Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common, debilitating, multi-factorial, functional gastrointestinal disorder where a definitive aetiology has not been established and no uniformly successful treatment exists. The condition is very prevalent in developed countries with IBS symptoms experienced by 8-22% of the population. (1)
 

IBS is characterised by a combination of symptoms and signs, such as abdominal pain, constipation (IBS-C), diarrhoea (IBS-D) — or alternating between both (IBS-A) — a noted change in both the frequency and consistency of stools, rectal mucus due to hyper-secretion of colonic mucus, dyspeptic symptoms including anorexia, flatulence, gastro-oesophageal reflux (GOR) and nausea, and an emotional component where anxiety and/or depression are often noted. Abdominal pain is often relieved following defecation. . Originally, diagnosis for IBS was made based on the Rome I Criteria. This previous criteria specified that there should be at least 3 months of abdominal pain, either continuous or recurrent, that is relieved by defecation &/or is associated with either a change in the frequency or consistency of the stool. Conversely, the Rome II Criteria differs from that of the Rome I in that it specifies that the abdominal pain should be present either continuously, or recurring for a period of 12 weeks or >. Both the Rome I & Rome II Criteria are consistent in their description of what constitutes accompanying symptoms, i.e., relief of abdominal pain following defecation, &/or associated changes in both the frequency & consistency of the stool, but the Rome II Criteria is more specific in stipulating that at least 2 of these accompanying symptoms must be noted, along with abdominal pain. Although the Rome I Criteria was also quite detailed in specifying that an individual had to have two or more associated symptoms of IBS, e.g., altered stool frequency of more than 3 per day or < 3 per week; abdominal distension; bloating; passage of mucus, etc, > 25% of the time, the newer Rome II Criteria has helped in simplifying the diagnosis of IBS. Where patients are <45 years of age, & they meet three or more of the Rome II diagnostic criteria (without ominous symptoms), a confident diagnosis can be provided without the need for invasive testing.

Rome III

Recently, there has been a further change, and that is the new Rome III criteria.

According to this latest criteria, IBS is defined as recurrent abdominal pain or discomfort for at least 3 days per month during the previous 3 months associated with two or more of the following symptoms: improvement with defecation, onset associated with a change in the frequency of stool and/or onset associated with a change in form or appearance of stool (2). Defined simply, symptoms are now recommended to originate 6 months prior to diagnosis and be currently active (i.e., meet criteria) for 3 months. This time frame is less restrictive when compared to Rome II (12 weeks of symptoms over 12 months) and is easier to understand and apply in research and clinical practice. (3)
 

Gas, diet and IBS

The daily production of gas in the human gastro-intestinal tract (GIT) is 500-1500ml, and the volume found at any given time is 200ml. Five major gases are responsible for the development of flatus, i.e. carbon dioxide, hydrogen, hydrogen sulphide, methane, and oxygen. Oxygen found in the GIT is the result of swallowed air during the course of eating and drinking (aerophagia), or it may be due to hyperventilation in cases of anxiety. Greater amounts would be expected in subjects who eat too quickly, chew gum, or smoke, as not all is absorbed or expelled following belching.The human large intestine is host to at least 400 different bacterial species, and examples include carbohydrate-fermenting bacteria, methane-generating bacteria (methanogens), and pectinolytic bacteria. These bacteria are responsible for the production of carbon dioxide (the main gaseous product), hydrogen, hydrogen sulphide, and methane. Flatus is the by product of fermentable substrates (carbohydrates and proteins). Examples of these fermentable substrates include: beans, cabbage, Brussel sprouts, broccoli, and whole grains (which contain raffinose; and fruit, onions and wheat (which contain fructose). These non-absorbable carbohydrates, together with ingested sugars such as fructose found in fruits, dietary starches (that escapes small intestinal absorption), e.g. potatoes, corn, wheat; and dietary fibre, such as that found in oat bran, beans, and peas, are all capable of producing gas. This is the result of these foods being metabolised by the colonic flora, followed by bacterial fermentation.

