Adrenal Fatigue Symptoms

Often patients will start up our conversation telling me that they are tired, or not sleeping right and keeping waking up feeling anxious.

That they’ve seen a doctor and having had their blood tests done are told that there is nothing wrong with them  … their blood tests are “ok” but they don’t feel that fine. They’re tired and are getting over being told that they need to “go and eat well, take it easy and start meditating”.

This causes frustration and feelings of a lack of understanding on the doctors’ part. That simply being told they’re ok or being written a script isn’t going to help their situation.

What is Adrenal Fatigue?

Medically speaking Adrenal Fatigue doesn’t exist.

Adrenal Fatigue Symptoms

It comes from a term coined by alternative practitioners on the basis of a cluster of symptoms that (in their ideology) relates to an chronically impaired adrenal  – HPA  (Hypothalamic Pituitary Adrenal ) axis stress pattern.  The latter is the central control unit that monitors many bodily processes with STRESS  MANAGEMENT being one of it’s roles.

“Adrenal fatigue is a term applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems. … Your adrenal glands produce a variety of hormones that are essential to life.” Definition by the Mayo Clinic.

Adrenal fatigue is a description of what happens when a person is exposed to chronic stress. It is better recognized in the medical literature as “HPA Axis Dysfunction”, this is a bit of a mouthful – yet a more accurate description.

Your adrenal glands are small pyramid shaped glands that sit on to on the kidneys. They produce over 200 hormones of which adrenaline, noradrenaline and cortisol play important  roles in our live. The 1st two are responsible for our fight / flight  responses.

Supporters of the unproven theory of ‘adrenal fatigue’ claim it occurs when the adrenal glands are ‘burnt out’ from producing these hormones in response to stress. Certain conditions, such as the rare Addison’s disease, can prevent your adrenal glands from making enough hormones. The symptoms of Addison’s disease include:

  • fatigue,
  • body aches,
  • unexplained weight loss,
  • low blood pressure,
  • light headedness,
  • loss of body hair and skin discolouration.

Addison’s disease is recognised by doctors and can be detected through blood tests that show insufficient hormone levels. On the other hand, these tests are often normal in adrenal fatigue.

Some might ask – WHAT’S THE FUSS ALL ABOUT???

What does Adrenal Fatigue (HPA Axis Dysfunction) mean?

Adrenal fatigue reflects dysfunction  or dysregulation of the adrenal gland and it’s relationship to the hypothalamus and pituitary glands – due to an extended period of chronic stress. Over time, this stress is thought to cause the adrenal glands and HPA axis to become imbalanced. The adrenals initially produce an excess of cortisol in response to the stress. The hypothalamus and pituitary step in and “down regulate” or simply “put the brakes” on the adrenals to self preserve themselves, thereby decreasing cortisol production.

This dysregulation in the cortisol cycle can also cause irregular peaks in the evening.

Adrenal fatigue is a controversial “condition” for several reasons. One important reason is the early focus on the adrenal glands becoming “tired”. The better description of “adrenal fatigue” and burnout tend to present themselves in the dysregulation of the HPA axis and disturbances in the cortisol cycle.

What are the symptoms of Adrenal Fatigue n/ HPA Axis Dysfunction?

Adrenal fatigue symptoms can vary from individual to individual, but there are some common symptoms experienced by almost all. These include insomnia, a feeling of being overwhelmed by stressful situations, food cravings, high levels of fatigue each day, and weak immunity.

These are all related to the dysregulation of the HPA axis and the various hormone levels that depend on it.

  • fatigue
  • body aches
  • nervousness / anxiety
  • low blood pressure – better from lying down.
  • sleeplessness
  • digestive issues

What is the cause of Adrenal Fatigue?

Long-term stressors as listed below can contribute to this.  Most often occurring is a  combination of factors, such as those burning the candles at both ends by juggling several stressors together. E.g. Working long hours with young children.

  • too much work
  • family life
  • lack of sleep
  • too little or too much physical activity
  • alcohol or substance use or abuse
  • mental health issues –  such as anxiety and depression

A poor diet means that your body has fewer reserves and less capacity to deal with stress. There are many causes of fatigue. Chronic or latent disease can be a factor, as can regular exposure to toxic chemicals or pollutants.

How do you treat Adrenal Fatigue / HPA Axis Dysfunction?

Modifying those chronic stressors that have lead to this are vital.

Lifestyle modification is vital, it is literally a case of taking stock of your life and start to distress.

This might mean removing added sugars and junk food from your diet, getting enough sleep, and avoiding or eliminating sources of stress.

There are other ways to support your body, make it more resilient to stress. Adaptogenic supplements are meant to potentially help to moderate your stress response, while basic nutrients like vitamin C can be of assistance.

Guidance from an appropriately trained health professional is advised.

What treatments help Adrenal Fatigue / HPA Axis Dysfuntion?

Modifying those chronic stressors is vital.

Sensibly basic lifestyle modification is the best place to start such as stress minimization, eating a good diet and getting more sleep.

Supplements in the form of vitamins and minerals are useful as is the judicious use of some herbal supplementation. The latter can be useful at trying to restore a balance within the adrenal glands and HPA axis by regulating cortisol levels.

For the best results, discuss your supplementation with your healthcare professional.

What’s The Next Step?

Be prepared to make changes, these may be confronting and at a time where one has been stressed this can be difficult to make objectively.

Allow yourself time to heal.  It took time to get into this situation and like anything – being given a road map to find your destination is most important.  It may take months or more to recover.

One step or change on it’s own isn’t going to work.  There is a magic cocktail for recovery and requires several facets to be brought together in SYNCHRONICITY.  Otherwise there is a high likely hood of not recovering.

Adjusting your day to day activities that includes time out and being able to switch off your “fight/flight mode.  Learning how to effectively manage and process our stress is vital.

Disclaimer:

This article is meant to inform the reader re: the term “adrenal fatigue”. It is not to be used for diagnostic purposes nor is the content to be used in a therapeutic sense for the reader to self treat. It is an overview of the topic and is meant to inform the reader only.

Readers are advised at all times to seek medical advice if they are unsure of their health.

