IBS deserves more media attention than it gets because it's so prevalent in today's society, and the inability of modern medicine to resolve it might be the system's most damning failure. Traditional medicine has very few cures in its medical bag any more -- its dependence on using drugs is designed to suppress symptoms but doesn't address the cause of the problem.
With IBS, a lifetime of symptom suppression results in frustration, changes in quality of life and potential future health consequences. This approach is of great benefit to the pharmaceutical companies but rarely to the patient.
Irritable Bowel Syndrome is a condition, not a disease or illness. It's a collection of symptoms that include gas, bloating, indigestion, pain, cramps, heartburn, reflux, diarrhea, constipation, alternating diarrhea/constipation and/or abnormal urgency or frequency. Some patients have a couple symptoms, and some have them all. The condition can also be referred to as colitis or spastic colon.
IBS is the leading reason for hospital stays in the United States and the second most common cause of missed work time behind the ordinary cold. It reportedly affects 50 million to 70 million people, is the most common condition diagnosed by gastroenterologists and accounts for 12 percent of visits to primary care physicians. These numbers are probably low, considering that many people self medicate and two to three times as many women seek treatment as men.
The fiscal cost of IBS is estimated at $8 billion in direct costs and $25 billion in indirect costs annually. The cost to the patient might be more than just discomfort -- it could be the inability to ever lead a healthy life.
Same old solutions
All IBS patients seem to share a common path, from first realizing that something has changed to finally seeking medical attention. It begins with a new pain, some stomach gurgling, a little heartburn, maybe gas and bloating you never had before or a change in bowel habits. You don't really notice at first; it's not that big of a deal.
As symptoms continue, you think it might go away but it doesn't, so you self medicate with over-the-counter products. For gas and bloating, heartburn or reflux, antacids like Tagamet, Pepsid AC, Tums or Rolaids would be the patient's first choice. It's such a common condition that such products are the No. 1 selling category of over-the-counter medications. If they don't work, its off to your physician for a four- to six-minute visit with someone who's probably not listening and a prescription for Prilosec or Prevasid.
If there's pain involved, you try aspirin, Tylenol, Advil, Bufferin, ibuprofen or other non-steroidal anti-inflammatory pain relievers -- the second most common over-the-counter medication sold today. These might or might not work and put you in a position for your doctor to want to remove your gallbladder, since he or she has found nothing else to explain the symptoms and, as the medical profession foolishly believes, you don't really need the thing anyway.
Removal of the gallbladder rarely results in any relief and in most cases creates additional digestive complaints, because you now have an inability to digest fatty foods in an efficient manner. This might actually increase pain, gas and bloating.
Imagine a physician suggesting that there are irrelevant organs in the human body. Perhaps they think it's a design mistake.
If your complaint is diarrhea or loose bowel movements, you guzzle Imodium or Pepto Bismol. If it's constipation, it's Metamucil, Citrucel, Fibercon and a stool softener. If the constipation continues, it's again off to your friendly doctor for Propulsid.
Somewhere along the way the patient realizes that certain foods exacerbate the problem and they begin to avoid them or become afraid to eat. Some are afraid to leave the house and, when they do, they have to know every bathroom between their home and destination.
Since none of these over-the-counter medications, prescriptions or dietary changes resolve the problem, it's once again off to our favorite well-intentioned physician. By now he or she is probably tired of seeing someone that they don't really have the tools or knowledge to help, so you're referred to a gastroenterologist.
Gastroenterologists are specialists in the intestinal tract, trained to perform unique testing to rule out a more serious condition or cancer, and are quite good at that, but IBS usually escapes their expertise. So the patient begins a series of tests that can include colonoscopy, endoscopy, barium enemas, MRIs and cat scans. You've been tested up this way and down that way, but your doctor walks into the room and proudly announces that all the tests are negative and there's nothing wrong with you. You the patient, however, know there's something wrong.
More time goes by and you try to cope as best you can, having been told that you'll just have to learn to live with it. But many patients' path through the traditional medical establishment probably has one more remaining surprise, particularly if you're a woman.
Continued visits to your favorite physician to make the same complaint over and over again results in an industrywide unspoken red flag that you need a prescription for an anti-depressant or a referral to counseling. This is a veiled medical insult. Your doctor is telling you that he or she has no idea how to help you, but it can't possibly be their fault.
Do they think you're too emotional, a little too tense, and maybe you should just calm down, go home and feel better about feeling so bad? Who wouldn't be tense living with IBS?
What a journey! No results, your quality of life continues to deteriorate, you might be on anti-depressants you don't need and you're wasting a lot of money. You also believe that the prescriptions and over-the-counter medications are safe to take -- after all, they're FDA-approved -- but unfortunately all medications have side effects and unintended consequences.
The use of antacids seems reasonable and safe enough. Certainly you feel like there's too much acid (a digestive enzyme) and sometimes you can taste it. Your gastroenterologist will confirm that very few people produce too much stomach acid and, in fact, most people produce too little.
