Complementary and alternative medicine for treatment of irritable bowel syndrome

Yi-Hao A. Shen; Richard Nahas

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Gluten and IBS
Richard Nahas

Published on: 19 March 2009
Link Between IBS, IBD and celiac Disease
Edward Leyton

Published on: 12 March 2009

Published on: (19 March 2009)

Gluten and IBS
Richard Nahas, Lecturer
Other Contributors:
Thank you for your thoughtful response. The understanding of the clinical spectrum of celiac disease is definitely evolving. It has also been our clinical experience that a significant number of patients with chronic complaints that include IBS symptoms experience major clinical improvement when placed on a three-month trial of a gluten-free diet.
Additionally, a number of third-party laboratories perform test...
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Thank you for your thoughtful response. The understanding of the clinical spectrum of celiac disease is definitely evolving. It has also been our clinical experience that a significant number of patients with chronic complaints that include IBS symptoms experience major clinical improvement when placed on a three-month trial of a gluten-free diet.
Additionally, a number of third-party laboratories perform testing of anti-gliadin antibodies in stool, a service that they often sell directly to patients on the internet. Interestingly, this test is positive in many patients whose blood tests are negative for a celiac panel that includes transglutaminase. While it must be noted that stool anti-gliadin testing is not recognized by the gastroenterology community and is not validated in the peer-reviewed literature, the large market for this testing underscores the widespread belief that the potential harm of gluten is far greater than currently recognized.
While we agree with the author's anecdotal experience, a clinical trial evaluating the benefit of a gluten-free diet in this subgroup of patients is definitely warranted. Until then, it is important for clinicians to keep an open mind about the potential benefit of a gluten- free trial and support patients who feel that they are gluten-sensitive in spite of negative blood testing.
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Competing Interests: None declared.
Published on: (12 March 2009)

Link Between IBS, IBD and celiac Disease
Edward Leyton, Physician
Monday, March 2, 2009 The Editor Canadian Family Physician 2630 Skymark Avenue Mississauga, Ontario
Dear Editor: I read with interest all 3 articles in the Canadian Family Physician February 2009 Re: "Home Blood Testing for Celiac Disease", "Complementary and Alternative Medicine for Treatment of Irritable Bowel Syndrome", and the Commentary on Irritable Bowel Syndrome by Dr. Richard Birtwhistle. It is good to s...
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Monday, March 2, 2009 The Editor Canadian Family Physician 2630 Skymark Avenue Mississauga, Ontario
Dear Editor: I read with interest all 3 articles in the Canadian Family Physician February 2009 Re: "Home Blood Testing for Celiac Disease", "Complementary and Alternative Medicine for Treatment of Irritable Bowel Syndrome", and the Commentary on Irritable Bowel Syndrome by Dr. Richard Birtwhistle. It is good to see that finally Irritable Bowel Syndrome and complementary medicine treatments are being given the respect that they deserve.
I believe that there is sufficient evidence in the literature to strongly suggest that there may be a spectrum disorder emerging between irritable bowel syndrome and celiac disease, and even (dare I say it) inflammatory bowel disorders. People with IBD have a more than double the frequency of serum antibodies to gliadin, and even to milk proteins than normal people. In addition, about 10% of people in the population will have anti-gliadin antibody in the serum even though they are "normal" or asymptomatic. Unfortunately, people with mild IBS will often consider their symptoms “normal” - particularly if they are ‘just’ bloating and gas. In addition Cooper et al. have written about gluten-sensitive diarrhea without evidence of celiac disease.(1) So it may be that these negative anti-gliadin tests are not false-negatives, but actually represent a functional sensitivity that has simply not manifest as pathologically demonstrable disease. It is here that we can intervene from a preventive point of view using integrative, holistic, complementary and alternative techniques and approaches. As Dr. Kenneth Fine has stated "We now know that you do not have to have villous atrophy for your intestine to react to gliadin and that you can get better on a gluten-free diet. That's what all of the studies showed."(2)
I think that IBS is now recognized as not only being a physical functional disorder of the intestinal tract, but also a disorder of hypothalamic pituitary gut axis dysregulation.(3) There also appear to be several functional somatic syndromes that fall into similar categories.(4) Thus it is not surprising that treatments of such as hypnosis and CBT can be useful. Also not surprising perhaps that wheat bran, that will contain remnants of gluten protein, is not well-tolerated in IBS patients.
I have treated many people with IBS and inflammatory bowel disorder over the last 30 years using complementary and alternative medicine with good success. So I would have to disagree with the author’s of "Home Blood Testing for Celiac Disease" when they state that "a gluten-free diet should be prescribed only when the diagnosis of celiac disease is confirmed using a small intestinal biopsy". If the test is positive then a test gluten-free diet, together with some of the other complementary approaches mentioned in the article by Rashid should be utilized. Intervening only when a small intestinal biopsy is positive is too late, especially when the patient can benefit from an elimination diet prior to this stage of the disease being evident. The elimination of gluten, and dairy, and other food allergens from the diet together with good supplementation with vitamins, minerals, phytonutrients, and other natural cell regulators, can give such relief to people who are in so much discomfort with little effort.(5)
Yours sincerely,
Edward Leyton MD FCFP CGPP
1. Cooper BT, Holmes GK, Ferguson R, Thompson RA, Allan RN, Cooke WT. Gluten-sensitive diarrhea without evidence of celiac disease. Gastroenterol. I1980;79(5 Pt 1):801-806.
2. Fine, K in Functional Medicine Update October 2005
3. Dinan T, Quigley E, Ahmed S, Scully P, O'Brien S, et al. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology. 2006 Feb;130(2):304-311.
4. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999;354:936-939.
5. Case study #1054 Nutritional Support Using Ultrainflamx® Medical Food In A Patient With Irritable Bowel Syndrome. 27 Sept. 2006 http://www.metagenics.com/pdf/case_studies/met1054.pdf
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Competing Interests: None declared.