by Heather Samson

Let us look at the health aspects and relevant facts relating to IBS.  We will also consider a personal case study, the background information and the individuals symptoms and associated problems. It will also run through the different methods used to overcome these problems and the outcomes.

It should be pointed out that while the case study individual has improved, this is an ongoing study; therefore, the conclusion can only be based on the results collected so far.

It is also important to state that medically there is no clear understanding why people get IBS and as a result, there is no cure, only methods of controlling it.

What is IBS?

Irritable Bowel Syndrome or IBS is becoming a more common digestive disorder.  While there are different symptoms for different people, normally the symptoms include abdominal pain, bloating, constipations and / or diarrhoea.  These symptoms can vary from one episode to another.  For some
people the symptoms can affect their day-to-day lives.

While IBS can be unpleasant and can affect an individual's daily life, it is not life threatening, nor can it lead to anything else life threatening. Some of the IBS symptoms are similar to other, more serious disorders can include ulcerative colitis or Crohn's Disease. Therefore, a doctor should check the symptoms to eliminate any of these more serious disorders.

The Main Symptoms

Abdominal Pain and Discomfort:  This can vary from mild pain or discomfort to cramps and spasms. It can come on suddenly, however in most cases, it can be associated with eating but this is not a strict rule and symptoms can occur at different times, and maybe caused by stress.

Walls of the intestine suddenly contract in spasms

Bloating:  this can be associated with the abdominal pain. It may be relieved by opening of the bowels or by passing wind. The bloating may feel like your clothes are too tight but there is no relief, even after undoing one's clothes.

Constipation and Diarrhoea: An individual can suffer from one or both of these symptoms. However, it is believed that constipation is more common than diarrhoea. Both of these can be accompanied by pain or urgencies to open one's bowel. In the case of Diarrhoea, the contents of the large intestine are pushed through too quickly, so there is not enough time for water to be removed. With constipation the contents of large intestine are pushed through too slowly, so too much water is extracted.

Other Symptoms:  Changes to the stools, they can be hard, hard to pass or runny. There may also be a feeling of not completely emptying one's bowel.

What can cause IBS?

The symptoms of IBS are caused by changes in the way the bowel works.  In IBS, the bowel is found completely normal on examination, but it behaves abnormally from time to time.  For this reason doctors classify IBS as a "functional disorder" to distinguish it from an "organic disorder" such as inflammation bowl disease.

It is unclear why certain people suffer from IBS.  It may be that different people are affected by different things, which is one of the reason that it is difficult to treat. The known triggers include lack of dietary fibre, food intolerance, infections, antibiotics, stress, menstruation and smoking.  Because IBS is a disorder of the digestive system, many people believe that the role of food is crucial.

It is also considered to be a "nervous disorder" because of the the way in which the nerves that link the brain and bowel work. This is the key to understanding the condition.  The gut becomes hypersensitive, behaving exactly as in "normal people" but with less provocation.

A Case Study

Background to the Case:  This individual, is female and 27 yr. old, has suffered from IBS on and off
for about nine years. She was nineteen when it first started and weighted approximately seven and half stone. For years she has suffered from various eating disorders, these included making herself sick, starving herself and taking laxatives.  While this cannot be directly connected to IBS it can have an affect on the
digestive system.

Details: The first time she suffered an IBS attack she went to her doctor who put her on "Copermine" (A peppermint capsule).  This did help, but she did not want to take tablets all the time so she went to a Natural Health Clinic, to seek advice about coming off the tablets and controlling her IBS by diet, which she achieved.

Over the next few years, while she had a few mild attacks, the IBS was being greatly controlled by eating patterns and diet.  She found the exercising and dieting to be rather excessive but over time she worked out that eating smaller regular meals helped, as well as avoiding meals that contained stodgy, high fat foods.

However, in the early summer of 2002 she suffered an attack unlike any she had ever had before.  She suffered from very bad stomach spasms and cramps, bloating and vomiting. Over a period of a few weeks she lost just over 3 kilos (half a stone). All the normal things that she would use to control the symptoms did not work, she had never been this ill. Her local doctor advised her to resume taking the Copermine and also a HCL (digestive enzyme) Supplement. 

At the time when this attack occurred, there were a number of things happening in her life that were causing stress. These included moving house, instability at work, the possibility of losing her job and emotional  / personal problems with her partner.  (This partner left a few months afterwards).

