Irritable bowel syndrome (IBS) is a chronic, functional gastrointestinal disorder characterized by recurrent abdominal pain and cramping, excessive bloating, constipation, and/or diarrhea. As many as 20 percent of the adult population, or one in five Americans, have symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people who suffer from it.
Causes of IBS
IBS is poorly understood, and its causes remain unknown. Various theories exist, however, to explain why people develop IBS, including those pointing to stress, diet, and hormonal issues as triggers. In my experience, emotional stress is almost always a factor in the development of IBS.
Diet: Both patients and primary care physicians relate IBS to food intolerance ; however, no correlation has been found between perceived food intolerance by patients and findings from common diagnostic tests for food intolerance.
While certain diets may relieve or trigger IBS symptoms, some IBS sufferers also experience a complete resolution of symptoms during times of relaxation, such as while on vacation, even if their diets are “poor” and they are eating forbidden or unusual foods. On the other hand, at other (i.e., stressful) times, anything they put in their mouths (even plain water) may cause immediate abdominal bloating and trigger other IBS symptoms. The bottom line: diet is important, but whether or not certain diets help or aggravate could be influenced by other factors such as the individual’s emotional state during a particular time period. Addressing diet alone will most likely be insufficient to achieve long-term management of IBS. (Related Article: Is There an Ideal IBS Diet?)
Hormones: Many women with IBS experience intensified symptoms around the time of menstruation. It is therefore believed that reproductive hormones play a role in IBS. This is possible, since the female hormonal system (HPG Axis) and stress hormones (HPA Axis) interact closely. In my opinion, however, some IBS symptoms are actually triggered by the intensified emotional symptoms associated with female conditions such as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea (painful periods). It is important to address these female menstrual conditions when treating IBS patients. Acupuncture and moxibustion therapy can be used to manage the aforementioned gynecological conditions.
Current Evidence - Conventional Drug Therapy and Acupuncture for IBS
Current drug therapy has been shown to be of limited benefit and to carry potential risks. In addition, a low level of patient satisfaction with care received from primary care physicians has been found among IBS patients. Consequently, almost 50% of IBS patients turn to acupuncture and other complementary and alternative medicine (CAM) therapies.
Acupuncture has traditionally been utilized for the treatment of a variety of digestive complaints. Research studies have suggested that acupuncture may be effective for certain cases of nausea, vomiting, gastroesophageal reflux disease, functional dyspepsia, bloating, abdominal pain, diarrhea, and constipation. Digestive symptoms could improve after acupuncture treatment partly because acupuncture affects the motility and perception of the digestive organs. Laboratory research using rats and dogs demonstrated that acupuncture stimulation significantly impacted gastrointestinal motility and visceral perception, both of which are closely associated with the development of IBS symptoms. Laboratory studies on rats also indicated that acupuncture stimulation on lower limbs (e.g., on the ST36 point) elicits gastric motility via vagal efferents, while acupuncture stimulation on the abdomen (e.g., on the ST25 point) inhibits gastric motility via sympathetic efferents.
Clinical trials on IBS patients, however, have shown mixed results. The 2006 Cochrane Collaboration Systematic Review concluded that current evidence regarding the effectiveness of acupuncture for treating IBS is inconclusive. Further rigorous clinical studies using adequate experimental design are certainly needed. However, compromised standardized acupuncture protocols that involve simply inserting needles into preselected points (often employed by previous clinical trials on acupuncture) are less likely to provide measurable benefits for the majority of IBS patients.
IBS is considered by gastroenterologists to be a “difficult” condition with significant psychological components. Carefully designed, individualized, and comprehensive acupuncture programs will likely be needed to provide profound clinical benefits for many IBS patients.
Acupuncture Procedures for IBS
At our Toronto clinic, acupuncture and moxibustion have been used to treat a variety of digestive conditions for over 20 years.
Treatment consists primarily of stimulating acupoints traditionally known to restore digestive functions by using both acupuncture and moxibustion. It also includes acupuncture and moxibustion therapy for emotional health. Our comprehensive acupuncture protocol is typically administered in three different patient positions.
Supine (facing up): Acupuncture is administered in this position primarily to stimulate points located in the legs, arms, and abdomen using our Japanese superficial needling techniques.
Prone (facing down): Acupuncture stimulation is applied on selected points along the spine, with attention to nerve segmentations associated with digestive organs. Moxibustion is applied to warm up selected acupoints.
Seated: At the end of the session, the patient is asked to sit on the treatment table so that a gentle superficial tapping acupuncture treatment can be administered on a point near his/her wrist. Studies have suggested that this particular acupuncture technique enhances autonomic nervous system (ANS) function. Optimal functioning of both branches of the ANS (sympathetic and parasympathetic) is crucial for proper digestion.
In addition, most patients are treated with our innovative approach, the Acupuncture and Sound-Assisted Autonomic Modulation Technique , which involves acupuncture and moxibustion in combination with a specific HRV biofeedback breathing exercise. This specialized technique further augments the modulation functioning of the autonomic nervous system. This particular breathing exercise is utilized during acupuncture sessions; in addition, we ask patients to practice it between treatments to maintain the therapeutic benefits. This combined acupuncture and HRV biofeedback approach is currently provided only at our Toronto acupuncture clinic.
Originally Published: February 12, 2011
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Is There an Ideal IBS Diet?
Although stress can be a major factor in irritable bowel syndrome (IBS), certain diets may relieve or aggravate IBS symptoms. There is, however, no standard IBS diet; healthcare practitioners offer a wide variety of food recommendations, which often leaves patients confused and frustrated. In fact, it is not unusual to hear that a patient visited a GI specialist who recommended a diet high in fiber, then went to another GI specialist who prescribed a diet very low in fiber.
Natural health care practitioners often recommend elimination diets. In reality, such diets are quite difficult for many people to follow. Their strictness can even cause stress for some patients, which in turn can aggravate IBS symptoms. It should be noted that certain segments of the patient population do respond very well to avoiding foods to which they are found to be “allergic.” However , such responders were likely not suffering purely from IBS in the first place; rather, they probably had other GI conditions such as lactose malabsorption or celiac disease.
Traditional East Asian Medicine Dietary Approach for IBS
Traditional East Asian medicine practitioners provide general dietary guidelines based on each patient’s constitutional pattern. The main diagnostic criteria for IBS patients include signs of repletion/vacuity, heat/cold, and dampness/dryness. It is considered extremely important that the digestive tract always be kept warm, especially in vacuity- and cold-type individuals.
In my experience as a resident of Canada, I have noticed that many people, especially young females, overeat raw vegetable salads and fruits. Eating a large bowl of vegetable salad may be good for replete body types that tend to accumulate heat (typically, individuals with such constitutions tend to develop heart disease, high cholesterol, high blood pressure, diabetes, and stroke). On the other hand, for individuals with other constitutional types, such as vacuity with cold (many IBS patients fit into this category), consuming large amounts of raw vegetables and fruits may not be beneficial. I can get a fairly good idea of a patient’s constitution by reviewing the Kampo Constitutional Evaluation Form in conjunction with assessing other physical signs (the pulse, tongue, abdomen, and so on).
You may also experiment for yourself: eat one large bowl of lettuce (preferably without any heavy dressing (you may add a small amount of salt or plain dressing), then see how you feel. If you develop bloating and diarrhea or constipation with small, pellet-like stools like those of rabbits, then you might try eating mainly cooked foods that belong to the neutral, warm, and hot categories in the Kampo food chart.
Originally Published: February 12, 2011
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