IBS (Irritable Bowel Syndrome)

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Finding a good herbalist

Most of what's written in this article is entirely suitable for a person to work through themselves but, especially if things are quite bad, or you just know that you need further help, then there may be a great deal of benefit to you to go to whatever lengths necessary to find a good herbalist or truly holistic practitioner to guide you on to a safe and strong treatment program. There's a short write-up to suggest how you might go about finding such a person here

Section 1: Is it IBS or something else?

I do have to make it clear right here at the outset that I understand the roots of true IBS to be in a nervous system that has become too tense for there not to be an effect in the physical body and that it is no accident that this is a problem that typically begins in the late teens or early twenties, when a young adult has to start confronting the world on their own terms. I will talk about how a person can work with this root cause at the end but I also very well understand that many people who have been diagnosed with IBS actually have a different kind of problem altogether and, before making any assumptions about stress and bowel function, we need to be very sure that what we are dealing with is not a different kind of problem with roots in quite different ground...


Common IBS symptoms

When the symptoms actually are from something you are eating!

Everyone with IBS symptoms worries about what they have eaten. In fact anyone who gets an upset digestion for any reason automatically thinks about what they have been eating lately. This is a process that is ‘hard-wired’ into our brains because it is an instinctive survival mechanism. If an organism could not associate the link between eating something injurious and then getting sick afterwards they could never evolve in a world where some things are food but some things are poison.

When a person gets a bad patch it doesn’t matter how many times they might work out that they did nothing different, they will still automatically think about and then suspect what they ate whenever their gut gets upset. The reason this point is so important to understand is that you have to get a firm grip on the fact that, if you have true IBS, you are going to be worried about what you eat and that sometimes this is what you need to focus on to get better but that sometimes this will be a guaranteed path to make you more tense and therefore eventually more sick!

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How do you know when it truly is caused by what you eat?

In my own practice I have seen a great many people who have been misdiagnosed with IBS when in actual fact they have chronic food intolerances. In most of these cases we have been able to get some crucial clues from the health history and their problems have not just started in the classic late-teens- early twenties time of life but there were earlier or other signs that food reactions have been a driving cause of their health problems...

Any history of eczema or asthma in childhood or beyond is almost a guarantee that food intolerance is in the picture and if your mother has told you that you had a terrible amount of colic or 'reflux' as a baby then you should also suspect this possibility. Likewise a lot of childhood infections in the ears, throat or chest may be a clue that you had undiagnosed allergies in earlier life.

What can happen when this root-problem is not dealt with by changing the diet but instead suppressive steroidal-type drugs are used to control the symptoms is that the condition goes deeper into the body and starts manifesting as chronically disturbed bowel function. In later years this can then turn into chronic joint and soft tissue inflammations. I can tell you for a fact that people with chronic food intolerances can have every single symptom of IBS and can consequently be completely misdirected with the wrong diagnosis as a result.

Another useful clinical tool from practice that I can share is to look for one or more of the physical signs of food reactions that include what we what we call 'allergic shiners' i.e. notable dark rings under the eyes and/or chronically swollen glands just diagonal from the corner of the jaw on the neck and/or a tendency to cracks at the corners of the mouth. If some or all of this is ringing true for you then I recommend you may be wise to initially focus on excluding food intolerances as your first step in healing your 'IBS' and, as this is a subject that is also rife with misunderstandings, I suggest you start that process by carefully reading my detailed article that goes into both the diagnosis and treatment of food allergy/intolerance here.

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When the IBS symptoms are not from what you are eating!

Having said the above I now want to comment that I have met many people with IBS who are on incredibly restrictive diets but in the long run have only gotten deeper into a worse level of health than where they were before they started. Partly I think this is because as the list of forbidden foods gets longer the chances of nutritional deficiencies gets higher but largely it is because of the tension that gets created when you worry a lot about what you eat.

There are many extreme diet plans out there for IBS. Extremely low fat, bland and monotonous diets were the thing when I came in to practice in the late 1980s but most notably in recent years are diets that remove all starchy polysaccharides (these are basically carbohydrates with complex sugar particles that can become excessively fermented in the gut). If you have already looked into these diets you will understand that I am not overstating it to say they are phenomenally restrictive on what is permitted to be eaten.