She is a very sensitive individual who not only takes things to heart, she also takes on problems of those she cares for and is highly affected by these and other matters. This means that stress factors contributed a lot to her problems and this is an area of concern.

Summary:  Previous abuse of body through eating disorders  - Excessive diet and exercise - Stress and stress factors - Emotional factors.  All of the above would in some shape or form have an impact on the IBS and would have to be dealt with individually and together in order to control the problem.

As well as looking for nutritional / alternative help she was advised to see a specialist doctor to ensure that there was nothing more seriously wrong. She was advised to do this for two main reasons: one, the weight loss, and two, the suddenly increase in her symptoms.  This doctor performed numerous x-rays, scans, etc and confirmed that medically there was nothing wrong.  She agreed to take the prescribed drugs from her doctors in order to stop the vomiting and the cramps.  It was following this confirmation that she came to me seeking alternative nutritional advice.

Nutritional Advice: For the nutritional advice I started explaining about the different healing zones and what is needed to make them better.  There are many different aspects to this idea, but for the purpose of this case study and this individual I looked at certain areas more than others. For example the resting metabolic rate (RMR), the correct weight for an individual, lifting ones spirits, water, controlling bad habits and wind therapy and stress control. (These are looked at in more detail through the paper). Taking the information from this analysis I was able to put eating plans together and make other suggestions.

The first point was to try and build her up again, to regain the weight while stopping the vomiting and cramps. I wanted to increase her weight to begin with to 50 kilos (about 8 stone) and then 55 kilos (about  8.75 stone.   The tablets from the doctor helped with the vomiting and she started to take fruit and vegetable juices as well as other nutritional drinks in order in get nutrients back in her body and start building her up.  If eating made her ill drinking was the best option.

Once she could eat more foods, it was suggested that a wholesome diet, avoiding already known trigger foods, plus any that were likely to make matter worse, was to be followed.  An increase in vitamins and minerals were also used, to ensure that nutritional balance was reached.

A reduced exercise plan was suggested as well as some form of relaxation / mediation in order to deal with the stress in her life. Exercise is important for stress relief as well as the relaxation methods. As well as this a diary was kept on a daily basis, looking at food, drinking symptoms, lifestyle, sleep and stress. This helped to determine if there were any patterns.

The wholesome diet did help her regain weight but the weight continued to change quite a lot up and down, it was this reason that a pure cleansing diet was not recommended.  It was feared the weight loss would be too great and could in the short and long terms make things worse.  However, this has not been ruled out altogether in the future, once the weigh is under control.

The diary highlighted a number of areas of concern such as Sleep patterns, Stress levels, Size and pattern of meals, Meat, Stodgy foods.

Sleep Patterns:  Due to the symptoms keeping her up at night, she did not always get a good night's sleep; also there were personal reasons that she did not get enough sleep. It was noted that the symptoms were worse with lack of sleep and her ability to cope was reduced with the lack of sleep.

Once a sleep pattern was introduced, and personal problems removed, going to bed at roughly the same time every night, and getting up at roughly the same time every morning, did make her feel better. It included seven hours of sleep each night, 10:30 to 05:30. At the weekends this went up to nine hours. It was also noted that too much sleep could also have a bad affect on her.

Taking peppermint tea an hour before bed and a natural sedative before bed, helped with the pain, which make it possible to sleep through. Getting enough sleep and waking feeling that one can cope is a great start to a day!

Stress Levels: As it became apparent that stress was influencing the IBS,  it was suggested that certain forms of relaxation and stress control were also looked into. This included yoga, taking time out during the day for her, etc. As well as this it was also suggested that she talked to someone outside the family, circle of friends who could help with this issue. She knew of a Homeopathic practitioner from her yoga class. She helped her talk about her problems, take natural remedies and practice relaxation methods such as mediation.

Size and Pattern of Meals / Meat / Stodgy Food:  Eating small regular portions throughout the day rather than three large meals a day. It was also suggested that red meats, spicy, fatty and rich foods be avoided as well as alcohol. Finally, it was suggested that the method of combining food should also be looked at, as this can make it easier for the digestion of food if one type is eaten at a time. Digestion, absorption and utilisation of the nutrients from our foods are all greatly improved when the ingested
combinations are harmonious.