How to treat Irritable Bowel Syndrome

How to treat Irritable Bowel Syndrome

The most important thing is to understand what pattern of Irritable Bowel Syndrome is present and causing symptoms. Excluding those conditions that are known as “red flags” or serious health conditions – such as IBD (Inflammatory Bowel Disease) – is vital.

Treatment guidelines based on Irritable Bowel Syndrome patterns are readily available online and from reputable sources based here in Australia.

The following is a summary of treatments already covered in my last article – see What are Irritable Bowel Syndrome Treatments?.

General advice is given to address general lifestyle and diet factors such as:

  • Diet – increase dietary fibre, for those for whom it is relevant. Avoid trigger foods that cause gas production. Include caffeine in this category as it accelerates bowel activity that can aggravate IBS – type D. 
  • Low FODMAP Diet 
  • Lifestyle advice – regular sleep and exercise has been found to be helpful with Irritable Bowel Syndrome. 
  • Stress Management and Relaxation Techniques – techniques to help manage stress where this has a clear impact on gut health. Mindfulness therapies to assist with relaxation and gut-related hypnotherapy may be of benefit and as effective as a low FODMAP Diet. (1) 
  • Medicines – anti-diarrhoeal, antispasmodic medicines, pain killers, antidepressants, and antibiotics are all discussed in “What are Irritable Bowel Syndrome Treatments”. 
  • Probiotics – this is a contentious area and needs further studies to clarify the efficacy of specific strains of probiotics or a combination of probiotics that are proven to be helpful. This area is full of ongoing studies and there is tentatively some relief for IBS sufferers with some Lactobacillus strains.  
  • New approaches – enzyme therapy and the impact of herbal extracts – both are novel and require further studies. 
stress management techniques
  1. Diet changes: a FODMAP approach may help to identify trigger foods. Avoiding caffeine can alleviate as it increases bowel motility. 
  2. Symptom control using anti-diarrhoeal medications +/ anti-spasm medications or peppermint may also assist with this.

Slightly *alternate view:  

  1. Probiotics: single probiotic therapy – Bacillus Coagulans MCT 5856 has been found in animal studies to relieve diarrhoea (2.a.) A small trial on humans showed a significant decrease in bloating, diarrhoea, abdominal pain and stool frequency in the group receiving Bacillus Coagulans MCT 5856 compared to the placebo group in IBS – Type D sufferers. (2.b.)

Overall relief from bloating, gas, and incomplete evacuation with Bifidobacterium infantis 35625. (2.c)

Combination therapy with a variety of probiotic strains (Lactobacillus acidophilusL. rhamnosusBifidobacterium breveB. actisB. longum, and Streptococcus thermophilus) was shown in one particular study was found to provide effective relief for IBS – Type D sufferers. (2.d.)

  1. Antibiotics: Rifaximin was approved by the FDA in 2015 to treat IBS – Type D. It is given over 10-14 days. (3)  
  2. Faecal Microbial Transplant (FMT): or “poo transplant” has been shown to give symptom relief for IBS – Type D and Type D + C for up to 3 months, but not effective at 12 months. (4) 
  1. Dietary fibre: in the form of soluble fibres such as taking psyllium husks, guar gum or inulin to assist with softening the consistency of the stool. 
  2. Hydration: increase water intake to improve stool consistency. 
  3. Laxatives: can create problems long term with disturbed bowel wall activity. It can lead to a “lazy” bowel thereby worsening the situation. 
  4. Antispasmodics: to relieve cramping pain. Such as Peppermint oil by decreasing the sensitivity of pain fibres in IBS. It is a calcium channel blocker and acts in the smooth muscle of the bowel, thus leading to a decrease in muscular contraction = anti-spasm.

Slightly *alternate view: 

  1. Probiotics: a study showed that a combination probiotic (L. acidophilus, L. reuteri, L. plantarum, L. rhamnosus, and B. animalis subsp. lactis) to help improve bowels movements and stool consistency in a group of IBS – Type C sufferers. (2.e.) 

Sboulardii CNCM I-745  was found to decrease substance P (pain fibres and proinflammatory cytokines in an animal study that mimicked the conditions found in IBS – Type C. (2.f.)

Another strain (S.Boulardii I-3856 at a dose of 1,000 mg per day) was found to decrease pain, discomfort and bloating cf to placebo. (2.g.)  

  1. Antibiotics: the use of Rifamxin + Neomycin was found to improve constipation, straining and bloating in a small group of IBS – Type C patients. (5)
  2. Faecal Microbial Transplant: it appears that IBS C patients have an altered gut flora and may benefit from FMT. (6) 

Mainstream focus is on: 

  1. Diet: is focussed on avoiding triggers that exacerbate symptoms. In this case fibre may aggravate symptoms and is best avoided. 

Avoid trigger foods!!! An elimination diet to figure out trigger foods. Dairy and caffeine also need to be considered carefully. 

  1. Lifestyle: sleep, regular exercise and stress management are vital. Even consider mindfulness therapies as previously mentioned – see above. 
  2. Medications: the use of antidepressants such as SSRI’s are used to alter the pain signalling associated with IBS. 
  3. Symptom relief: see above.

Slightly *alternate view: 

  1. Probiotics: there is no one probiotic that resolves all symptoms in IBS and there is a lack of consistent data. This link shows a table with probiotic strains and their efficacy. (2.h.)

Strain specificity for symptom relief, single or multiple strains, and dosage are needing further studies to give clear guidelines. (2.i.)

  1. Antibiotics: see above. 
  2. Faecal Microbial Transplant: so far the general consensus that FMT as a general treatment for IBS is that it has no advantage over a placebo. (7) IBS is a complex condition and it’s management needs to be more specific or targeted. 

Summary of How to treat Irritable Bowel Syndrome.

This overview is to give a guide as to what is accepted as evidence-based treatment options for Irritable Bowel Syndrome. Some areas definitely fall into the “grey zone” where the answer is as clear cut. E.g. the concept of a specific probiotic to alleviate specific symptoms.

What I often see in practice are patients are wanting clarity with what is wrong with them and what they need to do next to get better.