If they simply didn’t work it would not be a problem, people would hardly use and recommend them if they didn’t help. The problem is that they do work, at least temporarily, and so have become increasingly popular, but at what cost? If you remove all the food substances that can be fermented by bowel bacteria you will certainly get far less or even no bloating as those foods move through your gut and that is what happens, if people are sufficiently strict enough they effectively ‘fast’ their guts, there is nothing there to ferment! However what generally happens is that people improve significantly at first but unless they rigidly adhere to the diet the rapidly get set-backs, which of course achieves a powerful reinforcement of the need to be super-strict on the diet.

I have met many thin, emaciated people on such diets who have incredible levels of tension throughout their digestive and nervous systems. They are so strict with themselves and yet no matter how vigilant they are they still get relapses and the only thing they know that has helped is to tighten their diets even further so they end up on a bare handful of foods. You can end up very afraid of food with IBS and when you actually don't need to be afraid there is a heavy price to pay...

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When the real problem is actually a chronic gut-infection

Dysbiosis is the name for a chronic infection in the gut and, unlike the dramatic event of an acute gastroenteritis infection where everything gets purged, dysbiosis can come from many different kinds of parasites, fungi and bacteria that are able to take a hold in the digestive tract and then just not let go.

Exactly as just discussed above on food allergies, I have met a great many people who have been wrongly diagnosed with IBS when in fact their chronic bowel symptoms turn out to have been entirely rooted in dysbiosis and again we have to begin this process of exclusion by paying very close attention to the health history...

Diagnosing dysbiosis

One of the most important questions you can ever ask a person with a chronic illness is 'what happened or was happening in your life when you first got sick?' When dysbiosis is at the root of the 'IBS' there is often an answer to that question where the patient recalls getting a horrendous stomach 'bug' while they were travelling somewhere, or moving into a new environment, or even out of the blue. I have noticed that these people are often late arrivals to their 'IBS' and prior to this initial illness they had a perfectly normal gut in their earlier lives. They are ones that say that classic line 'I've never been right since...'

I wish there was a clear cut way to be sure that dysbiosis was the root cause. Everyone has enormous amounts of both good and bad bacteria growing in their guts so taking stool samples for testing is rarely any practical help. In my own practice I somewhat rely on using a hydrogen breath meter to give me a sense of how much unhelpful microbial life is growing down there but, especially if a) the history fits and b) if bloating, which is the number one symptom of dysbiosis, is the main distressing symptom then we may decide to determine whether it is an issue by simply treating it and seeing what happens!

This process comes from what is called empirical medicine; in a nutshell this is where you form a viable theory about what is causing a problem and then treat accordingly. If the patient gets better you were right if they don't you have to reconsider your hypotheses. It probably sounds terribly hit and miss and unscientific but I can assure you it always has been and still continues to form the basis of a great many therapies in all fields of medicine!

Wormwood

Fortunately with herbal medicines we usually don't have to overly worry about doing harm if the treatment isn't the right one but in this case please note that, as you will see one of the two main herbs I suggest for the 'weeding out' phase of the treatment is garlic that, if you already know you react badly to it then don't tempt fate but rather work solidly with the other great bad bug-killer - Wormwood!


Wonderfully weird Artemisia absinthium (Wormwood)

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An effective dysbiosis treatment will typically make the gut a little worse at first but this is very temporary and I have long lost count of the patients who thought they were permanently stuck with a dodgy digestion who were able to entirely cure their long standing gut problems by weeding out the bad bugs and making sure their bowel grew an excellent new 'rain-forest' of a healthy gut flora. If you think that this actually might be where you need to direct your attention then the next step is to read my detailed article on dysbiosis here.

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When the symptoms are actually coming from a leaky-gut

If you can picture the lining of the digestive tract as being like a very fine-meshed sieve that is able to absorb food only when it has been reduced down to tiny particles then a 'leaky-gut' is the presence of tiny holes in that sieve which allow particles of food that are larger than they should be to filter through into the blood. This in turn causes an immune reaction which in turn brings about many of the same inflammatory symptoms in true IBS such as bloating, discomfort, altered bowel function etc.

Note that we are now getting into some direct cross-overs because both food allergies and dysbiosis will also cause on-going physical damage to the gut-lining with consequent inflammation etc. but there are also cases where there has been some historic injury to the gut and it has just never properly healed itself.

Leaky-gut syndrome

Imagine falling on concrete whilst running and badly grazing your skin, not to the point of serious blood loss (in the case of the bowel this would be the example of an actual ulcer) but just in the form of a significantly damaged surface layer. Now imagine that every day and in fact several times a day you were to rub a lot of juicy, caustic substances over that graze. You can see how it just wouldn't get a chance to heal and this is exactly what can happen with the so called 'leaky-gut syndrome'.

