Adaptogens

Hands up if you feel stressed, exhausted and lacking in energy. Chances are that’s most of us: stress is the modern epidemic making us feel lacklustre, lowering our libidos — and making us fat.

One alarming recent survey revealed that stressed women office workers ate their way through 2,240 extra calories a week in snacks.

The latest solution to stress? Adaptogens — an unwieldy name for a group of plants that are so-called because they help the body adapt to stress and give it an energy boost.

There are around 20 plants that qualify as adaptogens, a term coined in 1947 by a Russian pharmacologist who was investigating the stress-busting and energy-enhancing herbs that traditional Chinese and Indian Ayurvedic doctors had been using for centuries.

They were once the preserve of hardcore medical herbalists, but are now big news on the wellness scene and becoming more mainstream by the day.

Adaptogens such as rhodiola, maca and ashwagandha are popping up as key ingredients in everything from skincare to teabags, smoothie powders and supplements.

As you might expect, they’ve been popular in Los Angeles for a while: actress and wellness guru Gwyneth Paltrow reportedly buys hers from trendy Moon Juice, where they make kooky-sounding adaptogenic ‘dusts’ to add to your morning smoothie.

Some cafes in London now offer adaptogenic lattes, or you can sip adaptogenic tonics with names such as Perseverance (containing ashwagandha) or Patience (containing schisandra) at the newly launched, yummy mummy-friendly Yeotown Kitchen café in London’s Marylebone.

Celebrity fitness trainer Rhian Stephenson offers adaptogenic smoothies containing maca at her hip fitness studio chain Psycle London, which counts Victoria Beckham and Liv Tyler among its clients. ‘There’s a real buzz around adaptogens, but they’re not hippy dippy ingredients,’ says Rhian, who’s also a nutritionist and naturopathic doctor.

‘They are quite heavily researched, with studies showing how and why they work to reduce stress hormones in your body.’

According to GP and nutritionist Dr Sarah Brewer, they work by helping the body modify its stress response.

She says: ‘When you’re under stress your adrenal glands are pumping out the hormone cortisol, which makes your heart race, constricts blood vessels and generally prepares your body to fight or flee the threat — which might once have been a sabre-toothed tiger, but now is more likely to be chronic stress sitting at your computer.

When the threat was a tiger, the exercise involved in fleeing or fighting would reset your body back to normal, but with modern stress you don’t burn off or use up the chemicals it produces.

‘That’s where adaptogens come in — they have a balancing effect and seem to help reset that stress response.’

Each adaptogen has a slightly different effect in addition to relieving stress, she says.

Rhodiola gives you more energy as it helps the cells use oxygen more efficiently — a study of doctors on night duty found it improved their ability to stay alert and think straight.

Maca root and reishi mushroom lower blood pressure; in fact, in some studies reishi has been shown to have a greater effect than medication.

‘A lot of these adaptogens can sound quite kooky and strange until you look at the evidence — and there’s excellent evidence for many of them, although most doctors don’t know about it,’ says Dr Brewer.

To qualify as an adaptogen the plant has to be non-toxic, so they are generally safe to take, although some shouldn’t be used in pregnancy. ‘But if you are taking other medication you should always check with your doctor or pharmacist first,’ adds Dr Brewer.

Nutritional therapist Henrietta Norton uses adaptogens in 60 per cent of her award-winning Wild Nutrition vitamin and mineral supplements. Her favourite is the Indian herb, ashwagandha.

‘Research has shown it can reduce levels of the stress hormone cortisol by an average of 27.9 per cent, and causes a lowering of depression and anxiety scores of more than 70 per cent over eight weeks,’ she says.

‘It would be difficult to find any other nutrient to have that dramatic an effect.’

Read on to find out what else you should try . . .

SMOOTHIE TO BOOST YOUR SEX LIFE

WHAT IS IT: Naomi’s Kitchen I Am Energised adaptogenic powder, (£30 for 300g, contains 30 servings, naomis.kitchen and Selfridges). Among other things it contains six adaptogens: ashwagandha, rhodiola, panax ginseng, maca, muira puama, and suma root.

