The case of the irritable bowel
Holistic approach to IBS: Dietary changes, supplements, herbs, and lifestyle adjustments bring relief and improved well-being.
A worried 43-year-old woman came to the clinic with a long history of recurring digestive problems. She had a stressful job, being the CEO of a medium-sized company as well as managing a household of three teenage children, compounded by ageing parents. The symptoms became worse with increased stress.
This woman’s symptoms were often debilitating, with her suffering abdominal pain and cramping with excessive wind and bloating — she stated she was so bloated that she looked pregnant in the evenings. She was also experiencing indigestion and heartburn after eating, her bowel habits alternated between constipation and diarrhoea and she often noticed mucous in her stools, a common sign of gut inflammation.
Apart from her gut symptoms she was chronically tired (her sleep patterns could have been improved) and she was losing weight and didn’t know why. She was also experiencing alternating bouts of anxiety and depression that could last for days.
Her local GP had referred her for blood testing and an endoscopy and colonoscopy, none of which had shown any major abnormalities, thus excluding any major pathology. Her doctor had therefore concluded that she had IBS (irritable bowel syndrome) and had recommended anti-anxiety medication.
Medically, IBS is considered a diagnosis of exclusion— if there are no pathologies discovered during testing, then IBS is often the diagnosis. It is not unusual as one in five Australians are diagnosed with this condition.
While IBS may be a diagnosis of exclusion medically, there are specific dietary and lifestyle causes that are known to contribute to the symptoms. Microbiome testing also indicates abnormal gut bacteria, an imbalance that needs to be corrected.
From a health perspective, her eating patterns were irregular and she was working hard, often forgetting to eat then grabbing whatever was available easily. She usually missed breakfast apart from a coffee to get her going, then ate a salami and cheese sandwich about 10.30am, and she drank several strong coffees with one sugar per day to help her stay awake. In the afternoons she would eat an apple with a coffee to keep her going. Missing lunch, she ate dinner at night with the family, and this was frequently pasta with a bolognaise sauce of beef, chilli, garlic, onions and tomatoes. On two meat-free nights per week her meals were based on legumes or mushrooms, a current favourite. Her husband cooked the nightly meal. She usually enjoyed a couple of glasses of wine with her meals, as she found this helped her to relax. She also drank very little water, using coffee and wine as her main fluid intake.
A food pattern that frequently exacerbates IBS symptoms is a high-FODMAP diet: FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, the chemical names for five naturally occurring sugars that are not well absorbed by the small intestine. Assessing her eating habits, she had a high proportion of these foods in her diet, the main ones being garlic, onions, mushrooms, apples, asparagus, processed meats, legumes, wheat and dairy foods. IBS is also known to be triggered by coffee, stress, high-fat foods and alcohol.
She was going to have to make some major changes.
Treatment
While I suggested she remove these high-FODMAP foods from her diet for a time, I recommended lower-FODMAP foods as alternatives: a wider range of vegetables and fruits, oats, corn and rice are usually safe. Most fresh meats, chicken, fish and eggs are good sources of protein. I suggested she download a copy of the low-FODMAP food charts, of which there are many on the internet. Low-FODMAP diets are initially only recommended for four to six weeks to reduce the symptoms, help with the healing and to give the person time to assess which foods are the major problems, as not all of them are always an issue.
There was also the problem of low nutrient density and potential hypoglycaemia. With the chronic severe digestive problems she has, her nutrient levels were already low, so we instigated a supplement regime, despite her initial resistance to taking anything. Initially I recommended zinc, magnesium, vitamins D3 and K2, vitamin C and a formula of activated B vitamins, along with methylation factors of extra B12, folate and B6 to support her liver.
Peppermint tea is an excellent alternative to coffee and research supports its use in relieving symptoms of IBS. I suggested increasing filtered water intake and reducing alcohol consumption. I also recommended a proprietary herbal formula that contains peppermint, lemon balm, liquorice root, camomile, milk thistle, celandine, angelica and caraway seed, and she found this helped reduce the symptoms.
As probiotics and prebiotics are needed to improve the gut microbiome, I suggested an organic coconut kefir in small doses or a lactose-free yoghurt daily with a teaspoon of slippery elm powder added.
Along with the dietary recommendations, I encouraged her to eat more regularly to manage her blood sugar, to start an exercise program, learn stress management or relaxation techniques and to get into the habit of doing these on a daily basis. She started these slowly and gradually built up over time as the benefits became clear.
Overall, while this change was difficult initially, over a few weeks her symptoms improved and she became more enthusiastic about the program, and now, several months later her energy has improved and she has become almost symptom-free, except for days when she breaks her diet. However, she now knows which are the major triggers for her, giving her more control over the situation, and knowing this has reduced her symptoms of anxiety significantly as well.
