Irritable Bowel Syndrome; Intervening for Success

Irritable bowel syndrome (IBS) is a common gastrointestinal condition that affects upwards of 15% of the American population, creating significant problems regarding quality of life and overall health.  Although irritable bowel syndrome is a recognized medical condition in people, there are very few medications which have provided clinical benefit to those that endure the condition.  The reason being is that there are many factors which contribute and it is hard to manage them all simultaneously for the best outcome.  Can herbs and dietary components assist with irritable bowel syndrome?  Yes, there is plenty of research to indicate there are benefits, in more areas than just your gut.

Irritable bowel syndrome (IBS) is a medical condition which primarily affects the large intestine or colon.  In those cases, patients with IBS may experience cramping, gas, diarrhea or constipation.  Sometimes the pattern includes all of the clinical signs, while in others, the symptoms may shift back and forth.  Most people experience mild symptoms with a lesser percentage experiencing severe symptoms.  In most cases, irritable bowel syndrome can be managed through dietary and lifestyle interventions, while in more severe cases, medications may be required to ease the symptoms.  IBS tends to impact more women than men.

The good news, if there is good news here with IBS, is that irritable bowel syndrome does not create tissue changes or pathology to the large intestine, meaning that in most cases, the risk of cancer development is very slim.  It is more of a clinical or symptomatic situation, rather than a pathological one.  Still not very nice to contend with for most people.

In truth, if you think about it, all of us have experienced irritable bowel syndrome at some point in time in our life.  Have you ever given a speech in front of a large audience and suffered the digestive ramifications?  Ever been extremely nervous or upset and experienced digestive cramping, bloating, and maybe diarrhea.  Have you ever been depressed and down in the dumps, experiencing constipation, cramps, and general unease in your belly?  Well, if you answered ‘yes’, then you have experienced irritable bowel syndrome.  The difference is that those diagnosed clinically with the condition experience those negative ramifications more often and usually daily in some cases.

Irritable Bowel Syndrome.  What’s Going On?

I will give it to you as I see it, being a person that will openly admit to contending with irritable bowel syndrome (IBS) for most of my life.  I have researched it, been examined, drilled gastroenterologists on the topic, and have come to my own conclusions.

IBS results in the clinical signs mentioned above and in most cases, diagnostic tests are inconclusive, meaning that no pathology or abnormality is evident.  This implies it is not a ‘structural’ problem, but more so a nerve or muscular problem, referring to abnormalities in bowel contractility and movement.  Now, with that being said, if the clinical signs ever become severe, or there is a significant change in your bowel habits, weight loss, pain, or blood in your stool, please consult with your doctor.

Irritable bowel syndrome from my perspective is likely 80% psychosomatic, meaning that most of it is in our mind, or a reflection of our mind.  The other 20% is environmental, dietary, and lifestyle driven.  That is my perspective as an IBS patient for many, many years, yet, managing it well through this understanding.  IBS impacts not just your gut, but can be an emotional drain, which can then further compound the problem.

Our mind is interconnected with our digestive system, which is referred to as the ‘brain-gut axis‘.  What happens in the mind is replayed or reflected in the digestive system.  What happens in the digestive system is also reflective in the mind.  It is a two-way street with one contributing to the other.  The mind-gut connection is real and plays a huge role not just in our digestive health but our overall health.  Your state of mind will and does dictate your health and well-being.  Most do not either realize this connection or do realize it, but refuse to accept it because then it puts the responsibility upon them to resolve the problem or health ailment.  Well, if you suffer from irritable bowel syndrome (IBS), then you have the solution right inside of you to remedy it, but some supplements do assist in this recovery and management.