They may not be aware they even have Irritable Bowel Syndrome and are relieved to have a diagnosis!

This isn’t a ONE SIZE FITS ALL situation.

What do you do when the above doesn’t work???

Well, this is a controversial area and each case needs to be considered very carefully. An integrative or holistic approach is an individualistic approach in that the focus is looking at that one individual as a whole and trying to find what is unique to that person and what may be of help for them.

The digestive tract is like a factory line, it takes one step in that process to muck up to create dysfunction.

My recommendation is: 

  1. Diagnosis: seek professional advice and guidance to exclude important “red flags” or medical conditions that are serious. This may include seeing a gastroenterologist (or gut doctor).
  2. Investigations: may include testing to determine exactly what’s going in your gut. This may involve blood testing, stool tests, and possibly breath testing to determine if there is an imbalance in the gut flora (or “gut bugs”). 
  1. Food Diary: where you write down what you’re eating every day and then noting any bowels symptoms. This can help to identify trigger foods for Irritable Bowel Syndrome. 
  1. Elimination diet: involves finding what foods trigger the IBS symptoms and removing them from the diet. A low FODMAP diet is helpful with this. 
  1. Referral: to a dietician or nutritionist familiar in dealing with introducing a low FODMAP diet, to see if this helps. Alternatively, check out what work is being done at https://www.monashfodmap.com/. This has a wonderful guide into the world of FODMAP’s with up to date information and aides. 

When nothing else works? Dysbiosis (or bacterial overgrowth) may be the culprit and further investigations – such as breath testing for Hydrogen or Methane production. 

Stay tuned for more re: SIBO – or Small Intestinal Bacterial Overgrowth. 

References:

1. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients.

Miller V, et al.

Aliment Pharmacol Ther. 2015 May; 41(9):844-55.

2.a. Evaluation of anti-diarrhoeal activity of Bacillus coagulansMTCC 5856 and its effect on gastrointestinal motility in Wistar rats. Int J Pharma Bio Sci 2016; 7: 311–16.

Majeed M, Natarajan S, Sivakumar A, Ali F, Pande A, Majeed S, et al.

2.b. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study.

Majeed M, et al.

https://www.ncbi.nlm.nih.gov/pubmed/26922379

2.c. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome.

Whorwell PJ, et al.

https://www.ncbi.nlm.nih.gov/pubmed/16863564

2.d. Effect of administering a multi-species probiotic mixture on the changes in fecal microbiota and symptoms of irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial

Hyuk Yoon, et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566021/

2.e. A Randomized, Double-Blind, Placebo-Controlled Trial: The Efficacy of Multispecies Probiotic Supplementation in Alleviating Symptoms of Irritable Bowel Syndrome Associated with Constipation

Valerio Mezzasalma et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993960/

2.f. Saccharomyces boulardii CNCM I-745 supplementation reduces gastrointestinal dysfunction in an animal model of IBS

Paola Brun, et al.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181863

2.g. Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation

Robin Spiller, et al

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924426/

2.h. https://badgut.org/information-centre/a-z-digestive-topics/probiotics-for-irritable-bowel-syndrome/

2.1. The Role of Bacteria, Probiotics and Diet in Irritable Bowel Syndrome

Ashton Harper, et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848117/

3. Rifaximin for Irritable Bowel Syndrome

A Meta-Analysis of Randomized Placebo-Controlled Trials

Jun Li, et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291563/

4. Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial.

Johnsen PH, et al.

https://www.ncbi.nlm.nih.gov/pubmed/29100842

5. Antibiotic treatment of constipation-predominant irritable bowel syndrome.

Pimentel M, et al.

https://www.ncbi.nlm.nih.gov/pubmed/24788320

6. Gut Microbiota and Chronic Constipation: A Review and Update.

Ohkusa T, et al.

https://www.ncbi.nlm.nih.gov/pubmed/30809523

7. Systematic review with meta‐analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome

Gianluca Ianiro, et al.

https://onlinelibrary.wiley.com/doi/10.1111/apt.15330

Disclaimer:

This article is written to give an overview of IBS Treatments only. It is meant to be a therapeutic guide that is best used in supervision with an appropriate health professional.

Where treatments are written as an “*alternate view” is to show an area that is not considered a mainstream medical approach to treating this condition. It is an emerging treatment that is under research and not accepted as a generally “accepted” or approved medical therapy.  

Irritable Bowel Syndrome (IBS) and Symptoms

Irritable Bowel Syndrome (IBS) and Symptoms

Irritable Bowel Syndrome (IBS) is a relatively modern phenomenon that came about from an increasing number of individuals developing a functional disorder of their bowels. 

What does that mean??? 

If you go back into the history of medicine – there was no Irritable Bowel Syndrome 50 years ago. 

If there was – we, mainstream medicos – had no idea that this was around and if so hadn’t yet understood what it means or described it. 

The criteria for diagnosing Irritable Bowel Syndrome was underway when I was a medical student! 

So if we look at Irritable Bowel Syndrome it can best be described as an issue with “how” the bowel works (or functions). 

The structure of the bowel or intestine doesn’t change. I.e. if an Irritable Bowel Syndrome sufferer was to have a colonoscopy (or camera on the inside) of their bowel it would look normal. 

It doesn’t lead to a serious condition such as bowel cancer. 

Unlike INFLAMMATORY BOWEL DISEASE (IBD), such as Crohn’s Disease or Ulcerative Colitis where there is inflammation of the bowel or intestinal wall. This inflammation causes a pathological change in the intestinal wall, thereby affecting the structural integrity of the intestinal wall, leading to the development of symptoms and signs. Such as pain (symptoms) associated with passing blood in stools with mucous (sign). 

With Irritable Bowel Syndrome, there is dysfunction leading to a number of symptoms that create discomfort/inconvenience for those that suffer from this. For some, the symptoms can be highly debilitating and distressing. 

It is thought to affect the large bowel or intestine mainly and as many as 1 in 5 Australians now suffer from Irritable Bowel Syndrome. 

Up to 50% of those that suffer from Irritable Bowel Syndrome can have symptoms that affect them physically and mentally with associated anxiety and depression. 