Once these suggestions were acted upon, the symptoms did decrease. She stopped taking some of the medical tablets expect when needed. This also helped with regular sleep patterns that also reduced the symptoms. However, she still needed to take the Copermine and HCL supplements every time she ate, she still is suffering from cramps and increased pain if she deviates from the suggested eating plan.  Due to her job she was often away on business and this caused problems because it was difficult to keep to the
eating plan, while staying in hotels. This issue in itself could increase the problem as she worried about going out, being away from home. It ended up being a vicious circle.  This was one of the areas that needed to be dealt with as well as getting her off the tablets.

I requested that she consulted her family doctor to ensure that he did not object to her coming off the tablets. This was confirmed as the tablets were not intended as a long-term solution to the problem.

The next issue was when there was a period in her life that would make it possible for her to consentrate on her eating and relaxation plan. It had to be period where she was not away on business or personal trips, so that food, exercise and relaxation could be plan careful and controlled. A two to four week period was chosen to begin the process; the following was to be tried.

High fibre, fresh- non-trigger food eating plan, for example: Porridge with water and fruit for breakfast,
Fruit as a mid morning snack, Lunch / dinner, salad with fish or chicken, Fruit or yogurt mid afternoon,
Dinner / tea, brown rice and mixed vegetables, fish or chicken with vegetables, An evening snack, never later that seven o'clock in the evening.

Herbal Remedies that were suggested:

Peppermint, Chamomile or Fennel for spasms, bloating and gas,
Valerian or wild yam for painful spasms,
Slippery elm for diarrhoea and nausea.

This plan was to be followed for approximately 10 days, reducing the number of tablets over this period, also keep a diary on everything that happened. Then after this, five days on the same plan with no tablets (unless the pain was unbearable).  Also over this period it was suggested that 2 or 3 litres of water was consumed and that hard exercise was eliminated so that the body was not under increased pressure.  The yoga and relaxation therapy was to continue. All this time she was under guidance.

A Summary of the Results on the Plan

As stated above, she had already stopped taking two the medical tablets and only used them when completely needed. The next choice was which tablets to reduce first, (doing both at the same time would make results unclear).  It was decided that the HCL Supplements would be reduced first.  This
decision was because while this was the natural supplement, it was probably the easier. The dosage was two tablets for small meals and three for larger main meals. First one tablet was reduced for each meal, for small and for trigger free meals this caused no problems. As the results where good, a further one tablet was then reduced. HCL was still needed for certain meals, for example when going out for a meal, for normal meals they were stopped completed.

Next was the Copermine, it was hoped that as peppermint could be included in her daily diet, through food and drink, for example peppermint tea, it would be easy to reduce the dosage here too.  Her current dosage was one table for small meals and two for larger main meals.  Stopping the one table dosage
was quite easy, for the smaller meals, especially if the meal was followed by a cup of peppermint tea.  The main meals were not so easy, any deviation for the eating plan, caused an attack even taking the tablets, therefore it was only possible to reduce the dosage down to one tablet, but not completely. Therefore, it was suggested that an herbal peppermint water mix was drunk throughout the day to help this.

The Next Planned Step

It became clear that planning meals also involved educating those around her to understand what she could and cannot eat. Planning did not only involve shopping or food, but also what she was doing during the week so that she was aware of days that may cause problems and prepared for them, maybe taking food with her, taking additional natural supplements, for example the HCL Supplements, etc.

Educating others meant showing them that it was not difficult to prepare food for her and that simple changes to a meal meant everyone could enjoy it.  For example spaghetti bogenisene, by supplementing beef mince with turkey mince and using wheat free pasta, and making the sauce fresh so that the ingredients was known, meant that everyone could enjoy the same meal.

It was still hoped that there would be a period to conduct the above eating plan, but by March 2003, this was being harder and other methods of control were being used.  For example eating at regular planned times of the day (see below), using the food combining method mentioned above and similar methods, was helping.

Eating Plan

Below is an example of the foods eaten in a week:

Breakfast: 

Muesli
Oats (hot made with water)
Poached or boiled egg
Fresh fruit and natural yogurt

Lunch:

Salads or mixed vegetables with chicken or fish
Homemade vegetable soups (low in fat, but thicker that shop brought)

Dinner:

Vegetables, grains, beans, pastas, white meat, and fish.

Snacks:

Fruit made up most of snacks as well as rice cakes and crisp bread.