Unlike the earlier areas we talked about there aren't usually any obvious clues in the history to point you in this direction but for what it is worth I do pick up there is a greater presence of actual pain in the gut when this is the core issue. In my own work I extensively use a high-powered microscope to analyse the blood of my patients and, when a leaky-gut is the root cause of the digestive disorder, you can see a much greater presence of objects in the blood plasma called protoplasts that all gratifyingly go away when you effectively treat this issue.

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Slippery elm powder

Again I suggest that empirical medicine is the best way to go if there is good reason to suspect that a leaky-gut is actually the root of the problem and in this case we have a widely available tool that should quickly tell us just how much this is the key driver; namely Slippery elm powder. This is a herb that I have found many of my patients to already know about and in fact many have even tried but, as is always the case with herbal medicine, the art of getting it right lies just as much in the correct dose as it does in the correct substance and many have not used nearly enough of it to properly trial if it really is the key healing agent they most need!

You can think of Slippery elm as forming a literal bandage over that 'graze' in the gut. If you will try it for yourself then I suggest you mix a little into water and then put it on your skin to feel how it makes a sticky but incredibly soft material that you will then easily be able to visualise working on your gut lining in the same way. Exactly as you would stop rubbing things against a wound for it to heal so you have to 'apply' the Slippery elm in frequent and robust quantities to really assess how much it may help. Only a few days will be required to know if it is the right action because the relief from finally getting a bandage on to a leaky gut can be quite profound! I have more info on this remarkable herb including more specific indications on dosage and how you might best take it written up here.


Ulmus fulva (Slippery elm)

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When the real problem is actually constipation

I firstly have to be clear that if someone swings from diarrhoea to constipation and then back again then that certainly can be true IBS but if they only get constipation and don't get loose stools, urgency etc. then, well, it's highly likely it's just constipation! Something happened in the last few decades whereby people who would have previously understood their problems being due to constipation have now been given the IBS-C label. To be honest I've never really understood this, the patients who present with constipation have such clearly different histories and symptoms to those who get the classic frequency and urgency of true IBS that it baffles me as to why it should have been put under the same umbrella. Is it because by the time you have seen your doctor and a specialist and paid many hundreds of dollars to rule out anything nasty it sounds better to give you a 'syndrome' than something a bit more ordinary?

A common condition

Here's the thing, constipation is a problem that affects huge numbers of people, it always has and it probably always will. Sometimes it's because of a lazy bowel that doesn't move well and sometimes it is from too much tension in the bowel that stops it from moving well. Sometimes it comes from being born with a longer section of the bowel or a twist and turn somewhere it shouldn't be (this is more common than people realise) and sometimes it comes from benign polyps in the bowel that block the transit of wastes. Whatever the cause of constipation a person who has it will eventually get bloated, tired, irritable and out of sorts and this is also where it gets confused with IBS. Older people can get somewhat obsessed about their bowel movements because they have lived long enough and have enough war-wounds from life to know that if their bowel isn't properly emptied every day then they and everything else feels so much worse!

The usual helpers

If your 'IBS' is actually constipation then most certainly use herbs to help and I think you should start with the great Plantago husks as written up in detail here. If the Plantago is just not enough by itself to sort you out and you have given it a proper trial then you should most certainly go on to use herbal laxatives as, whilst it is never ideal to be dependent on anything, it is far better to have to take a small dose of herbs each day for the duration that to suffer the miseries of constipation for a single day. Yellow dock is the most gentle of the bowel cleansing herbs and it is described in detail here. Again if it is not sufficient by itself (and the only way to know that is to try and see for yourself) then I recommend the potent Cascara sagrada and, so long as the extract that you get from it is fresh and well-prepared from properly aged Cascara it can be guaranteed to clean out the most stuck and stubborn bowel. As with many herbs, the best dose is the lowest dose that actually works, and you can read more about it here.


Plantago psyllium

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When the 'IBS' is really a physical bowel disease

I've saved this one till last of the 'when it's actually something else list' because it brings up the most unpleasant possibilities. Bowel disease may have to be considered in a person with IBS symptoms but, before I say anything else, let me reassure you that if you have had already had your symptoms for years without them getting increasingly worse then you can probably already exclude this option based on the simple and gruesome fact that physical bowel disease almost never lurks around without getting significantly worse over time and this is especially true of the scariest prospect of them all i.e. bowel cancer.