It tends to occur more in women than in men. 

It has a spectrum or variety in its presentation in that it can range from: 

  1. Bowel habit that ALTERNATES from diarrhoea to constipation (mixed type). 
  2. Bowel habit that is mainly CONSTIPATED (IBS Type C). 
  3. Bowel habit that is mainly DIARRHOEA (IBS Type D). 

Diagnosis of Irritable Bowel Syndrome relies on a patient’s symptoms. 

The cause of Irritable Bowel Syndrome is unknown. Although several mechanisms have been implicated in its pathophysiology or development and can be considered as multifactorial. It is thought to result from: 

a. Abnormal gastrointestinal tract movements – see Transit Time below. 

b. Gut – Brain miscommunication is thought to play a role in Irritable Bowel Syndrome. There are issues leading to a disruption in communication or signalling between these two areas and these signalling issues go both ways. 

  1. Central sensitisation: refers to altered pain perception in IBS sufferers. 

2.  Visceral sensitisation: IBS sufferers have a lower threshold for pain in their abdomen

c. Heightened awareness of or sensitivity to how one’s body functions. 

d.The inflammatory reaction occurring in the intestinal mucosa (gut lining).

e. Changes in gut microflora (or gut bugs). 

IBS/Irritable Bowel Syndrome can be triggered by: 

  • Infection: bowel symptoms can occur after having had gastroenteritis. They cause is unknown and may involve changes in how the nerves work in the bowels or possibly changes in gut flora/bacteria
  • Stress: some individuals have a heightened stress response when anxious or under duress.
  • Poor sleep
  • Food intolerance: symptoms may be exacerbated or worsened by impaired absorption of Lactose (the sugar found in dairy), fructose (the sugar found in fruit) or another sugar called sorbitol which is used as an artificial sweetener. A diet low in fibre may aggravate constipation.  
  • Hormonal factors such as menstruation  
  • Medications: certain medications can contribute to aggravating Irritable Bowel Syndrome symptoms such as antibiotics – may cause diarrhoea, painkillers – may cause constipation, and antacids. 

The triggers for IBS can vary according to an individual. What may trigger one person may not necessarily trigger another. 

triggers for irritable bowel syndrome

Understandably recurring pain over time is distressing with gut bloating, pain and cramps being some of the leading symptoms of Irritable Bowel
Syndrome. 

Normal Gut-Brain function relies on a coordinated signalling system between both systems for normal digestion to occur. The signals between the two systems use a combination of input from the autonomic nervous system, hormones and to some degree gut flora (gut bacteria) to communicate so that healthy digestion can occur. 

Irritable Bowel Syndrome sufferers appear to have their own specific signalling patterns or circuits involving these systems that impact on their Gut-Brain axis that is unique to them. See Central Sensitisation – above.

This describes that time it takes food to go from the mouth and to come out at the bottom as a “poo” (stool). 

Normally this process takes 8-12 hours. 

You can time this by eating corn and seeing how long it takes for this to come out of the rectum (bottom). 

The symptoms of Irritable Bowel Syndrome occur due to an alteration in the transit time of the sufferers’ bowels. 

The longer the stool takes to pass through the bowel leads to increased extraction of water. Making the stool dry and hard to pass. Hence making constipation worse. 

Leaves less time for water to be extracted and the stool tends to be looser. Hence diarrhoea. 

What are Irritable Bowel Syndrome Symptoms?

Symptoms of Irritable Bowel Syndrome may vary in their presentation in one person and be completely different in another person. There is no “one size fits all”. They can last for several days or weeks. Flaring up at times and then settling down. 

Irritable Bowel Syndrome is characterised by the following symptoms: 

  • Abdominal PAIN; often relieved by passing wind or bowel motion. 
  • Abdominal BLOATING; can occur straight after eating – this tends to suggest gastric bloating, or delayed bloating (1-2 hours after eating) – suggests intestinal origin. 
  • Chronic or recurrent DIARRHOEA. (IBS Type D)
  • Chronic or recurrent CONSTIPATION. (IBS Type C)
  • ALTERNATING bowel habit. (IBS – Mixed)
  • Mucous in the stool.

Associated symptoms: 

  • Fatigue.
  • Sleep difficulties.
  • Anxiety and Depression.

The 3 Types of Irritable Bowel Syndrome are: 

  1. IBS Type C – constipated IBS
  2. IBS Type D – diarrhoea type IBS
  3. IBS Mixed – where the bowel motion can alternate from constipation to diarrhoea. 

Take a look at our other blog about How to treat Irritable Bowel Syndrome.

What are Irritable Bowel Treatments

What are Irritable Bowel Treatments?

Just a quick overview of what is Irritable Bowel Syndrome:  

It is a functional gastrointestinal disorder meaning there are no biochemical or structural abnormalities on investigation such as those found in IBD (inflammatory Bowel Disease). It is fairly common in Australia. 

The syndrome is characterised by: 

  • Recurrent abdominal pain, related to defecation or passing of wind. 
  • Associated with a change in stool frequency or form. 

It is sub-typed by the predominant stool form as follows:

  • diarrhoea predominant (IBS-D)
  • constipation-predominant (IBS-C)
  • mixed subtype (IBS-M – for alternating bowel habit)

The diagnostic criteria, referred to as the Rome criteria, are based on an expert consensus governed by the Rome Foundation. 

The Rome IV diagnostic criteria for diagnosing Irritable Bowel Syndrome. 

Recurrent abdominal pain, on average, at least one day per week in the last three months associated with two or more of the following criteria: 

  1. Related to defecation or passing of a bowel motion. 
  2. Associated with a change in the frequency of stool. 
  3. Associated with a change in the form (appearance) of stool. 

Criteria fulfilled for the last three months with symptom onset at least 6 months before diagnosis. 

Screening for serious conditions that are medically known as “red flags” is vital so as not to miss an underlying serious health issue that needs a specialist to manage. 