HOW DO YOU TAKE IT: Add one heaped tablespoon to juices, smoothies or simply water and shake vigorously. Consume up to two doses a day.

WHAT DOES IT PROMISE: To strengthen the adrenal glands and immune system, and provide an energy boost. The highest concentrations of adaptogens are ashwagandha with 1.2g per serving and maca with 0.8g.

DR BREWER SAYS: ‘This includes key adaptogens plus antioxidant sources such as cacao and matcha. This is one I would want to try myself. It includes muira puama, which my own published research suggests may improve libido.’

SPRAY TO SOOTHE YOUR SKIN

WHAT IS IT: Sjal Mineral Kalla Energy Tonic (£47 for 150ml, spacenk.com). Contains rhodiola, Siberian ginseng, maral root.

HOW DO YOU TAKE IT: Spray on to the face after cleansing in the morning and evening, or use as a mist any time.

WHAT DOES IT PROMISE: To combat skin stress caused by the weather and to energise the skin; it also claims to work at a deeper cellular level to boost the skin’s metabolism.

DR BREWER SAYS: ‘While there is some evidence that rhodiola extracts can penetrate through the skin, I doubt you would absorb much from a quick watery spritz. It’s expensive, too. I’d prefer to invest my money in an oral supplement.’

SNACK AWAY YOUR STRESS

WHAT IS IT: Dried jujube (£1.99 for 40g, abakusfoods.com). Jujube are chewy red fruits, also called Chinese dates, which have been used for thousands of years to reduce anxiety and insomnia.

HOW DO YOU TAKE IT: Eat as a snack or add to breakfast porridge or smoothies

WHAT DOES IT PROMISE: To lift mood, calm the mind, improve sleep and boost immunity.

DR BREWER SAYS: ‘Jujube are energising, taste great and are a good source of antioxidant polyphenols and soluble fibre. Clinical trials suggest jujube may improve cholesterol levels, sleep and reduce constipation.

‘As a snack, they’re better than a bag of crisps, but you would have to eat them every day for a sustained benefit.’

TREAT ANXIETY WITH TEA

WHAT IS IT: Three Tulsi tea by Pukka (£2.49 for 20 sachets, Ocado, pukkaherbs.com). Each teabag contains 1.8g of tulsi (holy basil), 0.8g of purple tulsi, 0.8g of green tulsi and 0.2g of lemon tulsi leaf.

HOW DO YOU TAKE IT: Mix with boiling water and steep for up to 15 minutes.

WHAT DOES IT PROMISE: Purple tulsi enhances mental clarity in times of stress and green tulsi helps stress-related irritable bowel syndrome (IBS).

DR BREWER SAYS: ‘Holy basil, or tulsi, is a powerful medicinal herb used to improve glucose control, lower blood pressure and relieve anxiety.

‘Clinical trials show it can boost the percentage and activity of cells which fight infection. Tulsi is traditionally taken as an infusion, or tea, and this blend is a cost effective way to try it.’

PEP UP WITH A HERBAL PILL

WHAT IS IT: Vitano Rhodiola tablets, Schwabe Pharma (£9.90 for 30, schwabepharma.co.uk). Each tablet contains 200mg of rhodiola rosea extract.

HOW DO YOU TAKE IT: Take one tablet twice a day, 30 minutes before food.

WHAT DOES IT PROMISE: To relieve symptoms of stress, fatigue and mild anxiety.

DR BREWER’S VIEW: ‘Rhodiola is one of the most effective adaptogens for relieving stress and anxiety, and is also energising. I take it myself to prevent burnout during busy times.

‘I like the fact that this herbal medicine is regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA) to ensure pharmaceutical quality.’

THE TOP ADAPTOGENS TO TRY 

RHODIOLA

An evergreen perennial, rhodiola grows in the colder, mountainous regions of Europe, Asia, and at high altitudes in the Arctic.

Traditionally it has been used as a herbal cure for anxiety, fatigue, anaemia, impotence, infections, headache, and depression related to stress. People have also used it to increase physical endurance, work performance, longevity, and improve their resistance to altitude sickness.

