Irritable Bowel Syndrome in Children: Hope and Help

“Health begins in the colon”:  this fundamental precept of natural medicine was first introduced to me as a naturopathic medical student, and its homely but powerful wisdom has proven itself over time, through my clinical experience as a naturopathic physician and by a substantial and ever-increasing body of research.  What seemed to me a quaint, abstract concept in naturopathic medical school I now apply to almost every patient, whether they have gastrointestinal issues, chronic sinusitis, or anxiety.  So when children develop a problem such as irritable bowel syndrome, it’s even more important to view it from this holistic perspective: to consider the implications for not just the digestive tract but for the entire body (including the emotions and the mind), and to recognize that failure to resolve even mild, chronic bowel issues can have profoundly detrimental effects on health far into the future, even for life.

What is IBS?

In both adults and children, Irritable Bowel Syndrome, or IBS, is characterized by abdominal discomfort or pain, bloating, and flatulence (gas).   Constipation or diarrhea, which may alternate (a few days of constipation followed by loose or diarrheic bowel movements) are also common.  The intensity of symptoms ranges from mild to severe, and symptoms may be episodic or constant.  IBS may also be referred to as spastic colon, or mucous colitis.  It is considered to be a chronic condition, one which is uncomfortable and may impose lifestyle limitations on sufferers, but is less serious than inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. 

For those with moderate to severe IBS, however, the condition can significantly erode quality of life.  For in addition to the discomfort of the physical symptoms and the fatigue caused by chronic pain, the loss of control of a private body function can create feelings of embarrassment and shame, and can contribute to anxiety and depression.  The physical, emotional and mental effects of IBS can be deeply experienced by children: to hear a child with chronic bowel irritability unemotionally express that he or she does not want to live if it means ongoing abdominal pain and exhaustion makes disturbingly clear the toll this condition can take.

A report from the National Institutes of Health notes that five years after diagnosis, most people with IBS still have it – a discouraging prognosis, but one which can be significantly improved upon with natural medicine approaches.

May I have your attention please?

The term “Irritable Bowel” is an accurate description of the underlying problem:  the bowel (the lower part of the digestive tract, between the stomach and the rectum) becomes irritated and “acts out” in the same way an unhappy or distressed child may act out with poor behavior.  It’s the body’s way of asking for attention, telling us that something’s wrong here, and it’s a pretty effective message.  After all, the symptoms of irritable bowel syndrome – the bloating and gassiness, discomfort or pain, constipated or abnormally loose bowel movements – are hard to ignore.  In responding to this request for attention, we can just focus on treating symptoms, which is the conventional medical response to IBS – or we can listen carefully, search for the deeper causes of digestive dysfunction, and work to heal them.

Common Pro-Inflammatory Foods

·         Gluten-containing grains, which include wheat (including spelt, kamut, and triticale), rye, and barley.  The inflammatory effect may or may not be associated with celiac disease.

·         Cow’s milk products, including butter, yogurt, cheeses, casein and whey proteins.

·         Eggs and products made with egg.

·         Soy products and products made with peanuts.

·         Beef, pork, and shellfish, including processed meats such as cold cuts, frankfurters, and sausages.

·         Condiments such as ketchup, prepared mustard, BBQ sauce, soy sauce and salsa.

·         Refined sugars such as white and brown sugar, molasses, corn syrup (including high-fructose corn syrup), fructose, dextrose, and glucose.  Artificial sweeteners are also to be avoided.  Therefore,  popular beverages marketed to children are out:  water and herbal teas are fine.

Food toxicity

The first place to start with IBS is with the most common, frequent source of irritation for the bowel:  the food and drink that goes into it several times a day.  Food toxicity (also called food sensitivity or food intolerance) refers to the effects of certain negative interactions between the immune system, specific foods, and the body; these interactions create inflammatory reactions in the tissues affected by them, and among the most common tissues targeted by these toxic food reactions are those of the digestive tract.  These reactions are different from those of classic food allergy, which are caused by a different part of the immune system and have different effects in the body.   And in contrast to a classic  food allergy reaction, in which symptoms appear quickly after exposure to the problem food (for example, an immediate hive reaction or life-threatening anaphylactic response to eating peanut or shellfish), food toxicity/ sensitivity reactions usually occur after a delay of anywhere from two hours to two days after exposure to the offending food.  This makes them difficult to identify – if abdominal pain intensifies two days after having eaten a toxic, inflammatory food, tracking back to what was eaten a  couple of days before is a challenge.  Add to this the cumulative effect of this kind of food reaction, such that eating two problem foods in a day may have little noticeable effect, but eating four or five of them kicks up symptoms badly, and trying to pinpoint the culprits can be very confusing.

If you’re trying to reduce the total burden of food toxicity in your child, a good place to start is with foods that have become identified as being “pro-inflammatory”, such as those listed in the sidebar.  Avoiding foods from this group for two to four weeks, then carefully  reintroducing each category in isolation from the others, can shed light on which are most toxic for your child.  Even avoiding a couple of categories, if they are thoroughly cleared from the diet in every form for this two- to four-week timeframe, can provide useful information.