  • Age: >50 years of age, with no previous colon cancer screening and presence of symptoms. I.e. such as a recent change in bowel habit. 
  • Rectal bleeding – is called maleana and is an intestinal bleed until proven otherwise
  • Vomiting dark blood – is due to bleeding oesophageal varices (varicose veins at the base of the oesophagus) or in the stomach from an ulcer. This is called haematochezia.  
  • Unexplained weight loss.
  • Abdominal pain, especially if it’s not completely relieved by passing a bowel movement, or occurs at night. 
  • Family history of colorectal cancer or inflammatory bowel disease. 
  • Iron deficiency – unexplained. 
  • Positive faecal occult blood test. 
  • Persistent or night time diarrhoea – important to exclude coeliac disease. 

Insight: There is no one test to diagnose Irritable bowel syndrome. 

The main focus of treatment to date has been on symptom relief to enable anyone with IBS to live as normally as possible. 

Treatment options vary according to the type of IBS pattern present and the severity of symptoms. 

In mild cases, simple changes to lifestyle and diet may be of benefit such as: 

  • Diet: avoid eating foods that trigger symptoms, eat high fibre food and drink plenty of water. 
  • Trigger foods: try eliminating foods that cause gas and bloating, avoid gluten, or trial eating a low FODMAP diet. 
  • Stress management: with regular exercise and getting enough sleep. 
  • Medications: a review of these to avoid medications that may aggravate IBS. 

More moderate or severe symptoms may need further strategies. 

This needs to be tailored to each individual. What works for one person – may not work for another. E.g. Fibre – having soluble and increasing water intake can help with IBS – C (Constipation type IBS), and may aggravate with IBS – D (Diarrhoea type IBS). 

Trigger foods: are best avoided. 

  • Caffeine – increases gastric motility and may aggravate IBS – D. 
  • Alcohol – can irritate the stomach lining and has the potential to cause stomach ulcers long term. 
  • Spicy food. 
  • Fibre – for IBS – D. May cause gas and bloating. 
  • Fats and oils – may aggravate IBS – D. 

This information comes from Australian research and looks at the “sugar chains” attached to foods or specific carbohydrate chains that aren’t absorbed readily causing gas, bloating and sometimes diarrhoea. These are found in foods that are commonly eaten. 

  • F = Fermentable – foods that cause fermentation and gas. 
  • O = Oligosaccharides – Fructans and GOS (Galacto-Oligo-Saccharides) – found in wheat, rye, garlic, onions and legumes / beans. 
  • D = Disaccharides – Lactose 
  • M = Monosaccharides – Fructose
  • A = And
  • P = Polyols – Artificial sweeteners such as Sorbitol, Mannitol or Xylitol. 

This requires an in-depth assessment of one’s diet and the use of a food diary may help to find foods that trigger IBS. 

A low FODMAP diet may help to alleviate painful symptoms such as bloating, cramps and diarrhoea. 

It involves a 2-6 weeks period of trialling a low FODMAP diet. This involves removing foods that contain high FODMAP content. i.e. foods full of short-chain carbohydrates. 

Supervision with an experienced practitioner is useful and is the best way to guide one through this journey. 

If access is an issue there are resources found at www.monashfodmap.com. 

In cases where stress and or anxiety have an impact on IBS, seeing a psychologist or trained professional to work on stress management techniques may also be of value. 

Gut focussed hypnotherapy may be of assistance to some IBS sufferers. 

May be of benefit for those individuals that have episodic flares of their symptoms. 

  • Anti-diarrhoea medicines: readily available medications over the counter to acutely relieve diarrhoea. 
  • Antispasmodic medicines: to relieve cramping. Such as Peppermint oil by decreasing the sensitivity of pain fibres in IBS. And are calcium channel blockers in the smooth muscle of the bowel, thus leading to a decrease in muscular contraction = anti-spasm. 
  • Painkillers: to relieve acute pain and some times may slow down bowel transit time – which is increase with IBS-D. Best avoided due to long term complications such as addiction, tolerance and narcotic bowel syndrome. The latter is best described as chronic or frequently recurring abdominal pain that worsens with continued or escalating doses of narcotics.
  • Antidepressants: may alleviate symptoms for those that are sensitive to stress and present with IBS – M (Mixed). Where the excess stress response form the brain has a direct effect on gut function known as central sensitization or by altering visceral hypersensitivity. The latter occurs in IBS sufferers, they have a lower threshold for pain in their abdomen. SSRI’s and Tricyclic Antidepressants have been found to be useful for modulating neuropathic pain in IBS. 
  • Antibiotics: Rifaxamin is a non-absorbable antibiotic used in the treatment of SIBO (Small Intestinal Bacterial Overgrowth). It has been found to relieve IBS symptoms of gas and bloating in the short term. However, it’s role in long term management of IBS is uncertain. 

Probiotics are live bacteria or yeast found in food (yoghurt or fermented foods) or supplements and have become a part of gut focussed treatments. 

Our gut flora is full of bacteria and yeast. 

Probiotics are thought to have a role in enabling balance within our gut flora as these bacteria or yeast interact with our gut lining and immune system. 

Probiotic actions: 

  • Protective role – prevent harmful bacteria from entering our system.
  • Immune boost – help modulate the immune system in the gut and overall to improve resistance to infection.
  • Antimicrobial – are able to produce substances that act like antibiotics and inhibit the growth of other species. 
  • Aid digestion. 

There is some research identifying certain strains with assisting with IBS control. 

E.g. Bacillus Coagulans MCT 5856 has been found in animal studies to relieve diarrhoea (1.a.) A small trial on humans showed a significant decrease in bloating, diarrhoea, abdominal pain and stool frequency in the group receiving Bacillus Coagulans MCT 5856 compared to the placebo group in IBS – Type D sufferers. (1.b.)

Overall relief from bloating, gas, and incomplete evacuation with Bifidobacterium infantis 35625. (1.c.) 

And combination therapy with a variety of probiotic strains (Lactobacillus acidophilusL. rhamnosusBifidobacterium breveB. actisB. longum, and Streptococcus thermophilus) was shown in one particular study was found to provide effective relief for IBS – Type D sufferers. (1.d.)

Another study showed a combination probiotic (L. acidophilus, L. reuteri, L. plantarum, L. rhamnosus, and B. animalis subsp. lactis) to helped improve bowel movements and stool consistency in a group of IBS – Type C sufferers. (1.e.) 

