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A Gut Reaction

Treat irritable bowel syndrome naturally

By Nataliya Schetchikova, PhD

Having consulted countless doctors and hospitals, many patients come to see Ryan Niemiec, PsyD, as a last resort. They hope to regain their lives—to eat at restaurants, attend parties, and look forward to social situations, instead of dreading them.

These patients suffer from irritable bowel syndrome (IBS)—chronic abdominal pain accompanied by diarrhea, constipation, or both, estimated to affect approximately 10 percent of adults in the United States, predominantly women. Because being in public often provokes symptoms, many IBS patients lead reclusive lives, explains Dr. Niemiec, adding that he helps patients to feel more confident and comfortable, and to learn to manage their condition without sheltering themselves.

A licensed psychologist in private practice, Dr. Niemiec practices clinical hypnosis—teaching people to “tap into their natural healing resources and use them for medical purposes, such as coping with chronic pain or other symptoms.”

While studies show that hypnosis is 80-to-95-percent effective with IBS patients,^1-4 it remains a secret well kept from many patients and doctors. Many healthcare providers under-recognize the role of integrative management of the condition, says Gerard E. Mullin, MD, MHS, CNS, CNSP, director of integrative GI nutrition services and capsule endoscopy at Johns Hopkins Hospital.

“In the age when only 5 or 10 minutes is devoted to a patient, IBS is challenging to treat,” he adds, emphasizing that the condition requires “a lot of time to sort through the issues and develop a relationship with the doctor.”

A Challenging Diagnosis

Although IBS symptoms are fairly straightforward—stomach cramps, bloating, diarrhea or constipation, and mucus in the stool—proper diagnosis requires special testing by a gastroenterologist to rule out conditions with similar symptoms, such as celiac disease, Crohn’s disease or other GI disorders. “IBS cannot be diagnosed based on history alone,” says Michael Moses, DC, of Washington, D.C., a team doctor for Marine Corps Marathon athletes as well as Washington Redskins and Washington Wizards cheerleaders, who has helped patients manage IBS symptoms for 12 years.

In patients over 50, colon cancer also should be ruled out, says Dayna Early, MD, a gastroenterologist at the Barnes-Jewish Hospital in St. Louis and an associate professor at the Washington University School of Medicine, St. Louis. She adds that IBS symptoms typically don’t include bloody stools, unexpected or unintentional weight loss, or fever.

For 40 years since the first mention of IBS in 1950s’ medical literature, the condition was considered psychosomatic. With the discovery of specific biochemical changes in patient’s tissue biopsies and serum samples, IBS is now believed to have an organic cause—although that cause remains unclear. “Some patients with IBS develop symptoms after viral gastroenteritis; in others, the precipitating factor is stress, and anxiety and depression can amplify symptoms,” says Dr. Early.

Treating the Physiology

Because the disorder expresses itself through the gut, treatment often starts with minimizing the patient’s discomfort. “We focus on predominant symptoms, such as diarrhea or bloating, giving medications with the lowest side effects first, and escalating therapy depending on the patient’s response,” says Dr. Early.

To help patients with bowel irregularity and stomach discomfort, Dr. Early recommends supplemental fiber and probiotics. Fiber bulks up the stool, helping with mild diarrhea, and can retain water, relieving constipation. Patients with post-viral IBS may have some alteration in intestinal flora, and probiotics—specifically clinically-proven strains, such as bifidobacterium infantis 35624—help restore the bacterial balance necessary for colon health, she explains.

In addition to recommending acidophilus and lactobacillus to IBS patients, Dr. Moses says taking dietary enzymes 20 minutes before a meal may also help, although research is scant on the subject. Other nutritional strategies may include identifying and removing allergens from the diet and avoiding acidic and gas-producing foods, such as tomatoes, beans and cabbage.

Although elimination diets produce some relief, they are not a permanent fix, says Dr. Mullin. To help IBS patients long-term, he advocates supplements, such as peppermint oil or lemon balm, and stress reduction.

IBS and Chiropractic

Through collaboration with Loren Marks, DC, DACBN, a New York chiropractor, Dr. Mullin believes that IBS patients can benefit from chiropractic care through stress reduction and the effect of manipulation on the nervous system. In Dr. Mullin’s experience, “IBS patients do better [when treated] in a more holistic model.”

Chiropractors are likely to encounter IBS patients seeking treatment for other symptoms. According to a recent study, compared with a control group, IBS patients had a 40-to-80-percent higher chance of suffering from migraines, fibromyalgia, and depression⁵—conditions that send many patients to CAM providers.

Chiropractic’s holistic approach to care—assessing the patient’s structural, biochemical and emotional state—can help IBS patients look beyond suppression of symptoms toward modulating the main contributing factors, explains Dr. Marks. A certified clinical nutritionist, he has many tools in his arsenal—from natural restoration of gastrointestinal flora to hormone testing, which helps identify chronic-stress sufferers. “The key is to identify the cause(s) of the patient’s condition,” he says.

Dr. Moses, who also believes in nutritional support for stress relief—magnesium, B complex vitamins and pantothenic acid—says IBS patients report “feeling more relaxed and functioning better” after receiving spinal adjustments.

Hypnosis

While patients with anxiety or depression should be referred to a mental health expert, most IBS patients, following a diagnosis, should consider mind-body strategies such as diaphragmatic breathing, visual imagery, mindfulness meditation—or clinical hypnosis, says Dr. Niemiec.

Despite its bad rep—which Dr. Niemiec attributes to “stage” and lay hypnotists, who start practicing after attending weekend workshops, though untrained to safely handle the powerful technique—hypnosis is being explored and applied by medical schools worldwide (including Duke University and Johns Hopkins) in treating patients with IBS, chronic pain, psoriasis, obesity and other conditions. At St. Louis University, where he is a behavioral health consultant in the Primary Care and Prevention Center, Dr. Niemiec teaches IBS patients self-hypnosis techniques.

Hypnosis is just another natural state of mind that everyone experiences, explains Dr. Niemiec. Everyone at some points has gone into a “highway trance”—focusing on nothing but the road—or has become absorbed in a movie, book or conversation to the point of ignoring surrounding noise and other distractions.

For IBS patients, hypnosis involves “focusing attention and letting go to achieve deeper relaxation.” Next, the practitioner makes “suggestions for healing and decreasing pain sensitivity,” says Dr. Niemiec. Ultimately, patients learn to bring themselves into the relaxation state by using a cue, such as a breathing pattern or a phrase.

While he hasn’t seen side effects in his patients, Dr. Niemiec says coming out of the trance too quickly may make a patient feel light-headed. In addition, he notes, lay hypnotists may be unprepared to deal with some patients who encounter “uncomfortable things within themselves.”

While hypnosis may sound too good to be true, researchers are investigating how it works. Possible hypotheses include the effect of relaxation on the body or increased motility of the colon, says Dr. Niemiec. He attributes the value of hypnosis in IBS cases to its ability to reduce a person’s sensitivity to pain: “Patients learn to regulate themselves and triggering situations, taking greater control of their symptoms.”

Nataliya Schetchikova, PhD, ACA News associate editor, can be reached at nataliyas@acatoday.org.

References

1. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 2003 Nov;52(11):1623-9.
2. Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987 Apr, 28:4, 423-5.

3. Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14.

4. Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J, Cooper P, Cruickshanks P, Miller V, Whorwell PJ. Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome. Aliment Pharmacol Therapeutics 2003 Mar 1;17(5):635-42.
5. Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterology 2006 Sep 28;6:26.