ASHWAGANDHA

More properly known as withania somnifera, ashwagandha is also referred to as Indian ginseng. Ashwagandha is part of the nightshade family and has long been used in ayurvedic medicine to combat stress, fatigue, lack of energy and to treat problems with concentration.

JUJUBE

Part of the buckthorn family, jujube is a small, deciduous tree or shrub with thorny branches that usually reaches a height of between five and 12 metres. It has been widely cultivated around the world but is thought to be native to Asia. Used in various ways in different cuisines, the tree’s fruit may be candied and eaten as a snack, pickled, smoked, or made into tea and even into wine.

TULSI

An aromatic perennial plant native to the Indian subcontinent, tulsi is grown for religious and medical purposes — it is known as Thai holy basil and revered as the elixir of life within Hinduism.

Many cuisines cook with it, and in some parts of the world it is also used as an insect repellent.

MACA

Technically known as lepidium meyenii, maca is a herbaceous biennial native to the high Andes of Peru. It’s the root which is used in cooking — both as a vegetable (it is similar to radishes and turnips) and it can also be dried and used to create a maca flour. It has been used both to improve semen quality and to remedy symptoms of menopause.

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Fibre may NOT be good for you!

Deirdre Parsonage's knowledge about what constitutes a healthy diet was second to none: bran flakes for breakfast, wholegrain bread, pasta and rice for lunch and supper, and, of course, five servings of fruit or veg a day.

It's a diet she tried to stick to for more than ten years. The only problem was that it left her doubled up in agony.

The 52-year-old mother of four and former police officer has suffered from irritable bowel syndrome (IBS) for years. What she didn't realise was that her healthy diet only made her symptoms worse.

IBS sufferers are usually told by their GPs to eat more fibre. But a major study, due to be published soon in the British Medical Journal, shows conclusively that eating extra bran and other fibre is likely to do more harm than good.

Indeed, the lead researcher, Professor Peter Whorwell from Wythenshawe Hospital, Manchester, is demanding a change in terminology. He says fibre should no longer be seen as an essential cornerstone of a healthy diet, at least for IBS sufferers.

'It's wrong to say that eating fibre is healthy when it exacerbates unpleasant symptoms for so many people with IBS,' he told the Mail.

An estimated nine million Britons suffer from the condition. A chronic bowel disorder, IBS is characterised by cramping abdominal pain, bloating and diarrhoea as well as constipation.

While it's not known what causes it, three times as many women as men are affected - possibly because of their hormonal changes or increased tendency to depression and anxiety (which are linked to the disorder).

GPs commonly advise patients to increase their intake of fibre and prescribe fibre-based medication. 

But around five million people in the UK may have their symptoms made worse by this advice, according to Professor Whorwell, who is a leading authority on the disorder.

'The worst thing for a significant number of IBS patients is fibre, particularly bran,' he says. 'While eating more fibre undoubtedly helps to sort out mild constipation, it's rarely helpful for severe IBS symptoms. It won't help diarrhoea.

'And people with severe constipation have a problem in moving waste along the colon, so adding a bulking agent in the form of fibre gives the bowel even more work to do and is likely to worsen symptoms.'

At the South Manchester Functional Bowel Service he sees many patients other doctors have considered 'difficult to treat'.

'Many IBS patients insist their diet can't be the problem, because they eat so much fibre,' he says. 'I tell them straight out that they should be eating an unhealthy diet.'

He advises patients to replace high-fibre food with white bread, white pasta, biscuits, cakes and cream crackers - anything, as long as its made from refined white flour.

This means giving up not just wholemeal or granary bread, but brown pasta, most cereals and cereal bars, as well as digestive biscuits (which are wholemeal, although many people don't realise it).'We find their health improves if they swap anything brown for anything and everything that's white,' Professor Whorwell explains.

The fibre-is-healthy mantra only become dietary dogma in the Seventies, largely based on the findings of population studies comparing Africa and Western countries.

The results appeared to show that a fibre-rich African diet led to lower levels of digestive disorders including bowel and colon cancer and colonrelated diseases.