Here is a very good reference looking at single or double probiotic studies with various strains with treating IBS. The conclusion is that the results are mixed.  IBS is multi-factorial and specific probiotics have a “drug-like” effect suggesting that further clinical trials are required. (1.f.)

Strain specificity and ability to target certain symptoms are where probiotic research may give further treatment options. (1.g.)

Note: this topic is an article all on its own. The area is full of ongoing research using looking at a number of probiotic strains for a specific treatment/response with the management of IBS. 

What are IBS Treatments

NEW APPROACHES TO IBS TREATMENTS: Digestive enzymes 

Digestive enzymes in the management of IBS is a new direction. 

Only recently has there been a study at Monash University that used a specific enzyme for GOS – Galacto-Oligo-Saccharide – called alpha-galactosidase with a group of IBS sufferers. 

They had 31 individuals on a low FODMAP diet that had a high GOS content and were tested over a period of 3 days. 

Of this group 1/3 tolerated the diet and 2/3’s did not. They reacted to the high GOS content. 

The GOS sensitive IBS patients where given the digestive enzyme in: 

  1. full dose – half dose was given prior to the meal and the other half with the meal.
  2. half dose.
  3. Placebo. 

In this group the full dose of enzyme was found to relieve their symptoms. 

High GOS foods: type of sugar commonly found in beans. 

  • Legumes – e.g. hummus dip
  • Cashews and pistachios
  • Soy milk
  • Oat milk
  • Freekah
  • Thawed peas, butternut pumpkin, and beetroot. 
  • Custard apple

The use of pancreatic enzymes (Amylase, Lipase and Protease) maybe of help in a smaller number of IBS-D sufferers, this is approximately 6% IBS sufferers. This is thought to be due to a degree of exocrine pancreatic insufficiency (EPI). Exocrine refers to the dual role the pancreas has of making digestive enzymes that are secreted from the pancreas and released into the duodenum at the very beginning of the intestines. 

EXO = external or outside. Vs ENDO = refers to internal or inside. 

The endocrine role of the pancreas is to produce and release insulin INTO the bloodstream to help regulate blood sugar levels. 

There is a decline in the production of digestive enzymes from the pancreas that can lead to a secondary diarrhoea type of bowel habit and presenting as an IBS-D pattern. Loose stools that may be difficult to flush suggesting impaired fat absorption as we rely on lipase from the pancreas to initiate fat digestion.  

Lactase is the enzyme used to break down lactose and this has commonly been used in individuals that are lactose intolerant. Without it lactose will work it’s way down the digestive tract causing bloating, gas and cramps. 

Now these enzymes are highly specific and are exact in how they work. 

Over the counter digestive enzymes may have additives in them that can cause digestive issues and may have no evidence to support that they work. As found in the study at Monash Uni, the specificity of the enzyme and dose is important – the full dose was found to be efficacious. 

This may pave the way for specific or targeted approaches to Irritable Bowel Syndrome treatments in the future. 

Further potential treatments or adjuncts for IBS: 

CURCUMIN: 

Is derived from turmeric which is used widely as a spice in cooking. 

Curcumin has a number of actions in that is an antioxidant, anti-inflammatory, antimicrobial, antidepressant, immune-modulating and may give pain relief. 

Animal studies have shown a number of mechanisms by which curcumin alleviated anxiety and depressive-like behaviours in rats with IBS. (2)

Also with altering VH (visceral hypersensitivity) in rats with IBS via two different pain receptors.  

BERBERINE: 

Also extracted from several plants. Has anti-inflammatory, antioxidant, and antiulcer activity. 

A recent study found this to reduce IBS – D symptoms and improve QOL (Quality Of Life) in IBS patients. (3)  

GINSENG: 

The extracts from Ginsengs known as Ginosides inhibit the 5HT3A receptor (a serotonin receptor). (4) 

Stimulation by serotonin on it’s receptors in the gut cause bloating, nausea and vomiting. 

A trial using Panax Ginseng In IBS sufferers  (n 24) was found to help control abdominal pain. (5) 

FAECAL MICROBIAL TRANSPLANTS: otherwise known as FMT. 

This involves transplanting a faecal sample from a healthy donor to another also known as “poo transplants”. The thought behind this is that Irritable Bowel Syndrome is due to dysbiosis or imbalanced gut flora leading to bacterial overgrowth. 

It is a treatment for Clostridial Difficle colitis and trials as to its efficacy in IBD (Inflammatory Bowel Disease) show it cost-effective to treat the former and may have some therapeutic benefit for treating Ulcerative Colitis but not Crohns. (6) 

One trial has shown some benefit for relieving symptoms of IBS – Type D or Type D and C at 3 months, but not at 12 months. (7). 

OVERVIEW: 

The scope for approved treatment options for Irritable Bowel Syndrome has mainly focused on symptom control to date. 

A controversial view point that considers the underlying mechanism for Irritable Bowel Syndrome is that is may be due to a disruption in the gut microflora also known as a “baterial overgrowth”. Whereby a colony of bacteria establishes itself in the gut causing disruption and symptoms due to substances it makes.

Evidence from studies targeting gut flora with antibiotics and probiotics that show a degree of efficacy in symptom relief seem to support this concept. 

An area for further research and “food for thought”. 

References:

1. a.

Bacillus coagulans MTCC 5856 for the management of major 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034030/

1.b. 

https://www.ncbi.nlm.nih.gov/pubmed/26922379

1.c. 

https://www.ncbi.nlm.nih.gov/pubmed/16863564

1.d. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566021/

1.e. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993960/

1.f. 

https://badgut.org/information-centre/a-z-digestive-topics/probiotics-for-irritable-bowel-syndrome/

1.g.

https://www.racgp.org.au/afp/2009/december/ibs/

This is an excellent overview of probiotics. 

https://www.mja.com.au/journal/2008/188/5/probiotics-sorting-evidence-myths#0_i1092172

2. https://www.ncbi.nlm.nih.gov/pubmed/24807589

3.  https://www.ncbi.nlm.nih.gov/pubmed/26400188

4. https://www.ncbi.nlm.nih.gov/pubmed/14644011

5. https://www.sciencedirect.com/science/article/pii/S0102695X17303885

6. https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14212

7. https://www.ncbi.nlm.nih.gov/pubmed/29100842

Benifits Of Being Alkaline

ACIDITY VS ALKALINITY: THE ALKALINE BODY: MYTH OR REAL?

