Irritable Bowel Synrome (IBS) is a functional bowel disorder characterized by chronic abdominal pain, abdominal discomfort, abdominal distension (swelling) and changes in bowel habits in the absence of an organic disease.
Irritable Bowel Syndrome is successfully treated. The key to a successful treatment lies in the causes.
Diagnosis of Real Causes & Treatment of Irritable Bowel Syndrome
- Gradual restoration of cellular function
- Personalized therapeutic protocols, without chemical residues and excipients
- Treating the real causes
- Therapeutic formulas that work alone or in combination with any other medication
- Adopting a Molecular / Therapeutic Nutrition Plan
In some cases the symptoms persist after gut-purging. It may occur in the form of diarrhea or constipation, or by alternation of these (classified as IBS-D, IBS-C or IBS-A respectively). Also, the ΙΒS can occur after an infection (post-infectious, IBS-PI) or a stressful condition.
Various conditions can be experienced as the ACE, such as celiac disease (gluten malabsorption), fructose malabsorption, infections, parasitic infections such as gallbladder, idiopathic inflammatory bowel disease, chronic functional constipation and chronic functional abdominal pain.
Symptoms involve many people as it appears that 10-20% of the world population is suffering from IBS, with new incidents per year accounting to 1-2%. Of those who suffer from IBS, only 10-20% seek medical help, while 20-50% of visits involve irritable bowel syndrome.
Women seem to have a chance to develop IBS 2-3 times more than men. In studies conducted that divided the population based on age, a decrease was observed in the elderly. Available data show that irritable bowel syndrome is rare in sub-Saharan Africa, but common in China, India and South America.
Symptoms of Irritable Bowel Syndrome
Symptoms of Irritable Bowel Syndrome are:
- Disorder in bowel habits (diet – constipation – alternations),
- Abdominal pain,
- Flatulence (bloating).
It may also be accompanied by:
- Mucus in the stools,
- Indigestion, burning, nausea, vomiting,
- Increased frequency of Urination αυξημένη συχνότητα ούρησης,
- Aggravation of symptoms during menstruation,
- Muscle Pain
The fact that the irritable bowel is mainly a female syndrome (2: 1 ratio), suggests that sex hormones play a key role in causing the symptoms.
During menstruation, female hormones that cause mobility disturbances and gastrointestinal symptoms, change due to the presence of hormone receptors in the gastrointestinal wall. The hormone responsible mainly for gastrointestinal symptoms is progesterone which increases during menstruation.
In particular, we have a decrease in estrogen levels and an increase in the levels of progesterone in the luteal phase which cause an increase in the expression of the serotonin receptor in the intestine leading to a worsening of the symptoms of the intestine (increased mobility) and visceral pain hypersensitivity.
Irritable Bowel Syndrome & Stress Hormones
The list of hormones that have an effect on gastrointestinal function does not stop there. Adrenal hormone, cortisol is one that is particularly high in women with irritable bowel syndrome, which confirms that stress affects the progression of the disease.
Another hormone confirming this conclusion is corticotropin. This hormone is responsible for sending a signal to the intestine in order to shed large amounts of water and mucus by accelerating the defecation process. But because the stimulus does not stop after defecation, that’s why we feel like we want to go back to the toilet.
Food Intolerance Τροφική & Irritable Bowel Syndrome
Many patients with irritable bowel syndrome believe that the symptoms of the disease are triggered by specific foods, but this causal relationship is difficult to prove. Milk, wheat and eggs, as well as foods rich in salicylate (coffee, nuts, corn, wine, tomato, etc.) or amines (chocolate, banana, wine, etc.) are the foods most responsible for the exacerbation of symptoms.
The role of malabsorption of individual sugars (ie lactose, fructose and sorbitol) in the development of symptoms of irritable bowel syndrome deserves particular reference. Lactose malabsorption has been reported to occur in 25% of patients with irritable bowel syndrome in the United States and in northern Europe, while the prevalence in the Mediterranean countries may reach 52-68%. The malabsorption of lactose can cause diarrhea and flatulence and thus occurs more frequently in the subgroup of patients who are overwhelmed with these symptoms.
Malabsorption of fructose and sorbitol also occurs in patients with irritable bowel syndrome. The prevalence of malabsorption is particularly high when these two sugars are administered simultaneously (31-92%). Although these percentages are not different from those measured in healthy control individuals, the intensity of the symptoms after glucose uptake is significantly greater in patients with irritable bowel syndrome. This difference does not appear to be due to intestinal dyskinesia and the hypersensitivity to dilatation, but to the increase in fermentation capacity to patients with irritable bowel syndrome.