In 1994, Professor Whorwell's team challenged this, reporting in The Lancet that five times as many of his IBS patients had worse symptoms when they ate bran.

The study was ignored - perhaps because it focused only on patients with extremely severe symptoms.

There was also a growing consensus from the Nineties onwards that IBS was largely the result of stress or emotional turmoil - with counselling or psychotherapy the best treatment.

However, Professor Whorwell's latest study - monitoring the impact of different kinds of fibre, including bran, on 250 sufferers - reveals for the first time that it affects patients with even moderate symptoms. 

'Until now, many GPs have taken it for granted that bran stimulates the bowel and is, therefore, a good thing, especially if a patient is constipated,' says Professor Robin Spiller, director of the Nottingham Digestive Diseases Centre and Biomedical Research Unit.

'Now we have the definitive trial showing bran irritates an already irritable bowel. This study should bring about an end to the real problem for many IBS sufferers.'

He adds: 'Of course, there is a role for medication in treating IBS symptoms, and there is undoubtedly a psychological aspect which needs to be taken into consideration. But dietary advice is also crucial.'

But not all fibre is the same, and the study found that many sufferers can manage fruit and vegetables, which actually improved their symptoms. That's because fruit and veg contain soluble fibre, which dissolves in water to form a thick gel (as does Psyillium seed, from which many IBS medications are made).

This is different from insoluble fibre, which is found in foods such as bran and which remains largely unchanged throughout the digestive process, so irritating an already sensitive bowel. 

However, Professor Whorwell believes that tens of thousands of people with IBS are, like Deirdre, sensitive to soluble fibre, too. 'So far we haven't done any studies on this,' he says. 

'But there is anecdotal evidence of people having their lives wrecked by the symptoms caused by eating fruit and vegetables.'

Other problem foods include chocolate, coffee and the fructose in sugar-free products (such as gum and cola).

Dr Nick Read, chairman of The Gut Trust, a leading IBS network, agrees. 'The woody flakes and particles of fibre in foods rich in dietary fibre, including fruit and vegetables, can irritate the sensitive bowel and exacerbate gut symptoms including distension, bloating, pain and increased diarrhoea.'

For Deirdre, this rings true. 'I simply couldn't follow the five-a-day rule on eating fruit and veg - I'd be too ill,' she says. If I'm out shopping, the healthy choice for lunch would be a baked potato in its skin and salad. Instead, I have pie and chips.

'I love vegetables, but if I have even a couple of sprouts or a forkful of cauliflower, I know I'll be ill for days afterwards. I also know eating bran flakes is good for my heart, but I daren't touch them.'

'I'm still torn between eating a healthy diet and feeling healthy. These days, I eat to control my symptoms, even though I worry about my long-term health.'

What's true for Deirdre, however, cannot be taken as a rule. 'Those who suffer from IBS need to find out what food suits them, which can vary from person to person,' says Dr Read.

And while it is often helpful to remove bran for a while until the gut has calmed down, there are health benefits in a balanced diet containing different kinds of soluble fibre and some insoluble fibre, says GP Wendy Denning, author of The Diet Doctors Inside And Out.

One way to discover your personal triggers is a new online health diary (ibs-relief.co.uk). It has been developed by Professor Whorwell in conjunction with the manufacturer of IBS medication Buscopan and is launched today.

He says: 'Keeping this kind of food diary is a long-term commitment - you need to do it for a few months to get results - but it can be a truly effective DIY tool for IBS sufferers.'

Meanwhile, Deirdre has been referred to Dr Matthew Lewis, Consultant Gastroenterologist at BMI Edgbaston Hospital in Birmingham, where she is finally receiving useful dietary advice, including discovering the joys of porridge, a moderately soluble form of fibre.  

'In Deirdre's case, we were able to identify fibre as the main culprit of the IBS and to find a suitable alternative - at least for breakfast,' says Dr Lewis.        

'I've been delighted to discover something that is healthy and it doesn't make me ill,' says Deirdre. 'I'm over the moon.'

• The South Manchester Functional Bowel Service (www.ibs-care.org).

