Irritable Bowel Syndrome
By Jeanne Drisko, M.D.
This is taken from a Lunch and Lecture Dr. Drisko delivered recently at The Center.
Twenty percent of the population suffers from irritable bowel syndrome (IBS). That is one in five people. IBS accounts for 12% of all visits to health care providers. So, every day a health care provider will probably see someone with IBS.
… the incidence of food allergy is only about 2% of people, but 50% are hypersensitive to some foods.
We have calculated about $8billion a year in direct medical costs in the United States with about $25 billion in lost wages from IBS and similar symptoms.
But only 25% of those people with IBS are going to the doctor. There are a lot more people out there who suffer from IBS than get medical treatment.
What is IBS? Patients usually go through periods where they have increased abdominal pain,increased flatulence or gas, and diarrhea or constipation. When you are younger, you may have the constipation type. Older people revert to the diarrhea predominate type. These cycles may last from days at a time to weeks at a time. Eventually there is some time when you have relief from them, but the symptoms return.
We know that it is poorly controlled by mainstream medicine at this time. Pharmaceutical drugs give a little symptomatic relief or they may help with diarrhea, but they are dangerous to your health. Patients learn to ‘just live with it.” There are many theories about IBS ranging from the bowel has altered activity (the bowel just moves too fast) so it must be psychological (it has got to be the patient’s fault). The latest idea involves neurotransmitters or a serotonin imbalance.
What I am doing at the University of Kansas Medical Program in Kansas City is an outcome pilot study. Everyone who enrolls in the trial gets the study medication and participates in the study. We measure how well they are doing with an outcome questionnaire made by the University of North Carolina which is accepted by mainstream medicine. When this study is published, it will be accepted even though we don’t have a placebo group in it.
The patients have to have a medical work-up and a colonoscopy that shows negative. They have this terrible problem with diarrhea, pain, and lifestyle alterations, but the doctors can’t find it.
When they get into the study, we do a food hypersensitivity test-a blood test. We also do a stool analysis looking for infection, how well they are digesting, and what the levels of beneficial bacteria are. There is also a quality-of life survey the patients fill out.
In the first month, we give those in the study a diet tailored to that patient who comes in and has abnormalities in the food hypersensitivity test. The diet is based on their blood test. They come back the second month and we do the food challenge. We do this one food at a time. We also give the patients probiotics, a beneficial bacteria. At the end, we redo the blood test and stool test to see if there has been any benefit to that patient.
In mainstream medical offices, you get the skin prick test for allergies. This measures IGE, a small part of the immune system. The food hypersensitivity test is a blood test that measures IGE and IGG of the immune system-a larger slice of the immune system. This type of test is used at The Center.
We know that the incidence of food allergy is only about 2% of people, but 50% are hypersensitive to some foods. So half of the people are going to react in some way to some foods sometime in their life. With the results of this test we know the foods to which each individual is sensitive and then remove the sensitive foods from their diet. Let’s say a person is hypersensitive to wheat so we remove wheat from the diet for a month. Then we reintroduce wheat to the diet. If they are hypersensitive to wheat, it will trigger diarrhea and pain. They say, ”That’s it; that’s the way I’ve been feeling.”
We use a team approach in the study. We have a dietitian, a patient, and myself in on the meeting. It is not really a patient; it is what Dr. Riordan calls a co-learner because we are all in this discovery process together.
The inflammation from IBS causes the cells in the GI track to separate. It is like Velcro. When the information is there it causes the Velcro to come apart and food molecules to leak out of the GI track and get into the lymph system and the bloodstream.
Molds are also important in addition to the foods when it comes to irritable bowel syndrome. Molds are related to processed foods. A lot of foods are made with molds. What we tell people is the fresher the diet,the more whole foods diet you can eat, the better you will be.
We suggest they go to the grocery store everyday or every other day. We counsel them not to eat foods that have been in the refrigerator for more than 24 to 48 hours, preferably 24 hours. Your meat has to be fresh from the butcher and has to be prepared that day. You can’t put fresh food in the freezer compartment of your refrigerator because it freezes and partially thaws. The freeze thaw cycle allows mold to grow on the food in the freezer.
When you have food that your body does not like, your body makes immune complexes to get rid of it. That is good if you only have a little bit of exposure. But if you eat this food regularly, you are making more immune complexes to get rid of it. The digestive system gets overwhelmed with time. The body cannot eliminate all the immune complexes and it begins to deposit them in the liver, brain, and the skin. That is why we have the three-week clean out period in the study before starting the food challenge period-to eliminate the immune complexes.
The gold standard is the food challenge phase of the study. You may only be sensitive to 30% of the foods and this will give you a chance to find out which ones they are.
I can’t tell you that food is the only thing because it is not IBS is a complex, chronic problem. We know that another partner in this is how much bacteria you have in your GI tract. Good bacteria are called probiotics. You want to have plenty of probiotics in your GI tract. If you have inflammation going on in the GI tract and you don’t have good bacteria, you don’t have a good environment. The organs, including the pancreas and gallbladder, aren’t going to work well.
Ph is very important because it tells us how much acid or alkaline is in the stool. Good bacteria makes your stool more acidic, and that is important to know. The bad bacteria makes your stool more ammonia-like. Some people even tell me that they smell the ammonia odor. That is bad because it means that those bad guys are there. You need more of the good guys to make it more acidic. They called it probiotics because it means ”for life.” This beneficial microflora bacteria, probiotics, provides basic nutrition, heals ulcers, and actually quiets down IBS. All of this is in mainstream literature.
Probiotics make short chain fatty acids, which provides good food for our colon cells. If we don’t have these bacteria, then we aren’t giving the proper nutrition to our GI tract. Probiotics also make other types of proteins and vitamins. Did you know that a lot of your B vitamins and vitamin K comes from these bacteria?
Probiotics stimulate the immune system in a positive way, reduce allergies and asthma, reduce infection, and make vaccines work better. Probiotics also make materials that keep those cell junctions healthy. It prevents translocation, or leaky gut.
Finally, I want to talk to you about another partner in this whole system the nervous system. Actually, 95% of your serotonin is found in the GI tract. So what happens is you get infections, food allergies, stress, and it stimulates something called the EC cells in the GI tract. It dumps the serotonin and it speaks to the enteric nervous system and says, ‘We have a problem. Get rid of what is
in the GI tract.” The serotonin gets dumped and everything is washed out. You have diarrhea, cramping, and pain. The diarrhea washes out not only the food that you did not need to be eating or you are sensitive to, but also it washes out the good guys, the probiotics.
This explains the cycles of diarrhea you experience because eventually those EC cells are going to get emptied out of their serotonin and it will give you a period of relief. The function is still there, but the probiotics are gone. As soon as the serotonin builds back up in those cells again, you are going to go through the cycle again.
IBS is more than food hypersensitivity, probiotics, or serotonin. It is a hand-in-hand process-teamwork. It is about working with your doctor, your dietitian, spending time on your problem with them, and finding what works for you to get rid of IBS.