People with diverticulitis (ballooning 'pockets' from the bowel wall) always end up getting acutely unwell at some point and often get their actual condition diagnosed from an emergency hospital visit when all the correct diagnostic tests are performed. Likewise both Crohn's disease and Ulcerative Colitis present with such extreme inflammation when they are in their relapsing stages that most people with these diseases end up getting a definitive diagnosis by virtue of needing specialised care.

By the time many of my own patients have finally come to see me they have already had a colonoscopy to rule out all of these possibilities. If you yourself have presented to a Gastroenterologist then it is highly likely you will have done through this unpleasantness yourself. As uncomfortable a procedure as it no doubt is I am glad when my own patients have had it done because they and I can then have no possible doubt that their problem is primarily a functional one.

That said you need to know that a colonoscopy is not sensitive enough to detect the tiny tears of a leaky-gut and nor will it be able to exclude dysbiosis or food reactions as a driver for the condition however if you have been told that you have 'low-grade inflammation' in your bowel then these are added reasons to consider any of the options already discussed as likely possible causes of your condition.

My last comment in this section is an echo of the first. If you know yourself you are very worried that you have something sinister like a growth or an ulcer going on in your bowel then I would encourage you to purchase the peace of mind that an, undoubtedly invasive, but certain diagnosis via colonoscopy will bring. However if your problem is of a long history and you have been living with it for some years then you may be somewhat reassured by my own view of this which is that I've never yet seen such a case where it turned out to be something truly nasty after all. For those who have true, nervous-system related IBS I sometimes try and help my patients to think of it as a 'benign barometer'. It might closely reflect just how much stress and tension is in your system right now but it will never increase your likelihood of bowel cancer or any other kind of life-shortening condition...


The Complexity of IBS

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Section 2: Treating true IBS

If you have thought through or worked through the above and have good reason to believe that you do in fact have true IBS then there are several stages of treatment that I now recommend you go through. You might be tempted to do all of what follows at once but, unless I am working with you in person, I suggest you take one stage at a time because a) it is intensive work and you need to carefully pace these things so as not to create more tension in the whole system and b) you will need to listen to your body and get feedback from what you are doing to get a sense of how much it is helping.

Many people will find that whilst a certain step doesn't cure everything overnight it still clearly helps somewhat and this is usually how you make the biggest turn arounds with IBS, i.e. finding one or more things that do make a difference and then sticking with them because, with natural approaches, the longer you do something that helps the better it always works...

Stage One: Improve Digestion

I cannot overemphasise how much of a difference it can make to the bowel to improve the function and feeling of the stomach. The digestive process starts in your mouth and you need to understand that the whole system is utterly interlinked; what happens at one end will most certainly affect what happens at the other! The following three steps should have an immediate effect on how well you digest your food; try them for yourself to see what happens

a) Before you eat - take some Gentian & Ginger drops

The use of 'bitters' some 10-20 minutes before food is an ancient and extremely powerful way to improve digestion function and, to give this a proper try-out, I suggest you take them at least twice a day and even a third time if you are keen and willing; twice a day, once before breakfast and then the second time before the evening meal is how most people use them.

To someone who has not yet tried this I am sure that the concept of taking some drops of an intensely bitter herb before meals could hardly be less appealing but a) it is amazing what we can get used to when we do it a few times and b) if it makes a real and immediate difference to how your whole digestive tract feels and functions I can assure you it will seem entirely worth it!

In a nutshell the process of taking a bitter herb causes the digestive juices to start to flow; firstly and most palpably in the mouth but equally further down in the organs of digestion; the stomach, liver and pancreas. By thus 'priming the fire of digestion', so to speak, the body is much better able to absorb the goodness of its food and the consequences of this simple step can be quite profound to both digestive system health and the well-being of the person as a whole!

If this is something that you would like to try then I can assure you that it should be very inexpensive to obtain the key herbs in the amounts required. Both Gentian and Ginger will be widely available all over the world but again you may need to contact a herbalist or a trusted supplier of herbs to be sure to be getting the right stuff. Another practitioner might have some variation in how they do this but unless you are advised otherwise you can read exactly how to use these herbs in practical detail under the section 'Gentian & Ginger formula' that you can find in the page on Gentian here.


Gentiana lutea (Gentian)

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b) While you eat - slow down and don't overeat

You need to know that the Gentian & Ginger drops should make you feel quite hungry so it is of paramount importance that, when you do eat you take great care to eat slowly and to not eat too much! People with true IBS have too much tension in their digestive systems and this is not going to disappear overnight but one of the best ways for the bowel to relearn how to function normally is to practice relaxing whilst you eat. I suggest you do not have the TV or some other kind of distraction happening when you eat but rather you take your time, chew the food well, and simply slow down. If you are eating with family or your partner it will be helpful for everyone to understand that this is not the time to discuss problems but rather a time to enjoy each other's company and stories if they are there to be told.