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Treatments for IBS

As well as making changes to your diet and lifestyle to manage your IBS there are also treatments available for when you have a flare up, depending on your symptoms.

• Abdominal cramps, pain and discomfortIBS sufferers say this is the most common symptom of IBS but it is often mistreated with painkillers or antacids. However, the pain of abdominal cramps is different from the pain of a headache or indigestion so it needs a specific treatment that targets the cause of the pain. IBS pain is often described as ‘stabbing’, ‘sharp’ and ‘intense’ (not ‘burning’ sensation like indigestion or heartburn) and it’s caused by spasms in your digestive tract.
  If you’re feeling the discomfort of abdominal cramps and pain, then try an antispasmodic medicine that targets the cause of the pain such as Buscopan® IBS Relief. It acts locally in your digestive tract to interrupt the signal which tells the muscle to spasm. This helps the muscle to relax, which quickly releases the pain and the digestive process can return to normal – helping you get on with your day.
• Diarrhoea Perhaps one of the most inconvenient symptoms of IBS is diarrhoea. Always needing to know there is a loo close by, or in some cases not being able to leave home during an episode of diarrhoea – has this happened to you?
  Diarrhoea occurs when fluid cannot be absorbed from your intestines and this can happen for a number of different reasons. An estimated 27% of IBS sufferers have diarrhoea every time they have an IBS flare up.
  If you have diarrhoea then antidiarrhoeal medicines such as loperamide can help. They work by slowing down the passage of food in the intestine which allows more water to be absorbed and stools become firmer. Treatments like this can help take some of the stress out of not knowing when you will need the loo in a hurry.
• Constipation is another symptom of IBS, but we all have trouble going to the loo sometimes and find it difficult or embarrassing to talk about. It actually happens to most of us at some point in our lives. If you're not passing stools as often as usual, you're straining, or having difficulty passing a stool, this is known as constipation.
  If you are constipated you might want to try a laxative like Dulcolax® Tablets* which works by stimulating the natural movement of your bowel. Visit our friends at www.myconstipationrelief.com/uk and read stories about how other people feel, and get some simple, straight forward advice on constipation.
• Bloating and flatulence Some IBS sufferers say the abdominal bloating caused by IBS can make them “look pregnant” by the end of the day and it’s not always easy to deal with flatulence (wind) when you’re with friends or colleagues! Over half of IBS sufferers say they always have bloating when their IBS flares up.
  If you have bloating and flatulence, then you may want to try an antiflatulence treatment, such as simethicone, which can help to reduce the pressure of trapped wind and help you feel more comfortable in your clothes.

*Dulcolax 5mg Gastro-resistant Tablets contain Bisacodyl. Always read the label.

IBS treatments are available to buy from pharmacies and supermarkets and you can always ask your pharmacist if you need further advice.

Making changes to your lifestyle can also have a beneficial effect on your IBS symptoms. Reducing your stress levels, adapting your diet and taking some exercise (if you have time) are all achievable. Take one step at a time, it doesn’t matter how little, as small steps add up and could make a big difference to how you feel. Read our Top Tips section for help and advice.

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IBS

IBS SYMPTOM CHECKER

Take control of IBS

The three main ways to manage IBS are:

• Stress reduction & lifestyle changes – stress can take its toll on your body in many ways and unfortunately IBS can be one of them. Stress is one of the most common triggers of IBS.
  Stress management takes lots of different forms and even the smallest change in your life—like making some time for yourself, going for a walk, or prioritising your to-do list rather than struggling to complete it—can make a big impact on your stress levels and your IBS symptoms.
• Diet – it’s not only ‘healthy eating’ – find out more about and try some of our delicious IBS Recipes. No need to turn down a dinner party invitation because of your IBS again!
  We also have a list of useful Top Tips for more simple ways to manage your IBS and make the most of every day.
• Product/Treatment – it’s not always possible to avoid your IBS triggers but that doesn’t mean you have to suffer with an IBS flare-up. Find out about the helpful over the counter products available for relieving the symptoms of IBS, so that you know exactly what to look for when you need fast, effective relief.