However, if this exercise fails to clarify your child’s problem foods, it may be because their unique “pro-inflammatory” list includes otherwise perfectly healthy foods.  Because this issue is caused by an immune system which has developed an abnormal attitude towards foods, any food can become inflammatory – even garlic or broccoli! Even lettuce! Fortunately, there is testing available which uses a single blood sample to accurately determine which foods have become toxic for an individual, by measuring immunoglobulin G antibody levels in the serum (standard allergy testing looks for elevated levels of immunoglobulin E).  It is essential to use a lab with high standards of quality control for this testing, in order to minimize false negatives (in which harmful foods are missed) and false positives (In which foods are incorrectly identified as inflammatory and avoided unnecessarily).

Dysbiosis:  “Bad Bugs”

Our digestive tracts are home to a large number of microbe species, some “good bugs” and some “bad bugs”.  The majority of microbes present in the bowel ought to be beneficial, or probiotic species:  the Lactobacilli, Bifidobacteria, and healthy types of E. coli bacteria that do much to promote health both in the digestive tract and throughout the body.  Dysbiosis is digestive tract microbe imbalance characterized by insufficient numbers of beneficial probiotic organisms, and/ or the excessive presence of pathogenic (harmful) bacteria, yeast organisms, or even parasites.   In many children with symptoms of IBS, much of the inflammation and irritation to the bowel is caused by dysbiosis.  How does dysbiosis happen in a child?  The use and overuse of antibiotics, a high refined-carbohydrate, low fiber diet, steroid use (inhalers, topical steroids for eczema),  an “inheritance” of microbe imbalance passed on from parents (perhaps even in utero), the toxic impact of food intolerances – any of these negative influences can “tip over” the balance of healthy vs. unhealthy microbes in the bowel, .

In natural medicine treatment of IBS, special stool tests (more comprehensive than standard lab or hospital testing of stool) can be used to evaluate the levels of probiotic and dysbiotic microbes, to identify which herbs or other natural antimicrobials would be most effective to reduce any harmful microbes which are detected, and to get specific information about digestive enzyme function, nutrient absorption, and acid-base balance in the bowel.  This provides a good basis for correcting dysbiosis and ensuring that going forward, a healthier digestive tract environment is in place to better support the survival of probiotic organisms.

Nourish the bowel

It may seem odd to think of nourishing the bowel – we usually think of the intestine as helping us to get nourishment from our food – but yes, our intestinal cells, and the tiny, beneficial microbes (probiotics) that live in the digestive tract, all rely on us to feed them, and feed them well.  Unfortunately, the “Standard American Diet”, often referred to as the SAD, offers little of the nutrition our digestive tracts need to function properly, and plenty to throw them off balance.  “White foods” such as refined sugars and flours; processed foods, low in fiber and enzymes, flavor-enhanced and engineered for long-distance travel and high profit at the expense of nutritional quality; sweetened beverages, which have largely replaced that strange-tasting colorless liquid, water, in our children’s diets – these staples of the modern, ever “new and improved” food culture seriously disrupt the natural balance of digestion, nutrient absorption and elimination.  It’s not very surprising, given the dismally poor-quality diets on which many of our “overfed but undernourished” children subsist, that their digestive tracts eventually rebel.

If your child’s digestive tract is in rebellion (in about a quarter of IBS sufferers, gastritis or reflux is also an issue) you will need to feed her or him differently – better! – in order to resolve bowel irritability.

Basics of a “Better Bowel” diet

What is a “better bowel” way of eating? It provides fiber for good microbes to eat, so they can produce substances called “beneficial short chain fatty acids”, or SCFAs, which actually nourish the intestinal cells.  Fiber also makes for a fuller bowel, which stimulates the muscles in the intestinal wall to move things along, promoting a more regular bowel movement.  This way of eating just naturally creates a healthy acid/base balance (pH) in the stomach and small intestine, so that digestive enzymes can be activated and proteins, fats, and carbohydrates from food are broken down into particles that are well-absorbed through the healthy intestinal wall.  A “better bowel” way of eating forms a pH that also allows healthy bacteria (probiotics such as Lactobacillus acidophilus) to survive and thrive, and provides nutrients like amino acids, healthy fats, vitamins and minerals which keep the intestine well-nourished.

It isn’t complicated to eat this way, though it’s possible that getting there may take some time, particularly if the SAD has been your family’s accustomed way of eating.  Understandably, we tend to eat as our families ate growing up, more or less, and it takes conscious effort and intention to unlearn those old habits and to begin to learn about which foods support health, how to shop for them, how to prepare them, and how to transition your child (or even better, your entire family) to them.  If the idea of setting foot in a natural foods store is beyond consideration, you may as well stop reading now, and go stock up on whatever pharmaceuticals have been recommended to manage your child’s symptoms.  But if you really want to improve your child’s digestive function, fundamentally and for the long term, take this opportunity to use the simple tools of food and drink to begin to resolve the underlying issues of IBS.  The “Better Bowel” way of eating (see sidebar) is simply what Nature designed long ago for the body as a whole, so it’s no surprise that the digestive system thrives on the same: a diet of unprocessed or minimally processed high-fiber foods, which also happen to be high in nutrients and low in sugar. 

