas. Take 3 times per day.

• Thuja 12C: For chronic diarrhea with a sensation of something running around in the abdomen. Take 2 times per day.

Note: A wide range of homeopathic medicines can be helpful for individuals with colitis and irritable bowel syndrome. Consultation with a physician trained in homeopathic prescribing will usually be the best way to select the correct medicine.


AS AN ADDITIONAL MEASURE:

Apply cold packs to the abdominal area. Apply an ice pack wrapped in a towel – 3 minutes on, 3 minutes off for 3 consecutive times. Do this twice a day.


REGARDING STRESS REDUCTION:

Stress Reduction is essential. You may not be able to eliminate stressful situations in your life (such as a busy schedule or a stressful relationship), but you can learn to cope better with the stress. Some useful guidelines are:

1. Regular Physical Exercise – at least 30 minutes, 3 times per week.

2. Mental relaxation exercise – 20 minutes once a day. Relaxation tapes can be purchased at one of your local bookstores. Yoga, practiced on regular basis, can serve the same purpose.

3. Deep breathing exercises – Most of us tend to hold our breath or breath shallow breaths during stressful situations. This can cut down the amount of oxygen delivered to the body. Take a few 1 minute intervals of breathing and relaxation during the day. At these times, pay special attention to relaxing your shoulder muscles and breathing deeply.

4. Hypnosis can be helpful in releasing the underlying patterns of stress and reaction that contribute to inflammation and spasm.

You may also find counselling a big help in dealing with stress management.


Clinic


Footnotes

BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.

Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115-1117.

Alun Jones V, Shorthouse M, Workman E, Hunter JO. Food intolerance and the irritable bowel. Lancet 1983; ii:633-34. (Letter)

Arffmann S, Andersen JR, Hegnhoj J, et al. The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study. Scand J Gastroenterol 1985;20:295-298.

Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet 1983;ii:295-297.

Bohmer CJ, Tuynman HA. The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol 1996;8:1013-1016.

Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In: Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990, 421-426.

Dancey CP, Taghavi M, Fox RJ. The relationship between daily stress and symptoms of irritable bowel: a time-series approach. J Psychosom Res 1998;44:537-545.

Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: A multi-center trial. Br J Clin Pract 1984;38:394-398.

Farah DA, Calder I, Benson L, Mackenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985;26:164-168.

Fernandez-Banares F, Esteve-Pardo M, de Leon R, et al. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993;88:2044-2050.

Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344:39-40.

Francis CY, Houghton LA. Use of hypnotherapy in gastrointestinal disorders. Eur J Gastroenterol Hepatol. 1996 Jun;8(6):525-529. (Review)
Abstract: Medical history is full of anecdotal reports on the use of hypnosis in the treatment of gastrointestinal and other disorders. Unfortunately, much of the work published to date consists mainly of short case reports or involves small numbers of patients. They have, however, all broadly given the same message: that patients symptoms improve and they cope better with their condition after hypnotherapy. More recently, controlled trials have shown that patients with severe refractory irritable bowel syndrome or relapsing duodenal ulcer disease respond well to hypnotherapy. This article aims to give an overview of the areas in gastroenterology where hypnotherapy has been applied, discussing in particular what progress has been made in the area of irritable bowel syndrome.

Guthrie E, Creed F, Dawson D, Tomenson B. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br J Psychiatry. 1993 Sep;163:315-321.
Abstract: Patients with chronic, refractory irritable bowel syndrome (n = 102) were entered into a randomised controlled trial of psychotherapy versus supportive listening. Independent physical and psychological assessments were carried out at the beginning and end of the 12-week trial. For women, psychotherapy was found to be superior to supportive listening, in terms of an improvement in both physical and psychological symptoms. There was a similar trend for men, but this did not reach significance. Following completion of the trial, patients in the control group were offered psychotherapy; 33 accepted and following treatment experienced a marked improvement in their symptoms; ten declined. At follow-up one year later, those patients who had received psychotherapy remained well, patients who had dropped out of the trial were unwell with severe symptoms, and most of the controls who declined psychotherapy had relapsed. This study shows that psychotherapy is feasible and effective in the majority of irritable bowel syndrome patients with chronic symptoms unresponsive to medical treatment.

Guthrie E, Creed F, Dawson D, Tomenson BG. AA controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991 Feb;100(2):450-457.
Abstract: One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy, relaxation, and standard medical treatment compared with standard medical treatment alone. Patients were only selected if their symptoms had not improved with standard medical treatment over the previous 6 months. At 3 months, the treatment group showed significantly greater improvement than the controls on both gastroenterologists' and patients' ratings of diarrhea and abdominal pain, but constipation changed little. Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress, whereas those with constant abdominal pain were helped little by this treatment. This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to standard medical treatment.

Harvey RF, Hinton RA, Gunary RM, Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989 Feb 25;1(8635):424-426.
Abstract: 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.

Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645-651.

Houghton LA. Sensory dysfunction and the irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol. 1999 Oct;13(3):415-427.
Abstract: Dysfunction of the sensory system of the gut is now generally believed to be important in the pathophysiology of irritable bowel syndrome (IBS). This disturbance may well account for some of the symptoms of the disorder, such as abdominal pain, by virtue of the fact that intra-lumenal events (e.g. contractions) may be 'sensed' more easily. It can be assessed in the laboratory by a variety of techniques, but usually involves measuring the patient's response to distension of any site of the gut, most commonly the rectum. Hypersensitivity is the most frequent finding, but hyposensitivity can also occur--hypersensitivity does not appear to be specific to any particular pattern of bowel habit, but hyposensitivity does tend to be generally only seen in patients with constipation, especially those with the 'no urge' type. Although there is some evidence to support hypersensitivity being related to enhanced vigilance in some patients, other data suggest that there may be a true alteration in sensory processing. The mechanisms underlying this sensory dysfunction remain to be elucidated, but could involve changes in either the enteric, spinal and/or central nervous systems. Finally, factors such as gender, stress, emotion and infection can all influence the sensitivity of the gut and may therefore play a role in IBS.

Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome - the effect of hypnotherapy. Aliment Pharmacol Ther 1996 Feb;10(1):91-95.
Abstract: AIMS: The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features. METHODS: A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25-55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21-58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life. RESULTS: Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02), bowel habit (P < 0.0001), nausea (P < 0.05), flatulence (P < 0.05), urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P = 0.05) and dyspareunia (P = 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner ( 58% vs. 21%; P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group. CONCLUSION: This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long-term investment.

Jalihal A, Kurian G. Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol 1990;5:507-513.

King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352:1187-1189.

Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm during endoscopy. Lancet 1982;ii:989. (Letter)

Liu J-H, Chen G-H, Yeh H-Z, et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997;32:765-768.

Manning AP, Heaton KW, Harvey RF, Uglow P. Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417-418.

May B Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint/caraway oil combination in non-ulcer dyspepsia. Arzneim Forsch Drug Res 1996;46:1149-1153.

McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol 1987;9:526-528.

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Paganelli R, Fagiolo U, Cancian M, et al. Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration. Ann Allergy 1990;64:377-380.

Parker TJ, Naylor SJ, Riordan AM, Hunter JO. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Human Nutr Diet 1995;8:159-166.

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