Amylase

Another very practical result of eating your food slowly and chewing it well is that the powerful enzyme amylase that you make in copious quantities in your mouth (and also in your pancreas) will much better break down the starches in your food and it is those same starches that often cause problems with fermentation and bloating much further down the line, especially when they have not been digested well...

Overeating

A person with IBS can do more harm to their system by rushing their meals and overeating than they can with choosing the 'wrong' foods. Do not eat too much! If you have IBS I am pretty sure you have already worked out for yourself that if you eat too much your symptoms are always worse. Fortunately the process of priming the digestion and then eating slowly almost always results in people needing to eat less to feel fuller!

What to eat

I am squeezing this subject into a few sentences in this section because I don't want to overemphasise it and I know how frankly obsessed people can become with the 'what to eat?' question. Even if you feel sure that things like bread, beans, brassica-family foods etc. give you bad IBS symptoms; so long as you don't have food allergies then I strongly encourage you to keep an open mind about being able to eat anything in moderation!

Most of my patients who come to me with IBS have been on or are currently on ultra-restrictive diets and one of the first things we set up as a treatment goal is, as soon as they feel they are ready, to start introducing small amounts of some of the foods they had previously been convinced were making them worse. This relearning to both trust and enjoy your food is a vital part of the healing process for IBS and it is a real joy to me when my patients say to me that they are now eating whatever they like with no adverse reactions - this is a most certain sign that the healing process is well underway!

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c) After you eat - drink a cup of GI tea & relax for a few minutes!

One of the very best medicines that I have seen help people with IBS is a tremendous tea that we call GI tea (the GI for gastro-intestinal). It is a combination of Chamomile flowers, Fennel seeds and Caraway seeds and this formula comes from a very old European tradition that has been used since antiquity to improve digestion and relieve symptoms of bloating and discomfort. As with the Gentian drops I recommend you give this tea a proper trial by having it at least once or twice a day after food for a week or so. Most people drink a cup after dinner and if they can manage to make and have a 2nd cup after lunch then that certainly give us a lot more of a chance to see how well it can help. The GI tea is very simple to make and use and it should be extremely inexpensive though you may need to get the herbs that are in it from a herbalist or herbal dispensary to be sure of them being fresh and potent.  

The proportions of it are to what are known as ‘equal parts’. That means you use the same weight of each herb when you are making up a batch of it. The method to make the tea is very simple but you must make the tea fresh each time you use it. Take 2-3 heaped tsps of the combined herbs and place them in a tea pot, or a saucepan, or a cup, anything that you can then cover and leave for a good 10 minutes. Think about adding a tsp. of honey - I recommend you try it with honey because it helps to make it quite delicious but it is up to you. You then strain the tea through a tea strainer or some fine cloth like muslin and, importantly, sip the tea whilst it is nice and hot.

The aromatic oils, the essential oils in the herbs degrade quickly after they have been drawn out into the water. That is why you have to cover the tea and also why you have to sip it while it is hot and why you have to make it fresh each time. It is those oils that very quickly, in minutes, penetrate into your blood stream and serve to relieve both inflammation and muscle spasm in the gut. People who sit and sip this tea after eating report a potent and palpable relaxing effect on their whole digestion and this can be a profoundly important step towards healing IBS. One cup of tea will not transform the condition overnight but it is highly likely to help and should certainly be given a good trial of at least a couple of weeks.


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Assessment of Stage 1

The above steps will start to have immediate effects on how your digestive system functions as soon as you start using them and I think you only need two weeks to get a good sense of whether they are going to make a genuine difference to your IBS symptoms. If you honestly think that none of it made any difference then, well that would be quite unusual, but I think it is fair to say that you should put these steps aside and go on to the next stage as described below. If however you believe that they have made some positive difference then, even you think it is only a moderate one, you should keep doing all three steps and, at the same time, go on to start using the recommendations in stage 2.

Later on, assuming your IBS continues to improve to a much better condition you will have the 'happy problem' of working out which things you can safely drop away without there being any reversal of your progress but for now do not hesitate to add these extra layers to your treatment as a multi-layered approach can be what it takes to get a real shift in chronic IBS.

Lastly if you feel that the three steps of stage 1 have made a very clear and positive difference and that you are very much better then that is wonderful and I now suggest you do not assume that you have to go further into the next stage but rather should slowly start to reintroduce different foods as you continue to keep the treatment program of stage 1 going. Remember that with the natural approach, the longer you do something that helps the better it works.