A number of different treatment options are cited within the literature for IBS; however, dietary modifications are not viewed as a priority in many cases. Sulphur-containing foods such as beans, broccoli, Brussels sprouts, cabbage, cauliflower, garlic and onions have been identified as being extremely flatulogenic.

 
(4) Evidence relating to the exclusion of sulphur-containing foods is limited and, in many cases, dismisses exclusion diets as being of no use, limited use, or not proven to be effective. (5, 6) Nevertheless, other studies acknowledge that some foods may play a role in producing gas in the IBS patient. (7, 8-14)

The sulphur-containing amino acids cysteine, cystine, methionine and taurine are the main sources of dietary sulphur. Other sources are derived from glucosinolates found in Brassica vegetables (broccoli, Brussels sprouts, cabbage, cauliflower and turnip).

 
(15) In garlic and onions, the organic sulphur compounds are found in the form of diallyl thiosulfinates (allicin). Other dietary sources of sulphur are derived from meat or food additives used as preservatives (e.g. sulphur dioxide and sodium metabisulphite). Magee et al (16) found a significant dose-related increase in faecal sulphide concentrations associated with the intake of meat.
Some oligosaccharides, such as raffinose and stacchiose, appear to be the most important sources of gas from bean digestion, as these compounds cannot be degraded by intestinal mucosal enzymes. (17, 18) It might be expected that, following fermentation, these complex carbohydrates contribute to abdominal distension and bloating in IBS patients. Again, these patients might only demonstrate a greater sensitivity to due to their reduced gas handling ability as a result of altered motility. Information within the literature is limited as to the gas-producing ability of sulphur-containing foods and oligosaccharides, and addressing this knowledge gap may be important step in the treatment of IBS.

References

1. Spiller RC, et al. Irritable bowel or irritable mind? British Medical Journal 1994; 309(6969):1646

2. Hotoleanu C, et al. genetic determination of irritable bowel syndrome. World Journal of Gastroenterology 2008: 14(43): pp 6636-6640.

3. Drossman DA, Dumitrascu DL. Rome III: New standard for functional gastrointestinal disorders. Journal of Gastrointestinal Liver Disease 2006:15(3): pp 237-241

4. Dapoigny M, et al. Role of alimentation in irritable bowel syndrome. Digestion Basel 2003;67(4):225.

5. Hauschildt E. Exclusion diets have limited use in irritable bowel syndrome. J Hum Nut Dietet 2001;14:231–41.

6. Farthing MJG. Fortnightly review: Irritable bowel, irritable body, or irritable brain? BMJ 1995;310:171–5.

7. Dapoigny M, et al. Role of alimentation in irritable bowel syndrome. Digestion Basel 2003;67(4):225.

8. King TS, et al. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352(9135):1187.

9. Spiller RC, et al. Irritable bowel or irritable mind? BMJ 1994;309(6969):1646.

10. Jones J, et al. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome: Gut 2000;47(suppl II):S1–19.

11. Simren M, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome: Digestion Basel 2001;63(2):108–15.

12. Biali S. Beating the bloat: dietary changes can improve irritable bowel syndrome, but psychologic and mind-body factors also play a strong factor. Medical Post Toronto 2003;
http://www.medicalpost.com/mpcontent/article.jsp?content=20030922_102242_3436

13. Spanier JA, et al. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med 2003;163(3):265–74.

14. Hodges D. Calm irritable bowel by cutting fructose, fat: studies confirm significant benefits of modified diets. Medical Post. Toronto 2003;39(40):21.

15. Magee EA, et al. Contribution of dietary protein to sulfide production in the large intestine: an in vitro and a controlled study in humans. Am J Clin Nutr 2000;72(6):

1488-94.

16. Magee EA, et al. Contribution of dietary protein to sulfide production in the large intestine: an in vitro and a controlled study in humans. Am J Clin Nutr 2000;72(6):

1488-94.

