Question: I am a 40-year-old woman who has suffered from abdominal pain and alternating constipation and diarrhea for at least the past five years. I have tried many diet changes, including adding more fiber to my diet, all with very little relief. Recently I had a full evaluation with a gastroenterologist who, after many tests, concluded that I have Irritable Bowel Syndrome. He prescribed a high-fiber diet, a fiber supplement and, to my surprise, an antidepressant. I am wondering whether this is the correct approach for me and why he would prescribe an antidepressant. I would not be depressed if my darn bowels would behave!
Answer: In a recent issue of the New England Journal of Medicine there was a major review article on the causes and treatment of Irritable Bowel Syndrome (IBS). The authors point out that 15 percent of American adults suffer from symptoms consistent with IBS. Previously, I have discussed a related issue, the causes and treatment of constipation. To recap, to have normally functioning bowels means that you should have at least one bowel movement per day and that you should feel that you have completely emptied your bowels at least once per day. There should be no discomfort with the bowel movements nor should there be abdominal cramps, bloating or excessive gas. If these symptoms are present, it is a clear sign of intestinal dysfunction.
For years, modern gastroenterology has put its whole emphasis on the fiber theory of bowel function which, briefly stated, is the theory that those who consume lots of fiber will have healthy bowel function. Fiber, by the way, is a term that encompasses the family of complex carbohydrates and other substances that are present mainly in the cell walls of plants used as foods. The term includes cellulose, gums, mucilages, pectins and lignins. Humans cannot digest fiber, but these substances are said to contribute to the health of the digestive tract.
As I discussed in the article on constipation, this theory is inadequate to explain the complex dynamic of healthy bowel function. Rather than focusing entirely on fiber, we should look at the intestines as a complex ecosystem. Like all ecosystems, the intestines are populated by a wide variety of organisms all of which interact with each other and with their host. Each organism needs to be fed and its waste products eliminated, and each individual organism and the organisms as a whole have a profound connection with the health or disease of their host.
When the bowel system shifts towards disease, we see very characteristic changes in the population of organisms inside the bowel and in the characteristics of the bowel wall itself. Inside the bowel, the numbers of beneficial bacteria decline while the amount of undigested or partially digested food stuff increases. Pathogenic bacteria and fungi proliferate along with the toxic by-products that these abnormal microorganisms produce. Undesirable changes begin to occur in the lining of the bowel, and in the small intestine the fine hairs or villi become disturbed and deformed. The passageways through which absorption of food occurs become altered and we see abnormal neurological functioning within the intestinal walls. The combination of all these changes result in the disturbing symptoms so familiar to the many sufferers of IBS.
For years, holistic physicians have maintained that the health of this bowel ecosystem is the key to the health of the entire person. Nearly one-quarter of all traditional herbal medicines are directed at improving bowel health. Many traditions describe the intricate, complex decisions that the bowels must go through in “deciding” which foods to absorb and which to pass on. The recent discovery that the bowel wall contains all of the same neurological processes and receptors that are found in the brain has turned the orthodox medical world on its head, but this discovery comes as no surprise to holistic practitioners.
The discovery of sense receptors in the bowel is the reason that your gastroenterologist has prescribed an antidepressant. While I do not agree with the antidepressant, that fact that your doctor has suggested it is a sign that orthodox medicine has finally admitted that bowel health involves some of the most complex higher “reasoning” known to science. Put another way, managing your internal ecosystem and deciding what to absorb and what to discard is an example, albeit subconscious, of higher mental functioning. We can achieve good bowel health and overcome IBS only if we understand and work with this complexity.
The first step in treating IBS is to adopt a diet based on the cookbook Nourishing Traditions. Not only will this diet provide you with enough fiber to stimulate healthy bowel movements but, more importantly, because the diet supplies plenty of healthy fats and lacto-fermented foods, it is virtually the only dietary approach that feeds the healthy organisms populating your inner ecosystem.
A few points in the diet are worth highlighting. First, the good bacteria in our bowels thrive on fat and are poisoned by simple sugars. The Nourishing Traditions approach provides ample fat intake and strictly limits the refined carbohydrates and sugars that so undermine our health. Second, IBS patients need to consume lacto-fermented foods daily, including condiments like sauerkraut and beverages like kefir and kvass. Lactobacillus plantarum, found on vegetable leaves, is perhaps the most beneficial microorganism in our bowels and its numbers are greatly increased during the fermentation process.
Third, the Nourishing Traditions approach calls for the soaking of all grains for 12-24 hours and this practice is essential for anyone suffering from the symptoms of IBS. There is a growing body of scientific literature that supports this traditional practice because we have discovered that unfermented grains contain chemicals that irritate and inflame the bowel wall, and can even cause it to spasm. The practice of consuming large amounts of whole grains and rough bran, which has been the cornerstone of treatment for constipation, can actually lead to IBS.
Finally, broth made from bones should be used liberally by all those suffering from IBS. It seems as though the specific amino acids in soup broth act as a kind of tonic for the bowel wall, perhaps by providing compounds that function like antidepressants, much like the serotonin drugs which you were prescribed.
These four steps constitute the dietary approach for IBS. I also add an herbal intervention to help speed up the recovery process. It is called Okra-Pepsin, made by Standard Process. The preparation includes okra, which is a very mucilaginous plant, digestive enzymes and allantoin, a substance typically found in comfrey leaves. Among herbalists, okra is considered a demulcent in that it soothes and nourishes the intestinal wall. The digestive enzymes aid with the digestion of the food, thereby making it less irritating to the intestinal lining. And the allantoin stimulates the regeneration of the cells that form the inner lining of the intestinal wall.
In addition, I will often prescribe old fashioned castor oil compresses for one hour, two to three times per week, over the abdomen. This therapy relaxes the bowels and aids elimination.
Finally, I encourage my patients to embark on a regular exercise program that includes abdominal muscle strengthening exercises.
This program of therapy should have your bowel function normalized by six weeks and provide a huge boost to your overall health. . . and in your outlook on life.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2001.