It was noted from this that proteins would only be included in either lunch or dinner, but not both. Pasta could not be eaten more that twice a week. Also that the combination of foods within the same meal was just as important as combinations throughout the week.

Current Situation

Currently this individual still has to take one Copermine with main meals, and on those associations that she knows she is deviating from plan she increases the number and at times includes an HCL supplement.  She is still seeing her Homeopathic Practitioner and taking herbals remedies for stress. She is also continuing to practice relaxation methods.

By following the eating plan above, sleep patterns and controlling the stress levels, while also taking control of her own life she is a lot better all round. We are still hoping to reduce the tablets to none, or at very least to only when she knows that she is deviating from the eating plan.

Future Plans

It is hoped that a variation on the cleansing diet maybe conducted (now that more information is known a full one is not necessary), in the future. To be able to list in more detail the actual food and combination of
foods that affect her; to educate others more and to continue the progress already made.

Final Word

At the present time this individual on the whole is feeling a lot better and came to the conclusion that all the factors stated at the beginning of this paper did affect her and her IBS and that controlling all them was the key to feeling better.  Her lifestyle and life patterns were just as important as the food she ate.

While no formal conclusion has been made and there have been problems along the way, both my client and I feel that progress has been made.  In addition, this paper shows that many factors in an individual life can affect one's health, and that having a happy balance is half way to being healthy. It was not just the food that she ate, but many others areas that once working together helped her on the road to recovery.

We continue to work together to help her control and live with her IBS.

APPENDIX 1 - TRIGGER FOODS

The following information is meant as guideline, it should be remembered that each individual is different, and that the individual involved in this case study has had additional problems.

When embarking on the whole-food-eating plan, apart from the foods that she already knew upset her; the following were also avoided as they can be classed as "trigger foods".

1. Dairy products*
2. Chocolate
3. Eggs
4. Citrus fruit
5. Meat **
6. Wheat
7. Nuts and peanuts
8. Tomatoes
9. Onions
10. Corn
11. Apples
12. Bananas

* This would include skimed, whole cows milk, goat's milk, cheese, yogurt, etc. But in the case of the individual bio-yogurts and a small amount of semi-skimmed milk had no affect. Large amounts of cheese did cause a problem.

** In most cases it was red meat, including mince, small amounts of chicken, turkey, ham, etc although a few times a week was okay.

Wheat had more affect in pasta than bread; therefore a couple of slices of bread a week did no harm.

Onions if very well cooked were okay; it was uncooked ones that caused the problems.

Meals are based around grains, legumes, vegetables and fruit. The plain-safe foods based around these groups include; brown rice, cooked or dried fruits, cooked green, yellow and orange vegetables; such as asparagus, spinach, spring vegetables, etc, condiments such as modest amounts of salt, maple syrup and vanilla extract.

Tea and coffee should be avoided as much as possible, as should anything else that is known to cause problems.

 APPENDIX 2 - ELIMINATION / CLEANSING DIETS

Elimination diets and cleansing diets do vary slightly although the basic are the same in 99% of cases. In simple terms all trigger foods, meats, diary products, certain vegetables, drinks are eliminated from the individual's diet. The food would basically be brown rice, water and certain vegetables for period of time, from one week to three weeks, allowing the body to be cleansed of all other foods and toxins. 

Once the body is cleansed and all these foods removed, certain foods are reintroduced into the diet one at a time every three days, recording the impact of each one. If the body reacts badly that it is clear that the food is a trigger food, if there is no reaction then that food is okay.

Once this has been completed it is wise that combining foods are also tested. For example pasta with vegetables maybe okay, and chicken with vegetables may be okay, but pasta, chicken and vegetables maybe all too much for the body. So this is also important and may take time.

 APPENDIX 3 - FOOD COMBINING TABLE

APPENDIX 4 - 10 STEPS TO SUPER HEALING

1. Balanced eating is to nutrition what cross-training is to exercise.  It covers all the bases, leaving none of the body's target healing zones undefended in the same way that a variegated fitness regimen leaves none of the body's muscle groups unexercised.