Examinations for diagnosing individuals with Irritable Bowel Syndrome
Investigation of young patients with typical irritable bowel syndrome without signs of “alarm” for organic digestive disease does not require laboratory testing.
In patients with multiple diarrheal stools, the function of the thyroid gland should be tested and biopsies should be taken from the intestine to exclude microscopic or eosinophilic colitis. In the case of suspected bacterial overgrowth, the exhaled hydrogen test is useful.
If laboratory testing is required, the choice should be personalized based on their symptoms, their severity and the patient’s concerns. For patients with a short duration of symptoms, relatively young (but less than 50 years of age) and no obvious effusions for irritable bowel syndrome, general blood test, erythrocyte sedimentation rate (ESR) and colorectal examination can be used as initial screening tests.
The use of other tests such as CRP, biochemical tests, general microscopic and faecal parasitology are also some tests deemed necessary depending on the patient’s symptomatology and medical history.
We need to be careful and be checked when the onset of symptomatology starts after the middle age, and it is sudden. Also, when it is progressively worsening, when it causes night-time awakening and in cases where it is accompanied by anorexia, weight loss, fever and loss of blood in the stools. We also need to be careful when diarrhea is not painful but also when there are suspicions of malabsorption. Still, if there is a medical diagnosis of IBS, any new symptom should lead to our doctor.
Usually, the treatment focuses on limiting symptomatology and psychological support is used, as well as dietary measures and medication. There are several medications that help relieve the symptoms of IBS. Commonly, spasmolytics (eg pinaverium / dicetel) are used, but others are also used, such as anticholinergics (eg hyoscyamine / buscopan), antidiarrheals (eg loperamide / Imodium), tricyclic antidepressants (eg amitriptyline (Eg, diazepam / Valium), prokinetics (eg metoclopramide / Primperan), laxatives increasing the amount of stools (eg paraffin liquid / Nujol), serotonin receptor antagonists Paroxetine / Seroxat), receptor agonists (e.g., tegaserod / Zelnorm), rifaximin (e.g., Lormyx).
Nonetheless, these specific treatments, although widely used for years, aim primarily at reducing the symptoms of the disease rather than finding its cause and actually dealing with irritable bowel syndrome.
Thus, patients suffer from repeated relapses and recurrence of symptoms, which also affects them psychologically.
Regarding to dietary management of the disease, it is recommended to drink an adequate amount of water (2-3 liters a day), avoid caffeine, reduce over-excitement and the exacerbate of symptoms. It is also good to avoid legumes because they cause “bloating”.
Lactose, fructose or other saccharides should be restricted or avoided in patients with known sensitivity. There are preparations in pharmacies that are not drugs and help. Flax fiber preparations, which are recommended for both constipation and diarrhea, are of great importance. There are also formulations of probiotics and prebiotics. Probiotics are living microorganisms similar to those of the gut and help balance the intestinal flora. Prebiotics are substances that help develop and maintain the existing intestinal flora. Studies on the IBS typically involve probiotics. It appears that probiotics modify the intestinal flora and affect its interaction with food components and the immune system, while improving general symptomatology and especially flatulence.
Given that IBS patients are a group that have multiple combinations of symptomatology and that microbial flora has excellent human to human variability, setting criteria for choosing the right probiotic formulation is difficult. Here, a pharmacist plays a very important role, who in close and frequent relationship with the patient can help identify the most effective probiotic.
Cellular, Molecular Therapeutic Treatment
However, because there are many conditions that affect our hormone levels, it is necessary to look at cell biochemistry through specific biochemical, hormonal and metabolic examinations, as these fluctuations affect the onset and exacerbation of irritable bowel symptoms. Therefore balancing the imbalances is necessary for the recession or even the complete disappearance of the symptoms.
With personalized medical treatments and protocols, we can intervene and personalize each type of deficiency and remove the toxic load.
With this methodology, we are basically restoring Health in a cellular level and restore the body’s ability to produce high-quality combustion necessary for Life.
The Medical Protocols that are administered adjust the amounts, doses and type of components that change from person to person (actual personalization), as opposed to 50,100 or 500mg identical dosing approaches for all.