Since time immemorial, people have been trying to search for ways to eliminate diseases altogether, hoping to stumble upon some metaphorical elixir of life. Many believe that the concept of ‘acidic’ and ‘alkaline’ diets is a relatively new one. It has, in fact, been around for over a hundred years. However, in recent times, it has gained significant popularity and attention. The amount of speculation on the possible benefits of being alkaline led to
extensive research as well. Despite so much attention, though, the question as to whether it actually works remains a controversial one. Proponents of the theory, including celebrities and prominent media personalities, swear by it. The medical world is still largely divided on whether it is necessary or not.

In order to probe into this question, it is important to first understand what the terms ‘acidic’ and ‘alkaline’ mean.

Que : How the human body works to maintain its pH, and why it is so important to maintain a strict pH control?
Benifits Of Being AlkalineThe answer to the last question, simply speaking, is that you’d drop dead (literally) if the body lost its pH control mechanisms.

pH, or the ‘potential of hydrogen’, literally means the ‘capacity of hydrogen’. It is a measure of the hydrogen ion concentration in a solution. With the concentration of hydrogen and hydroxyl ions being equal, water has a neutral pH of 7.0. Solutions with a pH below 7.0 are said to be acidic, while those with a pH above 7.0 are called alkaline.

The human body maintains a strict blood pH control between 7.35 and 7.45. Outside this range, both the vital intracellular (within cells), as well as extracellular (outside cells) functions of the body are adversely affected.

An excess of hydrogen ions in the blood produces acidosis, whereas a deficiency thereof results in alkalosis. Both can result in a reduction in the activity, as well as stability of several vital proteins / organs in the body.

Since even minute changes in blood pH can spell the difference between life and death, several pH regulatory mechanisms exist in-vivo.

The two principal organs responsible for this homeostasis are the lungs and kidneys. The bones act as a back up or alkaline reservoir for pH regulation.

Hence, pH disturbances within the blood are also classified as being respiratory, metabolic, or mixed in nature.

pH control within the digestive tract is maintained mainly by the pancreas with pancreatic juices having a pH of 7.8-8.0. Alongside activating the endocrine (hormone producing) pancreas, the intake of a large meal also activates the exocrine (production and excretion) part of the pancreas. The partially digested food from the stomach is highly acidic, owing to the hydrochloric acid produced by the stomach lining – pH 1.2-3.0.. The pancreas, in turn, produces a bicarbonate (alkalizing) rich fluid to neutralize the pH of this partially digested food, and to provide an alkaline medium for the optimum activity of pancreatic enzymes.

CHEMICAL BUFFERS within the blood also play a vital role in pH homoeostasis. These buffers act according to the Henderson-Hasselbach equation (or the buffer equation), neutralizing both excess acids and alkalis up to a limit. Of these, the bicarbonate-carbonic acid buffer system is quantitatively the most important. Other chemical buffers include hemoglobin, plasma proteins and phosphates. Since bone contains a significant quantity of both bicarbonates and phosphates attached to either calcium or magnesium, it is hypothesized that it plays a major role in acute pH disturbances. This is important to the alkaline theory, as will be seen later.

LUNGS:

Ventilation rate (number of breaths per minute) in lung alveoli (sacs) is determined by changes in the blood concentration of carbon dioxide –which is detected in the medulla oblongata of the brainstem, and to a lesser extent by the chemoreceptive carotid bodies – in order to maintain a stable PCO2. These changes are rapid, and therefore, any respiratory disturbances in pH become quickly evident, and can also be corrected relatively quickly.

Respiratory alkalosis most commonly results from hyperventilation due to panic or anxiety. It can also occur in patients on mechanical ventilation.
Respiratory acidosis, on the other hand, is a result of hypoventilation, as can be seen with head injuries, for instance.

In contrast to respiratory changes, metabolic changes are rather slow to take place. An excess of nonvolatile acids (such as lactic acid and the by-products of fat metabolism in diabetic ketoacidosis), or a deficiency of bicarbonates due to renal or gastrointestinal bicarbonate loss results in metabolic acidosis. Excessive hydrogen ion losses – such as can occur with severe vomiting or diuretic use – can lead to metabolic alkalosis.

KIDNEYS:

Primarily regulate pH by maintaining the bicarbonate concentration through reabsorption of bicarbonate ions, as well as production of new bicarbonate ions by excreting excessive hydrogen ions – which means they excrete the acid in urine.

INTRACELLULAR pH:

While the body maintains the blood pH within a very narrow range, the intracellular pH varies from cell to cell depending upon function and metabolism. E.g. The pH of muscle cells is 6.1 vs urine pH 4.5-8.0.

As with extracellular pH, there are mechanisms in place to maintain intracellular pH as well. These include:
1. intracellular pH buffers, adjustments in arterial PCO2.
2. Membrane channels responsible for the influx or efflux of ions.

Intracellular pH buffering mechanisms can broadly be divided into three categories:

1. Physiochemical buffering – using intracellular proteins and phosphate, similar to extracellular physiochemical buffers.
2. Metabolic buffering – Metabolic buffering refers to changes in the metabolism of intracellular acids in response to changes in intracellular hydrogen ion concentration, for instance, in response to a fall in intracellular pH, lactic acid can be converted into glucose, or to carbon dioxide and water making the cell more alkaline.
3. Organellar (organ) buffering – Some organelles are capable of releasing hydrogen ions in response to acute pH changes.