17. Dapoigny M, et al. Role of alimentation in irritable bowel syndrome. Digestion Basel 2003;67(4):225.

18. Ahmed AJ. Intestinal gas: Not entirely a laughing matter. Total Health 1999;

21(3):50–1.

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John D. McGuire
University Masters Degree (with Distinction) in Complementary Medicine
DBM, ND, DHT, DH Pharm (Post Grad), BHlthSc (Comp Med), MHlthSc with Distinction (Comp Med), MATMS, MCMPAC, MNHAA.

Provider No. ATMS0484HN
Health Scientist / Complementary and Traditional Medicine Specialist.
(John McGuire is a registered provider with all private health funds)

York City Health And Natural
Therapies Centre

• Naturopathy
• Herbal Medicine
• Homoeopathy
• Nutritional Counselling/Dietetics

York City Health is conveniently located just 4 minutes walk from Town Hall Station at:The Gowings Building (Corner of George and Market Streets), Suite 605, Level 6, 45 Market Street, Sydney NSW 2000.

Phone: (02)9262 1011 
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Mobile: 0418 292 809 

Consulting Hours (By appointment only):
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About John McGuire

John McGuire graduated in medical herbalism in 1978 and naturopathy in 1979. His training and knowledge in both complementary medicine and the medical sciences has enabled him to successfully combine traditional medicine and modern scientific technique in his lecturing and practice. His diverse history in complementary medicine includes:

• Senior lecturer in herbal medicine and naturopathic clinic supervisor at the NSW College of Osteopathic and Natural Sciences (St. Leonards) Sydney 1980-1982

• Senior lecturer in symptomatology and diagnosis/pathology at Nature Care College (Chatswood) Sydney 1982-1983

• Vice President of The National Herbalist Association of Australia 1982

• Guest lecturer to The Australian Pharmaceutical Industry 1982

• Tutor NSW University 1982-1983

• Lecturer in herbal medicine at The Southern Cross herbal School (Glebe) Sydney 1982-1983

• Consulting editor in herbal medicine for both Nature and Health, and Australian well-being Magazine
1983-1984

• Consultant for Blackmore’s Professional Services
1985-1986

• Dean of The Australasian College of Natural Therapies
and senior lecturer (Ultimo) Sydney 1984-1987

• Senior lecturer in symptomatology and diagnosis/clinical methods/nutritional biochemistry/clinical chemistry/herbal pharmacology, and naturopathic clinic supervisor at Nature Care College (Artarmon) Sydney 1987-1989

• Senior lecturer in symptomatology and diagnosis for The Southern Cross Herbal School, (Gosford) NSW 1995

• Dean and senior lecturer in herbal pharmacology and drug interaction for SEARCH Scientific and Education (Killara and Chatswood) Sydney 1989-1996

• Honorarium, Novogen Women’s Health and Advisory Board, Sydney 2001-2003

• Conducting ongoing research into irritable bowel syndrome at Charles Sturt University (Albury, Bathurst, and Wagga Wagga campuses) 2001-2007

• Commenced Publishing scientific articles on irritable bowel syndrome 2005-2007

* Continued lecturing on his scientific research into
IBS 2005-Present

For over 31 years John has devoted his life to practicing traditional medicine, lecturing, research, and publishing scientific papers. His teaching posts have enabled him to educate both students, and a vast number of professionals (engaged in post-graduate training). These include biochemists, dieticians, doctors, herbalists, naturopaths, nurses, pharmacists, professors, etc.

His teaching and practice style encompasses a bipartisan approach utilising Western medical diagnostics and natural therapies (herbal medicine, homoeopathy, and nutrition) as the choice of treatment. Treatments are provided for a wide variety of disorders such as, environmental allergies, anxiety and stress disorders, men’s health, menopausal problems, skin and respiratory problems, gastro-intestinal disorders, e.g., irritable bowel syndrome, etc.

York City Health and Natural Therapies Centre strive to ensure that every patient is well informed and cared for throughout their treatment program. Whilst under the care of Mr.McGuire, he is contactable from 9:00am-6:00pm Monday to Saturday.