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IBS

17) Excess CCK

People with IBS are more likely to release too much CCK (a gut hormone) in response to a fat-rich meal.  (R)

CCK is the culprit that causes gas soon after eating. (R)  This might be because of activation of the vagus nerve or because CCK directly interacts with the hypothalamus to stimulate the flow of your colon, which will cause gas. (R)

See my post on CCK.

18) Excess Cortisol

I already spoke about CRH being a cause of IBS.  But cortisol may also be involved.

Cortisol is unusually high in women with IBS.  (R)

This is probably because we know that CRH causes significantly more ACTHto be released in people with IBS when compared to people without IBS. (R)

Cortisol was generally higher in the morning and lower in the evening than healthy controls. (R)

When researchers evaluated the psychological stress of the subjects, they found that the higher Cortisol levels in IBS could not be explained by differences in psychological stress.  (R)

19) Sex Hormones: Testosterone, Estrogen, Progesterone

Low estrogen and progesterone play an important role in IBS. (R)

Estrogen and progesterone receptors are in your gut.  (R)

Both women with and without IBS are more likely to experience
symptoms such as stomach pain, diarrhea, nausea, and bloating when estrogen and progesterone drop down to the lowest levels in the body (during the menses). (R)

During the low estrogen and progesterone phase (menses),  women with IBS are more sensitive to gut pain. (R)

Bloating also seems to be worse during the phase associated with higher progesterone (the luteal phase). (R)

Women tend to experience a decrease in IBS during menopause, where estrogen and progesterone decline. (R)  This indicates that the hormones may not have as much to do with IBS as does their fluctuation.

Testosterone is capable of increasing pain hypersensitivity. (R)

20) Decreased Motilin

Motilin is a hormone that stimulates the gut flow and is normally decreased after meals but increased in between meals or fasting.  Insulin inhibits motilin. (R)  Motilin stimulates the gut flow.

People with IBS have decreased motilin response to both a meal and water. (R)

However, they show an increase in motilin in response to mental stress and this causes abnormally increased gut activity. (R)

Studies suggest that pH in the beginning of the small intestine (duodenum) affects motilin release. (R)

Low pH (acidic) inhibits motilin and gastric motor activity, whereas a high pH (alkaline) it has a stimulatory effect. (R)

This is one culprit that causes gas soon after eating. (R)

21) Excess VIP

VIP stimulates the intestines. (R)

VIP stimulates the secretion of water and electrolytes, bicarbonate and pepsin (an enzyme).  It inhibits gastric acid secretion. (R)

VIP stimulates the bowels and can cause crampy and watery diarrhea when highly concentrated in the gut.  (R)

In two studies, VIP was twice as concentrated in IBS patients compared to control subjects. (R)

In another study, VIP was only high in women with IBS-D. (R)

22) Low PYY

PYY stimulates absorption of water and electrolytes and inhibits PGE2 and VIP, which stimulates intestinal fluid secretion.  (R)

It acts to slow down the small intestines.

PYY cells are reduced in both IBS-D and IBS-C.  (R)

23) Ghrelin

Ghrelin cell density was significantly higher in IBS-D and lower in IBS-C than in the controls. (R)

In people with IBS, Ghrelin and motilin are more in sync and vary with each other. (R)

The Obestatin/Ghrelin ratio also has some significance. (R)

24) Secretin, GIP

In IBS-diarrhea patients, there are fewer cells that release CCK, secretin, GIP, and somatostatin. (R)

These hormones stimulate bicarbonate, enzyme secretion, and gall bladder contraction (CCK). (R)

Secretin, GIP, and somatostatin inhibit stomach acid secretion, so having too little of them could result in excess stomach acid release. (R)

25) Low Oxyntomodulin

Oxyntomodulin cells were significantly lower in both IBS-D and IBS-C than controls. (R)

26) Somatostatin

Somatostatin cells were significantly lower in the IBS-D groups, but higher in IBS-C patients than in the controls.  (R)

27) Excess Substance P

Substance P was also elevated in people with IBS (0.11 vs. 0.03). (R)

28) TRH

TRH is the precursor to TSH and acts to stimulate gut flow and this is dependent on stimulation of the vagus nerve. (R)  This can worsen IBS-D.