The clinical results of the use of such Medical Protocols over the last 20 years are more than satisfactory, with rates of improvement and re-regulation of the body of over 80%. Patients undergoing treatment for Functional Medicine see the quality of their daily routine change. Their quality of life is improving. Along with treatment, their mental and physical resources are increasing.
Dr. Nikoleta Koini, M.D.
Doctor of Functional, Preventive, Anti-ageing and Restorative Medicine
Diplomate and Board Certified in Anti-aging, Preventive, Functional and Regenerative Medicine from A4M (American Academy in Antiaging Medicine).
- Schneider MR, Schmidt-Ullrich R, Paus R (2009) The hair follicle as a dynamic miniorgan. Curr Biol 19: R132-R142.
- Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A (2019) The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb) 9: 51-70.
- Guo EL, Katta R (2017) Diet and hair loss: Effects of nutrient deficiency and supplement use. Dermatol Pract Concept 7: 1-10.
- Finner AM (2013) Nutrition and hair: Deficiencies and supplements. Dermatol Clin 31: 167-172.
- Singh RK, Chang HW, Yan D, Lee KM, Ucmak D, et al. (2017) Influence of diet on the gut microbiome and implications for human health. J Transl Med 15: 73.
- Scott KP, Gratz SW, Sheridan PO, Flint HJ, Duncan SH (2013) The influence of diet on the gut microbiota. Pharmacol Res 69: 52-60.
- Vaughn AR, Notay M, Clark AK, Sivamani RK (2017) Skin-gut axis: The relationship between intestinal bacteria and skin health. World J Dermatol 6: 52-58.
- Bowe WP, Joshi SS, Shalita AR (2010) Diet and acne. J Am Acad Dermatol 63: 124-141.
- Dawber R (1989) Alopecia areata. Monogr Dermatol 2: 89-102.
- Odom RB, Davidsohn IJ, William D, Henry JB, Berger TG (2006) Clinical diagnosis by laboratory methods. In: Elston Dirk M, Andrews’ Diseases of the Skin: Clinical Dermatology. Saunders Elsevier.
- Brenner W, Diem E, Gschnait F (1979) Coincidence of vitiligo, alopecia areata, onychodystrophy, localized scleroderma and lichen planus. Dermatologica 159: 356-360.
- Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, et al. (2013) A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol 169: 690-694.
- Clavaud C, Jourdain R, Bar-Hen A, Magali Tichit, Christiane Bouchier, et al. (2013) Dandruff is associated with disequilibrium in the proportion of the major bacterial and fungal populations colonizing the scalp. PLoS One 8: e58203.
- Rinaldi F, Pinto D, Marzani B, Rucco M, Giuliani G, et al. (2018) Human microbiome: What’s new in scalp diseases. J Transl Sci 4: 1-4.
- Pinto D, Sorbellini E, Marzani B, Rucco M, Giuliani G, et al. (2019) Scalp bacterial shift in Alopecia areata. PLoS One 14: e0215206.
- Ho BS, Ho EXP, Chu CW, Ramasamy S, Bigliardi-Qi M, et al. (2019) Microbiome in the hair follicle of androgenetic alopecia patients. PLoS One 14: e0216330.
- Polak-Witka K, Rudnicka L, Blume-Peytavi U, Vogt A (2019) The role of the microbiome in scalp hair follicle biology and disease. Exp Dermatol.
- L Nair, Z Dai, AM Christiano (2017) 649 Gut microbiota plays a role in the development of alopecia areata. Journal of Investigative Dermatology 137: S112.
- Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, et al. (2004) Alopecia areata investigational assessment guidelines–Part II. National Alopecia Areata Foundation. J Am Acad Dermatol 51: 440-447.
- Grice EA, Kong HH, Conlan S, Deming CB, Davis J, et al. (2010) Topographical and temporal diversity of the human skin microbiome. Science 324: 1190-1192.
- Paulino LC, Tseng CH, Strober BE, Blaser MJ (2006) Molecular analysis of fungal microbiota in samples from healthy human skin and psoriatic lesions. J Clin Microbiol 44: 2933-2941.
- Gao Z, Perez-Perez GI, Chen Y, Blaser MJ (2010) Quantitation of major human cutaneous bacterial and fungal populations. J Clin Microbiol 48: 3575-3581.
- Klindworth A, Pruesse E, Schweer T, Jörg Peplies, Christian Quast, et al. (2013) Evaluation of general 16S ribosomal RNA gene PCR primers for classical and next-generation sequencing-based diversity studies. Nucleic Acids Res 41: e1.