The Better Bowel Diet

·         Fresh vegetables and fruits (or when fresh is not available, frozen & organic as a second-best choice).   Try making a puree of vegetables cooked as soup, and serve it with a straw; freeze grapes, pureed berries or bananas for a healthy summer alternative to ice cream.

·         Whole grains (such as brown rice instead of white rice – or brown basmati rice as a milder, “transitional” version of brown; whole grain breads – but not fake, caramel-colored “whole-wheat” bread).

·         Beans, nuts and nut butters, seeds and seed butters – try bean dip, hummus, beans in soups.

·         Starchy veggies:  sweet potatoes, potatoes, yams, beets, parsnips. 

·         Fish, fowl, lean meat is fine too.

·         Water – jazzed up with a splash of fruit juice, or lemon or lime, if plain won’t work.  Or ice some herbal tea, and sweeten, if necessary, with a little agave nectar.

There are many books and a lot of online support for this process, and with children (of all ages) the idea of making change “slowly but surely” is an effective strategy.  The challenge is hanging in there until tastes change (and they do) and improvement is established enough for you and your child to see (and feel) that this health-food diet stuff is actually working.  

 Because a child with IBS has a digestive tract that is out of balance, there may be temporary reactions such as increased gas or a change in bowel movements in response to positive dietary changes; if these persist or are more than mild, you may want to enlist the expertise of a naturopathic or other natural medicine physician. My experience over almost thirty years of doing this work has been that once positive changes begin and children really see the connection between how they eat and how they feel, they become some of my “best” and most compliant patients.

Nutraceuticals for IBS

There are wonderfully effective natural medicines to reduce discomfort and accelerate the healing process for irritable bowel.  What follows is a partial list of readily available nutrients and herbs that can be used in liquid or powder form, or can be removed from capsules and combined with applesauce, dilute fruit juice, or any liquid or food for easier administration to a child. 

  • A good quality probiotic: in my practice, I often start child IBS patients on a high-quality probiotic designed to treat IBS, which guarantees 60 billion organisms per dose at the time of expiration, and is tested to ensure the purity and viability of each strain.  This product contains the NCFM strain of Lactobacillus acidophilus and Bifidobacterium lactis strain Bi-07, both of which have been found in research to be effective for IBS.  I start child patients on a probiotic gradually, with a dose as small as 1/8 tsp. daily, increasing over the course of a few weeks to a treatment dose which is determined based on results of testing.
  • L-Glutamine:  this amino acid is nutritive and healing to the intestinal lining.  It is available in powder form and tastes slightly sweet, so it’s easy for children to take.  I may prescribe 3 grams per day or more, in 2-3 doses divided through the day, for a child with IBS.
  • Slippery Elm:  this mucus membrane-soothing herb can be taken as a tea, removed from capsules and stirred into applesauce, or it may be found in combination formulas designed for digestive tract healing.
  • Licorice Root Extract:  deglycyrrhinated licorice, for the child that enjoys the taste of licorice, can be a pleasant-tasting way to promote a regular bowel movement and heal the mucus lining of the upper and lower digestive tract.  It is available as an ingredient of powdered formulations, or in chewable form.
  • Aloe Leaf Extract which has had the bitter elements removed to prevent a laxative effect, is anti-inflammatory to the intestinal lining, may reduce harmful yeasts in the bowel, and provides fiber to normalize the bowel habit.  It can be found as a single ingredient product in liquid form (but be sure the laxative components have been taken out!), or in combination formulas.  I often prescribe about 200mg. per day of a concentrated extract.
  • Other supplements which can be helpful in rebalancing digestive tract functions include digestive enzymes, peppermint oil, fish oil, turkey rhubarb, and magnesium.

Mind, Mood & IBS

Did you know that the majority of serotonin, the brain chemical that helps us to feel positive and motivated, is made in the intestine?  When a child has a functional bowel disorder such as IBS, stress hormones, neurotransmitters, and toxins can profoundly disturb mood, energy and mental function.  Treating IBS naturally, healing the underlying causes and returning the digestive tract to the healthy, balanced  state which is natural to it, often creates amazing transformations in children:  from depressed, exhausted, anxious and brain-fogged to energetic, happy, focused and motivated.  To watch this process of physical, emotional, mental and energetic transformation take place in a child with irritable bowel syndrome is a source of great joy for everyone concerned.

Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, CT, USA office.  She can be reached at 203-431-4443 or at drgibsonsoffice@sbcglobal.net.

 

 

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