Please note that if, as can and does happen, you have a temporary set-back at some point do not despair but rather recognise that this is simply the nature of this problem and that, so long as it soon passes and you are back to being much better than you were before, the treatment is still helping and will continue to help...

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Stage Two: Improve Bowel Health

There are several herbal remedies and dietary strategies that reliably improve bowel health and one might think that this section would be at the top of any list for IBS but to the contrary if there is something else like a food allergy, a leaky gut or an infection that is actually causing the problem then just treating the bowel will make little difference and likewise if the upper digestive tract is not receiving and processing food well then you may not confidently expect there to be lasting improvements in the health of the bowel which is why I put all those areas first.

Probiotics

I imagine that just about all my readers in this subject will know about probiotics already and many will have tried them or will still be using them. I do personally feel that probiotics will make a positive difference to most people with IBS but the range of benefit can go from slight to significant. It is the fermentation of wastes in the bowel that causes both gas and bloating and it is the bacteria in the bowel that cause that fermentation. The more bloating and wind a person is suffering from the more I am likely to focus on this strategy but, in reference to my earlier discussion of 'when IBS is actually a chronic infection' you will not get very far with probiotics if there is a major overgrowth of bad bugs that needs to be eradicated first!

If you study this area in more depth you will see that there are now some specific strains of probiotic bacteria that are marketed as having been tested specifically for IBS. I have read the literature on these studies and, as an independent practitioner with no vested interest in any of the companies that produce and promote them, I can say that they are genuine and deserve to be taken seriously and if you are able to procure a probiotic that contains one of the strains that have been in the clinical studies I recommend you do so. With probiotics it is less the physical amount that you take that matters as it is the frequency with which you use them - so long as they are good, viable, living product they will rapidly reproduce in your system and make a great deal more of themselves, but you will have to keep drip-feeding them in to make sure that happens!

In my own clinic I use a multi-strain probiotic because I recognise that there are a great many different kinds of bacteria in the gut and it makes intuitive sense to me that any living ecosystem is better supported by diversity but I cannot sell or recommend a product to a person without seeing them in my clinic first so in this area I encourage you to spend your money wisely and, once again if possible, get a recommendation or a direct supply from a practitioner or trusted supplier because this is something that you may need to keep up for a long time if it is clearly going to benefit your bowel health.

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Plantago husks (or something like 'Life Greens')

When I am looking to improve bowel health I will almost always trial the effects of either Plantago husks or a product called Life Greens. I have already mentioned Plantago and you should know that this is also known by its commercial name of Psyllium though for our purposes one must make sure it is the coarse husks that are used rather than the powder such as is used in Metamucil, Bonvit, Fybogel or similar products. You can read a lot more about Plantago husks here and if you were closely reading 'when IBS is actually constipation' earlier you will realise that I have already mentioned it in that section!

One of the things I love about Plantago in terms of bowel health is that it is one of the very few substances in nature that you can give to one person with diarrhoea and another with constipation and expect there to be a very good chance for it to benefit both of them! Plantago is not absorbed into your body whatsoever so every time you take it you will eliminate it in its entirety but along the way it forms a remarkably soft and water-retentive spongy mass that effectively massages through the entire bowel. In the case of overly loose stools this action can eventually bring about some stability to the rapid transit that happens with diarrhoea and, in the case of a blocked or lazy bowel it will nearly always assist in a natural bowel elimination without needing any harsh laxatives.

So that was the good news! The bad news is both that you have to try from a little to a lot to see how it affects you and this can be a daunting prospect because many people with IBS grow to fear fibre from negative experiences where they have previously taken a fibre supplement, or simply eaten more fruit or vegetables than usual, and then had a marked increase in bowel motions with the associated urgency and discomfort that this can bring!

Plantago most certainly is a fibre and there is a very good chance that it will initially cause an increase in bowel activity but I will encourage anyone with IBS to persist with it for at least one week and preferably up to two weeks to find out for themselves if that initial over-activity does not quickly improve and for there then to be a marked decrease in many of the associated symptoms of IBS such as pain and bloating.

Moving the wastes through the bowel in a timely way can be an essential key to improving bowel health and this is something that Plantago excels at. In the article on it I talk in more detail about dose but in a nutshell you take from as little as two tsps once a day up to 4 heaped tsps twice a day and you have to trial and error going up and down with the dose to feel how your bowel responds. As you will find out today if you took the right dose yesterday this is usually a rapid learning curve!