In IBS cases, there is a disruption of intestinal motility or movement.  This disruption is not well understood, but essentially, your digestive tract should be moving (peristalsis), which moves gas and food stuff on down the line and out the rectum eventually.  If movement is slowed, then gas accumulates and causes distension, because it is not moving onward.  If movement is increased, then transit time is increased which does not allow enough time for nutrients and moisture to be absorbed, resulting in loose stools or diarrhea.  Both, over time, can lead to malnutrition and weight loss.  In addition, there is an increased state of pain perception in the lining of the intestines.  This means that with little distension or gas accumulation, the intestinal wall stretches and your body perceives variable degrees of pain or discomfort, when normally, it should not.

Now, if you experience irritable bowel syndrome in your life, what I ask of you is the next time you are experiencing an episode, take a moment, clear your head and focus on what is going on in your mind.  Be a ‘watcher’ per se, and watch your mind.  See what TV show is playing in your head.  Chances are pretty good that what you will witness is a drama series, like General Hospital, playing in your mind.  You are thinking too much on something, anxious over a situation or someone you encountered, depressed over a job or a lost lover, or just down in the dumps about worldly affairs.  The point here is to realize that your state of mind during that IBS episode is not on you frolicking through a field of daisies with a picnic basket in your hand.  Likely, your mind is not even in the present moment, but more so fixed on something that happened in the past, even an hour ago, or fretting over something in the future.  Your mind is out of sorts and through that release of chemical neurotransmitters, you are creating signals or waves in your belly.  Your mind is amiss and so will your belly, if you are the susceptible type.

Think of my scenarios above, when I mentioned that EVERYONE has experienced IBS at some point in their lives.  Every one of those scenarios is associated with a stressful mind activity.  They are not because you ate some old Chinese food.  The response in your gut is a response to the brain pattern at that point in time.

With all that being said, there is also another interesting connection here and that is the microbiome which is present in your digestive system.  That microbiome is the natural population of bacteria which are present that aid not just in food digestion, but gas formation, and production of either helpful or harmful chemicals, such as short chain fatty acids.  What you desire, regarding your gut microbiome, is a diverse population of bacteria.  You do not desire just one or two strains, but a diverse population.  When the microbiome loses diversity, then problems develop and those problems are far reaching in your health, way beyond just IBS.  An altered digestive microbiome is directly connected with everything from allergies to cancer, including anxiety and depression and other mental conditions.  That is how important the digestive microbiome is within your body. Here are a few articles on that topic:

1. Digestive microbiome and inflammation
2. Digestive microbiome and breast cancer
3. Digestive microbiome and vaginal yeast infection

Here is where the two-way street comes into play!  Very interesting stuff indeed!

When your mind is out of focus and anxious, the nerve transmissions to your gut are impaired, often resulting in either slowed or increased rates of motility or transit.  This altered motility pattern then can directly impact the microbiome by either allowing more time for food to ferment, which may permit harmful bugs to develop, or the increased transit time can literally remove accumulations of good bacteria.  So, your mind patterns influence the gut motility, which then impact the microbiome balance.  Over time, that microbiome shifts negatively and impacts health on many levels.

The digestive microbiome interplays with your health on many levels.  An out of balance microbiome can contribute to inflammation and immune related problems.  It can also directly influence nerve signaling and function.  Thus, on a simple level, an altered digestive microbiome can further stagnate or disrupt digestive motility, creating more of the same.  An altered digestive microbiome can influence inflammation in your body, which can create joint pain, back pain, and even mental pain and anguish.  That altered digestive microbiome can directly influence your mental state being interconnected with chronic anxiety and depression.

See the connection?  It can be a viscous cycle of events.  Mind creates digestive problems and digestive problems can create mind problems.

Irritable Bowel Syndrome; Approaches and Solutions

Hopefully you can see the big picture here when it comes to irritable bowel syndrome (IBS).  I would consider it a mental condition, which many gastroenterologists agree with overall.  I would even fathom a guess that the more severe digestive ailments such as irritable bowel disease (IBD) and Crohn’s are likewise strongly associated with mind patterns.