A tight pH control is important for the optimum activity of intracellular enzymes and ion channels, and for the processes involved in the cell cycle. Within skeletal muscle cells, it is also important to maintain the contractility of actin and myosin fibres. These fibres work best at a pH of 6.1 and even minor increases in acidity (= lowering pH) can dramatically reduce their activity. Although the accumulation of lactate during exercise was previously considered to be responsible for muscle fatigue, recent studies have shown the subsequent fall in pH to be a bigger culprit. Even among cardiac muscle cells, a significant amount of cellular damage during ischaemia (lack of oxygen) is a result of pH drop. A major intracellular pH drop results in the release of the dipeptide carnosine (β-alanyl-L-histidine). It is present in the greatest concentration in skeletal muscle cells, which lack the enzyme carnosinase, which is responsible for its breakdown.

Carnosine has been the subject of widespread research over the recent years due to its potential as a booster of muscle performance during high intensity athletic activity. As well as being a buffer, it also serves as an antioxidant and a free radical scavenger in weakly alkaline environments. While supplementation with carnosine itself failed to produce any notable changes in muscle activity, supplementation with β-alanine – a non-essential amino acid and a precursor of carnosine – was observed to significantly improve performance among athletes in various clinical studies. It improved various exercise variables including improved time to fatigue on a maximal cycle test, delayed onset of muscular fatigue, and increased ventilatory threshold and time to exhaustion.

Since it is found in almost all vital organs, its role in preventing complications from many diseases including diabetes, cardiovascular diseases, and Alzheimer disease is currently being investigated. Thus far, it seems that a
slightly more alkaline or balanced intracellular environment may be better for the overall health, vitality, and performance of cells.

Next, lets probe into another popular theory of alkalization – the alkaline ash theory and alkalization of the body through diet.

What exactly do people mean when they talk about being alkaline? What is the basis for an alkaline diet?

This is determined by measuring the pH of urine. In terms of food, it refers to the pH of the ‘ash’ or residue that food leaves behind in vitro. It is believed that upon consumption these foods have the same effect on the human body.
E.g. even though lemons and other citrus fruits are acidic in pH, they fall into the category of alkaline foods based on the pH of the ‘ash’ that they produce.

This pH would determine the potential renal acid load (*PRAL) of the food, and consequently, how much effort the body (kidneys) would have to make in order to neutralize this acid load.
(*PRAL = mEq of Cl + PO4 + SO4 – Na – K – Ca – Mg)

The pH of the food we eat does affect the pH and calcium content of the urine to some extent. Proponents of the alkaline ash theory propose that by measuring the pH of urine – and less commonly saliva – it is possible to determine if a person’s body is overall acidic or alkaline. Strip tests are easily available over the counter to measure these pH values. They believe that an acidic body is a rich source for the development of diseases such as diabetes and arthritis, as well as for the growth of cancer cells. They also believe that people who consume a predominantly acidic diet suffer more rapid bone loss and have a greater risk of developing osteoporosis, since calcium and magnesium will have to be drawn from their bones in order to
maintain blood pH as they are bound to bicarbonates and phosphates (alkalizing). Among other proposed benefits of being alkaline are better cardiac, digestive and mental health, better sleep, and a stronger immune system.

Average western diet: consists of a large proportion of animal proteins (including poultry and dairy), is considered to be acidic, since protein metabolism results in the production of phosphoric and sulfuric acids. Other acidic foods include grains and alcohol. Fruits, nuts, legumes and vegetables are the main components of an alkaline ash diet, while fats, starches, and some natural sugars are considered to be neutral.

Alkaline ash diet: recommends cutting animal proteins and grains out completely. Based on the premise of the alkaline ash theory, the urinary pH and calcium content should be reflective of the overall body pH and calcium metabolism, respectively. However, research has shown that this is not thecase. Studies found the overall bone metabolism markers to be higher among people with vegetarian diets rather than in those with omnivorous diets. Some studies even found proteins – the main content of an acidic diet – to have a positive overall effect on bone health as bone has a large protein component.

In post menopausal women, a diet that balances net endogenous acid production increases calcium and phosphate retention and reduces bone resorption markers, and increases markers of bone formation. I.e. a balanced diet that favoured minimizing net endogenous acid production lead to improved retention calcium and phosphate … leading to better bone health in post menopausal women.

Furthermore, while some research linked predominantly acidic diets with an increased cancer risk, no study was able to establish a cause-effect relationship between the two. In fact, cancer cells can thrive equally well in an
alkaline environment as well.

Is the alkaline ash diet another fad diet?

Not entirely. Evidence linking westernized diets to an increased risk of metabolic disorders such as type-2 diabetes and hypertension does exist. Eating more fruits and vegetables undoubtedly is beneficial for overall health. However, there is no evidence to warrant completely cutting out all acidic foods from the diet. While the alkaline ash diet consists of healthy unprocessed food, and may immensely benefit a small subset of people (such
as those with chronic renal disease, who are unable to handle a high PRAL). The alkaline ash diet is healthy, not because of its alkalinity but because it consists primarily of fruits and vegetables. A balanced diet may, in fact, be one that consists of a combination of both acidic and alkaline foods.

Despite being around for a long time, the concept of alkalinity being healthier is still under scrutiny and is being largely investigated. From the above discussion it can be inferred that a more ‘alkaline’ intracellular environment does have benefits for people involved in high intensity training and sports, and may also potentially be beneficial for those at risk of various metabolic disorders. And while the alkaline ash diet may not carry all the benefits that it boasts of, it may still be an overall healthy choice.

SUMMARY: The human body has a very narrowly controlled homeostasis and the pH of urine is in no way reflective of the intracellular or extracellular pH of the body. It is being used to monitor the renal pH buffering mechanisms. With a diet of highly acidic foods are being consumed, the urinary pH will reflect this accordingly.

Alkalizing urine has its use in medicine to reduce uric acid stone production, to improve elimination of toxic compounds (weak acids) in an overdose setting or there are those who swear by using to improve sports performance /
recovery. An animal study showed a four-fold improvement in excretion of ochratoxin A, a mycotoxin.

There may be ways to maintain an optimal pH intracellular environment, which may in turn have a number of protective effects on our vital organs. This concept seems promising, and probing further into it may in fact lead to breakthroughs in preventive medicine.

Disclaimer:

This article is written to give an overview of the subject to inform and educate. It is not to be used as a therapeutic guide for treatment of self or others, or for diagnostic purposes.

Readers are advised to seek medical advice if they seek guidance for their health.