In our clinic we make a product called Life Greens that has a substantial amount of Plantago in it as well as 8 different kinds of good bacteria and other beneficial nutrients. We cannot sell this outside our clinic but I have noticed many such products coming on to the natural health marketplace in recent years and, so long as they are not too expensive (because they may not suit you) I recommend you to be open to trying them out. In my case I specifically formulated the Life Greens to help people improve their bowel health and I use it a great deal (more info on it here) but I also have great faith in the action of Plantago and I suggest starting with this first and only if it clearly helps to then potentially go to the trouble and expense of getting a product that will achieve a few other therapeutic goals in the one step.

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Assessment of Stage 2

Once again these are strategies that have rapid effects on bowel health and, even if you may need to keep them up for a lot longer, if you can feel them giving a clear benefit to your IBS symptoms within at least two weeks then you can be confident that you are on the right track. If you feel that your symptoms are being made worse by either of these treatments in the first days of using them then do not lose heart and stop taking them right away. Putting new bacteria into the bowel, even if they are beneficial ones, will often upset the ecosystem of bacteria that are already there and can bring about something of a battle for the territory which the bugs see as a literal paradise on earth - i.e. your bowel!

Likewise and as mentioned already, the use of extra plant fibre can initially see an increase in bowel eliminations that can be quite unwelcome but this will often settle within a few days. Some people will need longer than others for this settling to happen and, at the same time, it can take a while to see how much Plantago husks are needed to get a full and complete evacuation of the bowel so I think at least a week but not more than two weeks in total is sufficient to see if this is a strategy that can really help. If you feel the bowel is not improving after at least a week or up to a maximum of two weeks of using Plantago (or a product like Life Greens) then you should discontinue them.

I do not think you should stop using your probiotics in any case as we know there is no chance that these will make IBS worse in any lasting way and you should at least finish the treatment that you have (however I would not recommend purchasing a second course of probiotics if you did not feel the first had made a palpable improvement). If you feel that the steps to improve bowel health have helped you a great deal then I suggest you do not take on further treatments but rather stay with them and give them time to continue to help you further.

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Stage Three: Improve General Health

For many of my own patients with IBS I have found that we can significantly improve their symptoms and general well-being with the steps as described but to make some true and lasting improvements we often have to get down to the deeper levels where the origins of the problem can be found. If you have gone through the first two stages but you know you still need to more to regain your health then I now suggest that you direct your attention to either your immune system or your nervous system.

Starting with immunity the following section is taken from the beginning of my article on immune health which you can read in full here.

Measuring Immune Health

You may already be in no doubt that a weakening or imbalance of your immune system is a core issue to your health right now. For example recurrent infections or a slow recovery from wounds or injuries is pretty much a guarantee that all is not well with the immune system. Likewise any illness that involves allergies or the immune system reacting against the body in some way is a sure sign that this is where the problem lies.

However there are many other common health problems where it is not so obvious but nevertheless the real issue at hand is just as much hinging on the health of the immune system. Lab tests that measure the number of white blood cells tell you nothing about the quality of those cells -- and for many it is exactly that quality which is what is making all the difference between a recovery and continued sickness. Early in my practice, especially in seeing how important this area in particular was, I began to use microscopes that are powerful enough to see the insides of white blood cells in order to give me a truly objective measure of immune health.

For many thousands of patients I have been able to literally look at their immune systems. The white blood cells stay alive for long after you take the sample and in good health they will have strong walls and they literally glisten (this shimmering effect comes from something called 'cytoplasmic streaming' and it can last for many minutes after the sample has been taken.) When people have a weakened immune system the actual numbers of cells are commonly low but, ever more importantly, they don't look healthy; their walls gets fragmented and break open and instead of shimmering they look dull and lifeless. When people have an overactive or allergic immune system there are typically increased numbers of certain kinds of white blood cells and again they often have broken borders or more fragmented cells.


Two white blood cells amongst red cells under the microscope

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Nature's Immune Tonics

The microscope has been of enormous help to me in finding out exactly what works best to restore a weakened, depressed or imbalanced immune system. A great many before and after tests have shown me what works the best and the fastest and based on actual results I can categorically say to anyone who needs to know that the best thing by far to help an immune system in trouble is the right use of several extraordinarily helpful herbs... If you have a weakened or imbalanced immune system then, before you do anything else, start by getting help from Nature.

