I thought that I would blog about something that is very close to my, …er, stomach. During the course of the last year, I’ve had to come to terms with adding irritable bowel syndrome (IBS) to my list of conditions. This isn’t all that unusual; according to the Chronic Pain Research Alliance, several chronic pain syndromes often co-occur in patients, and these include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, temporomandibular disorders, and vulvodynia. The CPRA points out that none of these conditions are understood well, and the relationships between them are equally unclear. Consequently, many physicians are inadequately trained to treat chronic pain syndromes, resulting in the misdiagnosis or incorrect treatment of patients.
In my case, the first gastrointestinal problems began about two years ago when I started having severe cramps when I had to ‘go’ to the bathroom during my menstrual cycle (I’m trying to keep this as non-graphic as possible, but any post on IBS is going to have TMI). My gynecologist thought it was most likely endometriosis and put me on the birth control pill, which did significantly reduce the pain. Over the next year, my fibromyalgia symptoms blossomed, so I was put on long-acting tramadol (synthetic opioid). One of the downsides of narcotics is constipation. Other than that, I have had the regular IBS symptoms of bloating, abdominal pain and irregularity. The usual culprits are whole grains, cruciferous veggies (broccoli, cauliflower, brussels sprouts), some beans and too many citrus fruits. Finally, last summer (2012) I started having episodes that are similar to stomach flu. They typically last for about 24 hours and include frequent urges to ‘go’, sleeplessness, sweats and chills (but no fever), and skin tingling or crawling. These are probably among the worst experiences I’ve ever had. In total, I’ve had about five of these episodes. The triggers seem to be eggs and beef. A naturopath did a food sensitivity test for me once and I have a food intolerance to eggs. The beef I can’t explain.
The most relevant article I’ve found to explain these episodes is called ‘Food intolerance is linked to different disorders’ by Science Nordic. The article focuses on research by Arnold Berstad and colleagues at Lovisenberg Diaconale Hospital in Oslo. Berstad conducted a study with 84 participants who had unexplained digestive problems that they attributed to food intolerances. The research team administered a provocation test in which the patients were given a non-digestible carbohydrate called lactulose to eat. The provocation test re-created the symptoms of digestive distress experienced by the patients, proving that their complaints were not psychosomatic. Researchers suspect that the indigestible carbohydrates were not absorbed in the small intestine, but fermented by intestinal microbes in the large intestine, resulting in the digestive problems. One result of this study was that patients were observed to get chills as part of their reaction to the provocation test, in addition to digestive upset (bloating, gas, and pain). This is the only mention in all of my research to food intolerance reactions which includes both G.I. tract distress and body wide symptoms like chills. Significantly, the researchers found that all but one of the participants were symptomatic of IBS, 84% were symptomatic of chronic fatigue syndrome and 71% were symptomatic of fibromyalgia. The authors of the study suggest that an imbalance in intestinal microbes might be part of a common disease mechanism for all three overlapping conditions. Other researchers dispute the claim that the cause of the three chronic pain diseases is intestinal, but agree that it might play a role.
This article was significant for me to understand the confusing and extremely unpleasant symptoms that I was experiencing. I still believe that some of my episodes result from eggs, not only difficult to digest carbohydrates, just because often the only food preceding an episode that differed from my usual diet has contained eggs – like lemon meringue pie or ranch dressing. My solution has been to focus more on taking care of my fussy intestines. I’ve been taking a probiotic called Align which is specifically formulated for IBS. It has a patented bacteria called Bifidobacterium infantis 35624, which has been clinically proven to reduce IBS symptoms. It’s a little bit pricey, so taking generic probiotics that include Bifidobacterium might also be helpful. I think eating foods rich in probiotics are beneficial. I like yogurt the best, but some people swear by miso and other fermented soy products. You’re probably better off with supplements though if you have a sensitivity to dairy or soy. I’ve also been feeling much better eating a high soluble fiber diet. There are two kinds of fiber – soluble and insoluble. Soluble fiber creates a gel in the intestinal tract, made up of the unabsorbed fiber dissolved in water, which helps with both kinds of irregularity. It slows down the transmission time of food in the gut but also creates enough bulk to ensure passage. In contrast, insoluble fiber just pushes through the gut, and can create problems with loose digestion, and also cause bloating or gas. High soluble fiber foods include oatmeal, squash, carrots, apples, oranges, flaxseed, potatoes, some beans/lentils and (according to some) French bread and white pasta. Also Metamucil (without irritating artificial sugars) is very helpful because it contains psyllium husks that are high in soluble fiber. Of course avoiding trigger foods is also key. IGG Food sensitivity tests, although critiqued by some, can help give you an idea. For me, the test that helped identify a food intolerance to eggs was totally right on.Lastly, I eat a plant-based diet that is focused on high nutrition, created by Dr. Fuhrman, and adapted to accommodate my IBS. I’ll write more about that another time, but the focus is on phytochemicals, antioxidants, micronutrients, anti-inflammatories and all the other benefits of fruits, veggies, grains, nuts and seeds, to give my body a fighting chance. I’m also big advocate of moderation, and not obsessing too much over rigidly following supplements and diets – I love food too much (even though we have a complicated relationship) to kill my enjoyment with dogmatism!