Sometimes to move forwards we need to look backwards. Finding ‘new’ treatments for conditions is a really good example of this. Let’s look at the treatment of irritable bowel syndrome (IBS).
Many people think of IBS as a modern condition, brought about by the lifestyle that we live in the late 20th/ early 21st century. Busy lives, stressful conditions, processed foods, too many medications – all things that are common to life now days. But did you know that IBS was identified as a condition in the 1820’s? Around the 1920’s to 1940’s this condition became a significant medical concern. In fact, in 1957 a review article by Dr Thomas P Almy M.D. states that IBS is a significant social concern, and functional bowel diseases rate second only to the common cold in lost production from work.
In the 1920’s we called IBS ‘mucous colitis’ and it was seen in many military personnel returning from the war. Research and case studies of the time thought that the condition was because of too many mucous producing cells found in the intestines or mucous being produced as a result of inflammation in the intestine lining. What was commented on time and time again was that people suffering with mucous colitis (IBS) were generally of the same personality type: highly anxious, worried and stressful. By the 1940’s another effect of IBS was seen; an alteration in the muscle function of the intestines (called spastic colon). From this time we see a description of mucous colitis. “Mucous colitis is considered to be a functional disorder of the colon neurogenic in origin, characterised by the excessive secretion of mucus in the stools, by marked irritability and spasticity of the colon, by excessive flatulence, localised or diffuse abdominal pain and diverse constitutional symptoms”. Sound familiar to what we call IBS today?
There has been little joy in finding the cause of IBS. Treatments since the 1940’s have remained remarkably similar, focusing on medications to reduce the spasms in the bowels and symptom management through diet. The only treatment that seeks to potentially address the underlying cause is psychological therapies such as counselling, relaxation and hypnotherapy. In the 1940’s the inflammation of the bowels was thought to be related to inflammation of the nervous system through stress and anxiety.
Dietary treatment of IBS has changed over the years. From a bland diet and bed rests (to reduce overall nutritional intake and therefore work of the digestive system) in the 1940’s to the 1970’s when lactose (milk sugar) was identified as a trigger to symptoms. However it was the 1980’s onwards that saw a real golden-era in understanding the dietary impact on IBS symptoms. It is in 1980 that we first see foods that we would now group together as FODMAP foods being implicated in symptom management. In the 1980’s as well we now see research showing changes in gut bacteria in people with IBS. In the 1990’s research on salicylates and amines (food chemicals) suggested that exclusion of these foods may help manage symptoms in people with IBS.
So where do we stand now? If we look back through the 2000’s we see that research on the low FODMAP diet for treatment of IBS flourished and we know now that about 75% of people with IBS will respond well to this diet. We also see that gut bacteria (microbiota) research is showing us that diet and stress can all affect our gut bacteria which can cause IBS. Can looking back show us where we need to look for treatment of people who don’t have any relief from the low FODMAP diet? Well, the good news is that the role of salicylates is now being investigated in the treatment of IBS symptoms. First identified in the 1990’s we have finally circled back to this group of foods as a possible missing-link if low FODMAP doesn’t help. Recent research has also shown that a low FODMAP diet can reduce histamine production in the gut. Too much histamine, or not being able to break down histamine or amines was also noted back in the 1990’s. And what about the psychological treatments of IBS? In the 1990’s hypnotherapy was the main treatment that worked. Now we have research showing that gut-directed hypnotherapy may be as effective as a low FODMAP diet for treating IBS.
So by looking backwards at the treatment of IBS we can see that current and future research is on the right track. After establishing a healthy whole food diet, a low FODMAP diet is perhaps the place to start and if this doesn’t help then investigating amine or salicylate trigger foods may be the next course of action.
What is IBS?
IBS is ‘irritable bowel syndrome’. We still don’t know fully why it happens but it is more likely to happen after a bout of gastroenteritis (tummy bug), antibiotics or a very stressful time of life.
How do I know if I have IBS?
Irritable bowel syndrome (IBS) is characterised by tummy pain and may be accompanied by either constipation or diarrhoea, bloating or excess wind.
What should I do if I think I have IBS?
It is important that your doctor has ruled out any other cause, such as coeliac disease, inflammatory bowel diseases, gall stones, diverticular disease or bowel cancer. Go and discuss your symptoms with your doctor before you start any form of treatment, such as dietary changes.
What can I do if I have IBS?
Always make sure you are eating a healthy whole food diet. If that doesn’t help then come and talk to us at K Pace, Dietitian. We have just heard how a low FODMAP diet can help in 75% of people. Katrina has many years of experience working with people to help manage symptoms and resolve underlying gut damage caused by IBS. She can work with you to tailor the low FODMAP diet to your symptoms and investigate a low amine or low salicylate diet if needed.
Katrina Pace, Dietitian
Gut bugs fascinate me. Diet and gut bugs intrigue me. Cooking is essential. Add them all together and you get a fairly interesting opinion on life! In my humble opinion.