Echinacea & Astragalus

The two herbs that I feel have the most overall benefit to a weakened immune system are Echinacea root from the American plains Indians (much more detail about it here) and Astragalus root from the great Chinese system of herbal medicine (more details here). These two herbs form the cornerstone of most of my immune health programs and I have a great deal of confidence in their ability to restore even the most depressed immunity to much better health in quite quick order; you typically begin to see their benefits within mere days of their use...

...After introducing these two key herbs I then go on to talk about a number of further strategies that can improve immunity and, if this is the key deeper area where you need to now focus your attention to get clear of your IBS, once again that article is here.


Echinacea angustifolia

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Nervous system health

When it comes to true IBS I have left what is potentially the most important subject of all till last. I did this because I believe that we must be very careful not to make assumptions but rather to treat IBS in a holistic manner and it is essential that we take care of essential housekeeping such as improving digestion and bowel health etc. before looking into deeper causes. Not only that but it has been an observable fact in my own work that for many people the basic processes I have been recommending to try can dramatically improve their IBS symptoms simply because they are taking better care of themselves and that in itself is so healing to the nerves!

I started this article with the statement that ' I understand the roots of true IBS to be in a nervous system that has become too tense for there not to be an effect in the physical body and that it is no accident that this is a problem that typically begins when a young adult has to start confronting the world on their own terms'. If this truly is the case then how do we go about making a true and lasting shift in what is, in effect, a mind-body condition? The answer is not simple and it is not easy and it will take time, effort and patience but I can assure you that a person can deeply and profoundly improve their nervous system health if they set their minds to it and do 'the work'.

That work is much too important, and detailed, to summarise and add to what has already been a long and complex discussion so, if this is the area where you most need to direct your attention towards, then I suggest you ask yourself a question about your mental health to help you to decide where to go next and that question is 'when I feel bad in my body, what is the main way I feel in myself?

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Tension & Anxiety

For the majority, but by no means everyone, of people with chronic IBS, the answer will be that there is an increase in tension and anxiety that is so entwined with the IBS that the person cannot tell if their symptoms are making them tense or their tension is creating worse symptoms. In this instance I urge you to carefully read and work with the practical suggestions in my article on tension and anxiety. Yes there are further steps that you simply have to take but I can assure you that they will most definitely work if you do them and I have a very great deal of experience to back up that bold statement. You can read my thoughts in detail on this very important subject here.

Depression/Low Mood

If on the other hand the honest answer is that the main way you feel bad in yourself in association to your bowel is one of sadness or depression then you will be best to direct your attention to this equally important area of our mental health and wellbeing. Depression has been rather monopolised by the 'chemical imbalance' theory of conventional medicine but, whilst it most certainly is a profound physical imbalance in the whole person there is so much more to it than that. If you can relate your own bowel condition to starting at a time in your life when you went into a negative spiral and your mood was low then don't feel guilty about that because it is simply a core part of the human experience but equally do not ever feel that you are victim to it as if you got some bad luck in your genes. This is obviously another really big and important subject in itself so if it is the area that you need to give your attention to then start here.

Fatigue

Lastly if the true answer if that you do not feel especially tense or low but that the way you feel when your body is not doing well is simply an experience of tiredness and exhausted then you may have to do some deep work into getting your mind and body back into good health by focusing on those strategies that reliably lift energy and vitality and these are described in practical detail here.

There are many cross-overs between these subjects but each has its own focal points and, if you need to heal your nervous system, I am sure that you will find the advice and suggested actions in these articles will make a very positive difference. I wish you every success on your way.


Eschscholtzia californica (Californian poppy)

Constitutional Health Note

You might want to learn about your constitution to help better understand how bowel problems have become an issue in your health as well more about what kinds of foods, herbs, exercises etc. may best help. Constitutional health is an old and fascinating way of understanding our differences and, to demonstrate how it works, I can say that the number one constitution, by far, that suffers from true IBS are the cool & damp Bears. I tell my Bear patients that I call it the Irritable Bear Syndrome because it such a common issue for those people who have to process a lot of their mental intensity in their physical bodies. On the other hand Tigers, the hot & damp constitutions, get a lot of problems with dysbiosis, Eagles (hot & dry) get a lot of food allergies and Elephant/Butterflies (cool & dry) are the ones who get the most problems with a damaged gut lining - of course these are just generalisations, not rules, but they are also patterns that I have seen over and over again. In any case there is a brief introduction to this great subject here and a more detailed section on working out which constitution you are here.

Please understand that I cannot personally advise you without seeing you in my clinic.
This living 'book' is my labour of love so, wherever you are, I wish you peace & good health!

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© 2011 R.J.Whelan Ltd