It's confusing, because the symptoms for too much or too little stomach acid production are the same. A combination of a deficiency of digestive enzymes, foods that don't agree with you and the drinking of too much liquid during your meals cause gas, bloating, heartburn and reflux.
If you consume too much beverage during a meal, not only do you dilute an already insufficient amount of digestive enzymes but you also create an acidic soup of chewed food that has the ability to splash onto your unprotected esophagus and burn it (commonly referred to as heartburn). This is why heartburn occurs frequently after a person has gone to bed, because lying down allows some acidic content to wash up against the base of the esophagus.
The use of antacids also neutralizes the digestive enzymes and slows their ability to break down foods. In order to prevent gas and bloating, food must be broken down in a timely manner. Also, minerals from your food must first contact an acidic environment in the stomach in order to be absorbed in the small intestine. Antacids neutralize hydrochloric acid and prevent that. Mineral malabsorption has long-term consequences.
Fiber products usually aren't high quality, tending to be rough on the insides of your digestive tract, and can escort nutrition out of your body. Another malabsorption problem, creating long-term consequences.
Chronic usage of aspirin and anti-inflammatory pain relievers causes damage to the tissue in the gastrointestinal system. They harm the intestinal mucosa, cause micro bleeding from capillaries and have been linked to arthritis. FDA-approved for pain, these medications seem like they should be safe to take.
Are you feeling lucky, though? More than 76,000 people are hospitalized each year from anti-inflammatory pain reliever use and 7,600 die from ulceration and intestinal bleeding. Another startling statistic is that more than 106,000 hospitalized patients die each year from prescription medications.
The desperate approach of removing the gallbladder also has unintended consequences. Unless you have gallstones, it rarely will be the cause of your discomfort. Once lost, you now have no ability to store bile, another digestive enzyme released when you eat fatty foods. That means you can't digest the fat in your food.
What's the cause of pain, gas and bloating? It's the inability to digest food in a timely manner.
Such a bleak picture. Could your doctor be right -- there's no cure and you must learn to live with IBS? Of course not. The answer is so simple.
Have doctors forgotten their training? Do the pharmaceutical companies have too much influence?
The biochemistry, endocrinology and physiology courses in school are straightforward, and the traditional doctor's lack of nutritional training only complicates his or her inability to treat the patient. These courses, however, hold the key to what helps the Irritable Bowel Syndrome patient.
There are many different methods of treatment for IBS within the holistic physician's office -- from nutritional or herbal supplements and homeopathic remedies to acupuncture, colonics and relaxation techniques. All have varying degrees of success.
The most successful treatment seems to be found with a growing number of holistic physicians that practice "functional medicine." These doctors are concerned with restoring normal function to the gastrointestinal system, believing that only two areas, bacteria and chemistry, need to be addressed because they govern "normal function" in the gastrointestinal system.
We all have both beneficial and harmful bacteria living inside us. If both aren't at optimal levels, the chemistry that governs digestion, absorption and elimination will change, resulting in the symptoms of IBS.
The primary reason that bacterial levels change is the use of antibiotics. Designed to kill bacteria, they do a great job curing an ear infection, sore throat, cold or urinary tract infection. But an unintended consequence of even three or four courses of antibiotics during a lifetime is the alteration of a delicate, necessary balance. Once altered, an environment now exists for the patient to pick up an additional bacteria, parasite or fungus.
Even without additional "uninvited guests," the balance between beneficial and harmful bacteria can reverse, the chemistry changes and the symptoms appear. Secondary reasons for bacterial levels to change are prescription and over-the-counter medications, poor dietary habits and alcohol. We have all had a combination of these influences.
The good news is that it's possible to re-establish a normal bacterial balance, restore proper chemistry, reduce inflammation and improve digestion through natural therapies and dietary change. All symptoms disappear. You prevent the reappearance of this condition through the judicious use of antibiotics, but if you find antibiotics necessary, take a product designed to re-establish the good bacteria that's being destroyed. This prevents you from again entering that viscious cycle that results in IBS.
If you sense an attitude present in this story, it's because I have seen the suffering that exists from trusting a professional who's failed you. There are patients who are merely physically uncomfortable, some with embarrassing moments, some who take too much time off from work and put their jobs in jeopardy. Some are no longer working and are on disability.
Quality of life is all we truly have in this world. Let's not allow a physician to tell us that we'll have to learn to live with it or that it's in our head.
Make them learn new things. Ask them to find the cause of your condition, not to suppress your symptoms.
The average patient knows that Irritable Bowel Syndrome isn't caused by a lack of Tums, Metamucil or Imodium in your body. Why don't doctors?
DAVID DAHLMAN, a chiropractic physician with a degree in nutrition, is director of the Hyde Park Holistic Center. He writes CityBeat's monthly "Alternative Health" column.