- Takahashi S, Tomita J, Nishioka K, Hisada T, Nishijima M (2014) Development of a prokaryotic universal primer for simultaneous analysis of bacteria and archaea using next-generation sequencing. PLoS One 9: e105592.
- Apprill A, McNally S, Parsons R, Weber L (2015) Minor revision to V4 region SSU rRNA 806R gene primer greatly increases detection of SAR11 bacterioplankton. Aquat Microb Ecol 75: 129-137.
- Parada AE, Needham DM, Fuhrman JA (2016) Every base matters: assessing small subunit rRNA primers for marine microbiomes with mock communities, time series and global field samples. Environ Microbiol 18: 1403-1414.
- Walters W, Hyde ER, Berg-Lyons D, Ackermann G, Humphrey G, et al. (2015) Improved bacterial 16S rRNA Gene (V4 and V4-5) and fungal internal transcribed spacer marker gene primers for microbial community surveys. mSystems 1.
- Caporaso JG, Lauber CL, Walters WA, Berg-Lyons D, Lozupone CA, et al. (2011) Global patterns of 16S rRNA diversity at a depth of millions of sequences per sample. Proc Natl Acad Sci USA 108: 4516-4522.
- Kozich JJ, Westcott SL, Baxter NT, Highlander SK, Schloss PD (2013) Development of a dual-index sequencing strategy and curation pipeline for analyzing amplicon sequence data on the MiSeq Illumina sequencing platform. Appl Environ Microbiol 79: 5112-5120.
- Vigetti D, Viola M, Karousou E, Rizzi M , Moretto P, et al. (2008) Hyaluronan-CD44-ERK1/2 regulate human aortic smooth muscle cell motility during aging. J Biol Chem 283: 4448-4458.
- Castro-Quezada I, Román-Viñas B, Serra-Majem L (2014) The mediterranean diet and nutritional adequacy: A review. Nutrients 6: 231-248.
- Rushton DH (2002) Nutritional factors and hair loss. Clin Exp Dermatol 27: 396-404.
- Mubki T, Rudnicka L, Olszewska M, Shapiro J (2014) Evaluation and diagnosis of the hair loss patient: Part I. History and clinical examination. J Am Acad Dermatol 71: 415.
- Spivak JL, Jackson DL (1997) Pellagra: An analysis of 18 patients and a review of the literature. Johns Hopkins Med J 140: 295-309.
- Goldberg LJ, Lenzy Y (2010) Nutrition and hair. Clin Dermatol 28: 412-419.
- Kato I, Vasquez A, Moyerbrailean G, Land S, Djuric Z, et al. (2017) Nutritional correlates of human oral microbiome. J Am Coll Nutr 36: 88-98.
- Manam S, Tsakok T, Till S, Flohr C (2014) The association between atopic dermatitis and food allergy in adults. Curr Opin Allergy Clin Immunol 14: 423-429.
- Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, et al. (2002) Acne vulgaris: A disease of Western civilization. Arch Dermatol. 138: 1584-1590.
- Grossi E, Cazzaniga S, Crotti S, Naldi L, Di Landro A, et al. (2016) The constellation of dietary factors in adolescent acne: A semantic connectivity map approach. J Eur Acad Dermatol Venereol 30: 96-100.
- Zouboulis CC, Jourdan E, Picardo M (2014) Acne is an inflammatory disease and alterations of sebum composition initiate acne lesions. J Eur Acad Dermatol Venereol 28: 527-532.
- Zákostelská Z, Málková J, Klimešová K, Pavel Rossmann, Michaela Hornová, et al. (2016) Intestinal microbiota promotes psoriasis-like skin inflammation by enhancing Th17 response. PLoS One 11: e0159539.
- Zhang C, Zhang M, Wang S, Han R, Cao Y, et al. (2010) Interactions between gut microbiota, host genetics and diet relevant to development of metabolic syndromes in mice. ISME J 4: 232-241.
- Turnbaugh PJ, Bäckhed F, Fulton L, Gordon JI (2008) Diet-induced obesity is linked to marked but reversible alterations in the mouse distal gut microbiome. Cell Host Microbe 3: 213-223.
- Mu Q, Kirby J, Reilly CM, Luo XM, (2017) Leaky gut as a danger signal for autoimmune diseases. Front Immunol 8: 598.