In IBS cases, not only is the digestive microbiome out of balance, but in some, the condition has progressed to the point where there is a disruption of the lining on the inside surface of the intestine, referred to as ‘leaky-gut syndrome’. I fully agree that this leakiness is present and when it is present, it contributes to a host of other clinical problems from the brain to the joints, as a result of LPS leakage and inflammatory events.  So, given this, many focus on repairing the gut as a solution for IBS, which is okay and should be done, but this is only an effect and not a direct cause of IBS.  To better manage irritable bowel syndrome, you have to go to the source, which is your mind and the dramas or thoughts which are present.  You have to change the way YOU react to the world, not how the world reacts overall.

Not an easy task, but it can be done, even on small scales to produce improvements.

There are many options regarding foods and herbs that have been shown to be beneficial, some more than others.  This list includes:

1. Glutamine – a semi-essential amino acid that is required for many body functions, but is heavily utilized by the cells in the digestive tract for overall health and function, specifically for leaky gut scenarios and leaky tight-cell junctions.  Many have found daily dosing from 1-2 grams per day to 5 grams three times a day to be beneficial in improving digestive function.  The dose can be variable and monitored as some will go from one extreme to the other with too heavy of usage, meaning they go from diarrhea to constipation.  Glutamine also demonstrates some clinical benefit when it comes to mental conditions such as anxiety and depression.
2. Ashwagandha – an adaptogenic herb used in Ayurveda to help settle the mind and smooth out brain transmissions and signaling.  It can have a calming effect in most, helping to settle the mood and mind patterns, while in some, they note a stimulating effect.  It can go either way and is really dependent upon what the body is needing.  Ashwaganhda is a very nice herb, but not for everyone.  If you experience heart burn or stomach ulcers, it may not be suitable due to its inherent warming properties.  Ashwagandha targets the mental aspect of IBS, helping to settle the mental component, which is what I believe is at the root of irritable bowel syndrome.
3. Lemon Balm– an adaptogenic herb that has a more cooling and drying effect upon the body versus Ashwaganhda.  Lemon balm again addresses the mental aspect of IBS and can be a real aid in helping to settle the mind, relax the body, and produce rest.  Lemon balm has also been known to help settle or smooth out nerve transmissions in the digestive system, thus relaxing it and allowing gas and other material to move onward, reducing cramps.
4. Bacopa monnieri– an adaptogenic herb which also has cooling and drying properties, benefitting the mind in aiding relaxation and even boosting memory function in some studies.
5. Blue Skullcap– (Scutellaria lateriflora) is a unique herb used in western herbalism to help soothe the liver and ease emotions, which are usually in excess, implying high levels of tension, anger and anxiety.  Blue skullcap is found in the United States and has been used for many years, dating back to the American Indians using it for aiding in sleep, tension, and menstrual problems in women.  It is cooling in property, not draining or heavily sedating, but helps to simply cut tension in your body.  It is also great to help settle your mind and aid in sleep. This is one herb that I take personally, at least every night.
6. Reishi– (Ganoderma lucidum) is a Chinese mushroom used to aid in restoring the body as a tonic of sorts.  It is especially useful for easing body tension and settling or calming the mind.  It is not sedating in any way, but simply helps to ease tension and create focus in some cases.  It is warming in nature, but not heating.  It is also beneficial for immune health, inflammation, and impacts digestive health through the microbiome and polysaccharides present in the mushroom.  A very nice herb to have around and take daily, especially if you are under tension or stress.
7. Lion’s Mane– (Hericium erinaceus) is another Chinese mushroom used for many health concerns, but mainly having a focus on the mind and mental health.  Lion’s mane is not a sedative herb, nor does it create a calming effect, at least in my experience, but it does impact nerve pathways and even aid in restoring some back to balance, which is critical not just for tension and anxiety, but overall mental aging.  This is one that I personally combine with Reishi on a daily basis.