Other

29) Defective Mucus Layer

The mucus layer in your gut is an important barrier to keep out the microbes in your gut. If it’s not functioning properly (not enough mucin (R)), bacteria will cross over, cause inflammation and this will also change your gut microbiota for the worse.  It can also alter the intestinal structure.  These changes are common in IBS. (R)

30) Guanylate cyclase 2C

Guanylate cyclase 2C is a receptor in your gut cells that influences gut flow.  When it’s activated, it speeds it up.  A drug called Linaclotide does just that (FDA approved in 2012 for IBS-C). (R)

Linaclotide reduces activation sensory neurons in the colon, reducing pain.  50% of those receiving linaclotide saw a significant reduction in pain, versus 37% with the placebo. (R)

Linaclotide activates colonic motor neurons, which increases gut flow and thus promotes bowel movements. (R)

31) Nutrient Deficiencies

Vitamin D deficiency may contribute to IBS and some case reports show improvement in symptoms. (R)

A low intake of vitamin B6 is correlated with worse symptoms of IBS. (R)

32) Lack of Soluble Fiber

Some evidence suggests soluble fiber supplementation (e.g., psyllium husk) is effective for IBS.  (R)

For IBS-D, it allows for a more consistent stool. For IBS-C patients, it seems to allow for a softer, moister, more easily passable stool. (R)

However, insoluble fiber (e.g., bran) has not been found to be effective for IBS and may aggravate symptoms in some. (R)

Fiber is especially beneficial in those with IBS-C.  Soluble fiber can reduce overall symptoms, but will not reduce pain. (R)

A meta-analysis found only soluble fiber improved global symptoms of irritable bowel, but neither type of fiber reduced pain. (R)

Studies have used 10–30 grams per day of psyllium. (R)

33) Fat Malabsorption

About 30% of IBS patients have fat malabsorption. (R)

Genetics

SelfDecode has a page on the genetics of IBS.  It’s the best genetic program to analyze your genes, so buy your 23andme ($99) and sign up.

There are many genes that can contribute to IBS.  These are just a few examples to give you an idea.

INFLAMMATION:

IBS/IBD individuals are less often HLA-DQ 2/8 positive than in  healthy populations.(R)

People with a genetic predisposition to produce higher TNF are more likely to have IBS and IBD.

The (A) allele of TNF-308 (rs1800629) is associated with higher levels of TNF.  41% of people with one An allele had IBS vs 26% of the people that didn’t. (R)

TRANSIT:

A mutation in the FGF4 gene (rs351855 – TT) results in slower gut transit. (R)

BILE:

A gene variation of TGR5 (rs11554825), a bile acid receptor, was associated with a quicker gut flow. The TC/CC group had an average 50% faster gut flow compared with the TT subgroup. (R)

OXIDATIVE STRESS:

The Glycine transporter (GLYT1) is essential for the protection of gut cells against oxidative damage.  This is controlled by the SLC6A9 gene (rs3791124 -AG is bad and AA is terrible).  The majority of clients with gut problems have a mutation in this gene.

Excluding Other Conditions

Conditions with IBS-like symptoms include parasitic infections, lactose intolerance, SIBO and celiac disease.  (R) However, SIBO goes hand and hand with most cases of IBS, so I wouldn’t necessarily consider them separate diseases.

The following investigations should be performed to exclude other conditions (R):

• Stool microscopy and culture (to exclude infectious conditions)
• Blood tests: Full blood examination, liver function tests, erythrocyte sedimentation rate, and serological testing for coeliac disease
• Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)
• Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and malignancies)
• Hydrogen breath testing (to exclude fructose and lactose malabsorption)

IBS is Commonly Found With:

Several medical conditions appear with greater frequency in patients diagnosed with IBS.

• 94% of IBS patients have psychiatric disorders -most commonly anxiety and depressive disorders. (R)
• IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients. (R)
• IBS occurs commonly with migraines and headaches. (R)

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