2. Is your body in biochemical balance for free radical control?  (This is called biological ionization in nutritional biochemistry).  It's easier than it sounds because there's a one-size-fits-all equation that can help prevent formation of disease-generating free radicals.  It's a 6.4 pH reading your urine - the state indicating that your body is in homeostatic balance.  Free radicals can multiply rapidly when the urine pH strays too far from the ideal - becoming either too acid or too alkaline.  There are approximately 10 quadrillion human cells and one hundred quadrillion healthy bacterial cells in a ration of 1 to 10 to keep the pH at a balance of 6.4 and to feed us with various nutrients.  When the balance is upset, free radicals invade
the body, compromising the immune system and producing disease unless defender cells - which super healing foods help your body manufacture - intervene.  Antibodies and drugs are indiscriminate killers that exterminate billions of healthy cells along with disease promoters, unbalancing your health in the process. 
If you've got a good more-alkaline-than-acid diet going, abundant in fruits and vegetables, all you need to do to maintain the inner balancing act is to have your family doctor do a urine pH reading or check with your chemist for a do-it-yourself kit.

3. Keep slim and trim by knowing your resting metabolic rate (RMR) to calculate your caloric needs.  Your resting metabolic rate, unlike your pH, is not an one-for-all figure.  It's based on body weight, and the following calculations will yield your ideal, more or less.

a. Find your current weight in kilograms.

b. Multiply your current weight in kilograms by the RMR factor (1.0 for men and 0.9 for women due
to the fact that the formula was first used for men and rates must be adapted for the female metabolism).

c. Multiply by 24 (the number of kilocalories per kilogram required to maintain basic metabolic function).

Meeting your own purely personal calorific needs is important because it prevents your metabolism from shifting into a "starvation mode", which triggers biochemical imbalance and ill health.

4. Normalise your weight.  Thinner is better than fatter for a long, healthy life, say progressive health professionals.  Normalizing your weight improves your circulation and promotes a better assimilation of
antioxidants. The best way to get a grip on your girth is to reduce your intake of fat. Not only does an ounce of fat have more than double the calories of protein or carbohydrate, but also fat oxidation does not respond rapidly to increases in fat intake.

5. Lift your spirits.  A principle of most popular and lesser known religious disciplines is that affirmative attitudes and emotions are essential to the holistic healing process.  Studies reveal that negative feelings, such as depression, release the toxic enzyme cathypain, which, along with free radicals, compromises immune system responses and functions. Exercise can allay negative emotions, so take up a realistic personalized long-range fitness plan.

6. Drink up for faster healing.  Water is the oldest of all natural medicines.  H2O can decrease or increase muscle tone, reduce pain, generate energy, improve digestion and elimination, and dissolve and remove the free radicals that trigger disease and speed the aging process.  Drink some water an hour before or after meals, not during, which dilutes antioxidants.  Juicing daily (with an occasional juice fast) is another liquid health-keeping strategy.

7. Get bad habit control.  A diet that protects you from diseases and ill health won't do you as much good if you smoke, drink, or indulge in recreational drugs.

8. Thake control of stress.  You need eight hours (give or take an hour) of sleep daily to restore vitality.  Your body clock runs on a circadian rhythm cycle, and the more you deviate from the asleep-by-11-awake-by-7 model, the greater you get into stress debt and the greater your need for stress intervention in the form of meditation, yoga, shiatsu, reiki, or similar therapies - anything that causes a rise in your interleukin-1 levels, a disease-fighting chain reaction.  But give your choice some deliberation time or that biofeedback might backfire.  Being relaxed isn't just about being dormant; it's actually about stimulating certain parts of the brain, and not everyone responds well to the same relaxation techniques.

9. Keeping a firm foot on some popular or lesser known spiritual path can make the difference between sickness or health.

10. Study a nutritional diet.

APPENDIX 5 - OTHER NATURAL THERAPIES FOR IBS

As well as the methods used for this individual there are others than be used, as one method does not suit all. Listed below are other methods that should be considered;

Aromatherapy: The use of essential oils, sometimes with massage.
Hypnotherapy: Healing of a person while they are in a trancelike state.
Acupressure: The use of pressure to certain points of the body to help rebalance the natural flow of the body.

Bibliography

1. SNHS Basic and Advanced Nutrition Course notes 2002/2003

2. What You Really Need to Know About Irritable Bowel Syndrome.
Dr. Robert Buckman, with Nigel Howard,
Published in 2000 by Marshall Publishing Ltd.

3. Eat to Beat IBS
Reduce Pain and Improve the Natural Way
Dr Sarah Brewer and Michelle Berriedale-Johnson

Irritable Bowel Syndrome - IBS