8. Poria cocos– is yet another Chinese mushroom which is mainly used to aid in digestion, helping to enhance water absorption and fluid regulation in the body.  Thus, it is helpful for cases of loose stools or diarrhea, when taken routinely.  Poria is also viewed as being able to impact the mind and ease mental anxiety, so it is a win-win in most cases.  It can be combined with other herbs and often is in Chinese formulas.
9. Tribulus terrestris– is an Ayurvedic herb mainly used to target urinary and reproductive problems, but can be very helpful for restoring balance to the body and helping to literally move excess tension from the head and redistribute it throughout the body.  This is called Liver Yang Rising in TCM terminology and is often associated with cases of anger, hot tempers, headaches, and high blood pressure.  Tribulus is viewed as having a balancing effect upon the body, aiding to restore a smoothness to how things function.  I personally take this herb daily and often combine it with Ashwagandha for the overall adaptogenic effect.  Tribulus is more cooling in nature, while Ashwagandha is more warming.  They balance each other.
10. L-Theanine– another amino acid that can have immense capabilities when it comes to your heath and mental function.  L-theanine is well researched and noted to have the ability to alter brain wave patterns, inducing more alpha waves, which is a benefit.  When you are anxious or depressed, your mind mainly emits beta-wave patterns, which is like all the white noise in your mind, just restless chatter.  L-theanine can help move that pattern to the next one up, which is alpha waves, which are more settling and conducive to health, mental function and sleep patterns. Thus, very beneficial for many when it comes to soothing the mind and easing mind-induced health problems, which includes IBS.
11. Apple Pectin– a direct fiber source from the apple itself.  Believe it or not, sometimes a nice source of soluble fiber can make a world of difference in cases of IBS, being directly related to fiber being a source of food and stability for the digestive microbiome.  Many are worried that excess gas will be produced, making IBS worse, but this has not been my personal experience, nor has research indicated it either.  In most cases, an increase of fiber intake from a reputable food source, is just what your gut ordered.
12. Boswellia serrata– an herbal ant-iinflammatory that demonstrates promise in research regarding the inhibition of key inflammatory enzymes, LOX, which are associated with certain conditions impacting digestive health, including IBS and IBD.  Benefits other aspects of health, including joint inflammation and pain.
13. Triphala– an Ayurvedic combination of three herbs (Terminalia bellerica, Terminalia chebula, and Phyllanthus emblica) that specifically targets the digestive tract by a gentle laxative effect, anti-inflammatory properties, and benefitting the microbiome.
14. Hawthorn Leaf & Berry– a herbal blend used in Chinese medicine with very interesting properties.  Hawthorn is traditionally used to alleviate food stagnation, which is bloating and gas accumulation, after meals.  It also has marked benefits to the cardiovascular system, helping heart and circulation health.  It can benefit the mood and mental health additionally, helping to alleviate anxiety.  An excellent herb after meals if you experience bloating.

Now, in addition to the list of above helpful supplements, it is critical that you become aware of your mind patterns and thoughts.  You are in control and no supplement will override your thinking patterns, and neither will any medication.  The more you are aware, the faster you can make changes in how you react to various situations so that you do not become too anxious or too angry or upset.  In addition, things like meditation, yoga, and Qi-Gong can be very helpful to re-establish mind patterns, as can routine or daily exercise.  Finally, take a good look at what you are eating and make proper food choices.  I recommend a whole-food diet.  It does not mean you need to be a vegetarian by any means, but eat with a focused mind and eat clean.  The food you take into your body will impact your digestive microbiome, which again can and does contribute to mental strife.

Irritable bowel syndrome can be properly managed.  More than likely, it is a constitutional problem that some of us are just predisposed to through mental conditioning over our lifetime, but either way, you are still in control.  There are many herbs which can assist with the problem of IBS, but it is a matter of finding which ones are appropriate for you.  This can be through a process of trial and error in many cases.  Some herbs are beneficial only in acute flare up situations, while others are beneficial on a daily basis.

 

Author:  Tom Schell, D.V.M, CVCH, CHN