Irritable Bowel Syndrome: Identifying the Cause
IRRITABLE BOWEL
Howard F. Loomis
Jr., DC
My recent articles have focused on treatable symptom patterns that are not considered diseases. A disease is a pathological process that can be identified with objective evidence. It may be seen on an MRI or X-ray, heard
through a stethoscope, identified with an EKG, or perhaps be suspected by palpating a breast lump or enlarged prostate gland. A disorder is a normal physiological process that is going too fast, too slow, or otherwise out of time with another normal body process.
IBS Definition
Look in a medical dictionary and you will see that irritable bowel syndrome (IBS) is a disorder that affects the colon and large intestine. The term IBS is used when there are no apparent changes hi bowel tissue or increased risk of colorectal cancer. This differentiates the disorder from ulcerative colitis and Crohn’s disease, which are considered forms of inflammatory bowel disease.
IBS Symptoms
Patients may present with bloating, gas, abdominal pain and cramping, and either constipation or diarrhea, but the combination of symptoms is unique to the individual. They often resemble those of other diseases and may include mucus in the stool or alternating bouts of constipation and diarrhea.
IBS is a chronic condition for many sufferers, although there are times when the symptoms are worse and times when they may improve or even disappear completely.
Only a small number of people with irritable bowel syndrome have severe symptoms. Most patients can control their symptoms with professional help by modifying their diet and improving digestion.
Demographics
One in five American adults has symptoms of irritable bowel syndrome, but fewer than 20% of those who have symptoms seek professional help. This makes it very important to review prescription and over-the-counter medications as well as the patient’s symptoms when taking a case history.
It is not uncommon for any patient to have occasional symptoms of irritable bowel syndrome, but patients are more prone to have IBS if they are under 45 years of age and female because women are twice as likely to suffer from IBS as men. A family history of IBS may also increase the likelihood of having it as well. There may be an inherited genetic weakness predisposing patients to digestive inadequacies and food sensitivity. This is
another very good reason for reviewing family history.
Physical Examination
Regardless of chief complaint, a careful abdominal palpation can reveal involuntary muscle contractions related to symptoms of IBS. When found in the lower abdomen, you will also find involuntary muscle contractions in the lumbar spine (L1-L3), which correspond to the sympathetic innervation to the colon. Parasympathetic involvement can involve muscle contractions attaching to the sacrum (S2-S4) as well as the upper cervical spine related to the vagus nerve, which innervates the ascending colon and part of the transverse colon.
Dietary Causes of IBS
Studies have failed to identify an exact cause of irritable bowel syndrome, but, no doubt, a variety of factors play a role. The walls of the intestines are lined with layers of muscle that normally contract and relax in a coordinated rhythm because they move food from the stomach through the intestinal tract.
When the contractions are stronger and last longer than normal, causing gas, bloating, and diarrhea, the cause is very often food sensitivity to lactose or gluten. Sensitivity to genetically modified foods also is becoming more common.
However, the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools. Oddly enough, this can occur with excessive white sugar or flour ingestion, which results in constipation. This also can occur with ingestion of canned fruits, carbonated beverages, and alcohol.
But don’t rule out low stomach acid and biliary dysfunction caused by ingesting fried foods, pork, cucumbers, cabbage, onions, and radishes. Biliary dysfunction is frequently the root cause of constipation.
Other Causes of IBS
Most people with IBS find that their symptoms are worse during periods of increased emotional stress, but while stress may aggravate symptoms, it doesn’t cause them. Instead, it is during these periods that dietary overindulgences occur.
Since women are twice as likely to have IBS, it’s suggested that hormonal changes may play a role in this condition. Many women find that their IBS is worse during or around their periods.
Pharmaceutical Treatment of IBS with Constipation
I think you are going to find this very interesting. Synthetic drugs have been developed to activate receptor sites in the intestinal mucosa and simulate the normal body response to heat-stable enterotoxins produced by pathogens such as Escherichia coli. A similar response occurs with excessive lactose or gluten ingestion. The response is always, gas, bloating, and diarrhea.
The new synthetic drags are referred to as “agonists” since they bind to a receptor and activate it to produce a biological response. In this case, the receptor-targeted site is the guanylyl cyclase C receptor (GCC). This is a key receptor for heat-stable enterotoxins that are responsible for acute secretory diarrhea. **
These agonists bind to GCC at intestinal epithelial surfaces and activate the receptor’s intracellular catalytic function, which is to increase fluid secretion into the bowel and GI motility and reduce visceral hypersensitivity.
This approach may sound quite reasonable until you consider the side effects of the new pharmaceutical approach. Please remember before I list the side effects of a new drug Linzess® that prescription drugs are necessary for the treatment of disease where they block a human enzyme system or fill specific receptor sites. That is why they have side effects. They cannot restore normal body function.
The most common side effects of Linzess® (linaclotide) are:
• Gas and stomach distention
• Stomach pain
• Diarrhea, with the suggestion to stop the medication with the onset of severe diarrhea—dehydration being a possibility.
www. theamericanchiropractor. com
Other important side effects include:
• Headache
• Fatigue
• Respiratory infections
• Sinusitis
• Stomach or intestinal viral infections
Now compare those symptoms with the areas of involuntary muscle contraction I mentioned earlier—LI to L3, sacrum, and upper cervical.
Are You Looking for Ways to Help More Patients?
Have you ever noticed that normal digestion is taken for granted? In other words, if you ingest, the body will use it. It is seldom considered whether the patient can adequately digest the dietary choices they are making. There are no commonly used tests to determine if the patient’s digestive weakness is carbohydrate (including fiber and sugars), protein, or lipids.
All patients should not be considered on a statistical average curve. Instead, they should be considered as unique individuals with a proper examination to determine which diet would be best for them. History-taking methods should be used to identify possible weak areas. Medications, past surgery, and family history can be very useful in identifying areas that need support.
When normal digestion does not happen, its consequences and restoration are ignored. It is common to cover up the symptoms of poor digestion with antacids, products to relieve the discomfort of abdominal gas, laxatives, and products that relieve diarrhea. Little attention is paid to the prevention of these occurrences.
Dietary selections and their digestion are critical for maintaining normal bowel function. When food is not adequately digested and utilized for energy production by the body, the digestive remnants challenge homeostasis and are symptom productive. However, few in the healing sciences specialize in restoring normal digestive function.
** Weiglmeier PR, RoschP, Berkner H(August 2010). Cure and Curse: E. coli Heat-Stable Enterotoxin and Its Receptor Guanylyl Cyclase C. Toxins. 2 (9):2213-2229.
Dr. Loomis has an extensive background in enzymes and enzyme supplements. He is the founder and president of the Food Enzyme Institute. His extensive knowledge of physiology, biochemistry, and enzymology has made him a sought-after speaker and a prolife writer. The Food Enzyme Institute offers seminars to healthcare practitioners around the country. Dr. Loomis published ENZYMES: The Key to Health in 1999. He also co-authored andpublished The Enzyme Advantage: For Healthcare Providers and People Who Care About Their Health in 2015, For more information about Linzess, visit www.linzess.com and The Enzyme Advantage for Women in 2016, with respected medicaljournalist Arnold Mann. Contact info: 6421 Enterprise Lane, Madison, WI53 719 customer service afoodenzymeins/i/u/e. com, 800-662-2630.
